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Biomedical subjects

E Jaurrieta

Publications and source records attributed to E Jaurrieta.

At least 73 records · Page 4Linked to original sources
PubMed2000

Perforated colonic cancer. Evolution and prognosis.

OBJECTIVE: The purpose of this study was to determine whether patients with perforating colonic cancer, among patients who need emergency surgery, should be considered to comprise a group with a worse prognosis. METHODS: We retrospectively revised the clinical records for 91 cases of emergency primary resection for carcinoma of the colon, of which 22 were perforating (4 Dukes A, 10 Dukes B and 8 Dukes C) and 69 were obstructive (3 Dukes A, 30 Dukes B and 36 Dukes C). For purposes of comparison we also analyzed a synchronous series of 112 patients who underwent elective surgery. RESULTS: There were no recurrences or deaths among the 7 patients with Dukes A disease (follow-up from 6 to 90 months), so these patients were excluded. In the 84 remaining emergency patients, 38 showed progression of the disease (13 local recurrence, 17 liver metastases, 4 lung, 3 peritoneal and 1 bone metastases). There were 26 deaths (6 patients with perforating and 20 with obstructive disease). There was no significant difference in survival or disease progression between patients with perforating and obstructive disease. CONCLUSIONS: These results do not support the classical view of considering perforating cancer as a type with an especially ominous prognosis among patients who require emergency surgery.

Adult↗
PubMed2000

Hypothyroidism after iodine-131 or surgical therapy for Graves' disease hyperthyroidism.

BACKGROUND: The aim of this work was to describe late permanent hypothyroidism after iodine-131 or surgery, and to seek predictive factors of hypothyroidism for the two treatments. MATERIAL: From 1979 to 1994, 462 patients with Graves' disease hyperthyroidism underwent definitive treatment. Three hundred and fifty-five patients were treated with low calculated doses of iodine-131, and 107 patients with subtotal thyroidectomy. Life-table analysis was performed and the cumulative incidence of hypothyroidism was calculated by Kaplan-Meier's method, and survival (euthyroidism) within the groups was compared by the Mantel-Cox method. RESULTS: Of the 355 patients treated with one dose of 6.6 1.9 mCi of iodine-131, 246 became euthyroid after one dose, and 109 needed 2 or more doses. Twenty-two patients received one or more doses higher than 10 mCi. The probability of euthyroidism at 145 months after low-dose was 10. 19% and age, sex, pretreatment with antithyroid drugs, previous subtotal surgery did not influence the final outcome. Of the 107 surgically treated patients the probability of euthyroidism at 144 months was 56.1%. Age, sex, duration of hyperthyroidism, duration of antithyroid treatment, weight of thyroid resected, did not influence the final outcome. The weight of the thyroid remnant was 5.4 1.5 g and the multivariate statistical model by conditional logistic regression showed that the weight of thyroid remnant was the only variable that influenced long-term thyroid function. CONCLUSIONS: There is no ideal dose of iodine-131 that would correct hyperthyroidism in Graveś disease without risk of hypothyroidism. Surgery is an alternative definitive treatment with a risk of hypothyroidism within the 2 first years, and a cumulative risk of hypothyroidism lower than with iodine-131.

Adult↗
PubMed2000

Results of treatment in severe acute pancreatitis.

AIM: To analyze our results in the management of severe acute pancreatitis (SAP), especially in patients who required surgery. METHODS: In a retrospective study, 90 patients admitted between January 1992 and January 1998 were diagnosed as having SAP on the basis of clinical and radiological criteria. Contrast-enhanced tomography (CT) was done in all patients. The surgical technique of choice was necrosectomy and postoperative local lavage. RESULTS: Seventy percent of the patients (63/90) had pancreatic necrosis. Tomography had a sensitivity of 73% in detecting necrosis. Forty-nine patients (54%) needed surgery: 31 had infected SAP and 18 had sterile pancreatitis. Overall mortality rate was 25.6% (23/90); mortality was 43.8% (14/32) in patients with infected pancreatitis and 15.5% (9/58) in those with sterile SAP (p < 0.05). The mortality rate was 44.4% higher (8/18) in patients with sterile SAP who were operated on. Patients with infected SAP who were operated on during the first week of admission had a higher mortality rate (81%) than those operated on after the first week (20%) (p < 0.05). CONCLUSIONS: Pancreatic necrosis and infection are the most important prognostic factors in the course of SAP. The sooner the patients are operated on, the worse the prognosis, especially if there is infection. Efforts should be aimed at avoiding the onset of infection and organ failure, and at delaying surgery.

Abscess↗
PubMed1999

Influence of the vitamin D receptor gene polymorphism on bone loss in men after liver transplantation.

BACKGROUND: Bone loss is a frequent complication after liver transplantation. OBJECTIVE: To investigate whether vitamin D receptor gene polymorphism influences bone loss in men after liver transplantation. DESIGN: Prospective cohort study. SETTING: University hospital. PATIENTS: 55 male candidates for liver transplantation. MEASUREMENTS: Lumbar spine bone mineral density was measured before and 3, 6, 12, and 24 months after liver transplantation. Vitamin D receptor genotype was determined by restriction endonuclease Bsml. RESULTS: Vitamin D receptor genotypes were significantly associated with post-transplantation changes in bone mineral density (P = 0.028). Within 3 months after transplantation, patients with the genotypes Bb or BB showed a vertebral bone loss substantially greater than that in patients with the bb genotype (between-group difference in the percentage change with respect to baseline bone mineral density, 3.7% [95% CI, 0.6% to 6.9%1). In 3 to 24 months after transplantation, bone mineral density increased steadily in the three allelic groups. CONCLUSIONS: Vitamin D receptor gene polymorphism influences bone loss after liver transplantation. Patients with the bb genotype are, to some extent, protected against post-transplantation bone loss.

Bone Density↗
PubMed1999

Analysis of the complications of the piggy-back technique in 1,112 liver transplants.

BACKGROUND: The "piggy-back" technique has gained acceptance in adult orthotopic liver transplantation during the last few years, especially in European countries. At the moment, however, there is controversy over advantages or specific complications (suprahepatic thrombosis or narrowing, etc.) related to this surgical technique. The aim of this study is to know of the immediate per-and postoperative morbidity and mortality rates in 1112 orthotopic liver transplantations performed with a vena cava preservation technique. METHODS: All liver transplant units in Spain were sent a questionnaire on retrohepatic vena cava preservation during orthotopic liver transplantation. The number of orthotopic liver transplantations that had been performed in the seven centers that answered the questionnaire, because the beginning of the program, was 1674, with the vena cava preservation technique used in 1112. RESULTS: Twenty-eight patients (2.5%) had intraoperative complications related to the vena cava preservation technique, which were treated during the operation. Eleven patients (1%) had early postoperative complications (first week), the most frequent (nine cases) being an acute Budd-Chiari syndrome in the first 48 hr. Three patients developed symptoms of massive ascites between 2 and 3 months (late postoperative complications), with patency of the retrohepatic cava verified by cavography. A hemodynamic study revealed a hyperpressure at the suprahepatic veins. This chronic Budd-Chiari syndrome was controlled in all patients with diuretics. Only six patients (0.5%) died as a result of complications related to the "piggy-back" technique. These complications were more frequent when venous reconstruction was done using two suprahepatic veins than when the three veins were used (P<0.001). CONCLUSIONS: The vena cava preservation technique can be used routinely in orthotopic liver transplantation because it is safe and efficient and involves few surgical complications especially if for venous reconstruction we use the patch obtained by joining the three suprahepatic veins.

Adult↗
PubMed1999

Laparoscopic adrenalectomy. A review of 30 initial cases.

BACKGROUND: Laparoscopic adrenalectomy is a good option for removal of the adrenal gland that is becoming preferred over the conventional open technique. METHODS: We reviewed the initial 30 laparoscopic adrenalectomies (in 27 patients) that were performed at our institution from 1995 to 1998. We used the lateral decubitus transperitoneal approach in 26 cases and the retroperitoneal approach in only one case. The indications for adrenalectomy were Conn's adenoma in eight patients, pheochromocytoma in six, Cushing's syndrome in five, nonfunctional adenomas in seven, and metastasis in one case. RESULTS: Only two patients (7%) were converted to laparotomy. Operating time ranged from 75 to 240 min. Average adrenal gland size was 6.1 cm (range, 4-9 cm). There was no mortality, and morbidity occurred in only two patients (8%)-one case of self-limited gastrointestinal bleeding and one case of hypercapnia and subcutaneous emphysema (in the only patient operated by the retroperitonal approach). Mean hospital stay was 3 days (range, 1-6). CONCLUSIONS: Laparoscopic adrenalectomy is a safe and useful procedure for nearly all adrenal pathologies. Lateral decubitus transperitoneal approach is the procedure of choice in most cases.

Adenoma↗