Ferral H.,NorthShore University HealthSystem |
Gomez-Reyes E.,Instituto Nacional Of La Nutricion Salvador Zubiran |
Fimmel C.J.,University of Chicago
Techniques in Vascular and Interventional Radiology | Year: 2016
The transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt created using endovascular techniques. The first TIPS was performed in Germany in 1988. The VIATORR self-expandable PTFE covered stent-graft (WL Gore, Flagstaff AZ) was approved by the FDA for a TIPS application in December of 2004. This stent-graft offers excellent shunt patency rates and it is possible that it has a beneficial effect on patient survival. Patient surveillance and post-procedural management have changed after the introduction of this stent-graft. This article presents the current management strategies that are followed at our Institution for patients who have undergone a TIPS procedure with a VIATORR stent graft including imaging follow-up, management of encephalopathy, medical management and nutritional aspects. © 2016 Elsevier Inc.
Gonzalez-Perez J.,Instituto Nacional Of La Nutricion Salvador Zubiran |
Sanchez-Leenheer S.,Instituto Nacional Of La Nutricion Salvador Zubiran |
Delgado A.R.,Instituto Nacional Of La Nutricion Salvador Zubiran |
Gonzalez-Vargas L.,Clinic for Obesity |
And 5 more authors.
Obesity Surgery | Year: 2013
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a technically challenging surgical technique when features such as thick abdominal wall and increased liver volume are present. Very low calorie diets in the form of liquid meal replacements given 6 weeks prior to surgery have proven to decrease liver volume. The aim of our study was to assess the effect of a 6-week preoperative low calorie/regular diet on liver volume and body weight in morbidly obese patients. Methods: A pilot study was carried out in 20 morbidly obese patients with an 800-kcal diet for 6 weeks. They were followed weekly to ensure proper compliance. CT scan was used for determining liver volume every 2 weeks in order to assess the impact of the diet. Baseline values were taken as controls for every patient as tied measures. Statistical analysis was suitable to variable scaling and performed using SPSS v. 20.0. Parametric and non-parametric test for tied measures were done. Any p value lesser than 0.05 or 5 % was considered as statistically significant. Results: Twenty patients adhered to the diet intervention for 6 weeks prior to LRYGB. Median ± SD age was 34.5 ± 11.5 years and 17 were female (85 %). Heart rate and blood pressure did not vary across the study. Initial median ± SD BMI was 46.02 ± 5.29 kg/m2 (range 38.7-54.8). Repeated and tied measurements across the 6 weeks of treatment within individuals resulted statistically significant for reducing BMI (p < 0.0001). CT scan assessed liver volume initially as a control and in weeks 2, 4 and 6. Parametric and non-parametric assessment for multiple measurements also showed statistical significance among these values (p < 0.0001). Diet tolerability was additionally evaluated with a questionnaire showing more than 80 % of acceptability with discrete rates of nausea (15 %) and diarrhoea (15 %). Conclusions: Based on our results, we demonstrated that a very low calorie diet with home ingredients is capable for effectively reducing body weight and liver size in morbidly obese patients. This relatively short intervention (4 to 6 weeks) was accomplished in all our patients with a high frequency of compliance and a low rate of secondary effects. © 2013 Springer Science+Business Media New York.
Montalvo J.,Instituto Nacional Of La Nutricion Salvador Zubiran |
Velazquez D.,Instituto Nacional Of La Nutricion Salvador Zubiran |
Pantoja J.P.,Instituto Nacional Of La Nutricion Salvador Zubiran |
Sierra M.,Instituto Nacional Of La Nutricion Salvador Zubiran |
And 2 more authors.
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2014
Background: Laparoscopic splenectomy (LS) is considered the standard treatment for patients with refractory primary immune thrombocytopenia (ITP). Patients and Methods: All patients with ITP who underwent LS during the last 17 years and who had a minimum follow-up of 1 year were included. Several perioperative variables such as age, platelet count, and duration of preoperative therapy were recorded and analyzed, looking for potential predictive variables of clinical response. Results: In total, 150 patients were included: 108 (72%) women and 42 (28%) men, with a mean age of 37.3±15.8 years. In the evaluation 1 year after surgery, 133 (88.7%) patients had achieved complete response, 4 (2.7%) had a response, and in 13 (8.6%) there was no response. None of the analyzed preoperative variables was identified as a predictive factor of response at 1 year. Immediate responders after surgery (≥150,000 platelets/mL during the first week) had a higher platelet count and rate of complete response at 1 year (94.2%). Conclusions: LS has a high success rate in patients with refractory ITP. Potential predictive indicators of success remain to be determined. © Copyright 2014, Mary Ann Liebert, Inc. 2014.