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Assessing sirtuin expression in endometrial carcinoma and non-neoplastic endometrium

Bartosch, Carla; Monteiro-Reis, Sara; Almeida-Rios, Diogo; Vieira, Renata; Castro, Armando; Moutinho, Manuel; Rodrigues, Marta; Graca, Ines; Lopes, Jose Manuel; Jeronimo, Carmen
Sirtuins participate in hormone imbalance, metabolism and aging, which are important processes for endometrial cancer (EC) development. Sirtuins mRNA expression (SIRT1 to 7) was determined in 76 ECs (63 Type I, 12 Type II and one mixed EC), and 30 non-neoplastic endometria (NNE) by quantitative real-time PCR. SIRT1 and SIRT7 protein expression was evaluated by immunohistochemistry using Allred score. Compared to NNE, ECs showed SIRT7 (p < 0.001) mRNA overexpression, whereas SIRT1 (p < 0.001), SIRT2 (p < 0.001), SIRT4 (p < 0.001) and SIRT5 (p < 0.001) were underexpressed. No significant differences were observed for SIRT3 and SIRT6. Type II ECs displayed lower SIRT1 (p = 0.032) and SIRT3 (p = 0.016) transcript levels than Type I ECs. Concerning protein expression, SIRT1 immunostaining median score was higher in ECs compared to NNE epithelium (EC = 5 vs. NNE = 2, p < 0.001), while SIRT7 was lower in ECs (EC = 6 vs. NNE = 7, p < 0.001). No significant associations were found between SIRT1/7 immunoexpression and histological subtype, grade, lymphovascular invasion or stage. Our data shows that sirtuins are deregulated in EC. The diversity of expression patterns observed suggests that sirtuins may have distinctive roles in endometrial cancer similarly to what has been described in other cancer models.
PMCID:4811449
PMID: 26701732
ISSN: 1949-2553
CID: 1896552

Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature

Bellorin, Omar; Kundel, Anna; Ramirez-Valderrama, Alexander; Castro, Armando
Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7. Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.
PMCID:4620429
PMID: 26543659
ISSN: 2090-6900
CID: 1826072

Are laparoscopic bariatric procedures safe in superobese (BMI >/=50 kg/m2) patients? An NSQIP data analysis

Kakarla, Venkata R; Nandipati, Kalyana; Lalla, Michael; Castro, Armando; Merola, Stephen
BACKGROUND: The safety of laparoscopic bariatric procedures in superobese patients is still debatable. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program's participant-use file, the patients who had undergone laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding for morbid obesity were identified. Several perioperative variables, including 30-day morbidity and mortality, were collected, and the data were compared within each procedure after dividing the patients according to the body mass index: <50 kg/m(2) (morbidly obese group and >/=50 kg/m(2) (superobese group). RESULTS: A total of 29,323 patients who had undergone laparoscopic bariatric procedures from 2005 to 2008 were identified. Overall, compared with the morbidly obese group, the superobese group had more men (3:2), younger patients, a greater incidence of co-morbidities (e.g., hypertension and dyspnea), a significantly increased length of stay, and a greater rate of 30-day mortality (.26% versus .07%, odds ratio [OR] 4.38, P = .0001). In the gastric bypass group, the superobese group had a significantly greater incidence of postoperative complications, including superficial wound infections (2.45%, OR 1.68, P = .0001), reintubation (.61%, OR 1.97, P = .003), pulmonary embolism (.30%, OR 2.13, P = .032), myocardial infarction (.07%, P = .017), deep vein thrombosis (.49%, OR 2.06, P = .006), septic shock (.44%, OR 1.74, P = .04), and 30-day mortality (.28%, OR 2.26, P = .026). In the laparoscopic adjustable gastric banding group, the superobese group had a significantly greater incidence of postoperative complications, including superficial (1.65%, OR 2.18, P = .0013) and deep (.23%, OR 2.56, P = .035) wound infections, sepsis, septic shock and 30-day mortality (.17%, OR 13.4, P = .0219). CONCLUSION: Laparoscopic bariatric procedures in superobese patients have been associated with significantly increased complications, including 30-day mortality, compared with morbidly obese patients. However, overall, the procedures appear to be safe, with low complication and 30-day mortality rates.
PMID: 21159564
ISSN: 1878-7533
CID: 1896562

Laparoscopic ventral and incisional hernia repair

Chapter by: Castro, AE; Edwards, Eric D; Vulpe, CT; Ferzli, George s
in: International principles of laparoscopic surgery by Frezza, Eldo E; Gagner, Michel; Li, Michael K [Eds]
Woodbury, CT : Distributed by CineÌ-Med Publishing, c2010
pp. 653-660
ISBN: 0982451431
CID: 1772942

Medial-to-lateral laparoscopic colon resection: a view beyond the learning curve

Kim, J; Edwards, E; Bowne, W; Castro, A; Moon, V; Gadangi, P; Ferzli, G
BACKGROUND: Since the authors' report on the lateral approach to laparoscopic colon resection (LCR), medial-to-lateral (M-L) segmental resection has continued to evolve. This report analyzes their learning curve experience with a standardized three-trocar M-L technique, which demonstrates the influence of operative volume on proficiency and outcome. METHODS: From January 1999 to December 2004, 100 consecutive patients underwent a standardized three-trocar M-L segmental LCR. Patient demographics, indications for surgery, operative proficiency (time), and outcome (i.e., blood loss, conversion to open surgery, length of hospital stay, morbidity, and mortality) were recorded. A learning curve analysis was performed using a t-test and analysis of variance (ANOVA). RESULTS: The 100 M-L LCRs included sigmoid (55%), right (34%), left (6%), and transverse (5%) approaches. Overall learning curve proficiency was influenced by increasing operative experience (p = 0.02). However, significant and consistent improvement in the learning curve occurred only after 38 LCRs (p < 0.008). Notably, all conversions to open surgery (3%) occurred during the early learning curve. Similarly, early LCR patients experienced greater morbidity (mean, 21% vs 12%) and mortality (mean, 5% vs 2%) than their later counterparts. CONCLUSION: To obtain optimum proficiency in performing LCR, a minimum of 38 M-L procedures is required. Operative and patient outcomes improve beyond the early learning curve.
PMID: 17641928
ISSN: 1432-2218
CID: 1748322

The role of endoscopic extraperitoneal herniorrhaphy: where do we stand in 2005?

Bowne, W B; Morgenthal, C B; Castro, A E; Shah, P; Ferzli, G S
Inguinal hernia repair is a common surgical procedure, but the most effective surgical technique remains controversial. The evolution of laparoscopic techniques has allowed reproduction of open preperitoneal repair via an endoscopic total extraperitoneal (TEP) approach. More recently, the advent of comprehensive training in laparoscopy has allowed TEP to continue evolving as the feasibility of this approach gains recognition as a preferable technique. Once considered very difficult to learn, TEP currently is adequately taught in many surgical training programs. This report reviews the fundamentals and details various modifications that make this procedure more desirable than open procedures and other laparoscopic techniques. A resultant decrease in operative time, cost of the procedure, and morbidity to the patient is routine. In addition, the authors review their institutional experience and examine other current evidence-based data.
PMID: 17279303
ISSN: 1432-2218
CID: 1739612

Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis

Bowne, Wilbur B; Julliard, Kell; Castro, Armando E; Shah, Palak; Morgenthal, Craig B; Ferzli, George S
HYPOTHESIS: Outcome following laparoscopic adjustable gastric banding (LAGB) in super morbidly obese patients is significantly worse compared with the standard laparoscopic Roux-en-Y gastric bypass (LRYGB). DESIGN: Prospective case series. SETTING: Community teaching hospital (490 beds). PATIENTS: A prospectively maintained database identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004. The study group included super morbidly obese patients (body mass index >50 [calculated as weight in kilograms divided by the square of height in meters]) following LAGB and LRYGB. INTERVENTIONS: Among 106 patients with super morbid obesity, 60 (57%) and 46 (43%) underwent LAGB and LRYGB, respectively. MAIN OUTCOME MEASURES: Patient demographics, weight loss, percentage of excess weight loss, change in body mass index, early (<30 days) and late (> or =30 days) complications, reoperations, medical comorbidity, and patient satisfaction were studied. Analysis was performed using the t test and Pearson chi 2 analysis. RESULTS: Overall median follow-up was 16.2 months (range, 1-40 months). Preoperative factors of patient age, sex, weight, body mass index, and medical comorbidity were similar between the 2 groups. Compared with LRYGB, patients who underwent LAGB experienced a greater incidence of late complications (P < .05), reoperations (P < .04), less weight loss (P<.001), and decreased overall satisfaction (P < .006). Likewise, patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus (P < .05) and sleep apnea (P<.01) compared with the LAGB group. Furthermore, postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations. Our single mortality was in the LAGB group. CONCLUSIONS: In super morbidly obese patients, LAGB is significantly associated with more late complications, reoperations, less weight loss, less reduction of medical comorbidity, and patient dissatisfaction compared with LRYGB. Further evaluation of LAGB in this patient population appears warranted.
PMID: 16847241
ISSN: 0004-0010
CID: 1739482