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ABSTRACT: BackgroundSmall size, high benignity rate, and sporadic nature make insulinomas suitable for laparoscopic resection. On the other hand,
occult location or multicentricity mandate open surgery. This study was designed to analyze a series of patients who had pancreatic
insulinomas and underwent initial treatment at our institution.
MethodsClinical records of the 34 patients with pancreatic insulinomas who underwent surgical resection between 1995 and 2007 were
reviewed. Main variables for analysis were cure of the disease and surgical complications.
ResultsThere were 20 women and 14 men with a mean age of 40±13years. Mean size of the tumors was 2.2±1cm. Laparoscopic resection
was completed in 14 of 21 patients. Most tumors that were resected by laparoscopy were solitary, benign, and located in the
body and tail of the pancreas. Open surgery was selected for 13 patients, including 7 sporadic (5 in the head), 4 related
to the MEN syndrome, and 2 malignant tumors. Surgical morbidity occurred in 23 patients. The most common complication was
pancreatic fistula (3/13 in open, 4/14 in laparoscopic, and 6/7 in conversions). One patient in the open group died 15days
after surgery from massive PTE. Postoperative normoglycemia was achieved in all patients and persisted for a follow-up period
of 4±3.7years.
ConclusionsMost insulinomas in our series were small and benign. Tumors that were located in the body and tail were more often amenable
for laparoscopic resection. The cure rate was very high. Pancreatic fistula was the most frequent complication.
World Journal of Surgery 04/2012; 33(9):1966-1970. · 2.36 Impact Factor
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ABSTRACT: Adrenocortical carcinoma (ACC) is an aggressive tumor showing frequent metastatic spread and poor survival. Although recent genome-wide studies of ACC have contributed to our understanding of the disease, major challenges remain for both diagnostic and prognostic assessments. The aim of this study was to identify specific microRNAs (miRNAs) associated with malignancy and survival of ACC patients. miRNA expression profiles were determined in a series of ACC, adenoma, and normal cortices using microarray. A subset of miRNAs showed distinct expression patterns in the ACC compared with adrenal cortices and adenomas. Among others, miR-483-3p, miR-483-5p, miR-210, and miR-21 were found overexpressed, while miR-195, miR-497, and miR-1974 were underexpressed in ACC. Inhibition of miR-483-3p or miR-483-5p and overexpression of miR-195 or miR-497 reduced cell proliferation in human NCI-H295R ACC cells. In addition, downregulation of miR-483-3p, but not miR-483-5p, and increased expression of miR-195 or miR-497 led to significant induction of cell death. Protein expression of p53 upregulated modulator of apoptosis (PUMA), a potential target of miR-483-3p, was significantly decreased in ACC, and inversely correlated with miR-483-3p expression. In addition, high expression of miR-503, miR-1202, and miR-1275 were found significantly associated with shorter overall survival among patients with ACC (P values: 0.006, 0.005, and 0.042 respectively). In summary, we identified additional miRNAs associated with ACC, elucidated the functional role of four miRNAs in the pathogenesis of ACC cells, demonstrated the potential involvement of the pro-apoptotic factor PUMA (a miR-483-3p target) in adrenocortical tumors, and found novel miRNAs associated with survival in ACC.
Endocrine Related Cancer 08/2011; 18(6):643-55. · 4.36 Impact Factor
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Miguel F Herrera,
Juan Pablo Pantoja, David Velázquez-Fernández,
Javier Cabiedes,
Carlos Aguilar-Salinas,
Eduardo García-García,
Alfredo Rivas,
Christian Villeda,
Diego F Hernández-Ramírez,
Andrea Dávila,
Aarón Zaraín
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ABSTRACT: To assess the additional effect of sudden visceral fat reduction by omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in patients with grade III obesity (G-III O) undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB).
Twenty-two patients were randomized into two groups, LRYGB alone or with omentectomy. Levels of interleukin-6, C-reactive protein, tumor necrosis factor-alpha, leptin, adiponectin, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides, as well as clinical characteristics, were evaluated before surgery and at 1, 3, 6, and 12 months after surgery. Results were compared between groups.
Baseline characteristics were comparable in both groups. Mean operative time was significantly higher in the group of patients who underwent omentectomy (P < 0.001). Median weight of the omentum was 795 +/- 341 g. In one patient, a duodenal perforation occurred at the time of omentectomy. BMI, blood pressure, glucose, total cholesterol, LDL, and triglycerides significantly improved in both groups at 1, 3, 6, and 12 months of follow-up when compared with basal values. However, there were no consistent statistically significant differences among the groups in terms of metabolic syndrome components, acute-phase reactants, and inflammatory mediators.
Omentectomy does not have an ancillary short-term significant impact on the components of metabolic syndrome and does not induce important changes in the inflammatory mediators in patients undergoing LRYGB. Operative time is more prolonged when omentectomy is performed.
Diabetes care 07/2010; 33(7):1413-8. · 8.09 Impact Factor
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Eduardo García-García,
Manuel De la Llata-Romero,
Kaufer-Horwitz Martha,
María Teresa Tusié-Luna,
Raúl Calzada-León,
Verónica Vázquez Velásquez,
Simón Barquera-Cervera,
Alejandro de Jesús Caballero-Romo,
Orozco Lorena, David Velázquez-Fernández,
Martín Rosas Peralta,
José Armando Barriguete Meléndez,
Rogelio Zacarías-Castillo R,
Julio Sotelo Morales
Salud Mental. 01/2009;
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ABSTRACT: Laparoscopic Roux-en-Y gastric bypass (LRYGB) leads to significant weight loss and correction of co-morbidities in most patients. Banded LRYGB was designed to enhance weight loss and avoid weight regain.
A randomized controlled pilot trial was designed to comparatively analyze the results and complications of banded (6.5 cm) and unbanded LRYGB. The present study was an interim analysis focused on morbidity, mortality, and maximal weight loss.
The 60 patients were divided into 2 groups. Group 1 underwent unbanded LRYGB (n = 30) and group 2 underwent banded LRYGB (n = 30). No differences were found between the 2 groups in terms of age, gender, body mass index, or operative time. No significant differences were found in the percentage of excess weight loss and body mass index at 6, 12, and 24 months between the 2 groups. The frequency of complications was similar in both groups; 1 patient required band removal because of stenosis at the level of the mesh.
The weight loss pattern in both groups was similar at 1 and 2 years postoperatively. Proper assessment of weight maintenance and late weight regain will require longer follow-up.
Surgery for Obesity and Related Diseases 02/2008; 4(4):507-11. · 3.93 Impact Factor
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ABSTRACT: Differential diagnosis between adenoma and hyperplasia in primary hyperparathyroidism (pHPT) remains a dilemma. The aim of this study was to assess differences in transcriptional genomic expression profiles between sporadic (nonfamilial) parathyroid hyperplasia (SPH), adenoma, and normal tissue.
Parathyroid tissue from 12 patients with parathyroid adenoma, 3 with SPH, and 2 with normal glands was selected for analysis. Histopathology was reviewed in all cases, and all patients with adenomas presented normocalcemia for a minimum of 6 months after one gland resection. Hybridizations were performed in a microarray containing 19,968 human cDNA clones including contiguous replicates. Direct comparisons were performed with reverse labeling for every different pooled sample entity. Expression levels were analyzed using the SAM, SMA, LIMMA, Cluster, and PAM packages in the R environment for statistical computing.
There were significant statistical differences between SPH and adenomas. In the direct comparison, a total of 200 genes showed differential expression (P < 0.03): 61 genes were upregulated (> 1.65-fold increase) and 139 were downregulated (> 1.58-fold decrease) with a B value > 4.68 (99.08% probability of real differential expression). When SPH was compared to normal parathyroid tissue, 50 genes were differentially expressed: 42 were upregulated (> 1.89) and 8 were downregulated (> 1.7) with a B > 4.26 (98.6% probability of real differential expression). At least 17 genes were differentially expressed and able to discriminate SPH from adenoma or normal tissue. Upregulated genes were related to apoptosis inhibition, cell proliferation, transcriptional activity and cell adhesion, among other activities. Downregulated genes were mainly related to ion channel activity, lipopolysaccharides, prostaglandin-d synthase, and integral membrane proteins.
Our data suggest that SPH and adenoma have a singular molecular signature that, theoretically, could be used for the differential diagnosis of these entities and normal parathyroid tissue.
World Journal of Surgery 06/2006; 30(5):705-13. · 2.36 Impact Factor
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ABSTRACT: Distinguishing between adrenocortical adenomas and carcinomas is often difficult. Our aim was to investigate the differences in transcriptional profiles between benign and malignant adrenocortical neoplasms using complementary DNA microarray techniques.
We studied 7 patients with adrenocortical carcinomas and 13 with adenomas. Histopathology was reviewed in all patients; clinical follow-up was at least 1 year. Hybridizations were performed in duplicate against RNA reference. Expression levels were analyzed in the R environment for statistical computing with the use of aroma, limma, statistics, and class packages.
Transcriptional profiles were homogeneous among adenomas, while carcinomas were much more heterogeneous. Hierarchical clustering and self-organizing maps could separate clearly carcinomas from adenomas. Among genes that were most significantly upregulated in carcinomas were 2 ubiquitin-related genes (USP4 and UFD1L) and several insulinlike growth factor-related genes (IGF2, IGF2R, IGFBP3 and IGFBP6). Among genes that were most significantly downregulated in carcinomas were a cytokine gene (CXCL10), several genes related to cell metabolism (RARRES2, ALDH1A1, CYBRD1 and GSTA4), and the cadherin 2 gene (CDH2).
Through the use of cDNA arrays, adrenocortical adenomas and carcinomas appear to be clearly distinguishable on the basis of their specific molecular signature. The biologic importance of the up- and downregulated genes is yet to be determined.
Surgery 01/2006; 138(6):1087-94. · 3.10 Impact Factor
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ABSTRACT: Primary adrenal malignancies are rare and have a dismal prognosis. We report our experience in both adrenocortical carcinomas and malignant pheochromocytomas who received medical care at our Institution between 1994 and 2009.
The data bases of hospital discharges, surgery and pathology were reviewed looking for patients with diagnosis of primary adrenal malignant tumors. Clinical presentation, laboratory and image characteristics, surgical details, histopathology findings and outcome were analyzed.
A total of eight patients were identified, two men and six women with a mean age of 48.1 +/- 15.7 years (31-80). Six patients presented with adrenocortical carcinomas and two had malignant pheochromocytomas. Of the six cortical tumors four were functioning. Five were stage II, two were stage III and one was stage IV. All patients underwent surgery as initial treatment. Six patients underwent open and two, laparoscopic adrenalectomy. Three patients received adjuvant chemotherapy. In a mean follow up of 32 +/- 27 months, only three patients with stage II were alive and free of the disease.
As in other series, primary adrenal carcinoma in our population proved to be a rare endocrine neoplasm with poor prognosis despite complete surgical resection. Treatment at initial stages provides better outcome.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 64(3):234-9. · 0.42 Impact Factor
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ABSTRACT: A protective loop ileostomy for a distal anastomosis of the rectum or anus, decreases the risk of sepsis secondary to anastomotic leak or dehiscence. This study examines whether the surgical technique employed in the construction of the anastomosis (open vs. laparoscopic) alters the subsequent closure of ileostomy.
The goal of this study is to determine whether at the time of a protective ileostomy closure, the fact of doing an initial laparoscopic surgery has advantages over those who underwent open surgery.
This is a comparative and retrospective analysis of the results of an ileostomy closure with prior open surgery (ICPOS) vs those performed with a prior laparoscopic surgery (ICPLS). Demographic and surgical results were analyzed. Fisher's test and Chi square tests were used. A statistically significant results was defined as p < 0.05.
A total of 71 patients were included: 42 (59.2%) ICPOS and 29 (40.8%) ICPLS. Surgical time and hospital stay were less in the ICPLS group when compared with the ICPOS group. 79 vs. 133 min (p = 0.0001) and 3 vs. 5 days (p = 0.0001). Four patients (66.7%) from the ICPOS group developed ileum, whereas only 2 (33.3% from the ICPLS presented it (p = 0.04). Six patients had surgical wound infection, 5 (83.3%) of them represented the ICPOS group and only 1 (16.7%) represented the ICPLS group (p = 0.01). Four patients (5.6%) had anastomotic dehiscence, all of them were from the ICPOS group (p = 0.0037). On the ICPOS group 6 patients were reinterveined after the ileostomy closure, whereas none from the ICPLS required it (p = 0.01).
An ICPLS seems to have advantages over a ICPOS when analyzing surgical time, hospital stay and surgical ileum development, a lesser infection rate and a lesser re intervention rate at last.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 61(6):461-5. · 0.42 Impact Factor
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Eduardo García-García,
Manuel De la Llata-Romero,
Martha Kaufer-Horwitz,
María Teresa Tusié-Luna,
Raúl Calzada-León,
Verónica Vázquez-Velázquez,
Simón Barquera-Cervera,
Alejandro de Jesús Caballero-Romo,
Lorena Orozco, David Velázquez-Fernández,
Martín Rosas-Peralta,
Armando Barriguete-Meléndez,
Rogelio Zacarías-Castillo,
Carlos Ortega-González,
Julio Sotelo-Morales
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ABSTRACT: Numerous efforts for the development of basic and clinical research in obesity are being made by the National Institutes of Health and Federal Reference Hospitals in Mexico. However, greater interaction among researchers and stronger efforts towards the dissemination of the results are needed. The document outlines the general ideas and proposals of the Academic Group for the Study, Prevention and Treatment of Obesity and Metabolic Syndrome of the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals (CCINSHAE). This is the first step in developing common objectives, with the aim of understanding the effect of these entities in public health and to establish guidelines to limit and eventually overcome them. We discuss the appropriateness of analyzing obesity and the metabolic syndrome together, and the current management of these entities at the National Institutes of Health in Mexico. The problems that arise in clinical practice lead to the need to generate a new model of medical care, including a new health worker and a new patient. It is imperative to establish permanent lines of communication and education with health personnel and with patients. The group proposes an integrated approach for research in these areas. Finally, a master plan that links the National Institutes of Health, particularly in the areas of research and programs within the institutions, is required as a first step in seeking answers useful in solving the problem. The second step would be linking the first and second levels of care through concrete actions needed to limit and reduce obesity and metabolic syndrome in the population.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 61(4):337-46. · 0.42 Impact Factor
