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Biomedical subjects

C M Haddad

Publications and source records attributed to C M Haddad.

26 records · Page 2Linked to original sources
PubMedDate not supplied

[Upper gastrointestinal hemorrhage caused by a fistula from a right anomalous subclavian artery to the esophagus].

Bleeding from an arterio-esophageal fistula is a rare and nearly lethal condition and surgical treatment is the only curative option. We report a case of bleeding from a fistula from an aberrant right subclavian artery to the esophagus. Diagnosis was made only at necropsy, despite of three previous laparotomies. This anatomical variation is found in 0.5% of the general population. Development of a communication between this artery and the esophagus, secondary to aneurysmatic dilatation or to prolonged nasogastric intubation, as probably occurred with this patient, is a extremely rare condition. Surgical treatment depends on the early recognition of clinical signs of the arterio-esophageal communication, before the onset of systemic complications of hypovolemic shock.

Adolescent↗
PubMedDate not supplied

[Obstruction of terminal ileum due to heterotopic gastric mucosa].

Heterotopic gastric mucosa situated in the small bowel distal to the Treitz suspensory ligament is very rare, except in Meckel's diverticulum and in intestinal duplications. There are two forms of this disease, congenital and acquired. The former is secondary to inflammatory bowel disease. The main difference between these forms is histological, although determining diverse physiopathological aspects. A case of a 34 year old man with heterotopic gastric mucosa in the terminal ileum manifested by intestinal obstruction is reported. He was treated surgically by enterectomy of two small bowel segments, both reconstructed by primary suture. His postoperative course was remarkable. The histopathologic study showed a typical pattern of the acquired type because of the presence of antral the antral mucosa and intense fibrosis. That is probably related to intestinal tuberculosis, but was not histologically confirmed. Individual and family recent history of pulmonary tuberculosis corroborates the suspicion. This is a unique report in the literature, among 28 other heterotopic gastric mucosa situated in the jejunum and ileum.

Adult↗
PubMedDate not supplied

[Late results of Heller operation and fundoplication for the treatment of the megaesophagus: analysis of 83 cases].

BACKGROUND: Retrospective study of the late results of the Heller's cardiomyotomy and fundoplication for the treatment of the megaesophagus. MATERIAL AND METHODS: Were studied 83 patients with a follow-up from one to 186 months (average 40.0 +/- 47.4 months). The fundoplications used were in three plans in 15.7% and posterior in 83.1%. The main pre-operatory complain was dysphagia followed by regurgitation and loss of weight. Chagas, Disease as the etiology was confirmed in 72.3% of the patients. RESULTS: In the follow-up 55.4% of the patients were assymptomatic, 34.9% complained of sporadic dysphagia, 14.4% of heartburn, 8.4% of regurgitation and 2.4% did not changed the dysphagia, these being re-operated and had improvement the symptoms. Gastro-esophageal reflux was noted in 8.4% of the patients. Other late complications were par-esophageal hernia, sliping of the fundoplication, Barrett esophagus and cancer. CONCLUSIONS: The necessity of a long-term clinical and endoscopical follow-up, even after surgery, owing to the possibility of late complications, especially cancer was emphasized. The late results are good in relation to the dysphagia. Myotomy is proposed as an alternative to patients with advanced megaesophagus with bad clinical conditions who can not be submitted to an esophagectomy.

Adolescent↗
PubMedDate not supplied

[High dose rate brachytherapy].

The high dose rate brachytherapy uses a single source os 192Ir with 10Ci of nominal activity in a remote afterloading machine. This technique allows an outpatient treatment, without the inconveniences of the conventional low dose rate brachytherapy such as use of general anesthesia, rhachianesthesia, prolonged immobilization, and personal exposition to radiation. The radiotherapy department is now studying 5 basic treatment schemes concerning carcinomas of the uterine cervix, endometrium, lung, esophagus and central nervous system tumors. With the Micro Selectron HDR, 257 treatment sessions were done in 90 patients. Mostly were treated with weekly fractions, receiving a total of three to four treatments each. No complications were observed neither during nor after the procedure. Doses, fraction and ideal associations still have to be studied, so that a higher therapeutic ratio can be reached.

Brachytherapy↗
PubMedDate not supplied

[Endoscopic sclerotherapy of bleeding esophagogastric varices and functional liver status].

Endoscopic sclerotherapy of bleeding gastroesophageal varices was carried out in 52 patients within a sclerosis program for acute hemorrhage. According to Child's classification, 18 (34.6%) were A, 12 (23.1%) B and 22 (42.3%) C. The hemorrhagic focus was endoscopically proven in oesophageal varices in 45 (86.5%) and in 7 (13.5%) in gastric varices. The sclerotherapy was performed by both intra and extravascular injections of 3% ethanolamine according to treatment for emergency bleeding. The procedure was repeated on the 7th day or when necessary for recurrent hemorrhage. Hemostasis was achieved in 94.4% Child's class A, 75.0% Child's class B and 54.5% Child's class C, all of them with bleeding oesophageal varices. All patients with severe gastric hemorrhage (2 Child's class A, 2 Child's class B and 3 Child's class C) needed surgical treatment for uncontrolled bleeding. Liver failure and bleeding were the leading causes of death in 15 (68.1%) Child's class C and 2 (16.6%) Child's class B. There was no death in Child's class A. The conclusion was drawn that the results of endoscopic sclerotherapy of bleeding oesophageal varices was effective and clearly related to liver function. The endoscopic sclerotherapy, however, was not able to control severe hemorrhage from gastric varices and this was not related to liver function.

Brazil↗
PubMedDate not supplied

Late clinical, biochemical, endoscopic and electroencephalographic evaluation of patients with schistosomal portal hypertension treated with distal splenorenal shunt.

The authors performed a late evaluation of a distal splenorenal anastomosis minimum of five years following operation on 13 patients with schistosomiasis of the compensated liver-splenic type. The study of the anastomosis had been proven patent when the evaluation took place. Each patient underwent clinical, laboratorial, endoscopic and electroencephalographic assessment. The results demonstrated that no patient had shown any sign of recurrence of upper gastrointestinal hemorrhage. Among the endoscopic aspects, esophageal varices disappeared in 46.1% of the cases. There was reduction in the number, extent and volume of esophageal varices in 46.1%, 38.4% and 53.8% of the cases. Gastric varices disappeared in 91.6% of the cases. Only one patient (7.6%) had shown clinical and electroencephalographic signs of hepatic encephalopathy in the late final evaluation (non-significant). Only one patient (7.6%) had shown late postoperative ascites (non-significant). There were no significant alterations in serum levels of sodium, potassium, urea and creatinine in all the 13 patients. The values of indirect serum bilirubin increased in 92.3% of the patients. There was regression of splenomegaly in all 13 patients, as well as a significant improvement in their hematological values. There were no significant changes in the serum levels of aspartate aminotransferase and alanine aminotransferase or in the activity of the plasma prothrombin. The authors concluded that the distal splenorenal anastomosis became a protection factor against upper gastrointestinal hemorrhage and led to long-term improvement in the endoscopic aspects of esophagogastric varices, a significant improvement in the laboratorial aspects of hypersplenism and a marked reduction of splenomegaly with no significant changes in the hydroelectrolytic metabolism, renal function and hepatic function and had not compromised, long term, the quality of life of the majority of patients.

Adult↗