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Guadalajara H, Yiasemidou M, Muñoz de Nova JL, Sedman P, Fernandez Gonzalez S, Maslekar S, Recarte Rico M, Egan R, Juez LD, Riyad K, García Septiem J, Lockwood S, Galindo Jara P, Giorga A, García Virosta M, Hance J, Lobo Martínez E, Martín-Pérez E, Howitt A, Jayne D, Chetter I, García-Olmo D, Fernández-Cebrián JM, Jover JM, Acín-Gándara D, Perea-del-Pozo E, Dios-Barbeito S, Aparicio-Sánchez D, Durán-Muñoz-Cruzado VM, Pareja-Ciuró F, Martin-Antona E, Cano-Valderrama O, Torres-Garcia AJ, Zarain-Obrador L, Durán-Poveda M, Peinado-Iribar B, Fernandez-Luengas D, Pascual-Migueláñez I, Garcia-Chiloeches A, Puerta A, Martín-Pérez E, García-del-Álamo-Hernández Y, Maqueda-González R, Gutiérrez-Samaniego M, Colao-García L, Núñez-O’Sullivan S, Vaquero MA, Picardo-Nieto A, Blazquez-Martin A, Vera-Mansilla C, Soto-Schüte S, Gutiérrez-Calvo A, Mínguez-García J, Sanchez-Argüeso A, Hernández-Villafranca S, Qian-Zhang S, Gortazar-de-las-Casas S, Dominguez-Prieto V, Lopez-Fernandez O, Casalduero-García L, Iparraguirre MÁ, Florez-Gamarra M, Argüello-de-Andrés JM, Tallón-Iglesias B, Pereira-Perez F, García-Ureña MÁ, Paeriro G, Fuenmayor-Valera ML, Pardo R, Pellen M, Basheer M, Harries R, Parkins K, Spencer N, Li Z, Burridge J, Wynn H, Mesri M. The international PIACO study: pattern of surgical approaches for acute surgical pathologies in Spain versus UK. Was conservative treatment and open surgery during COVID-19 the way to go? BJS Open 2022; 6:6658292. [PMID: 35939374 PMCID: PMC9359448 DOI: 10.1093/bjsopen/zrac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hector Guadalajara
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
| | | | - José Luis Muñoz de Nova
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Peter Sedman
- Upper Gi Surgery, Hull University Teaching Hospitals , Hull , UK
| | - Saul Fernandez Gonzalez
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
| | | | - María Recarte Rico
- Department of General and Digestive Surgery, Tajo University Hospital , Madrid , Spain
| | - Richard Egan
- Department of General Surgery, Swansea Bay UHB, Swansea University , Swansea, Wales , UK
| | - Luz Divina Juez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital , Madrid , Spain
| | | | - Javier García Septiem
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Sonia Lockwood
- Colorectal Surgery, Bradford Teaching Hospitals , Bradford , UK
| | - Pablo Galindo Jara
- Department of General and Digestive Surgery, Torrejon University Hospital , Madrid , Spain
| | - Andrea Giorga
- Colorectal Surgery, Leeds Teaching Hospitals , Leeds , UK
| | - Mariana García Virosta
- Department of General and Digestive Surgery, Infanta Sofia University Hospital , Madrid , Spain
| | - Julian Hance
- Colorectal Surgery, Leeds Teaching Hospitals , Leeds , UK
| | - Eduardo Lobo Martínez
- Department of General and Digestive Surgery, Ramon y Cajal University Hospital , Madrid , Spain
| | - Elena Martín-Pérez
- Department of General and Digestive Surgery, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-IP) , Madrid , Spain
| | - Annabel Howitt
- Department of Colorectal Surgery, Bradford Teaching Hospitals , Bradford , UK
| | - David Jayne
- Leeds Institute of Biomedical Sciences, University of Leeds , Leeds , UK
| | - Ian Chetter
- Academic Vascular Surgery, University of Hull , Hull , UK
| | - Damian García-Olmo
- Department of General and Digestive Surgery, Fundación Jimenez Díaz University Hospital , Madrid , Spain
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Villodre C, Taccogna L, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F, Afonso N, Aguilella V, Aguiló J, Alados JC, Alberich M, Apio AB, Balongo R, Bra E, Bravo-Gutiérrez A, Briceño FJ, Cabañas J, Cánovas G, Caravaca I, Carbonell S, Carrera-Dacosta E, Castro EE, Caula C, Choolani-Bhojwani E, Codina A, Corral S, Cuenca C, Curbelo-Peña Y, Delgado-Morales MM, Delgado-Plasencia L, Doménech E, Estévez AM, Feria AM, Gascón-Domínguez MA, Gianchandani R, González C, Hevia RJ, González MA, Hidalgo JM, Lainez M, Lluís N, López F, López-Fernández J, López-Ruíz JA, Lora-Cumplido P, Madrazo Z, Marchena J, de la Cuadra MB, Martín S, Casas MI, Martínez P, Mena-Mateos A, Morales-García D, Mulas C, Muñoz-Forner E, Naranjo A, Navarro-Sánchez A, Oliver I, Ortega I, Ortega-Higueruelo R, Ortega-Ruiz S, Osorio J, Padín MH, Pamies JJ, Paredes M, Pareja-Ciuró F, Parra J, Pérez-Guarinós CV, Pérez-Saborido B, Pintor-Tortolero J, Plua-Muñiz K, Rey M, Rodríguez I, Ruiz C, Ruíz R, Ruiz S, Sánchez A, Sánchez D, Sánchez R, Sánchez-Cabezudo F, Sánchez-Santos R, Santos J, Serrano-Paz MP, Soria-Aledo V, Tallón-Aguilar L, Valdivia-Risco JH, Vallverdú-Cartié H, Varela C, Villar-Del-Moral J, Zambudio N. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg 2022; 97:106168. [PMID: 34785344 DOI: 10.1016/j.ijsu.2021.106168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
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Affiliation(s)
- C Villodre
- Hospital Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain Hospital Universitario de Badajoz, Badajoz, Spain Hospital Universitario de Bellvitge, Barcelona, Spain Hospital Marina Baixa, Alicante, Spain Hospital Juan Ramón Jiménez, Infanta Elena, Huelva, Spain Hospital Infanta Cristina, Parla, Madrid, Spain Hospital Universitario de Canarias, Tenerife, Spain Hospital Reina Sofía de Córdoba, Córdoba, Spain H. Ramón y Cajal, Madrid, Spain Hospital Parc Taulí de Sabadell, Barcelona, Spain Hospital General Universitario de Alicante, Alicante, Spain Complejo Hospitalario Universitario de Vigo, Hospital Pontevedra, Spain Hospital Trueta de Girona, Girona, Spain Hospital Universitario Rio Hortega, Valladolid, Spain Hospital Mutua Terrassa, Barcelona, Spain Consorci Hospitalari de Vic, Barcelona, Spain POVISA, Pontevedra, Spain Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain Hospital Universitario Basurto, Bizkaia, Spain Hospital Universitario Marqués de Valdecilla, Santander, Spain Hospital de Viladecans, Barcelona, Spain Hospital Clínico de Valencia, Valencia, Spain Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain Hospital Vírgen de la Macarena, Sevilla, Spain Hospital Cabueñes, Gijón, Spain Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitari Sant Joan de Reus, Tarragona, Spain Hospital Universitario Infanta Sofía, Madrid, Spain Complejo Hospitalario Torrecárdenas, Almería, Spain Hospital Sant Pau i Santa Tecla, Tarragona, Spain Hospital General Rafael Méndez de Lorca, Murcia, Spain Hospital Vírgen del Rocío, Sevilla, Spain Hospital Morales Meseguer, Murcia, Spain Hospital del Vinalopó, Alicante, Spain Hospital Universitario del Vinalopó, Alicante, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain Department of Surgery, General University Hospital of Alicante, Alicante, Spain Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain Computing, BomhardIP, Alicante, Spain Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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Durán-Muñoz-Cruzado VM, Pareja-Ciuró F, Padillo-Ruiz J. Analysis of the safety of patients and professionals during the COVID-19 pandemic in the context of emergency surgery. ACTA ACUST UNITED AC 2020; 156:34-35. [PMID: 33521307 PMCID: PMC7834622 DOI: 10.1016/j.medcle.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Felipe Pareja-Ciuró
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Javier Padillo-Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Durán-Muñoz-Cruzado VM, Pareja-Ciuró F, Padillo-Ruiz J. [Analysis of the safety of patients and professionals during the COVID-19 pandemic in the context of emergency surgery]. Med Clin (Barc) 2020; 156:34-35. [PMID: 33268130 PMCID: PMC7518175 DOI: 10.1016/j.medcli.2020.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Felipe Pareja-Ciuró
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Javier Padillo-Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España
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Tallón-Aguilar L, Durán-Muñoz-Cruzado VM, Martínez-Casas I, Aranda-Narváez JM, Pérez-Díaz MD, Montón-Condón S, Turégano-Fuentes F, Pareja-Ciuró F. Are Spanish surgeons prepared to treat trauma patients? Multicentre descriptive observational study. Eur J Trauma Emerg Surg 2020; 48:901-906. [PMID: 32920673 DOI: 10.1007/s00068-020-01492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Specific training in the management of trauma patients is beneficial for surgeons. Training through specific courses in this area has a direct impact on the care of these patients. The aim of this work is to understand the participation and specific training in the care of trauma patients by Spanish surgeons. METHODS A national survey was conducted and administered to all members of the Spanish Association of Surgeons. The survey assessed their degree of participation in emergency surgery, and therefore the probability of attending trauma patients, their assessment of the initial care of trauma patients in their centre, and their specific training in this field. RESULTS The survey was completed by 510 surgeons from 47 Spanish provinces, with Catalonia and Andalusia being the most represented regions. In total, 456 (89.41%) of those surveyed work in the emergency department on a routine basis. Only 171 (33.53%) refer to having a registry of trauma patients in their hospital. While 79.02% of surgeons reported that general surgeons are not involved in care of severe trauma from the outset, only 66.47% have completed the ATLS course, 40.78% the DSTC course and 18.82% the MUSEC course. Despite this, 85.69% believe that the ATLS course should be compulsory during residency and 43.33% believe that severe trauma care in their hospital is poor or very poor. CONCLUSION Only 40% have received specific training in definitive surgical management of severe trauma. Despite this, a large percentage of surgeons work in the emergency department on a routine basis and potentially face the challenge of managing these patients.
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Senent-Boza A, Jurado-Serrano J, Beltrán-Miranda P, Angulo-González DM, Pareja-Ciuró F, Awad-Breval F, Doblado-López A, Castell-Monsalve J, Padillo-Ruiz J. Preoperative CT thorax as a COVID-19 screen. Br J Surg 2020; 107:e500-e501. [PMID: 32866281 PMCID: PMC7929305 DOI: 10.1002/bjs.11957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Ana Senent-Boza
- Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Seville, Spain
| | - Juan Jurado-Serrano
- Department of Radiology, Virgen del Rocio University Hospital, Seville, Spain
| | - Pablo Beltrán-Miranda
- Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Seville, Spain
| | | | - Felipe Pareja-Ciuró
- Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Seville, Spain
| | - Fadia Awad-Breval
- Department of Radiology, Virgen del Rocio University Hospital, Seville, Spain
| | - Ana Doblado-López
- Department of Radiology, Virgen del Rocio University Hospital, Seville, Spain
| | | | - Javier Padillo-Ruiz
- Head of the Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Seville, Spain.,Professor of Surgery, University of Seville, Spain
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Aranda-Narváez JM, Tallón-Aguilar L, Pareja-Ciuró F, Martín-Martín G, González-Sánchez AJ, Rey-Simó I, Tamayo-Medel G, Yánez-Benítez C, Costa-Navarro D, Montón-Condón S, Navarro-Soto S, Turégano-Fuentes F, Pérez-Díaz MD, Ceballos-Esparragón J, Jover-Navalón JM, Balibrea JM, Morales-Conde S. [Emergency Surgery and Trauma Care During COVID-19 Pandemic. Recommendations of the Spanish Association of Surgeons]. Cir Esp 2020; 98:433-441. [PMID: 32439139 PMCID: PMC7188641 DOI: 10.1016/j.ciresp.2020.04.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
La infección por el nuevo coronavirus SARS-CoV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados.
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Affiliation(s)
| | - Luis Tallón-Aguilar
- Servicio de Cirugía, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Felipe Pareja-Ciuró
- Servicio de Cirugía, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | - Ignacio Rey-Simó
- Servicio de Cirugía, Complejo Hospitalario Universitario, A Coruña, España
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Tinoco-González J, Rubio-Manzanares-Dorado M, Senent-Boza A, Durán-Muñoz-Cruzado V, Tallón-Aguilar L, Pareja-Ciuró F, Padillo-Ruíz J. Acute appendicitis during pregnancy: differences in clinical presentation, management, and outcome. Emergencias 2019; 30:261-264. [PMID: 30033700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To analyze the clinical presentation, management, and outcome of acute appendicitis (AA) in pregnant and nonpregnant women of childbearing age. MATERIAL AND METHODS Descriptive study of 2 cohorts of women (pregnant -P- and nonpregnant -NP-). The women, who were matched according to risk factors, were included when they underwent an emergency appendectomy based on clinical suspicion of AA. We recorded age, medical history, clinical presentation, management, and outcome. Pregnant women were classified according to gestational age of the fetus (trimester). RESULTS . We included 153 women (51 P, 102 NP). The mean (SD) age was 28.8 (6.5) years (P women, 29.7 [5.8] years; NP, 28.3 [6.8]; P=.242). The mean Alvarado score was 7.1 (1.6) (P, 6.7 [1.7]; NP, 7.3 [1.5]; P=.016). The rate of complicated AA was higher in P (19.6%) than NP (2.9%) women (P<.001). Pregnancy was also associated with higher rates of surgical wound infection (P, 14.0%; NP, 3.0%; P=.016) and a longer mean hospital stay (P, 5.1 [4.8] days; NP, 1.7 [1.0]; P<.001). In the third trimester of P, poorer outcomes were recorded in relation to these risks (P=.031; P=.003, and P<.001, respectively). CONCLUSION The atypical clinical presentation of AA during pregnancy makes diagnosis difficult and may lead to a higher incidence of complicated AA and surgical wound infection as well as longer hospital stays, particularly when AA presents in the third trimester.
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Affiliation(s)
- José Tinoco-González
- Unidad de Cirugía de Urgencias, Hospital Virgen del Rocío. Hospital General, Sevilla, España
| | | | - Ana Senent-Boza
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Virgen del Rocío. Hospital General, Sevilla, España
| | | | - Luis Tallón-Aguilar
- Unidad de Cirugía de Urgencias, Hospital Virgen del Rocío. Hospital General, Sevilla, España
| | - Felipe Pareja-Ciuró
- Unidad de Cirugía de Urgencias, Hospital Virgen del Rocío. Hospital General, Sevilla, España
| | - Javier Padillo-Ruíz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Virgen del Rocío. Hospital General, Sevilla, España. Facultad de Medicina de la Universidad de Sevilla
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Aranda-Narváez JM, Tallón-Aguilar L, López-Ruiz JA, Pareja-Ciuró F, Jover-Navalón JM, Turégano-Fuentes F, Navarro-Soto S, Ceballos-Esparragón J, Pérez-Díaz L. The Acute Care Surgery model in the world, and the need for and implementation of trauma and emergency surgery units in Spain. Cir Esp 2018; 97:3-10. [PMID: 30415793 DOI: 10.1016/j.ciresp.2018.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
The Acute Care Surgery model groups trauma and emergency surgery with surgical critical care. Conceived and extended during the last 2 decades throughout North America, the magnitude and clinical idiosyncrasy of emergency general surgery have determined that this model has been expanded to other parts of the world. In our country, this has led to the introduction and implementation of the so-called trauma and emergency surgery units, with common objectives as those previously published for the original model: to decrease the rates of emergency surgery at night, to allow surgeons linked to elective surgery to develop their activity in their own disciplines during the daily schedule, and to become the perfect link and reference for the continuity of care. This review summarizes how the original model was born and how it expanded throughout the world, providing evidence in terms of results and a description of the current situation in our country.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lola Pérez-Díaz
- Hospital General Universitario Gregorio Marañón, Madrid, España
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Dios-Barbeito S, Durán-Muñoz-Cruzado V, Martín-García C, Rubio-Manzanares-Dorado M, Padillo-Ruiz F, Pareja-Ciuró F. ¿Qué pacientes politraumatizados graves se benefician de la realización de un total-body CT ? Med Intensiva 2018; 42:129-131. [DOI: 10.1016/j.medin.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/06/2017] [Accepted: 03/03/2017] [Indexed: 01/02/2023]
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Tallón-Aguilar L, López-Ruiz JA, Domínguez-Sánchez C, Pareja-Ciuró F, Padillo-Ruiz J. Laparoscopic aproach in post-traumatic chylous ascites. Ann R Coll Surg Engl 2018; 100:e57-e58. [PMID: 29364009 DOI: 10.1308/rcsann.2017.0220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chylous ascites is a rare condition little reported in literature, with even more exceptional traumatic origin. Its production mechanism is not known exactly but has been attributed to hyperflexion or hyperextension of the spine leading to a rupture of lymph ducts. We present a case of post-traumatic chyloperitoneum in a young patient after abdominal blunt trauma. Conservative treatment should be the first therapeutic option, especially if the origin is traumatic, reserving more aggressive possibilities for cases that do not respond after 15 days, if debt is greater than 1.5 litres/day in adult patients or in those with metabolic complications. A laparoscopic approach is indicated to confirm the diagnosis and to rule out other associated injuries that may require other surgical procedures.
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Affiliation(s)
- L Tallón-Aguilar
- Trauma and Emergency Surgery Unit, Surgery Department, University Hospital Virgen del Rocío University , Seville , Spain
| | - J A López-Ruiz
- Trauma and Emergency Surgery Unit, Surgery Department, University Hospital Virgen Macarena , Seville , Spain
| | - C Domínguez-Sánchez
- Trauma and Emergency Surgery Unit, Surgery Department, University Hospital Virgen Macarena , Seville , Spain
| | - F Pareja-Ciuró
- Trauma and Emergency Surgery Unit, Surgery Department, University Hospital Virgen del Rocío University , Seville , Spain
| | - J Padillo-Ruiz
- Trauma and Emergency Surgery Unit, Surgery Department, University Hospital Virgen del Rocío University , Seville , Spain
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Segura-Sampedro JJ, Rivero-Belenchón I, Pino-Díaz V, Rodríguez Sánchez MC, Pareja-Ciuró F, Padillo-Ruiz J, Jimenez-Rodriguez RM. Feasibility and safety of surgical wound remote follow-up by smart phone in appendectomy: A pilot study. Ann Med Surg (Lond) 2017; 21:58-62. [PMID: 28794868 PMCID: PMC5537421 DOI: 10.1016/j.amsu.2017.07.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/16/2017] [Accepted: 07/16/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The objective of the present study is to assess the safety and feasibility of the use of telemedicine-based services for surgical wound care and to measure patient satisfaction with telemedicine-based follow-up. MATERIAL AND METHODS 24 patients were included, they were provided with a corporate mail address. On day 7 after surgery patients sent, via email, an image of their surgical wound together with a completed questionnaire in order to obtain an early diagnosis. Two independent physicians studied this information and the histologic analysis of the specimen. On day 8, all patients underwent face-to-face office examination by a third physician and all of them completed a satisfaction questionnaire at the end of the study. RESULTS The use of telemedicine-based services showed a sensitivity of 100%, a specificity of 91.6%, a positive predictive value of 75% and a negative predictive value of 100%. Degree of concordance between the two physicians, as regards the necessity of face-to-face follow-up yielded a kappa coefficient of 0.42 (standard error 0.25 and confidence interval 95% (0.92-0.08), which means a moderate agreement between the two evaluations. 94% of patients were satisfied with telemedicine-based follow-up and 93% showed their preference for this procedure over conventional methods. CONCLUSIONS The telemedicine-based follow-up, has proven to be feasible and safe for the evaluation of early postoperative complications. Patients reported high levels of satisfaction with the procedure. Telemedicine-based follow-up could become standard practice with the development of a specific mobile application.
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Affiliation(s)
- Juan José Segura-Sampedro
- Department of Surgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Peritoneal Surgical Oncology Unit, Department of Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain.,Malignant Peritoneal Disease Research Group, Health Research Institute of Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | | | - Verónica Pino-Díaz
- Department of Surgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Felipe Pareja-Ciuró
- Department of Surgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Javier Padillo-Ruiz
- Department of Surgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Segura-Sampedro JJ, Jiménez-Rodríguez R, Camacho-Marente V, Pareja-Ciuró F, Padillo-Ruiz J. Absceso mamario y sepsis con origen en infección oral. Cir Esp 2016; 94:308-9. [PMID: 26148851 DOI: 10.1016/j.ciresp.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
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14
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Tinoco-González J, Ramírez-Plaza CP, Ramallo-Solís I, Pareja-Ciuró F, Padillo-Ruiz FJ. Corrigendum to “Gastrointestinal stromal tumor (GIST) presenting as a groin mass mimicking and incarcerated hernia” [Int. J. Surg. Case Rep. (2015) 166–168]. Int J Surg Case Rep 2015. [DOI: 10.1016/j.ijscr.2015.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Barrera-Pulido L, Álamo-Martínez J, Marín-Gómez L, Suárez-Artacho G, Bernal-Bellido C, Domínguez-Usero D, Tallón-Aguilar L, Pareja-Ciuró F, Sousa-Martín J, García-González I, Gómez-Bravo M. Switching From Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium in Liver Transplant Patients With Gastrointestinal Complications. Transplant Proc 2009; 41:2192-4. [DOI: 10.1016/j.transproceed.2009.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barrera-Pulido L, Aguilera-García I, Docobo-Pérez F, Alamo-Martínez JM, Pareja-Ciuró F, Nuñez-Roldán A, Gómez-Bravo MA, Bernardos-Rodríguez A. Clinical relevance and prevalence of polymorphisms in CYP3A5 and MDR1 genes that encode tacrolimus biotransformation enzymes in liver transplant recipients. Transplant Proc 2009; 40:2949-51. [PMID: 19010156 DOI: 10.1016/j.transproceed.2008.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To study the prevalence and clinical significance of polymorphisms in the CYP3A5 and MDR1 genes in liver transplant patients and their donors; to determine the relative importance of genes from the donor and the recipient; to assess the relationship of polymorphisms with the variability of concentration/dose of tacrolimus for optimization and individualization regimens. MATERIALS AND METHODS This prospective study included 53 liver transplant recipients who received tacrolimus de novo. CYP3A5 and MDR1 gene polymorphisms were identified in the donors and recipients using polymerase chain reaction. We collected indicator variables of graft function and the patient for 3 months after the transplantation: days 0, 1, 3, 7, 14, 30, 60, and 90. RESULTS The frequencies of CYP3A5 polymorphisms were: 90.6% (G/G), 9.4% (G/A) and 0% (A/C) in donors and 88.7% (G/G), 11.3% (G/A), and 0% (A/A) in recipients. For the MDR1 gene, they were: 26.4% (C/C), 50.9% (C/T), and 22.6% (T/T) in donors and 17.0% (C/C), 71.7% (C/T), and 11.3% (T/T) in recipients. In the early days after transplant, G/A recipients from G/A donors did not reach the minimum drug levels. Between days 30 and 60, G/G recipients from G/A donors required higher tacrolimus doses. G/G recipients (CYP3A5) from C/T donors (MDR1) had a lower frequency of renal dysfunction, the same rejection rate, and a higher rate of diabetes than the other groups. CONCLUSIONS For CYP3A5, the presence of the A allele appeared to be related to greater requirements for tacrolimus in the early days after transplantation. Pharmacogenetics combined with pharmacodynamics may be a useful tool to adjust the concentration of tacrolimus depending on the absorption by the individual patient.
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Affiliation(s)
- L Barrera-Pulido
- Hepatobiliopancreatic Unit of Surgery and Liver Transplantation, Virgen del Rocío Hospitals, Sevilla, Spain.
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Tallón-Aguilar L, Olano-Acosta C, López-Porras M, Flores-Cortés M, Pareja-Ciuró F. [Endosalpingiosis of the appendix]. Cir Esp 2009; 85:383. [PMID: 19406386 DOI: 10.1016/j.ciresp.2008.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Accepted: 09/01/2008] [Indexed: 11/25/2022]
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Tallón-Aguilar L, Gutiérrez-Moreno M, Flores-Cortés M, Pareja-Ciuró F. [Hepatic abscess after scrape for natural abortion]. Med Clin (Barc) 2008; 131:679. [PMID: 19087802 DOI: 10.1157/13128729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Suárez-Grau JM, Rubio-Chaves C, Pareja-Ciuró F, Gómez-Bravo MA, Diez-Canedo JS, García-González I. [Obstructive jaundice secondary to hepatic artery aneurysm]. CIR CIR 2008; 76:253-256. [PMID: 18647560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Aneurysm of the hepatic artery is relatively infrequent, representing 16-20% of aneurysms of the visceral arteries. Clinical presentation is nonspecific and may include abdominal pain, upper digestive system hemorrhage, or obstructive jaundice, as in the case presented here. CLINICAL CASE We present the case of a 47-year-old patient referred to our service due to obstructive jaundice, verifying that the pathology was caused by an aneurysm of >7 cm in diameter in the hepatic artery. Despite elective treatment and intensive collaboration of different surgical specialists, the patient's prognosis was poor. DISCUSSION These types of aneurysms occur infrequently and with an uncertain prognosis. Therefore, individualized treatment for each case is necessary. CONCLUSIONS We must carefully select the approach that fits the needs of our patient. The endovascular route is often currently used. However, because of the complexity of the location of the injury, in some cases it is impossible and surgical intervention is necessary with trained hepatobiliary and vascular surgeons.
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Tallón-Aguilar L, Pareja-Ciuró F, Alamo-Martínez JM, Gómez-Bravo MA. [Caroli syndrome as a reason for liver transplant]. Cir Esp 2008; 83:48. [PMID: 18208757 DOI: 10.1016/s0009-739x(08)70503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Romero-Vargas ME, Flores-Cortés M, Valera Z, Gómez-Bravo MA, Barrera-Pulido L, Pareja-Ciuró F, Serrano Díez-Canedo J, García I, Bernardos A. Cancers of new appearance in liver transplant recipients: incidence and evolution. Transplant Proc 2007; 38:2508-10. [PMID: 17097983 DOI: 10.1016/j.transproceed.2006.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the incidence, time of appearance, treatment, and evolution of tumors appearing in liver transplant recipients at our hospital. MATERIAL AND METHODS We undertook a retrospective analysis of our series of liver transplants between 1990 and 2005. Patients who died during the immediate postoperative period were excluded. RESULTS Of the 515 patients, 25 died during the immediate postoperative period and therefore had no occasion to develop neoplasms. Of the remaining 490, 32 developed cancers (6.5%). The average age was 55.4 +/- 7.17 years. The reasons for transplant were alcoholic cirrhosis (n = 15), hepatitis C virus (2), hepatitis B virus (n = 1), alcoholic and viral cirrhosis (n = 7), primary biliary cirrhosis (n = 1), and cryptogenic cirrhosis (n = 1). Four patients developed multiple neoplasms. Most of the tumors were cutaneous: nine basal cell and six squamous cell carcinomas. Other locations were the lung, urothelium, stomach, thyroid, and brain. Eight patients presented metastasis at the time of diagnosis. The average tumor-free period was 3.36 years. Nine patients died as a result of the tumor. DISCUSSION Patients with a liver transplant have a high risk of developing cancers as a result of the immunosuppression treatment, which is lifelong. Nevertheless, other factors can be involved, such as infection by cytomegalovirus or the original diagnosis leading to transplantation. The risk for developing cancers is significantly greater than in the general population, with a higher tendency to recurrence and later development of second neoplasms.
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Affiliation(s)
- M E Romero-Vargas
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Hepatobiliopancreática y Trasplantes, HHUU Virgen del Rocio, Seville, Spain
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Valera-Sanchez Z, Flores-Cortes M, Romero-Vargas ME, Gómez-Bravo MA, Pareja-Ciuró F, Lopez-Bernal F, Barrera-Pulido A, Bermejo-Navas J, García-González I, Bernardos-Rodriguez A. Biliodigestive Anastomosis in Liver Transplantation: Review of 13 Years. Transplant Proc 2006; 38:2471-2. [PMID: 17097970 DOI: 10.1016/j.transproceed.2006.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hepaticojejunostomy is a good alternative technique for biliary reconstruction in liver transplantation. Among 517 liver transplants performed between March 1992 and July 2005, 33 involved hepaticojejunostomy, namely, 18 men and 12 women of average age: 44.8 years. The main cause for this technique was retransplant (n = 10), secondary biliary cirrhosis (n = 5), alcoholic cirrhosis (n = 5), HCV cirrhosis (n = 2), primary biliary cirrhosis (n = 1), cryptogenic cirrhosis (n = 1), sclerosing cholangitis (n = 3), fulminant liver failure (n = 1), autoimmune cirrhosis (n = 1), and insulinoma metastasis (n = 1). Choledochojejunostomy was performed for all Roux-en-Y loops, with an average cold ischemia time of 361.16 minutes (180-780). The biliary complications were biliary fistula in four cases (13.3%), including two who required surgery; stenosis of the anastomosis in two cases (6.6%) including one diagnosed by HIDA that resolved with medical treatment and the other, diagnosed by cholangio-MRI, requiring a new hepaticojejunostomy; and biliary peritonitis in three cases (10%), all of whom required surgery. The vascular complications were thrombosis of the hepatic artery (n = 1), which required retransplantation, and pseudoaneurysm of hepatic artery (n = 1). No biliary complications occurred. The 6-month patient survival was 80% and the 6-month graft survival was 77%; no patient died due to biliary complications. Hepaticojejunostomy is a technique with higher morbidity than choledocho-choledochostomy, but it is the best alternative when the latter is not possible.
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Affiliation(s)
- Z Valera-Sanchez
- Department of General Surgery, Virgen del Rocio University Hospital, Seville, Spain.
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Pareja-Ciuró F, Alamo-Martinez JM, Barrera-Pulido L, Serrano-Díez J, Gomez-Bravo MA, García-Gonzalez I, Sousa-Martín JM, Pascasio-Acevedo JM, Porras-López FM, Gavilan-Carrasco F, Bernardos-Rodriguez A. Scoring Guide When Deciding to Accept an Organ for a Liver Transplant. Transplant Proc 2006; 38:2382-4. [PMID: 17097941 DOI: 10.1016/j.transproceed.2006.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED Our objective was establish a scoring system that allows a donor to be evaluated quickly and easily using a set of variables that are evaluated prior to the donation and another set that are evaluated during surgery. MATERIALS AND METHODS Prior to the donation we analyzed age, medication requirements, natremia, hepatic biochemistry, gas levels, days in ICU, history of hypertension, and weight. A value of 40% was allocated to this group of factors. During the transplant we assessed the characteristics of the organ-shine, consistency, surface, edge, color, presence of steatosis, and atheromatosis. A value of 60% was allocated to this set. We established a scale of 1 to 10, only accepting organs scoring 5 or more points. Those grafts that received a score between 5 and 7.5 points were called suboptimal and those with over 7.5 points, optimal. We prospectively analyzed 133 donors whose organs were implanted. RESULTS The survival rate at 1 year was 85%, and the rejection rate was 12%. The incidence of primary graft dysfunction was 8.2% (n = 11) and that of primary graft nonfunction 2.2% (n = 3). The incidence of primary graft dysfunction was greater within the group with fewer points (suboptimal). There were no differences between the optimal and suboptimal groups in terms of primary malfunction, survival, or rejection rate. CONCLUSIONS The score provided a guide to decide whether to accept viable organs for implantation, given that the point system was obtained quickly and easily. When greater than 5, it correlated with low rates of primary nonfunction (<3%) and of primary graft dysfunction (<15%), with acceptable survival at 1 year (>80%) and acute rejections rate (<15%).
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Affiliation(s)
- F Pareja-Ciuró
- Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Virgen Del Rocío University Hospitals, Seville, Spain.
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Pareja-Ciuró F, Díez-Canedo JS, Gómez-Bravo MA, García-Gonzalez I, Tamayo-López MJ, Sousa-Martín JM, Pascasio-Acevedo JM, Porras-Lopez MF, Gavilán-Carrasco F, Bernardos-Rodríguez A. Efficacy and Safety of Mycophenolate Mofetil as Part of Induction Therapy in Liver Transplantation. Transplant Proc 2005; 37:3926-9. [PMID: 16386587 DOI: 10.1016/j.transproceed.2005.10.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIMS To report our experience with mycophenolate mofetil (MMF) for induction and maintenance therapy to prevent acute liver transplant rejection. METHODS A retrospective analysis of 66 elective, noncombined liver transplant patients treated beginning de novo MMF and follow for a minimum of 2 years. Thirty-nine of the 66 cases received MMF, calcineurin inhibitors, and steroids. In 11 cases daclizumab was added; in 16 daclizumab was added without steroids. RESULTS The global survival rate was 91% at 6 months, 89.4% at 1 year, and 87.9% after 2 years. Acute rejection episodes were observed in six patients (9.1%). All episodes responded to corticoids. Toxicity possibly, probably, or partially related to MMF was observed in 35 patients (53%) with definitive suspension required in 13 cases (20%), with dose reduction or temporary suspension in 22 (33%). Hematological toxicity associated with MMF was observed in 12 patients (18%), leading to definitive suspension in two patients (3.03%), temporary suspension in two cases (3.03%), and dose reduction in eight cases (12%). Opportunistic infection was observed in seven cases (10%). Gastrointestinal toxicity was mild and infrequent (five cases, 7.5%). CONCLUSION Regimens containing MMF reduce rejection episodes with high survival rates and low toxicity.
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Affiliation(s)
- F Pareja-Ciuró
- Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Virgen del Rocío Hospital, Seville, Spain.
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