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Biomedical subjects

A Csendes

Publications and source records attributed to A Csendes.

At least 55 records · Page 3Linked to original sources
PubMed1997

Correlation among ultrasonographic and videoscopic findings of the gallbladder: surgical difficulties and reasons for conversion during laparoscopic surgery.

Laparoscopic cholecystectomy is currently the standard procedure for chronic and acute cholecystitis. The purpose of this prospective study was to evaluate the preoperative ultrasound findings of the gallbladder and correlate those aspects with surgical videoscopic and histopathologic findings and the results concerning intraoperative complications and the conversion index to open surgery. Gallbladder findings were classified into three categories according to the gallbladder wall characteristics and the presence of visible lumen and stones. Simple chronic cholecystitis (type I) and acute cholecystitis, with gallbladder wall thickness <5 mm (type IIa) presented significantly lower intraoperative complications without conversion to open surgery. Scleroatrophic (type III) and acute cholecystitis with gallbladder wall thickness >5 mm (type IIB) presented significantly more surgical difficulties and a higher conversion rate to open surgery (p < 0.01). We postulate that this classification will be useful for surgeons in predicting potential problems in individual patients, at least at the initial laparoscopic cholecystectomy experience, and in advising patients of the potential risks of and conversion to open surgery.

Acute Disease↗
PubMed1997

[Gastroesophageal reflux and obesity].

BACKGROUND: There is a possible relationship between gastroesophageal reflux and overweight, that has not been studied extensively. AIM: To study the association between overweight and gastroesophageal reflux in a group of patients and normal controls. SUBJECTS AND METHODS: Body mass index of 85 patients with gastroesophageal reflux and 100 patients with Barrett esophagus, was compared with that of 171 healthy controls. RESULTS: There were no differences in body mass index between healthy subjects and patients with gastroesophageal reflux. However, there was a higher proportion of overweight males and obese females with Barrett esophagus than among healthy controls. CONCLUSIONS: We did not find an association between overweight and gastroesophageal reflux, but patients with Barrett esophagus had a higher body mass index than normal controls.

Adolescent↗
PubMed1996

Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones.

OBJECTIVES: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings. METHODS: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures. RESULTS: Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. CONCLUSIONS: In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.

Acute Disease↗
PubMed1996

The presence of Helicobacter pylori in nonoperated duodenal ulcer patients compared to patients late after highly selective vagotomy.

There are many recent studies that clearly suggest that Helicobacter pylori (HP) is an etiological agent for duodenal ulcer disease (1-3). Randomized trials have shown that duodenal ulcers treated by omeprazole or H2 blockers heal faster if HP is eradicated concurrently (4-6). Besides, several studies have demonstrated that eradication of HP significantly reduces duodenal ulcer relapses (7-9). Patients followed up to 7 years after eradication of HP demonstrated that 92% remained HP negative, with only 3% recurrence (10). Highly selective vagotomy has been the treatment of choice for duodenal ulcer patients who are candidates for surgical therapy (11, 12). The late results have shown an approximately 10% recurrence rate 8 to 10 years after surgery (13, 14). We hypothesized that in these asymptomatic cases after HSV, HP probably will exist in a minor proportion of cases, similar to what happens after successful medical antiulcer therapy. Therefore the purpose of the present study was to determine the HP status at the antrum in a group of nonoperated duodenal ulcer patients compared to a group submitted to highly selective vagotomy many years prior to the actual study.

Adult↗
PubMed1996

[Subjective and objective evaluation of the results of laparoscopic antireflux surgery in patients with gastroesophageal reflux].

BACKGROUND: Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment. AIM: To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux. PATIENTS AND METHODS: Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery. RESULTS: There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 +/- 3.9 to 13.0 +/- 3.5 mm Hg and from 8.1 +/- 6.2 to 13.5 +/- 5.4 cm after surgery (p < 0.01). There was a decrease in acid reflux in 82% of patients. CONCLUSIONS: Laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures.

Adult↗
PubMed1996

[Long-term follow-up of non-operated patients with symptomatic and asymptomatic cholelithiasis].

BACKGROUND: In Chile, cholelithiasis is a serious public health problem and there are no studies about its natural history. AIM: To assess the long term evolution of patients with symptomatic and asymptomatic cholelithiasis. PATIENTS AND METHODS: Ninety two patients with cholelithiasis (57 female), aged 15 to 80 years old and that were not operated, were followed during a period of 9 to 14 years. RESULTS: Thirteen patients were initially asymptomatic. Of them, seven bad complications or symptoms during follow-up and two were operated. Among the 69 symptomatic patients, 38 (55%) were not operated during follow-up, and seventeen (25%) did not have symptoms again. Ten patients died during follow-up, four due to complications of biliary tract stones. CONCLUSIONS: The present finding suggest that the evolution of cholelithiasis in Chile is more aggressive than abroad, and an early surgical treatment is warranted.

Adolescent↗
PubMed1996

[Endoscopic location of squamous columnar mucosal changes in patients with different degrees of pathologic gastroesophageal reflux].

BACKGROUND: There is little information about the precise location of the squamous columnar mucosal junction in the Chilean population. AIM: To study endoscopically, the location of the squamous columnar mucosal junction in patients with esophageal disease. PATIENTS AND METHODS: The location of the squamous columnar mucosal junction was prospectively studied by endoscopy in 347 subjects with normal upper gastrointestinal endoscopy, 117 patients with chronic gastroesophageal reflux without esophagitis, 117 patients with erosive esophagitis, 63 patients with short Barret's esophagus and 28 patients with an extensive Barret's esophagus. RESULTS: No differences in the mucosal junction location were observed between controls and patients with gastroesophageal reflux or erosive esophagitis. In patients with Barret's esophagus, the junction was more proximal. In women, the junction was three cm more proximal than in men, probably due to their shorter stature. CONCLUSIONS: Women have a more proximal squamous columnar mucosal junction than men.

Adolescent↗
PubMed1995

[Presence of Helicobacter pylori in the duodenum, antrum, and fundus in control subjects and patients with duodenal ulcer, gastric ulcer, gastritis, or erosive duodenitis. Histological analysis of 357 subjects].

The prevalence of Helicobacter pylori infection was studied in 152 subjects with a normal upper gastrointestinal endoscopy, 125 with duodenal ulcer, 25 with gastric ulcer, 46 with erosive gastritis and 9 with erosive duodenitis. Two biopsies from duodenum, antrum and fundus were obtained from each subject during endoscopy for histological diagnosis and Helicobacter pylori search. None of the patients with normal endoscopy and 2% of patients with duodenal ulcers had Helicobacter pylori in duodenal biopsies. These last patients had a significantly higher frequency of Helicobacter pylori in the antrum (71%) than the rest of the studied groups. Five percent of subjects with normal endoscopy and 5% of those with duodenal ulcers had Helicobacter pylori in the antrum. An active gastritis was demonstrated in almost all patients with Helicobacter infection. Intestinal metaplasia occurred almost exclusively in the absence of Helicobacter pylori infection.

Adolescent↗
PubMed1995

[Prevalence of digestive symptoms in normal adult women and its association with cholelithiasis].

The aim of this work was to study the prevalence of biliary diseases and digestive symptoms in normal adult women. Four hundred nineteen women were chosen; of these 145 were discarded due to previous gastrointestinal diseases (20), previous gastrointestinal complaints (38) and previous cholecystectomy (85). Two hundred seventy six women were subjected to abdominal ultrasound examination; of these 53 had cholelithiasis and in three a gallbladder cancer was suspected (and confirmed by surgery). Considering women with previous cholecystectomy, cholelithiasis and gallbladder cancer, a 33.6% prevalence of biliary diseases can be inferred. An interrogation about gastrointestinal symptoms was performed to women subjected to ultrasound examinations, by 2 professionals unaware of ultrasound results. A high frequency of pyrosis, food intolerance and constipation was found, not observing differences between women with or without cholelithiasis. However, these last women had a higher frequency of upper abdominal pain. Both groups had also a high rate of previous surgical procedures.

Adult↗
PubMed1995

[Epidemiological and etiological aspects of upper digestive hemorrhage. Multicenter study in nine Chilean hospitals (1980-1990)].

An epidemiological survey about the incidence of upper gastrointestinal bleeding during three periods (1980, 1985 and 1990), was performed in 9 Chilean hospitals. Its annual incidence decreased in 1990, when compared to 1980. Likewise the etiologies changed, with an increase in the incidence of duodenal ulcers and a decrease in the incidence of erosive gastritis and bleeding of unknown origin in 1990. A seasonal variation with higher bleeding rates in autumn was also recorded.

Chile↗
PubMed1994

Late results of primary repair and follow-up in 53 patients with injuries to the common bile duct occurring during cholecystectomy (distal perforation, tears, ligation or suture).

The late results of primary repair of accidental injuries to the common bile duct occurring during cholecystectomy were evaluated in 53 cases. These lesions occurred in 20 patients who had distal perforation produced by the Bakes dilator, in 17 cases with accidental tearing of the anterior or posterior wall of the common bile duct, and in 16 cases in whom the common bile duct was accidentally ligated or sutured. In cases of perforation, choledochostomy plus suturing of the perforation had a high operative mortality and 4 out of 6 cases developed benign stricture soon after surgery. When sphincteroplasty or choledochoduodenostomy was added, a stricture developed in only 1 out of 7 cases. In cases with accidental tears, suturing of the lesion plus choledochostomy produced very good late results. In patients with accidental ligation or suturing of the common bile duct, two different postoperative complications were seen: seven cases had biliary fistula and all developed benign stricture 2 years after surgery. In nine cases jaundice appeared 6 months after surgery, and a benign stricture developed in 7 of them. The most important "treatment" of these lesions is to prevent them from occurring during cholecystectomy by employing a meticulous surgical technique.

Cholecystectomy↗
PubMed1994

[Magnitude of acid gastroesophageal reflux measured by 24-hour esophageal pH monitoring compared to the degree of endoscopic esophagitis].

Twenty four hour esophageal pH monitoring was performed in 110 patients, placing a pH electrode 5 cm above the proximal border of the lower esophageal sphincter. This test allows to measure the total lapse in which there is an acid pH in the esophagus, the ability of the esophagus to get rid of the acid reflux and documents the relationship between esophageal pH and symptoms. Upper GI endoscopy showed a normal esophagus in 38 patients, and esophagitis grade I in 25, grade II in 11, grade III in 25 and grade IV in 11. There was a high correlation between the severity of esophagitis and the total time in which the esophagus was exposed to an acid pH. It is concluded that this test can be used as a "gold standard" for gastroesophageal reflux detection.

Adolescent↗
PubMed1994

[Patients with pathologic gastroesophageal reflux without erosive esophagitis: correlation of the endoscopic and histological aspect of the esophagus].

Eighty four patients with chronic gastroesophageal reflux in whom endoscopy showed a normal or minimally altered esophageal mucosa (hyperemia, erythema or mucosal congestion) were prospectively studied. In each patient, two esophageal biopsies were obtained (1 and 3 cm above the mucosal change zone). Histological esophagitis was found in 28% of patients with endoscopically normal mucosa and in 26% of patients with minimal endoscopical mucosal alterations. It is concluded that the description of these minimal esophageal alterations during endoscopy is subjective, unreproducible and do not clearly indicate the presence of esophagitis. A classification of endoscopical findings is proposed, based on the presence of objective lesions such as erosions or Barrett esophagus.

Adult↗
PubMed1993

Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer.

A prospective randomized clinical trial was performed in order to evaluate the results of three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Ninety patients with clinical and laboratory evidence of gastric retention were enrolled. After laparotomy, patients underwent either highly selective vagotomy (HSV) + gastrojejunostomy, HSV + Jaboulay gastroduodenostomy, or selective vagotomy (SV) + antrectomy. One patient died after HSV + Jaboulay gastroduodenostomy due to postoperative acute pancreatitis. There were no differences in the postoperative course of the three groups. Patients were followed for a mean of 98 months (range: 30 to 156 months). There was a significantly better result after HSV + gastrojejunostomy than after Jaboulay anastomosis (p < 0.01), but not after SV + antrectomy. Gastric acid reduction was similar in the small group of patients studied. We propose HSV + gastrojejunostomy as the treatment of choice in patients with duodenal ulcer and gastric outlet obstruction.

Adult↗
PubMed1993

Location of the lower oesophageal sphincter and the squamous columnar mucosal junction in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis.

In this study the location of the lower oesophageal sphincter measured by manometry and the location of the squamous columnar junction measured by endoscopy were determined in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis. No significant differences in the prevalence and severity of the heartburn and regurgitation were observed when different degrees of oesophagitis were compared but dysphagia was more common and severe in patients with complicated Barrett's oesophagus (p < 0.001). This group also showed a male predominance and older age compared with other groups. The total length of the oesophagus, measured by the location of the distal end of the lower oesophageal sphincter was similar in all patients; however, the location of the squamous columnar junction extended more proximally and was related to the increasing severity of endoscopic oesophagitis. The manometric defects at the cardia were more frequent in severe oesophagitis (p < 0.001). These results suggest that, during the course of oesophagitis, the squamous columnar junction is displaced proximally. This displacement is limited to the mucosa, however, and does not involve the muscular layer, because the lower oesophageal sphincter undergoes no dislocation.

Cardia↗
PubMed1993

[Long-term survival of patients with stomach cancer treated with subtotal gastrectomy].

The aim of this work was to determine the 5 and 12 years survival of 233 patients with gastric cancer subjected to subtotal gastrectomy. Patients with early gastric cancer (n = 51) had a 95% survival and those with intermediate cancer (n = 19) a 87% survival. Patients with advanced gastric cancer (n = 163) subjected to curative surgery had a 60% survival, whereas none subjected to palliative surgery survived. Those patients that survive more than 24 months after the surgical procedure, have an excellent long term prognosis.

Adult↗