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Uchima H, Calm A, Muñoz-González R, Caballero N, Rosinach M, Marín I, Colán-Hernández J, Iborra I, Castillo-Regalado E, Temiño R, Mata A, Turró R, Espinós J, Moreno De Vega V, Pellisé M. Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions. Endoscopy 2023; 55:1045-1050. [PMID: 37348544 DOI: 10.1055/a-2115-7797] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND We aimed to evaluate the safety and technical success of an easy-to-use technique that applies underwater cap suction pseudopolyp formation to facilitate the resection of flat lesions or those at the appendiceal orifice or ileocecal valve. METHODS We retrospectively analyzed a register of consecutive cap suction underwater endoscopic mucosal resection (CAP-UEMR) procedures performed at two centers between September 2020 and December 2021. Procedures were performed using a cone-shaped cap, extending 7 mm from the endoscope tip, to suction the lesion while submerged underwater, followed by underwater snare resection. Our primary end point was technical success, defined as macroscopic complete resection. RESULTS We treated 83 lesions (median size 20 mm; interquartile range [IQR] 15-30 mm) with CAP-UEMR: 64 depressed or flat lesions (18 previously manipulated, 9 with difficult access), 11 from the appendix, and 8 from the ileocecal valve. Technical success was 100 %. There were seven intraprocedural bleedings and two delayed bleedings, all managed endoscopically. No perforations or other complications occurred. Among the 64 lesions with follow-up colonoscopy, only one recurrence was detected, which was treated endoscopically. CONCLUSIONS CAP-UEMR was a safe and effective technique for removing nonpolypoid colorectal lesions, including those arising from the appendiceal orifice or ileocecal valve.
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Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Anna Calm
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Raquel Muñoz-González
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Noemí Caballero
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | | | - Ingrid Marín
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Juan Colán-Hernández
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ignacio Iborra
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Edgar Castillo-Regalado
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Rocío Temiño
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Alfredo Mata
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Román Turró
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Jorge Espinós
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Vicente Moreno De Vega
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Maria Pellisé
- Gastroenterology, Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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2
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Uchima H, Diez-Caballero A, Capdevila J, Rosinach M, Mata A, Turró R, Espinós J. Underwater endoscopic mucosal resection for en bloc resection of a neuroendocrine tumor in the duodenal bulb. Endoscopy 2022; 54:E264-E265. [PMID: 34144620 DOI: 10.1055/a-1512-8954] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain.,Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | - Jaume Capdevila
- Teknon Oncology Institute, Teknon Medical Center, Barcelona, Spain
| | | | - Alfredo Mata
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Román Turró
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Jorge Espinós
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
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3
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Sendino O, Loras C, Mata A, Momblán D, Andujar X, Cruz M, Cárdenas A, Marquez I, Uchima H, Cordova H, de Lacy AM, Espinós J. Safety and efficacy of endoscopic vacuum therapy for the treatment of perforations and anastomotic leaks of the upper gastrointestinal tract. Gastroenterol Hepatol 2020; 43:431-438. [PMID: 32680732 DOI: 10.1016/j.gastrohep.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/19/2020] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated.
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Affiliation(s)
- O Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
| | - C Loras
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - A Mata
- Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - D Momblán
- Servicio de Cirugía Gastrointestinal, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - X Andujar
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - M Cruz
- Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - A Cárdenas
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - I Marquez
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - H Uchima
- Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - H Cordova
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - A M de Lacy
- Servicio de Cirugía Gastrointestinal, ICMDiM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - J Espinós
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España; Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
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4
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Albéniz E, Gimeno-García AZ, Fraile M, Ibáñez B, Guarner-Argente C, Alonso-Aguirre P, Álvarez MA, Gargallo CJ, Pellisé M, Ramos Zabala F, Herreros de Tejada A, Nogales Ó, Martínez-Ares D, Múgica F, de la Peña J, Espinós J, Huerta A, Álvarez A, Gonzalez-Santiago JM, Navajas F, Martínez-Cara JG, Redondo-Cerezo E, Merlo Mas J, Sábado F, Rivero L, Saperas E, Soto S, Rodríguez-Sánchez J, López-Roses L, Rodríguez-Téllez M, Rullán Iriarte M, Elosua González A, Pardeiro R, Valdivielso Cortázar E, Concepción-Martín M, Huelin Álvarez P, Colán Hernández J, Cobian J, Santiago J, Jiménez A, Remedios D, López-Viedma B, García O, Martínez-Alcalá F, Pérez-Roldán F, Carbó J, Enguita M. Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions. Gastrointest Endosc 2020; 91:868-878.e3. [PMID: 31655045 DOI: 10.1016/j.gie.2019.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).
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Affiliation(s)
| | | | | | - Berta Ibáñez
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA and REDISSEC, Pamplona, Spain
| | - Carlos Guarner-Argente
- Hospital de la Santa Creu y Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Óscar Nogales
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Múgica
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | | | | | | | - Alberto Álvarez
- Complejo Asistencial Universitario de Salamanca, IBSAL, Salamanca, Spain
| | | | | | | | | | | | - Fernando Sábado
- Consorcio Hospitalario Provincial Castellón, Castellón, Spain
| | | | | | | | | | | | | | | | | | | | | | - Mar Concepción-Martín
- Hospital de la Santa Creu y Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Juan Colán Hernández
- Hospital de la Santa Creu y Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Julyssa Cobian
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - José Santiago
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | | | | | | | | | - Jorge Carbó
- Hospital Universitario La Paz, Madrid, Spain
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5
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Carrera-Lasfuentes P, Lanas A, Bujanda L, Strunk M, Quintero E, Santolaria S, Benito R, Sopeña F, Piazuelo E, Thomson C, Pérez-Aisa A, Nicolás-Pérez D, Hijona E, Espinel J, Campo R, Manzano M, Geijo F, Pellise M, Zaballa M, González-Huix F, Espinós J, Titó L, Barranco L, D'Amato M, García-González MA. Relevance of DNA repair gene polymorphisms to gastric cancer risk and phenotype. Oncotarget 2018; 8:35848-35862. [PMID: 28415781 PMCID: PMC5482622 DOI: 10.18632/oncotarget.16261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/17/2016] [Accepted: 02/27/2017] [Indexed: 12/21/2022] Open
Abstract
Variations in DNA repair genes have been reported as key factors in gastric cancer (GC) susceptibility but results among studies are inconsistent. We aimed to assess the relevance of DNA repair gene polymorphisms and environmental factors to GC risk and phenotype in a Caucasian population in Spain. Genomic DNA from 603 patients with primary GC and 603 healthy controls was typed for 123 single nucleotide polymorphisms in DNA repair genes using the Illumina platform. Helicobacter pylori infection with CagA strains (odds ratio (OR): 1.99; 95% confidence interval (CI): 1.55–2.54), tobacco smoking (OR: 1.77; 95% CI: 1.22–2.57), and family history of GC (OR: 2.87; 95% CI: 1.85–4.45) were identified as independent risk factors for GC. By contrast, the TP53 rs9894946A (OR: 0.73; 95% CI: 0.56–0.96), TP53 rs1042522C (OR: 0.76; 95% CI: 0.56–0.96), and BRIP1 rs4986764T (OR: 0.55; 95% CI: 0.38–0.78) variants were associated with lower GC risk. Significant associations with specific anatomopathological GC subtypes were also observed, most notably in the ERCC4 gene with the rs1799801C, rs2238463G, and rs3136038T variants being inversely associated with cardia GC risk. Moreover, the XRCC3 rs861528 allele A was significantly increased in the patient subgroup with diffuse GC (OR: 1.75; 95% CI: 1.30–2.37). Our data show that specific TP53, BRIP1, ERCC4, and XRCC3 polymorphisms are relevant in susceptibility to GC risk and specific subtypes in Caucasians.
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Affiliation(s)
| | - Angel Lanas
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Faculty of Medicine, Universidad de Zaragoza, Zaragoza, Spain
| | - Luis Bujanda
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Mark Strunk
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN), Tenerife, Spain
| | | | - Rafael Benito
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Faculty of Medicine and Department of Microbiology, Hospital Clínico Universitario, Zaragoza, Spain
| | - Federico Sopeña
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Elena Piazuelo
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Concha Thomson
- Department of Gastroenterology, Hospital Obispo Polanco, Teruel, Spain
| | | | - David Nicolás-Pérez
- Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB), Centro de Investigación Biomédica de Canarias (CIBICAN), Tenerife, Spain
| | - Elizabeth Hijona
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Jesús Espinel
- Department of Gastroenterology, Complejo Hospitalario, León, Spain
| | - Rafael Campo
- Department of Gastroenterology, Hospital Parc Tauli, Sabadell, Spain
| | - Marisa Manzano
- Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain
| | - Fernando Geijo
- Department of Gastroenterology, Hospital Clínico Universitario, Salamanca, Spain
| | - María Pellise
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Clinic I Provincial, Institut d Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Manuel Zaballa
- Department of Gastroenterology, Hospital de Cruces, Barakaldo, Spain
| | | | - Jorge Espinós
- Department of Gastroenterology, Mutua de Tarrasa, Spain
| | - Llúcia Titó
- Department of Gastroenterology, Hospital de Mataró, Mataró, Spain
| | - Luis Barranco
- Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Mauro D'Amato
- BioDonostia Health Research Institute, IKERBASQUE, Basque Foundation for Science, San Sebastián, Spain
| | - María Asunción García-González
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
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6
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Fusco JP, Rolfo C, Castañón E, Ceniceros L, Legaspi J, Espinós J, Rodríguez J, Aramendía JM, Santisteban M, Gil-Bazo I. Safety and efficacy of temsirolimus under compassionate use in heavily pretreated patients with poor-prognosis solid tumors. MINERVA CHIR 2015; 70:495-498. [PMID: 26657760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J P Fusco
- Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain -
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7
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García-González MA, Bujanda L, Quintero E, Santolaria S, Benito R, Strunk M, Sopeña F, Thomson C, Pérez-Aisa A, Nicolás-Pérez D, Hijona E, Carrera-Lasfuentes P, Piazuelo E, Jiménez P, Espinel J, Campo R, Manzano M, Geijo F, Pellise M, Zaballa M, González-Huix F, Espinós J, Titó L, Barranco L, Pazo-Cid R, Lanas A. Association ofPSCArs2294008 gene variants with poor prognosis and increased susceptibility to gastric cancer and decreased risk of duodenal ulcer disease. Int J Cancer 2015; 137:1362-73. [PMID: 25721731 DOI: 10.1002/ijc.29500] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Affiliation(s)
- María Asunción García-González
- Instituto De Investigación Sanitaria Aragón (IIS Aragón); Zaragoza Spain
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
| | - Luis Bujanda
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
- Department of Gastroenterology; Hospital Donostia/Instituto Biodonostia, Universidad Del País Vasco (UPV/EHU); San Sebastián Spain
| | - Enrique Quintero
- Department of Gastroenterology; Hospital Universitario De Canarias, Instituto Universitario De Tecnologías Biomédicas (ITB), Centro De Investigación Biomédica De Canarias (CIBICAN); Tenerife Spain
| | | | - Rafael Benito
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
- Department of Microbiology; Faculty of Medicine; Hospital Clínico Universitario; Zaragoza Spain
| | - Mark Strunk
- Instituto De Investigación Sanitaria Aragón (IIS Aragón); Zaragoza Spain
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
| | - Federico Sopeña
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
- Department of Gastroenterology; Hospital Clínico Universitario Lozano Blesa; Zaragoza Spain
| | - Concha Thomson
- Department of Gastroenterology; Hospital Obispo Polanco; Teruel Spain
| | | | - David Nicolás-Pérez
- Department of Gastroenterology; Hospital Universitario De Canarias, Instituto Universitario De Tecnologías Biomédicas (ITB), Centro De Investigación Biomédica De Canarias (CIBICAN); Tenerife Spain
| | - Elizabeth Hijona
- Department of Gastroenterology; Hospital Donostia/Instituto Biodonostia, Universidad Del País Vasco (UPV/EHU); San Sebastián Spain
| | | | - Elena Piazuelo
- Instituto De Investigación Sanitaria Aragón (IIS Aragón); Zaragoza Spain
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
| | - Pilar Jiménez
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
| | - Jesús Espinel
- Department of Gastroenterology; Complejo Hospitalario; León Spain
| | - Rafael Campo
- Department of Gastroenterology; Hospital Parc Tauli; Sabadell Spain
| | - Marisa Manzano
- Department of Gastroenterology; Hospital 12 De Octubre; Madrid Spain
| | - Fernando Geijo
- Department of Gastroenterology; Hospital Clínico Universitario; Salamanca Spain
| | - María Pellise
- Department of Gastroenterology; Hospital Clinic I Provincial; Barcelona Spain
| | - Manuel Zaballa
- Department of Gastroenterology; Hospital De Cruces; Barakaldo Spain
| | | | - Jorge Espinós
- Department of Gastroenterology; Mutua De Tarrasa; Spain
| | - Llúcia Titó
- Department of Gastroenterology; Hospital De Mataró; Mataró Spain
| | - Luis Barranco
- Department of Gastroenterology; Hospital Del Mar; Barcelona Spain
| | | | - Angel Lanas
- Instituto De Investigación Sanitaria Aragón (IIS Aragón); Zaragoza Spain
- CIBER De Enfermedades Hepáticas Y Digestivas (CIBERehd); Zaragoza Spain
- Department of Gastroenterology; Hospital Clínico Universitario Lozano Blesa; Zaragoza Spain
- Department of Medicine; Universidad de Zaragoza; Spain
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8
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Sereno M, Merino M, López-Gómez M, Gómez-Raposo C, Zambrana Tébar F, Moreno Rubio J, Espinós J, Martín-Algarra S, Casado Sáenz E. MYH polyposis syndrome: clinical findings, genetics issues and management. Clin Transl Oncol 2014; 16:675-9. [DOI: 10.1007/s12094-014-1171-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/21/2014] [Indexed: 12/15/2022]
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9
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Santisteban M, López Díaz de Cerio A, García Cenoz M, Martín P, Zubiri L, Sola I, Espinós J, Salgado E, Fernández Hidalgo O, Inogés S. Abstract P4-13-04: Autologous dendritic cells vaccines combined with neoadjuvant chemotherapy increase total pCR in stages II-III non-overexpressing HER2 breast cancer patients and induce phenotypic changes in peripheral blood. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-13-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Based on the synergistic effect between immuno- and chemotherapy (CT), we have elaborated an autologous vaccine with dendritic cells loaded with patients´ own tumor antigens (lysate), and we have already demonstrated that the addition of the vaccines to a standard neoadjuvant CT schedule has increased total pCR (breast+ axilla) in stages II-III non-overexpressing HER2 breast cancer patients (Santisteban M, SABCS 2012). Both cohorts, the control (C) and the vaccinated (V) were well balanced related to demographic characteristics. Toxicity has been similar in both the C and the V cohorts. Moreover, we have analyzed the phenotypic changes in peripheral blood induced by the vaccine and its correlation with pathologic responses. Indeed, we have studied if the amount of lysate used to load the dendritic cells or the total dendritic cell numbers received by the patients in the first five doses (before surgery) is correlated with pCR Methods Twenty-eight patients with stage II-III HER2 negative breast cancer have started on sequential neoadjuvant CT based on dose dense antracyclines (E 100mg/m2 and C 600 mgr/m2) x4 cycles plus GM-CSF followed by taxanes (DOC 75-100 mgr/m2) x4 cycles plus vaccination. The C historic cohort was composed of thirty patients who received the same treatment except for the absence of the vaccines. Vaccine calendar was started after the 4th EC and alternated with DOC and as maintenance up to a maximum of a 2 year-period. The first 5 vaccines were administered before breast surgery. Changes in different lymphocytes populations were measured in peripheral blood of patients at different points by flow cytometry (absolute cell counts). To date, twenty-one patients have both determinations of lymphocyte subpopulations before the 1st and the 6th vaccine. Paired samples t-tests and Fisher exact were used Results pCR was superior in the V cohort (24% versus 3.3%, p = 0.04). Lymphocyte subpopulations were measured in peripheral blood (cells/uL) and a stimulation of the immune system was found after the 5 vaccines schedule at the time of surgery as follows: NK (p<0.001), T cytotoxic CD8 (p = 0.018), T helper CD4 (p = 0.04), CD19 (p = 0.001), HLADRCD8 (p = 0.007), CD16CD8 (p = 0.003), HLADRCD4 (p<0.001), CD16CD4 (p = 0.008) and T regulators lymphocytes (p = 0.004). We did not find any differences among CD57CD8 (p = 0.17), CD56CD8 (p = 0.11), CD57CD4 (p = 0.45) and CD56CD4 (p = 0.65). We neither see correlation among the amount of lysate to load dendritic cells and the tpCR (p = 0.09) nor the amount of dendritic cells (summatory of 5 vaccines) administered intradermally and the pCR (p = 0.59) Conclusions Immunotherapy added to standard neoadjuvant CT could improve total pCR in stage II-III non-overexpressing HER2 breast cancer patients. After 5 doses of vaccination plus chemotherapy, we can observe phenotypic changes in peripheral blood: some immune system subpopulations increased statistically after the treatment in vaccinated patients. Neither the amount of lysate nor the number of dendritic cells used in the five first vaccines significantly correlated with the pRC.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-13-04.
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Affiliation(s)
- M Santisteban
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - A López Díaz de Cerio
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - M García Cenoz
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - P Martín
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - L Zubiri
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - I Sola
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - J Espinós
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - E Salgado
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - O Fernández Hidalgo
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - S Inogés
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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García-González MA, Nicolás-Pérez D, Lanas A, Bujanda L, Carrera P, Benito R, Strunk M, Sopeña F, Santolaria S, Piazuelo E, Jiménez P, Campo R, Espinel J, Manzano M, Geijo F, Pellisé M, González-Huix F, Espinós J, Zaballa M, Titó L, Barranco L, Pazo R, Quintero E. Prognostic role of host cyclooxygenase and cytokine genotypes in a Caucasian cohort of patients with gastric adenocarcinoma. PLoS One 2012; 7:e46179. [PMID: 23029430 PMCID: PMC3460851 DOI: 10.1371/journal.pone.0046179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 08/30/2012] [Indexed: 12/14/2022] Open
Abstract
Background Genetic factors influencing the prognosis of gastric adenocarcinoma (GAC) are not well known. Given the relevance of cytokines and other pro-inflammatory mediators in cancer progression and invasiveness, we aimed to assess the prognostic role of several functional cytokine and cyclooxygenase gene polymorphisms in patients with GAC. Methodology Genomic DNA from 380 Spanish Caucasian patients with primary GAC was genotyped for 23 polymorphisms in pro-inflammatory (IL1B, TNFA, LTA, IL6, IL12p40), anti-inflammatory (IL4, IL1RN, IL10, TGFB1) cytokine, and cyclooxygenase (PTGS1 and PTGS2) genes by PCR, RFLP and TaqMan assays. Clinical and histological information was collected prospectively. Survival curves were estimated by the Kaplan-Meier method and compared using the log rank test. Outcome was determined by analysis of Cox proportional hazards, adjusting for confounding factors. Results The median follow-up period and median overall survival (OS) time were 9.9 months (range 0.4–120.3) and 10.9 months (95% CI: 8.9–14.1), respectively. Multivariate analysis identified tumor stages III (HR, 3.23; 95% CI:2–5.22) and IV (HR, 5.5; 95% CI: 3.51–8.63) as independent factors associated with a significantly reduced OS, whereas surgical treatment (HR: 0.44; 95%CI: 0.3–0.6) was related to a better prognosis of the disease. Concerning genetic factors, none of the 23 polymorphisms evaluated in the current study did influence survival. Moreover, no gene-environment interactions on GAC prognosis were observed. Conclusions Our results show that, in our population, the panel of selected pro- and anti-inflammatory cytokine, and cyclooxygenase gene polymorphisms are not relevant in determining the prognosis of gastric adenocarcinoma.
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García-González MA, Quintero E, Bujanda L, Nicolás D, Benito R, Strunk M, Santolaria S, Sopeña F, Badía M, Hijona E, Pérez-Aísa MA, Méndez-Sánchez IM, Thomson C, Carrera P, Piazuelo E, Jiménez P, Espinel J, Campo R, Manzano M, Geijo F, Pellisé M, González-Huix F, Espinós J, Titó L, Zaballa M, Pazo R, Lanas A. Relevance of GSTM1, GSTT1, and GSTP1 gene polymorphisms to gastric cancer susceptibility and phenotype. Mutagenesis 2012; 27:771-7. [PMID: 22952149 DOI: 10.1093/mutage/ges049] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Human glutathione S-transferases (GSTs) are phase II metabolizing enzymes that play a key role in protecting against cancer by detoxifying numerous potentially cytotoxic/genotoxic compounds. The genes encoding the human GST isoenzymes GSTM(mu)1, GSTT(theta)1 and GSTP(pi)1 harbour polymorphisms, which have been considered important modifiers of the individual risk for environmentally induced cancers such as gastric cancer (GC). However, results are inconsistent among studies from different geographic areas and ethnic groups. Our goal was to perform a nationwide, case-control study in Spain to evaluate the relevance of several functional GST gene polymorphisms and environmental factors to GC risk and phenotype. DNA from 557 GC patients and 557 sex- and age-matched healthy controls (HC) was typed for two deletions in the GSTM1 and GSTT1 genes and two SNPs in the GSTP1 gene (rs1695 and rs1138272) using polymerase chain reaction-restriction fragment length polymorphism methods. Logistic regression analysis identified Helicobacter pylori infection with CagA strains [odds ratio (OR): 2.36; 95% confidence interval (CI): 1.78-3.15], smoking habit (OR: 2.10; 95% CI: 1.48-2.97) and family history of GC (OR: 3.2; 95% CI: 2.02-5.16) as independent risk factors for GC. No differences in the frequencies of GSTM1 or GSTT1 null genotypes were observed between cases and controls (GSTM1: 50.8% vs. 48%; GSTT1: 21.5% vs. 21%). Moreover, simultaneous carriage of both, the GSTM1 and the GSTT1 null genotypes, was almost identical in both groups (10.7% in GC vs. 10.6% in HC). In addition, no significant differences in GSTP1 Ile105Val (rs1695) and GSTP1 Val114Ala (rs1138272) genotype distribution were observed between GC patients and controls. Subgroup analysis for age, gender, Helicobacter pylori status, smoking habits, family history of GC, anatomic location and histological subtype revealed no significant association between GST variants and GC risk. Our results show that the GST polymorphisms evaluated in this study are not relevant when determining the individual susceptibility to GC or phenotype in a South-European population.
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Da Costa M, Mata A, Espinós J, Vila V, Roca JM, Turró J, Ballesta C. Endoscopic dilation of gastrojejunal anastomotic strictures after laparoscopic gastric bypass. Predictors of initial failure. Obes Surg 2011; 21:36-41. [PMID: 20396992 DOI: 10.1007/s11695-010-0154-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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: 12/11/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most frequent technique performed in bariatric surgery. Gastrojejunal anastomotic stricture is one of the most common postoperative complications. The aims of this study were to evaluate the efficacy and safety of endoscopic balloon dilation in the treatment of the gastrojejunal anastomotic strictures after LRYGB and to look for predicting factors that would indicate the need of repeated dilations. METHODS We included all patients with morbid obesity who underwent a LRYGB at our institution between January 2002 and July 2007. All patients who developed symptoms compatible with stricture of the gastrojejunostomy were referred to upper gastrointestinal endoscopy and underwent endoscopic balloon dilation. RESULTS One hundred and five out of the 1,330 patients (7.8%) developed an anastomotic stricture. The mean time to diagnosis was 3 months after the surgery. The mean diameter of the stricture was 5 mm. Sixty out of the 105 patients required only one dilation (57%), 29 required two dilations (27,6%), 13 required three dilations, and 3 patients underwent a fourth dilation. Clinical success was achieved in 100% of the cases, with an average of 1.6 dilations. The statistical analysis showed that only the time from surgery to stricture formation (p = 0.007) and the diameter achieved at the first dilation (p = 0.015) had statistical significance as predictors of the need of one or more dilations. CONCLUSIONS Endoscopic balloon dilation is a safe and effective method. Most of the patients are successfully managed with one or two dilations. The longer time from surgery to the appearance of symptoms ant the largest diameter achieved at the first dilation are the only predicting factors of success with only one dilation.
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Gastaminza G, de la Borbolla JM, Goikoetxea MJ, Escudero R, Antón J, Espinós J, Lacasa C, Fernández-Benítez M, Sanz ML, Ferrer M. A new rapid desensitization protocol for chemotherapy agents. J Investig Allergol Clin Immunol 2011; 21:108-112. [PMID: 21462800] [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: 05/30/2023] Open
Abstract
BACKGROUND Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar efficacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years. OBJECTIVE To assess the efficacy of a new desensitization protocol in patients allergic to chemotherapy drugs. METHODS We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used. RESULTS We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carboplatin that reverted with treatment. One patient had dyspnea after a paclitaxel cycle. One patient experienced dyspnea due to chronic pulmonary thromboembolism related to her disease. CONCLUSION Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents.
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Affiliation(s)
- G Gastaminza
- Department of Allergology and Clinical Immunology, Clinica Universidad de Navarra, Pamplona, Spain.
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Espinós J, Hernández A, Castillo A, Zudaire M, Fernández-Hidalgo O, Aramendia JM, Santisteban M, Garcia-Foncillas J. Pegylated liposomal doxorubicin (PLD) and gemcitabine in the treatment of metastatic breast cancer: A single-institution experience. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11510] [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: 11/20/2022] Open
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15
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Hernandez-Jorge A, Reyna C, Espinós J, delaCruz S, Santisteban M, Fernandez-Hidalgo O, Aramendia J, Aristu J, Garcia-Foncillas J. 8720 Improved survival in patients with refractory glioblastoma that response to Irinotecan and Bevacizumab. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71694-5] [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: 10/20/2022] Open
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Fernández-Bañares F, Casalots J, Salas A, Esteve M, Rosinach M, Forné M, Loras C, Santaolalla R, Espinós J, Viver JM. Paucicellular lymphocytic colitis: is it a minor form of lymphocytic colitis? A clinical pathological and immunological study. Am J Gastroenterol 2009; 104:1189-98. [PMID: 19352342 DOI: 10.1038/ajg.2009.65] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It has been suggested that paucicellular lymphocytic colitis (PLC) should be considered to be part of the morphological spectrum of microscopic colitis. The aim of the study was to evaluate whether PLC may be considered to be a true microscopic colitis, and in this case, whether it is a minor form of lymphocytic colitis (LC) or a different entity. METHODS All incident cases of PLC, LC, and collagenous colitis (CC) during the period 2004-2006 were included. The incidence rate and the clinical, histopathological, and immunological features of PLC were assessed and compared with those of both LC and CC. Immunoreactivities to CD25, c-Kit, and FOXP3 in lamina propria were assessed. RESULTS In all, 19 patients with CC, 19 with LC, and 26 with PLC were identified. CD25+FOXP3+ expression was seen only in classical forms of microscopic colitis: 12 of 19 LC, 14 of 20 CC, and none of 20 PLC cases (P < 0.0001). Diarrhea ceased in 21 of the 26 patients, with a decrease in the daily stool number from 5.08 +/- 0.44 to 1.7 +/- 0.2 (P < 0.005). The five patients with no response to therapy fulfilled the Rome II criteria of irritable bowel syndrome (IBS). CONCLUSIONS The incidence rate of PLC, identified using objective histological criteria, was higher than those of CC and LC. The lack of expression of CD25+FOXP3+ cells in PLC, in contrast to those seen in both LC and CC, would suggest the existence of different pathophysiological mechanisms and does not support that PLC is a minor form of LC.
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Affiliation(s)
- Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Mutua Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain.
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Forné M, Fernández-Bañares F, González-Mínguez C, Casalots J, Poblet-Mas N, Garcia-Gil LJ, Esteve M, Rosinach M, Espinós J, Loras C, Salas A, Viver JM. Lack of clinical usefulness of Das-1 monoclonal antibody and mucin expression as risk markers of gastric carcinoma in patients with gastric intestinal metaplasia. Am J Clin Pathol 2009; 131:99-105. [PMID: 19095572 DOI: 10.1309/ajcpnp7bk3kuuojl] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Our aim was to evaluate the usefulness of the monoclonal antibody Das-1 as a premalignant marker of gastric intestinal metaplasia (GIM) associated with gastric cancer and its association with mucin expression. We evaluated Das-1 and mucin expression in 4 groups: 1 (n = 50), gastric carcinoma, paired samples of the cancer area and GIM away from the tumor; 2 (n = 25), gastric or duodenal ulcer with Helicobacter pylori infection with GIM and chronic gastritis; 3 (n = 25),H pylori- autoimmune chronic atrophic gastritis with GIM; and 4 (n = 25),H pylori- chronic gastritis without GIM. Das-1 immunostaining was observed in 20 (40%) of 50 cases in cancer areas. The expression of Das-1 in GIM from group 1 cases away from the cancer area was different from that in GIM from nontumor cases (groups 2 and 3): 13 (26%) of 50 vs 2 (8%) and 0 (0%) of 25 (P = .004). There was no association between Das-1 and mucin expression. Das-1 expression was associated with GIM from patients with gastric cancer. However, this relation was weaker than previously reported, precluding clinical usefulness as a premalignant marker of GIM.
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Affiliation(s)
- Montserrat Forné
- Departments of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | | | - Jaume Casalots
- Pathology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Núria Poblet-Mas
- Laboratory of Molecular Microbiology, Department of Biology, University of Girona, Girona, Spain
| | - L. Jesús Garcia-Gil
- Laboratory of Molecular Microbiology, Department of Biology, University of Girona, Girona, Spain
| | - Maria Esteve
- Departments of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Mercè Rosinach
- Departments of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Jorge Espinós
- Departments of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Carme Loras
- Departments of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Antonio Salas
- Pathology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Josep M. Viver
- Departments of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
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González-Cao M, Viteri S, Díaz-Lagares A, González A, Redondo P, Nieto Y, Espinós J, Chopitea A, Ponz M, Martín-Algarra S. Preliminary results of the combination of bevacizumab and weekly Paclitaxel in advanced melanoma. Oncology 2008; 74:12-6. [PMID: 18536525 DOI: 10.1159/000138351] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 12/16/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pretreated advanced melanoma is a poor prognosis scenario with few, if any, active therapeutic options. The antibody against vascular endothelial growth factor, bevacizumab, has demonstrated increased activity in combination with chemotherapy in many tumors. We intended to evaluate the activity of the combination of weekly paclitaxel and bevacizumab in previously treated metastatic melanoma. PATIENTS AND METHODS Patients with previously treated metastatic melanoma received paclitaxel 70 mg/m(2) weekly and bevacizumab 10 mg/kg biweekly for 5 consecutive weeks every 6 weeks. RESULTS Twelve patients were treated. Two patients (16.6%) achieved a partial response and 7 patients (58.3%) stable disease. Responses were seen in soft tissue, lung and brain metastases. Median disease-free and overall survival times were 3.7 and 7.8 months, respectively. Treatment was well tolerated. Main toxicities were grade 3 asymptomatic lymphopenia in 6 patients, grade 3 leucopenia in 2 patients, and grade 3 thrombocytopenia in 1 patient. CONCLUSIONS Our preliminary results suggest that the combination of bevacizumab and weekly paclitaxel is active and safe in patients with metastatic melanoma, warranting further investigation.
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Affiliation(s)
- M González-Cao
- Department of Oncology, University Clinic of Navarra, Navarra University, Pamplona, Spain
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De la Cruz S, Aramendia JM, Espinós J, Fernandez-Hidalgo O, Santisteban M, Arbea L, Aristu J, Garran C, Martinez-Monge R, Martinez-Regueira F, Nieto Y. Phase II trial of sequential dose-dense epirubicin/cyclophosphamide (E/C) followed by docetaxel/capecitabine (D/X) as adjuvant or neoadjuvant chemotherapy for patients with HER2-negative breast cancer (BC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Espinós J, Olier-Garate C, Aramendia JM, Fernandez Hidalgo O, Reyna C, De la Cruz S, del Barrio A, García-Foncillas J. Efficacy of the combination of irinotecan and bevacizumab in heavely pretreated metastatic breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.12001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Santaolalla R, Fernández-Bañares F, Rodríguez R, Alsina M, Rosinach M, Mariné M, Farré C, Salas A, Forné M, Loras C, Espinós J, Viver JM, Esteve M. Diagnostic value of duodenal antitissue transglutaminase antibodies in gluten-sensitive enteropathy. Aliment Pharmacol Ther 2008; 27:820-9. [PMID: 18284655 DOI: 10.1111/j.1365-2036.2008.03652.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In gluten-sensitive enteropathy, antitissue transglutaminase antibodies are synthesized in the duodenum. AIM To compare the diagnostic yield of these autoantibodies in cultured duodenal biopsies, duodenal aspirate and serum. METHODS Patients (n = 315, 135 female, 180 male; age: 37.3 +/- 1.1 years) referred for duodenal biopsies, were recruited and HLA-DQ2/DQ8 haplotyped. Histological measurements were made from duodenal biopsies and cultured duodenal biopsies were used for antitissue transglutaminase antibodies analysis by enzyme-linked immunosorbent assay. Duodenal aspirate was collected in a subgroup of 81 patients. Patients were classified, according to their histology, response to a gluten-free diet and DQ2/DQ8 status, as definite, likely or nongluten-sensitive enteropathy. RESULTS Histology was normal in 59% of patients; 28% had lymphocytic enteritis, 1% had crypt hyperplasia and 13% showed atrophy. In Marsh III patients, there was complete agreement between duodenal and serological antitissue transglutaminase antibodies measurements. Marsh I patients showed a slight antitissue transglutaminase antibodies sensitivity improvement in cultured duodenal biopsy compared to serum in definite (22% vs. 19%) and likely gluten-sensitive enteropathy (20% vs. 14%) patients. Combined serum and cultured duodenal biopsy antitissue transglutaminase antibodies assessment increased serological sensitivity from 19% to 30% in Marsh I patients. CONCLUSION Duodenal antitissue transglutaminase antibodies detection improves serological determination sensitivity in Marsh I patients, providing diagnostic value and therapeutic impact.
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Affiliation(s)
- R Santaolalla
- Department of Gastroenterology, Hospital Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Barcelona, Spain
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Espinós J, Reyna C, de la Cruz S, Oiler C, Hernández A, Fernández Hidalgo O, Santisteban M, García Foncillas J. [Hormonal therapy in breast cancer]. Rev Med Univ Navarra 2008; 52:40-48. [PMID: 18578196] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Hormonal therapy has been the first systemic treatment against breast cancer. Up to now Tamoxifen and ovarian supression/ablation were the best optionts we had to treat early breast cancer as advancer disease. The advent of aromatase inhibitors, new SERMS and antistrogen Fulvestrant have supoused a great advance in the treatment of this disease and at the same time have complicated the election of the optimal drug for each patient. This article tries to review the aviable treatment options insiting on its indications.
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Affiliation(s)
- J Espinós
- Area de tumores ginecológicos y de mama, Departamento de Oncología, Clínica Universitaria, Facultad de Medicina. Universidad de Navarra, Pamploma.
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García-González MA, Lanas A, Quintero E, Nicolás D, Parra-Blanco A, Strunk M, Benito R, Angel Simón M, Santolaria S, Sopeña F, Piazuelo E, Jiménez P, Pascual C, Mas E, Irún P, Espinel J, Campo R, Manzano M, Geijo F, Pellisé M, González-Huix F, Nieto M, Espinós J, Titó L, Bujanda L, Zaballa M. Gastric cancer susceptibility is not linked to pro-and anti-inflammatory cytokine gene polymorphisms in whites: a Nationwide Multicenter Study in Spain. Am J Gastroenterol 2007; 102:1878-92. [PMID: 17640324 DOI: 10.1111/j.1572-0241.2007.01423.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recent studies have reported an association between cytokine gene polymorphisms and GC risk. However, results are inconsistent among studies from different geographic regions and ethnic groups. Our goal was to evaluate the influence of Helicobacter pylori (H. pylori) infection and host genetic factors on GC susceptibility in a population of Spanish white GC patients. METHODS DNA from 404 unrelated patients with GC and 404 sex- and age-matched healthy controls was typed for several functional polymorphisms in pro- (IL-1B, TNFA, LTA, IL-12p40) and anti-inflammatory (IL-4, IL-1RN, IL-10, TGFB1) genes by PCR, RFLP, and TaqMan assays. H. pylori infection and CagA/VacA antibody status were also determined by western blot serology. RESULTS Logistic regression analysis identified H. pylori infection with cagA strains (OR 2.54, 95% CI 1.77-3.66), smoking habit (OR 1.91, 95% CI 1.25-2.93), and positive family history of GC (OR 3.67, 95% CI 2.01-6.71) as independent risk factors for GC. None of the cytokine gene polymorphisms analyzed in this study were associated with susceptibility to GC development, whether GC patients were analyzed as a group or categorized according to anatomic location or histological subtype. Some simultaneous combinations of proinflammatory genotypes reportedly associated with greater GC risk yielded no significant differences between patients and controls. CONCLUSIONS Our results show that, at least in some white populations, the contribution of the cytokine gene polymorphisms evaluated in this study (IL-1B, IL-1RN, IL-12p40, LTA, IL-10, IL-4, and TGF-B1) to GC susceptibility may be less relevant than previously reported.
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García-Cano J, González-Huix F, Juzgado D, Igea F, Pérez-Miranda M, López-Rosés L, Rodríguez A, González-Carro P, Yuguero L, Espinós J, Ducóns J, Orive V, Rodríguez S. Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos). Gastrointest Endosc 2006; 64:914-20. [PMID: 17140898 DOI: 10.1016/j.gie.2006.06.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 06/14/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Self-expanding metal stents (SEMS) are being increasingly used to solve malignant colorectal obstruction (MCRO). Patients can then either undergo scheduled surgery or have the stent left in place as a definitive palliative treatment. The majority of reports on the use of SEMS in MCRO come from single centers; therefore, its use in general endoscopic practice is not clearly known. OBJECTIVE To study the use of SEMS for MCRO in a wide endoscopic practice. DESIGN Retrospective study. SETTING A survey was carried out among endoscopists in 13 hospitals in Spain (6 tertiary referral centers and 7 community hospitals). PATIENTS Those who presented with MCRO. INTERVENTIONS A total of 175 attempts to insert colorectal SEMS were made during a 12-month period (October 2003 to September 2004). MAIN OUTCOME MEASURES Technical and clinical success and possible differences according to the type of hospital. RESULTS There was a mean of 1.2 attempts/mo per center (range, 2-0.5 attempts/mo per center). Insertion success was achieved in 162 (92.6%) and acceptable colonic decompression in 138 of 175 (78.8%) attempts and in 138 of 162 (85.1%) of successfully inserted stents. SEMS served as a bridge to scheduled surgery in 72 of 175 (41%) and as a palliative definitive treatment in 66 of 175 (37.7%). The major complication was perforation, which occurred in 7 of 175 occasions (4%) and led to death in 2 patients (1%). There were other less severe complications (25 [14%]). No significant differences in outcome of stent placement procedures were found between both categories of centers. LIMITATIONS Retrospective study involving many centers and the possibility of bias for different assessments of outcomes. CONCLUSIONS In this study, success rates for SEMS placement and colonic decompression in MCRO were acceptable, without substantial differences according to the type of hospital. This procedure appeared to be feasible in general endoscopic practice.
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Affiliation(s)
- Jesús García-Cano
- Gastroenterology Department, Hospital Virgen de la Luz, Cuenca, Gastroenterology Department, Hospital Josep Trueta, Girona, Spain
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25
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Fernández-Bañares F, Esteve M, Farré C, Salas A, Alsina M, Casalots J, Espinós J, Forné M, Viver JM. Predisposing HLA-DQ2 and HLA-DQ8 haplotypes of coeliac disease and associated enteropathy in microscopic colitis. Eur J Gastroenterol Hepatol 2005; 17:1333-8. [PMID: 16292086 DOI: 10.1097/00042737-200512000-00011] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the presence of both genetic and serological markers of coeliac disease in patients with microscopic colitis, and whether there was associated enteropathy. METHODS HLA-DQ2, HLA-DQ8, serum immunoglobulin A-antiendomysial and immunoglobulin A-anti-tissue transglutaminase antibodies were investigated in 59 patients with microscopic colitis. Seventy healthy subjects acted as the control group. Endoscopic biopsies from the distal duodenum were obtained in DQ2-positive or DQ8-positive patients. Patients with histological changes compatible with gluten-sensitive enteropathy were started on a gluten-free diet. RESULTS Seventeen of 70 (24.3%) healthy controls were DQ2-positive. Twelve of 25 (48%) patients with lymphocytic colitis (P = 0.027 versus controls), and 11 of 34 (32.3%) with collagenous colitis (P = 0.38 versus controls) were DQ2-positive. There were no differences in the frequency of DQ8-positivity. The coeliac serology was positive in one patient. Duodenal biopsies were performed in 23 DQ2-positive and/or DQ8-positive patients. None had villous atrophy (Marsh III lesion) (0%; 95% confidence interval, 0-6.1). A Marsh type I lesion was found in four patients. Three of these patients were put on a gluten-free diet with disappearance of diarrhoea. CONCLUSIONS The results suggest that there is an association of lymphocytic colitis with HLA-DQ2 genes, which might be relevant in the pathogenesis of this disease. The association of microscopic colitis with Marsh type III coeliac disease seems to be rare, making it unnecessary to routinely screen for coeliac disease in microscopic colitis patients.
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Rodriguez J, Viudez A, Salgado E, García-Foncillas J, De La Cámara J, Espinós J, Garrán C, Chopitea A, Fernández-Hidalgo O, Martín-Algarra S. Irinotecan and mitomycin C (MMC) as salvage therapy for patients with metastatic colorectal cancer previously treated with fluoropyrimidine, irinotecan and/or oxaliplatin based chemotherapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Rodriguez
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - A. Viudez
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - E. Salgado
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | | | - J. De La Cámara
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - J. Espinós
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - C. Garrán
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - A. Chopitea
- Clínica Universitaria. University of Navarra, Pamplona, Spain
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Viúdez A, Rodríguez J, De La Cámara J, Salgado E, Chopitea A, Gil-Bazo I, García-Foncillas J, Valero J, Espinós J, Martin-Algarra S. Triplet therapy with gemcitabine, 5-fluorouracil, leucovorin and cisplatin in patients with metastatic pancreatic cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4252] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Viúdez
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. Rodríguez
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. De La Cámara
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - E. Salgado
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - A. Chopitea
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - I. Gil-Bazo
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. García-Foncillas
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. Valero
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. Espinós
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - S. Martin-Algarra
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
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Gil-Bazo I, Rodríguez J, Catalán V, Navarro V, Chopitea A, Espinós J, Gúrpide A, Santisteban M, García-Foncillas J, Martín-Algarra S. Vascular endothelial growth factor and von Willebrand factor levels: Clinical outcome in stage IV colorectal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3754] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gil-Bazo I, Catalán V, Páramo J, Quero C, Escrivá de Romaní S, Pérez-Ochoa A, Arbea L, Navarro V, de la Cámara J, Garrán C, Espinós J, Rocha E, García-Foncillas J, Martín-Algarra S. [Von Willebrand factor as an intermediate between hemostasis and angiogenesis of tumor origin]. Rev Med Univ Navarra 2003; 47:22-8. [PMID: 14727571] [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] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Cancer patients often show an imbalance condition between coagulation system and fibrinolysis which causes a prothrombotic state. Different molecular factors like von Willebrand factor (vWf), presenting higher plasmatic rates in these patients, play an important role in this situation. During active angiogenesis taking place in tumor growth, the vascular endothelial growth factor (VEGF) and the fibroblast growth factor (FGF-2) contribute to the proliferation and differentiation of endothelial tissue, the main vWf producer, promoting increased rates of vWf in the serum of neoplastic patients. Recently vWf's contribution to tumor cells and platelet adhesion has been described. In this process, the discovery of platelet, endothelial and tumor cell membrane integrins and their implication in cellular adhesion has represented a major step in demonstrating how blood clotting and platelet aggregation are mediated by tumor cell and platelet linkage. Migration properties acquired by tumor cells as a result of this binding have been also pointed out. Clinical trials show higher rates of plasmatic vWf in cancer patients the more advanced clinical and radiological stage they present (metastasic versus localized). Moreover, higher pre-surgical serum vWf rates in patients can be used to predict poorer survival after resection surgery. vWf high molecular weight multimers have been also related to a cleavage protease deficiency in the serum of the oncologic population. The promising results of antiaggregation/anticoagulation therapies in these patients permit us to envisage new therapeutic targets.
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Affiliation(s)
- I Gil-Bazo
- Departamento de Oncología Médica, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra.
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FERNANDEZBANARES F, Salas A, Esteve M, Espinós J, Forné M, Viver JM. Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up. Am J Gastroenterol 2003. [PMID: 12591052 DOI: 10.1016/s0002-9270(02)05893-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Data on collagenous colitis (CC) and lymphocytic colitis (LC) have been based on retrospective studies of registries of patients from multiple hospitals. Such studies may induce a selection of patients with severe forms of the disease, and conclusions about the clinical spectrum of the disease and treatment efficacy are difficult to be drawn. The aim of this study was to compare the clinical features, response to treatment, and long-term follow-up of CC and LC in a large group of patients prospectively diagnosed in a single center. METHODS A specific program was undertaken to prospectively diagnose all patients with microscopic colitis from those referred for a full colonoscopy because of recurrent or chronic diarrhea. Detailed clinical and histological features, response to treatment, and long-term follow-up were compared in patients with confirmed CC and LC. RESULTS Thirty-seven patients with CC and 44 with LC were included. Patients with CC were significantly younger and had a significantly longer duration of diarrhea before diagnosis than those with LC. Otherwise, clinical presentation was similar. Drug-induced disease was suspected for ticlopidine, flutamide, gold salts, and bentazepam in LC. Complete resolution of diarrhea was achieved in all patients, spontaneously occurring in nearly 20% of them. Response to salicylates (mainly, mesalazine) was significantly better in LC than in CC (86% vs 42%, p = 0.005). Cholestyramine was highly effective in patients of both groups with concomitant bile acid malabsorption. Patients with CC required prednisone more often than those with LC (30% vs 4.5%, p = 0.005). Both prednisone and budesonide controlled ileal release were highly effective in patients with CC (82% and 89% efficacy). After cessation of diarrhea, 25% of patients with LC and 30% of those with CC relapsed after a mean follow-up of around 3 yr. CONCLUSIONS CC and LC share a similar clinical picture and have a benign course with long-term cessation of diarrhea in more than 70% of patients. Mesalazine and budesonide seem to be good options as first-line treatment in LC and CC, respectively. Cholestyramine may be a good alternative in patients with concomitant bile acid malabsorption.
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Fernández-Bañares F, Salas A, Esteve M, Espinós J, Forné M, Viver JM. Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up. Am J Gastroenterol 2003; 98:340-7. [PMID: 12591052 DOI: 10.1111/j.1572-0241.2003.07225.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Data on collagenous colitis (CC) and lymphocytic colitis (LC) have been based on retrospective studies of registries of patients from multiple hospitals. Such studies may induce a selection of patients with severe forms of the disease, and conclusions about the clinical spectrum of the disease and treatment efficacy are difficult to be drawn. The aim of this study was to compare the clinical features, response to treatment, and long-term follow-up of CC and LC in a large group of patients prospectively diagnosed in a single center. METHODS A specific program was undertaken to prospectively diagnose all patients with microscopic colitis from those referred for a full colonoscopy because of recurrent or chronic diarrhea. Detailed clinical and histological features, response to treatment, and long-term follow-up were compared in patients with confirmed CC and LC. RESULTS Thirty-seven patients with CC and 44 with LC were included. Patients with CC were significantly younger and had a significantly longer duration of diarrhea before diagnosis than those with LC. Otherwise, clinical presentation was similar. Drug-induced disease was suspected for ticlopidine, flutamide, gold salts, and bentazepam in LC. Complete resolution of diarrhea was achieved in all patients, spontaneously occurring in nearly 20% of them. Response to salicylates (mainly, mesalazine) was significantly better in LC than in CC (86% vs 42%, p = 0.005). Cholestyramine was highly effective in patients of both groups with concomitant bile acid malabsorption. Patients with CC required prednisone more often than those with LC (30% vs 4.5%, p = 0.005). Both prednisone and budesonide controlled ileal release were highly effective in patients with CC (82% and 89% efficacy). After cessation of diarrhea, 25% of patients with LC and 30% of those with CC relapsed after a mean follow-up of around 3 yr. CONCLUSIONS CC and LC share a similar clinical picture and have a benign course with long-term cessation of diarrhea in more than 70% of patients. Mesalazine and budesonide seem to be good options as first-line treatment in LC and CC, respectively. Cholestyramine may be a good alternative in patients with concomitant bile acid malabsorption.
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Fernández E, Falcó J, Martín J, Brullet E, Campo R, Darnell A, Espinós J. Estudio prospectivo comparativo en el diagnóstico de la patología biliar. Colangiopancreatografía por resonancia magnética frente a colangiografía directa. Radiología 2001. [DOI: 10.1016/s0033-8338(01)78004-6] [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: 10/27/2022]
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Abstract
OBJECTIVE To evaluate the results of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of those patients suspected of harboring bile duct stones before laparoscopic cholecystectomy (LC). PATIENTS AND METHODS A total of 1,235 consecutive LCs performed between 1991 and 1997 were studied prospectively. ERCP was performed to explore the common bile duct (CBD) preoperatively when choledocholithiasis was suspected on the basis of clinical, analytical or echographical data. RESULTS ERCPs were performed in 268 patients: unsuccessful CBD evaluation in 3%; dilated CBD without lithiasis in 13%, and normal exploration in 37% (99 patients). CBD stones were found in 46% (124 patients), and endoscopic sphincterotomy was then performed and stone extraction attempted. Endoscopic therapy achieved 92.8% successful removal of CBD stones (115 patients). There was no ERCP-related mortality and the morbidity rate was 6%. Retained CBD stones have been observed in 7 cases after ERCP-LC; all of them have been successfully treated by ERCP. CONCLUSIONS A combined approach to bile duct stones with selective use of ERCP followed by LC is a good therapeutical alternative. Nevertheless, the usual selection criteria for ERCP may lead to unnecessary exploration. It appears to be necessary to modify the current diagnostic and therapeutic strategy.
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Affiliation(s)
- C Hoyuela
- Hepatobiliary and Pancreatic Surgery, Department of Surgery, Mútua de Terrassa Hospital, Terrassa, and University of Barcelona, Spain
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Maluenda M, Pou JM, Varas MJ, Turró J, Abad R, Espinós J. [Echo-endoscopy: the clinical implications after a period of more than 16 years of its existence]. Rev Esp Enferm Dig 1999; 91:209-22. [PMID: 10231312] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Endosonography is an imaging diagnostic technique recently introduced in our country. It allows us to perform an ultrasound from within the digestive tube. Because of the transducer proximity to the gut wall and the high frequency of emission we are able to visualize with great resolution small lesions as well as differentiate the five layers of the gastric wall and examine structures close to the digestive lumen with a 7 to 8 cm penetration. This is a brief introduction to the basic pillars of endosonography and its main indications, well defined after sixteen years of clinical practice.
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Affiliation(s)
- M Maluenda
- Centro Médico Teknon, Barcelona 08017, España
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Abstract
OBJECTIVE The incidence of collagenous and lymphocytic colitis is not well known. We sought to assess the incidence of collagenous and lymphocytic colitis in a well-defined population during a 5-yr study period. METHODS From January 1, 1993, to December 31, 1997, all new patients diagnosed with collagenous or lymphocytic colitis living in the catchment area of the Hospital Mutua de Terrassa (Barcelona, Spain) were identified. Since 1993 all patients with chronic diarrhea were referred for a diagnostic colonoscopy. Multiple biopsy sampling of the entire colon was performed when appearance of the colonic mucosa was grossly normal. RESULTS Twenty-three cases of collagenous colitis and 37 of lymphocytic colitis were diagnosed. The female:male ratios were 4.75:1 and 2.7:1 for collagenous and lymphocytic colitis, respectively. The mean age at onset of symptoms was 53.4+/-3.2 (range, 29-82) yr for collagenous colitis, and 64.3+/-2.7 (range, 28-87) yr for lymphocytic colitis (p = 0.012). The mean annual incidence per 100,000 inhabitants based on the year of onset of symptoms was 1.1 (95% confidence interval [CI], 0.4-1.7) for collagenous colitis, and 3.1 (95% CI, 2.0-4.2) for lymphocytic colitis. A peak incidence was observed in older women in both diseases. A rate of microscopic colitis of 9.5 per 100 normal-looking colonoscopies performed in patients with chronic watery diarrhea was observed. Normal rectal biopsies were found in 43 % and 8% of patients with collagenous and lymphocytic colitis, respectively. CONCLUSIONS The incidence of lymphocytic colitis is three times higher than that of collagenous colitis. Microscopic colitis should be considered as a major possibility in the work-up of chronic diarrhea in older women.
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Affiliation(s)
- F Fernández-Bañares
- Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Barcelona, Catalonia, Spain
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Brullet E, Espinós J, Campo R, Viver JM, Calvet X, Forné M, Dalmau B, Fernández A, Gil M, Canet JJ, Mas YP. [Endoscopic ligation with elastic bands in the prevention of hemorrhage recurrence caused by esophageal varices. Study of 45 patients]. Gastroenterol Hepatol 1996; 19:339-43. [PMID: 8963901] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to determine the usefulness of elastic band ligation in the prevention of hemorrhage recurrence by esophageal varices. Forty-five patients without known hepatocarcinoma who had survived a hemorrhagic variceal episode were included in the study. Seventeen patients (38%) were Child-Pugh A, 22 (49%) B, and 6 (13%) C, with the hepatitis C virus and alcohol being the etiology of cirrosis in 55 and 20% of the cases, respectively. The first ligation session was performed between the third and fifth days after the hemorrhagic episode and the posterior sessions were carried out at intervals of 2-4 weeks. The ligation sessions were performed without antibiotic prophylaxis and with placement of an overtube. A mean of 4 +/- 2 bands were placed per session (range, 1-8) and the mean number of sessions required per patient to achieve erradication of the varices was 3.5 +/- 1.5 (range, 2-8). The rate of bleeding recurrence was 17.7% (9 episodes, five by variceal rupture and four by ulcer secondary to ligation). All the episodes of bleeding recurrence occurred between the sessions, with the mortality being 11% (5/45 patients). In the 40 remaining patients the varices were erradicated although 19 (47.5%) required one or two additional sessions of sclerotherapy. The accumulated percentage of patients free of bleeding recurrence was 82% during a mean follow-up of 10.2 +/- 6.7 months. Ten lesions of dislaceration of the esophageal mucosa caused by placement of the were observed overtube. In conclusion, endoscopic elastic band ligation is a useful technique for the erradication of esophageal varices an in the prevention of bleeding recurrence.
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Affiliation(s)
- E Brullet
- Servicio de Endoscopia Digestiva, Consorci Hospitalari Parc Tauli, Sabadell, Barcelona
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Sánchez-Tapias JM, Forns X, Ampurdanés S, Titó L, Planas R, Viver JM, Acero D, Torres M, Mas P, Morillas R, Forné M, Espinós J, Llovet JM, Costa J, Olmedo E, López-Labrador FX, Jiménez de Anta MT, Rodés J. Low dose alpha interferon therapy can be effective in chronic active hepatitis C. Results of a multicentre, randomised trial. Gut 1996; 38:603-9. [PMID: 8707096 PMCID: PMC1383123 DOI: 10.1136/gut.38.4.603] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is some controversy concerning the efficacy of low dose alpha interferon therapy in chronic hepatitis C. AIMS To evaluate the effectiveness of treatment with low doses of alpha interferon in chronic hepatitis C. PATIENTS One hundred and forty one patients with anti-HCV positive chronic active hepatitis C from six hospitals were enrolled in the study. METHODS Patients were randomised to treatment with 5 MU (group A) or 1.5 MU (group B) injections. The dose was reduced in responders from group A or increased in non-responders from group B to maintain treatment with the minimal effective dose. Patients were treated for 48 weeks and followed up for 24 additional weeks with no treatment. Normalisation of alanine aminotransferase (ALT) was used to evaluate response. RESULTS A sustained response was seen in eight patients from group A (12%) and in 15 (21%) from group B. This difference was not statistically significant. Increasing the dose of interferon led to sustained response in only five of 58 patients (9%) from group B who did not respond to 1.5 MU injections. In contrast, 15 of 21 patients (71%) in whom ALT remained normal with 1.5 MU injections developed a sustained response. By multivariate analysis sustained response seemed associated with young age and was more frequent in patients with genotype 3 HCV infection. Sustained response was preceded by a rapid normalisation of ALT and was inversely related to the amount of alpha interferon necessary to maintain ALT at low values during treatment. CONCLUSIONS Some patients with chronic hepatitis C are very sensitive to alpha interferon and can be successfully treated with low doses. Treatment with higher doses may be effective in a minority of patients who do not respond to low doses.
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