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Browsing by Author "Hepp, Juan"

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Angiomiolipoma hepático epitelioide: reporte de un caso
(2022) Ahumada, Oscar; Hepp, Juan; Gallegos, Marcela; Schiappacasse, Giancarlo
Angiomyolipomas (AML) are mesenchymal tumors belonging to the group of perivascular epithelioid cell tumors, which, rarely, can display a malignant behavior. They are composed of adipose tissue, vessels, and muscle tissue in different proportions, and constitute a differential diagnosis for other focal liver lesions. We report a 34-year-old woman in whom a focal hepatic lesion was discovered incidentally. The pathology report of an ultrasound guided biopsy informed an epithelioid angiomyolipoma, a rare variant of these lesions. During ten years of imaging follow, the size and features of the lesion has not changed. The patient rejected a surgical excision.
Caracterización del perfil epidemiológico, patológico, radiológico y de manejo de los pacientes con tumores estromales del tubo digestivo. Experiencia chilena de cinco años
(2024) Schiappacasse, Giancarlo; Cocio, Rolando; Cristi, J.; Torres, Javiera; Aliaga, Francisca; Vial, Macarena; Hepp, Juan; Castiblanco, Adriana
Introducción y objetivos Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquimáticas más frecuentes del tubo digestivo y su expresión y manejo dependen de su agresividad. Nuestro objetivo es caracterizar los GIST diagnosticados en nuestro centro, a partir de variables epidemiológicas, anatomopatológicas, imagenológicas y de manejo. Material y métodos Estudio observacional de cohorte retrospectiva en pacientes adultos con diagnóstico de GIST mediante imágenes y biopsia entre los años 2017 y 2022 en nuestro centro, caracterizando datos epidemiológicos, imagenológicos, de anatomía patológica y terapéuticos. Resultados Se incluyeron 33 pacientes, promedio de edad 59 años. La mayoría fue un hallazgo incidental (54.5%) y de los sintomáticos, lo más frecuente fue hemorragia digestiva (24%). La ubicación más frecuente fue el estómago (19/33 casos) y su forma de presentación exofítica fue la más habitual (48.5%). Imagenológicamente, su impregnación fue mayormente heterogénea y progresiva y 54% presentaron alguna característica intrínseca, siendo la necrosis/áreas quísticas lo más frecuente, sin casos de invasión local ni diseminación a distancia. Histológicamente la variante fusada fue la más frecuente (78.8%) y la mayoría presentaron menos de cinco mitosis por campo mayor. En nuestro recinto, 30 casos fueron tratados, siendo la cirugía la forma de resolución más frecuente (29/30). No se registraron muertos a causa de GIST en nuestra serie. Conclusiones Nuestra serie tiene características epidemiológicas e imagenológicas similares a la literatura, diferenciándose por un diagnóstico precoz y baja agresividad de los casos. Introduction and aims Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplastic tumors of the gastrointestinal tract and their expression and management is dependent on their aggressivity. Our aim was to characterize the GISTs diagnosed at our center, analyzing the epidemiologic, anatomopathologic, imaging study, and management variables. Material and methods A retrospective, observational cohort study was conducted on adult patients diagnosed with GIST through imaging studies and biopsy, within the time frame of 2017 and 2022 at our center, characterizing the epidemiologic, imaging study, anatomopathologic, and therapeutic data. Results Thirty-three patients with a mean age of 59 years were included. The majority of cases were incidental findings (54.5%), and of the symptomatic cases, the most frequent presentation was gastrointestinal bleeding (24%). The most common location was the stomach (19/33 cases), and the most frequent presentation was exophytic (48.5%). In the imaging studies, impregnation was mainly heterogeneous and progressive and 54% had an intrinsic characteristic, with necrosis/cystic areas the most frequent feature. There were no cases of local invasion or distant metastasis. Histologically, the spindle cell type was the most frequent (78.8%) and the majority had fewer than 5 mitoses per high power field. Thirty cases were treated at our center and surgery was the most frequent form of resolution (29/30). No deaths caused by GIST were registered in our case series. Conclusions The epidemiologic and imaging study characteristics in our case series were similar to those reported in the literature, but our results were different, with respect to early diagnosis and the low aggressivity of the cases.
Donación y trasplante de órganos: propuesta desde la Academia Chilena de Medicina
(2020) Hepp, Juan; Beca, Juan Pablo; Moran, Sergio; Roessler, Emilio; Uribe, Mario; Palacios, José Manuel
The Chilean Academy of Medicine designated a group of specialists to evaluate the practice and to propose reforms for organ donation and transplantation, due to the general insufficiencies at the national level with these procedures. In the last six years the mean number of organ transplants in Chile was 340 cases per year while effective cadaveric donors ranged between 6 and 10 per million inhabitants. These averages remained stable during this period and are among the lowest in the region. Our analysis attributed these deficient results mainly to low organ donation and inefficient procurement due to lack of compliance with protocols and little accountability. The committee proposes several measures for improvement. These are a systematic and obligatory report of potential organ donors by all emergency and critical care centers, frequent evaluation of results, empowering of health authorities to correct insufficiencies in organ procurement, education programs for primary, secondary, technical and university students to improve their knowledge about the social significance and solidarity required for transplantation policies and specialized updated training of all health professionals involved. Organ donation and transplantation must be based on clear and fair ethical considerations in order to be accepted by the general public
El retiro del cirujano de su actividad quirúrgica y profesional: algunas consideraciones
(2024) Braghetto, Italo; Hepp, Juan
El envejecimiento está asociado con disminuciones en la función cognitiva y el desempeño psicomotor, del cual el cirujano no está exento y sufre ante esta situación, factor importante para decidir el momento de su retiro. Actualmente, tanto en países del hemisferio norte como tampoco en Chile no existen requisitos establecidos y estandarizados, como tampoco consenso universal, sobre cuándo o en qué momento un cirujano debe dejar de hacer procedimientos quirúrgicos y retirarse. En este artículo se resalta la importancia del cirujano en edad de retiro para la comunidad médica y se da una visión general basada en evidencia y se discuten cada uno de los factores involucrados en la decisión de cómo enfrentar el retiro. En los antecedentes revisados no se favorece una edad de jubilación obligatoria porque el inicio de la disminución del desempeño clínico relacionada con la edad varía entre los individuos. La evaluación objetiva de la aptitud debería sustituir la consideración de una edad de jubilación obligatoria. Deben establecerse estrategias institucionales para una re- certificación y reacreditación estricta y una jubilación oportuna. Un cirujano no debe verse obligado a su retiro a una edad predeterminada, debe poder ejercer mientras sus habilidades quirúrgicas se mantengan objetivamente en el nivel apropiado de competencia. Aging is associated with decreases in cognitive function and psychomotor performance, from which the surgeon is not exempt and suffers in this situation, an important factor in deciding when to retire. Currently, both in countries in the northern hemisphere and in Chile there are no established and standardized requirements, nor universal consensus, on when or at what time a surgeon should stop performing surgical procedures or retire. This article highlights the importance of the surgeon of retirement age for the medical community and gives an overview based on evidence and discusses each of the factors involved in the decision of how to face retirement. The reviewed background does not favor a mandatory retirement age because the onset of age-related decline in clinical performance varies among individuals. The objective assessment of fitness should replace the consideration of a mandatory retirement age. Institutional strategies must be established for strict re-certification and re-accreditation and timely retirement. A surgeon should not be forced into retirement at a predetermined age but should be able to practice as long as his or her surgical skills are objectively maintained at the appropriate level of competence.
¿Está la cirugía académica en jaque? Visión acerca de los cirujanos/as del futuro
(2024) Braghetto, Italo; Hepp, Juan
La cirugía académica requiere de un compromiso mayor comparado a la práctica quirúrgica fuera de centros académicos. Es mucho mas demandante por la carga docente y de investigación que involucra aparte de la labor asistencial, lo cual provoca conflictos en la relación laboral, familiar y desarrollo profesional integral. Las futuras generaciones tienen aspiraciones y visiones diferentes de cómo enfrentar el trabajo diario sin descuidar la calidad de vida. En este articulo se analizan los diferentes factores que afectan este equilibrio y como se espera que se manejará el escenario laboral en los próximos años. Academic surgery requires a greater commitment compared to surgical practice outside academic centers. It is much more demanding due to the teaching and research load that it involves apart from the care work, which causes conflicts in the work, family relationship and comprehensive professional development. Future generations have different aspirations and visions of how to face daily work without neglecting quality of life. This article analyzes the different factors that affect this balance and how the labor scenario is expected to be managed in the coming years.
Importancia del liderazgo e innovación para el futuro de la cirugía
(2022) Braghetto, Italo; Hepp, Juan
Históricamente, desde los inicios de la cirugía han existido líderes innovadores que ha hecho posible el progreso continuo de la cirugía a lo largo del tiempo hasta nuestros días. El proceso innovador cada vez más tecnológico que si bien trae consigo enormes avances se ha hecho más complejo por múltiples razones tales como su desarrollo e implementación, los costos, factores éticos, su correcta indicación y obviamente su evaluación en cuanto a los beneficios que aporta para el paciente y la sociedad. En este artículo se hace una somera revisión del desarrollo histórico de la innovación en cirugía y se presenta la opinión de los autores basado en la literatura respecto del proceso de innovación y del rol de líder innovador haciendo un análisis los múltiples factores involucrados.
Resección hepática extendida con vena cava inferior por colangiocarcinoma intrahepático. Presentación de 2 casos
(2019) Rencoret, Guillermo; Vivanco, Marcelo; Castillo, Felipe; Schiappacasse, Giancarlo; de Aretxabala, Xabier; Bianchi, Víctor; Hepp, Juan; Ríos, Horacio
Introduction: Intrahepatic cholangiocarcinoma is the second most common primary liver tumor and surgical resection the only valid curative treatment. Case reports: We describe two patients harboring an intrahepatic cholangiocarcinoma with cava vein involvement who underwent resection at Clinica Alemana of Santiago. Both patients were females with ages of 39 and 47 years old. Both patients underwent left liver resection, associated to resection of segment I and of a portion of cava vein. Reconstruction of resected portion of the cava vein was performed by using a pericardium bovine patch and primary closure respectively. Postoperative period was uneventfully being discharged at 13 and 23 days respectively. Discussion: Although surgical resection is the only way to get curativeness, frequent involvement of large vascular structures make treatment unfeasible. A multidisciplinary approach associated with a meticulous technique performed by an experienced surgical team make possible to accomplish the above objective.

Browsing by Author "Hepp, Juan"

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