Surgery and radioembolization of liver tumors

Surgical resection is considered the curative treatment par excellence for patients with primary or metastatic liver tumors. However, less than 40% of them are candidates for surgery, either due to nonmodifiable factors (comorbidities, age, liver dysfunction. . .), or to the invasion or proximity of the tumor to the main vascular requirements, the lack of a future liver remnant (FLR) adequate to maintain postoperative liver function, or criteria oftumor size and number. In these lastfactors, hepatic radioembolization has been shown to play a role as a presurgical tool, either by hypertrophy of the FLR or by reducing tumor size that manages to reduce tumor staging (term known as downstaging ¨ ¨ ). To these is added a third factor, which is its ability to apply the test oftime, which makes it possible to identify those patients who present progression of the disease in a short period of time (both locally and at distance), avoiding a unnecessary surgery. This paper aims to review RE as a tool to facilitate liver surgery, both through the experience of our center and the available scientific evidence.La resección quirúrgica se considera eltratamiento curativo por excelencia para los pacientes con tumores hepáticos primarios o metastásicos. Sin embargo, menos del 40% de ellos son candidatos a cirugía, ya sea por factores no modificables (comorbilidades, edad, disfunción hepática. . .), como por la invasión o proximidad del tumor a los principales pedículos vasculares, la falta de un futuro remanente hepático (FRH) adecuado para mantener una función hepática postoperatoria, o criterios de tamano˜ y numero tumoral. En estos últimos factores, la radioembolización hepática ha mostrado tener un papel como herramienta prequirúrgica, ya sea mediante la hipertrofia del FRH o mediante la reducción del tamano˜ tumoral que consigue disminuir la estadificación tumoral (término conocido como “downstaging”). A estos se suma un tercer factor, que es su capacidad de aplicar el test del tiempo, que permite identificar aquellos pacientes que presenten en un plazo corto de tiempo progresión de la enfermedad (tanto a nivel local como a distancia), evitándoles una cirugía innecesaria. En este trabajo se pretende hacer una revisión de la RE como herramienta facilitadora de la cirugía hepática, tanto a través de la experiencia de nuestro centro como de la evidencia científica disponible

Association of laparoscopic surgery with improved perioperative and survival outcomes in patients with resectable intrahepatic cholangiocarcinoma: A systematic seview and meta-analysis from propensity-score matched studies

Background: Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC). Methods: A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model. Results: Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]). Conclusions: This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR

Estudio de la dinámica del humor acuoso mediante fluorofotometría en la trabeculoplastia láser argón

Tesis Univ. Complutense de Madrid, 1991Depto. de Inmunología, Oftalmología y ORLFac. de MedicinaTRUEpu

Effect of Re λ and Rouse numbers on the settling of inertial droplets in homogeneous isotropic turbulence

International audienc

¿Jugamos a los cuentos? Una propuesta práctica de animación a la lectura a través de la educación física

This paper justifies the possibility of uniting children’s literature in the area of Physical Education through a methodological proposal: «Playing tales». This proposal is based on the concept of motor story but insists on the importance of reading/understanding of the written text as a starting point. Subsequently, there has been a practical experience of 5 sessions during two academic years by applying this proposal of «Playing tales» in a kindergarden. The choice of stories and the design of the practical sessions has been done with full respect and completing the learning program proposed by the teachers holders in early childhood education. Finally, it describes a lesson by way of example of such experience. The findings suggest that «Playing tales» has proved to be a methodological proposal valid to achieve global and interdisciplinary programming based on stories and movement.El documento justifica la posibilidad de unir la literatura infantil con el área de Educación Física mediante una propuesta metodológica: «Jugar a los cuentos». Dicha propuesta está basada en el concepto de cuento motor pero insiste en la importancia de la lectura/comprensión del texto escrito como punto de partida. Posteriormente, se ha realizado una experiencia práctica de 5 sesiones durante dos cursos académicos aplicando esta propuesta de «Jugar a los cuentos» en un centro de educación infantil. La selección de los cuentos y el diseño de las sesiones prácticas se han realizado respetando y completando el programa de aprendizaje propuesto por las maestras titulares en educación infantil. Por último, se describe una sesión a modo de ejemplo de dicha experiencia. Las conclusiones apuntan que «Jugar a los cuentos» ha resultado ser una propuesta metodológica válida para conseguir aprendizajes globales e interdisciplinares a partir de los cuentos y el movimiento

1D analysis of preferential concentration of inertial particles

International audienc

Measuring Inertial Particle Turbulent Clustering with 2D, and 1D techniques: a study of common pitfalls

International audienc