Mario Uribe

Thyroid hormone preconditioning: Protection against ischemia‐reperfusion liver injury in the rat

Recently, we reported that oxidative stress due to 3,3′,5‐triiodothyronine (T3)‐induced calorigenesis up‐regulates the hepatic expression of mediators promoting cell protection. In this study, T3 administration in rats (single dose of 0.1 mg/kg intraperitoneally) induced significant depletion of reduced liver glutathione (GSH), with higher protein oxidation, O2 consumption, and Kupffer cell function (carbon phagocytosis and carbon‐induced O2 uptake). These changes occurred within a period of 36 hours of T3 treatment in animals showing normal liver histology and lack of alteration in serum AST and ALT levels. Partial hepatic ischemia‐reperfusion (IR) (1 h of ischemia via vascular clamping and 20 h reperfusion) led to 11‐fold and 42‐fold increases in serum AST and ALT levels, respectively, and significant changes in liver histology, with a 36% decrease in liver GSH content and a 133% increase in that of protein carbonyls. T3 administration in a time window of 48 hours was substantially protective against hepatic IR injury, with a net 60% and 90% reduction in liver GSH depletion and protein oxidation induced by IR, respectively. Liver IR led to decreased DNA binding of nuclear factor‐κB (NF‐κB) (54%) and signal transducer and activator of transcription 3 (STAT3) (53%) (electromobility shift assay), with 50% diminution in the protein expression of haptoglobin (Western blot), changes that were normalized by T3 preconditioning. Conclusion: T3 administration involving transient oxidative stress in the liver exerts significant protection against IR injury, a novel preconditioning maneuver that is associated with NF‐κB and STAT3 activation and acute‐phase response. (HEPATOLOGY 2007;45:170–177.)

Trasplante hepático en Chile: Aspectos generales, indicaciones y contraindicaciones (Documento de consenso)

Liver transplantation is an excellent therapeutic option forterminal liver disease. During the last decades the results of liver transplantation have improvedsignificantly with a patient survival rate of nearly 90% at one year and 80% at 5 years offollow-up. The main indications for liver transplantation include: end-stage liver diseaseassociated to cirrhosis, acute liver failure, and hepatic tumors (mainly hepatocarcinoma). Theabsolute contraindications for a transplant are less frequent than in the past, and include:severe co-morbidity (cardiac or pulmonary), sepsis, advanced HIV disease and extra-hepaticmalignancy. This document presents a Consensus of the main groups performing livertransplantation in Chile, about its indications and contraindications. It also reviews generalaspects of liver transplantation, including the selection and referral of liver transplantcandidates, allocation of organs and the evaluation of severity of liver disease (Rev Med Chile2008; 136: 793-804).(

Severe novel H1N1 influenza A infection in the immediate postoperative period of a liver transplant patient.

In 2009, the World Health Organization recognized the novel H1N1 influenza A virus as a pandemic infection. Since April 2009, thousands of cases of novel H1N1 influenza A infection have been reported worldwide, and they have resulted in thousands of deaths. South American countries were affected by this infection during their winter season, and Chile presented one of the highest incidence rates. We have recently managed a liver transplant patient who presented with a severe novel H1N1 influenza A infection in the early postoperative period and required prolonged mechanical ventilation. The early suspicion of this infection during the current pandemic influenza in Chile made possible a timely treatment with oseltamivir. We decided to report this case because no other cases of liver transplant patients affected by H1N1 influenza A have been reported so far. We intend to alert clinicians about this potentially devastating viral infection in view of the current pandemic scenario, and here we review some of the recommendations for its prevention, diagnosis, therapy, and possible complications. Liver Transpl, 2010.

Magnetic Surgery: Results from First Prospective Clinical Trial in 50 Patients.

Objective: To evaluate a new magnetic surgical system during reduced-port laparoscopic cholecystectomy in a prospective, multicenter clinical trial. Background: Laparoscopic instrumentation coupled by magnetic fields may enhance surgeon performance by allowing for shaft-less retraction and mobilization. The movements can be performed under direct visualization, generating different angles of traction and reducing the number of trocars to perform the procedure. This may reduce well-known associated complications of trocars, including incisional pain, scarring, infection, bowel, and vascular injuries, among others. Methods: A prospective, multicenter, single-arm, open-label study was performed to assess the safety and performance of a magnetic surgical system (Levita Magnetics’ Surgical System). The investigational device was used during a 3-port laparoscopic technique. The primary endpoints evaluated were safety and feasibility of the device to adequately mobilize the gallbladder to achieve effective exposure of the targeted surgical site. Patients were followed for 30 days postprocedure. Results: Between January 2014 and March 2015, 50 patients presenting with benign gallbladder disease were recruited. Forty-five women and 5 men with an average age of 39 years (18–59), average body mass index of 27 kg/m2 (20.4–34.1) and an average abdominal wall thickness of 2.6 cm (1.8–4.6). The procedures were successfully performed in all 50 patients. No device-related serious adverse events were reported. Surgeons rated as “excellent” (90%) or “sufficient” (10%) the exposure of the surgical site. Conclusions: This clinical trial shows that this new magnetic surgical system is safe and effective in reduced-port laparoscopic cholecystectomy.

Actualización en cáncer de vesícula biliar

Resumen El cancer de vesicula biliar (CVB) corresponde a una patologia altamente prevalente en nuestro pais, alcanzando incluso la mas alta de incidencia del mundo. Lamentablemente es una enfermedad que solo presenta sintomas cuando ya se encuentra en estados avanzados. Dentro de los factores de riesgo, la colelitiasis, la obesidad, la edad, el genero, infecciones bacterianas y algunos factores geneticos ocupan una posicion relevante en su etiopatogenia. El diagnostico se realiza principalmente por imagenes como la Ultrasonografia (US) y la Tomografia Computada (TC), sin embargo el uso de otros metodos como la Resonancia Nuclear Magnetica (RNM) son de gran utilidad. Dentro del diagnostico se utilizan tambien algunos marcadores tumorales que pueden servir de ayuda en el seguimiento y el pronostico en algunos casos. La cirugia es el tratamiento de eleccion sobre todo en etapas iniciales, ya que muchas veces esta enfermedad se pesquisa como hallazgo de colecistectomias de rutina por colelitiasis.

High CD8 + and absence of Foxp3 + T lymphocytes infiltration in gallbladder tumors correlate with prolonged patients survival

BackgroundGallbladder cancer (GBC), although infrequent in industrialized countries, has high incidence rates in certain world regions, being a leading cause of death among elderly Chilean women. Surgery is the only effective treatment, and a five-year survival rate of advanced-stage patients is less than 10%. Hence, exploring immunotherapy is relevant, although GBC immunogenicity is poorly understood. This study examined the relationship between the host immune response and GBC patient survival based on the presence of tumor-infiltrating lymphocytes at different disease stages.MethodsTumor tissues from 80 GBC patients were analyzed by immunohistochemistry for the presence of CD3+, CD4+, CD8+, and Foxp3+ T cell populations, and the results were associated with clinical stage and patient survival.ResultsThe majority of tumor samples showed CD3+ T cell infiltration, which correlated with better prognosis, particularly in advanced disease stages. CD8+, but not CD4+, T cell infiltration correlated with improved survival, particularly in advanced disease stages. Interestingly, a < 1 CD4+/CD8+ T cell ratio was related with increased survival. Additionally, the presence of Foxp3+ T cells correlated with decreased patient survival, whereas a ≤ 1 Foxp3+/CD8+ T cell ratio was associated with improved patient survival.ConclusionsDepending on the disease stage, the presence of CD8+ and absence of Foxp3+ T cell populations in tumor tissues correlated with improved GBC patient survival, and thus represent potential markers for prognosis and management of advanced disease, and supports testing of immunotherapy.

Manejo inicial y conceptos en trauma: vía aérea, reposición de volumen, toracotomía de urgencia

Resumen La atencion inicial del paciente politraumatizado incluye una evaluacion inicial y resucitacion, una fase intermedia o de monitorizacion y una evaluacion secundaria, diagnostica en la que se debe realizar un examen detallado por organos y sistemas para proceder a un tratamiento definitivo. En este articulo se tratan aquellas patologias que ponen en peligro la vida del paciente y que precisan acciones terapeuticas inmediatas, como son la obstruccion de via aerea, el neumotorax a tension, el taponamiento cardiaco, neumotorax simple y neumotorax abierto. El shock, definido por un grado severo de hipoperfusion tisular, necesita ser corregido mediante una infusion adecuada de volumen incluyendo factores de coagulacion para evitar el circulo vicioso de la llamada “triada letal” que corresponde a hemorragia, hipotermia y coagulopatia, que a su vez perpetua la hemorragia. La toracotomia de reanimacion tiene indicaciones precisas y sus resultados dependen de la etiologia del traumatismo, siendo mejor al utilizarse en lesiones penetrantes cardiacas y con el menor tiempo en que se efectua.

Trasplante hepático pediátrico estudio descriptivo de la experiencia recogida por el grupo de trasplante pediátrico de Clínica Las Condes y Hospital Luis Calvo Mackenna

Resumen El trasplante hepatico pediatrico (THP) es la unica alternativa de tratamiento para ninos que padecen enfermedades hepaticas terminales, ya sean estas agudas o cronicas. trasplantes de higado realizados en nuestro pais. Objetivo Exponer las indicaciones, procedimientos y principales complicaciones del THP desde el punto de vista teorico y realizar un estudio descriptivo de la experiencia recogida por el grupo de trasplante pediatrico de Clinica Las Condes y Hospital Luis Calvo Mackenna desde 1994 a 2009 en esta materia. Material y Metodos Se recolectaron los datos de 209 trasplantes hepaticos realizados a 173 pacientes menores de 18 entre 1994 y 2009 en ambos centros, realizando estadistica descriptiva y curvas de sobrevida de Kaplan y Meier. Resultados Las principales causas de trasplante fueron Atresia de Vias Biliares (48%) y Falla hepatica aguda (28%). Cuarenta y un trasplantes se realizaron en ninos menores de 10 kilos. Se trasplantaron con donante vivo 27% de los casos. Las complicaciones vasculares se presentaron en 13% de los casos y las biliares en 14%. Rechazos moderados o severos se diagnosticaron en 36% de los trasplantes. Enfermedad por Citomegalovirus se detecto en 30% de los pacientes dentro del primer ano post trasplante y sindrome linfoproliferativo en 5%. La sobrevida actuarial de pacientes a 1 ano ha sido de 76%, a 5 anos de 67% y a 10 anos de 65%. Conclusion Los resultados del THP en terminos de sobrevida y complicaciones es similar a la experiencia de centros extranjeros, la cual es superior a las expectativas y calidad de vida de los pacientes sin trasplante. Las areas de mayor desarrollo de nuestro centro y que presentan los mayores desafios son el trasplante hepatico en ninos menores de 10 kilos, en falla hepatica aguda, y el uso de donante vivo.

Fenómeno de acomodación inmunológica: Trasplante hepático ABO incompatible. Caso clínico

We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accommodation opens the possibility of using ABO-incompatible organs as a definitive grafts.

Declaración de Estambul en relación al tráfico de órganos y turismo en trasplante

This is a translation into Spanish, done by Mario Uribe, M.D., F.A.C.S., and authorized by the Conference Organization, of the official statements signed by The Transplantation Society, The International Society of Nephrology and the representatives who participated at a WHO sponsored Conference held in Istambul, Turkey, April 30 to May 2, 2008.This is a translation into Spanish, done by Mario Uribe, M.D., F.A.C.S., and authorized by the Conference Organization, of the official statements signed by The Transplantation Society, The International Society of Nephrology and the representatives who participated at a WHO sponsored Conference held in Istambul, Turkey, April 30 to May 2, 2008.