Open Access
Profilaxis con somatostatina tras duodenopancreatectomía cefálica
(Arán Ediciones, 1995) Beguiristáin, A.; Espí, A.; Balén Rivera, Enrique; Pardo, Fernando ; Hernández, José Luis ; Cienfuegos, Javier A.; Ciencias de la Salud; Osasun Zientziak
Open Access
Repair of ventral hernias with expanded polytetrafluoroethylene patch
(Oxford University Press, 1998) Balén Rivera, Enrique; Díez-Caballero, A.; Hernández, José Luis; Pardo, Fernando; Torramadé, Jaime R.; Regueira, F.; Cienfuegos, Javier A.; Ciencias de la Salud; Osasun Zientziak
Background. Operations for large and recurrent abdominal hernias have a high associated recurrence rate, although it is lower when prosthetic material is used. Expanded polytetrafluoroethylene (ePTFE) seems to be the best tolerated prosthetic material in surgery. Methods. A series of 45 ventral hernias repaired using ePTFE for closure or reinforcement of the herniorrhaphy has been evaluated prospectively. Thirty-six were midline incisional hernias and nine were transverse or pararectal ventral hernias. There were 13 recurrent ventral hernias and three defects were operated as an emergency procedure. The patch was sutured to the anterior aponeurosis with a running non-absorbable suture. Some other kind of intra-abdominal procedure was undertaken in 12 cases. Results. ePTFE was well tolerated. Complications occurred in five patients. Major complications were found in three patients: cutaneous necrosis requiring a myocutaneous flap; and infection of the prosthesis (primary, and secondary to enterocutaneous fistula due to diverticulitis, both requiring removal of the patch). Mean follow-up was 39 months and hernia recurrence occurred in only one patient. Conclusion. This clinical experience shows that ePTFE is a very reliable prosthetic material for the repair of abdominal wall hernias.
Open Access
Allopurinol and n-acetylcysteine avoid 60% of intestinal necrosis in an ischemia-reperfusion experimental model
(Elsevier, 1998) Ferrer, J. V.; Ariceta, J.; Gerrero, D.; Gomis, T.; Larrea, M. M.; Balén Rivera, Enrique; Lera, José Miguel; Ciencias de la Salud; Osasun Zientziak
Open Access
Assessment of intestinal preservation injury and duodenal rejection in a multivisceral allotransplantation model in the pig
(Appleton & Lange, 1996) Balén Rivera, Enrique; Cienfuegos, Javier A.; Montuenga, Luis M.; Hernández, José Luis; Pardo, Fernando; Villa, Vanessa H. de; Torramadé, Jaime R.; Regueira, F. ; Ciencias de la Salud; Osasun Zientziak
Open Access
International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams
(Springer, 2010-08-12) Augestad, Knut M.; Lindsetmo, Rolv-Ole; Stulberg, Jonah; Reynolds, Harry; Senagore, Anthony; Champagne, Brad; Heriot, Alexander G.; Leblanc, Fabien; Delaney, Conor P.; International Rectal Cancer Study Group (IRCSG); Balén Rivera, Enrique; Ciencias de la Salud; Osasun Zientziak
Background Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. Methods One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. Results One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years¿ experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). Conclusions There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.
Open Access
Stent or surgery for incurable obstructive colorectal cancer: an individualized decision
(Springer, 2010) Suárez Alecha, Javier; Jiménez, Javier; Vera García, Ruth; Tarifa, Antonio; Balén, E.; Arrazubi, Virginia; Vila, Juan J.; Lera, José Miguel; Balén Rivera, Enrique; Ciencias de la Salud; Osasun Zientziak
Introduction In the setting of stage-IV obstructive colorectal cancer, self-expanding metallic stents (SEMS) placement and palliative surgery may be appropriate options. The aim of the present study is to evaluate the long-term results of surgery compared with stent implantation and to identify patients in whom one of these options can provide more benefit. Materials and methods From November 2000 to November 2008, 98 patients with incurable stage-IV colorectal cancer were treated with palliative surgery (n=53) or SEMS (n=45). Data were recorded with respect to age, gender, tumor location, carcinoembryogenic antigen, ASAclass, presence of metastatic disease in one or multiple organs, volume of liver metastases, urgency of the procedure and treatment with chemotherapy. Comparison between surgery and stent placement was performed for all group and for patients who received and did not receive chemotherapy. Results Both groups were comparable regarding age, ASA-class, chemotherapy treatment, tumor location and presence of metastatic disease in one or multiple organs but not in gender, rate of urgent procedures, abnormal CEA and of volume of liver metastases >25%. Survival in surgical group was significantly higher (11.9 vs 7.3 months; log-rank test, p = 0.002). SEMS group had lower early morbidity, hospital stay and stoma creation. For patients who received chemotherapy, surgery provided benefit in survival (6.8 vs 3.9 months; log-rank test, p = 0.101); in this subgroup, long-term complications from the primary tumour were more common in stented group, and time to chemotherapy was longer in the group of surgery. No differences in survival were shown in patients who did not receive chemotherapy. Conclusion Stent placement offers advantages regarding early morbidity, hospital stay and stoma creation. Surgery offers a benefit in survival in patients who receive chemotherapy but not in non-candidates to chemotherapy.
Open Access
Arteriodigestive fistula: a complication associated with intra-operative and external beam radiotherapy following surgery for gastric cancer
(Wiley, 1992) Villa, Vanessa H. de; Calvo, Felipe A.; Bilbao, Jose I.; Balén Rivera, Enrique; Hernández, José Luis ; Pardo, Fernando; Cienfuegos, Javier A.; Ciencias de la Salud; Osasun Zientziak
Intestinal hemorrhage due to arteriodigestive fistula is described to be a rare and serious complication of radiotherapy. Three cases of this type of fistula in gastric cancer patients treated with gastrectomy, intraoperative electron boost (15 Gy), and fractionated external beam irradiation (46 Gy) are reported. Selective angiography is most helpful in the diagnosis and immediate surgery could be lifesaving. An attempt to explain the etiopathogenesis is made.
Open Access
The Endo-GIA stapler for the side-to-side colorectal anastomosis in the Duhamel operation
(Springer, 1994) Balén Rivera, Enrique; Hernández, José Luis; Pardo, Fernando; Villa, Vanessa H. de; Cienfuegos, Javier A.; Ciencias de la Salud; Osasun Zientziak
A new technical modification of the Duhamel operation for construction of the side-to-side colorectal anastomosis is reported. A 21/2-year-old boy was duagnosed as having Hirschsprung's disease affecting the rectum and sigmoid colon. A Duhamel operation was performed with three modifications of the technique described by Lester W. Martin: the side-to-side colorectal anastomosis was performed with an Endo-GIA 30 stapler (Auto Suture; United States Surgical Corporation, Norwalk, Conn.) in an inverted V-shaped triangular manner; the remnant of the rectal stump was excited just above the Endo-GIA anastomosis, thus preserving only the rectal ampulla; and the rectal stump was left closed without being anstomosed to the descending colon. The postoperative functional results were excellent 6 months after the operation.
Open Access
Influence of cold ischemia time on oxidative stress after experimental pancreas transplantation
(Elsevier, 1999) Zazpe, Cruz; Balén Rivera, Enrique; Ferrer, J. V.; Sáez, M. J.; Guerrero, David; Herrera Cabezón, Javier; Lera, José Miguel; Ciencias de la Salud; Osasun Zientziak
Open Access
The complications of central venous access systems: a study of 218 patients.
(Scandinavian University Press, 1993) Torramadé, Jaime R.; Cienfuegos, Javier A.; Hernández, José Luis; Pardo, Fernando; Benito, César; González, Jesús; Balén Rivera, Enrique; Villa, Vanessa H. de; Ciencias de la Salud; Osasun Zientziak
Objective: To evaluate the safety and usefulness of systems for obtaining central venous access. Design: Prospective open study. Setting: Clinica Universitaria de Navarra, Spain. Subjects: 218 consecutive patients who required long term venous access either for chemotherapy or for total parenteral nutrition, and who had no evidence of infection, a platelet count of over 40 x 10(9)/l, and a life expectancy of three months or more, had 234 devices inserted. Interventions: Insertion of either a silicone rubber (Port-A-Cath) or a polyurethane (Implantofix) catheter into the cephalic, jugular or subclavian vein, leaving the tip in the superior vena cava. Results: Between February 1985 and December 1990, 234 devices were implanted in 218 patients aged from 0.9 to 78 years. The median (range) length of time that the catheters functioned was 277 (7-1887) days. The overall incidence of complications was 0.09/100 days inserted, and the complication rates for infection and thrombosis were 0.02 and 0.03/100 days, respectively. Thirty two devices were removed because of complications, and 19 because the treatment had finished. Five of the 218 patients (2%) were lost to follow up. Conclusions: These devices have a long working life, and a low rate of complications, and are of great value to patients who require long term or cyclical intravenous treatment.