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Biomedical subjects

H Aletras

Publications and source records attributed to H Aletras.

At least 37 records · Page 2Linked to original sources
PubMed1990

Early endoscopic fibrin sealing of high-output postoperative enterocutaneous fistulas.

In seven patients with high-volume enterocutaneous fistula following gastric surgery, a new method of treatment was used. Fibrin tissue adhesive was applied transintestinally under endoscopic guidance, in one or multiple sessions, to occlude the anastomotic dehiscence and the perianastomotic cavity. Fistula output diminished rapidly in all cases, and complete closure was endoscopically confirmed. There were no complications related to the method. Because of the simplicity and safety of this procedure compared with the complexity of surgical treatment and the persistently high mortality associated with conservative management, interventional endoscopic approach is suggested as an option for treatment of high-volume alimentary fistula.

Adult↗
PubMed1989

Congestive gastropathy and antral varices: is there an association?

Gastric mucosal lesions are frequently observed during endoscopy in cirrhotics, but only recently has attention been paid to the gastric mucosal vessels themselves as the cause of such lesions. The presence - observed during endoscopy - of areas of erythema outlined by a yellow mosaic-like network, and the existence - ascertained by histology - of focal ectasia of mucosal vessels are termed "congestive gastropathy". In a prospective investigation of this entity, gastric mucosal biopsies have been obtained in 20 portal hypertensive patients with or without signs of congestive gastropathy at their initial sclerotherapy session. During the progress of the study two - Child's C - patients (having negative endoscopic and microscopic findings of congestive gastropathy) exhibited severe lesions of congestive gastropathy at the 2nd and 3rd session, respectively, and further biopsies were therefore obtained. Histologic examination after eosin-hematoxylin and Masson's trichrome staining revealed dilated mucosal vessels. At the 3rd and the 5th sclerotherapy session, respectively, - their esophageal varices having been obliterated - antral varices were prominent. We ascribe the endoscopic changes observed in the gastric mucosa to the alteration of gastric vascularity due to blood flow redistribution, but we pose the question as to whether there is any association between these progressive mucosal alterations and the formation of antral varices.

Adult↗
PubMed1989

Experimental acute and chronic vascular access through the femoral vessels: hemodynamic study in dogs.

In a side-to-side fistula between femoral artery and vein, an external "shunt" was created that simultaneously connected the distal femoral vein and the proximal femoral vein in 14 normal dogs with weight ranging from 14 to 28 kg. Blood flow and pressure alterations of different sites of this experimental model of vascular access were studied. The results showed that the degree of blood flow on these two vascular communications depends on the structural integrity of the femoral artery with adequate blood flow and blood pressure. Also, the correct connection of external shunt with the fistula is of equal importance. It is suggested that the blood pressure as well as the blood flow rate of these two vascular communications were adequate to allow performance of acute and chronic hemodialysis.

Animals↗
PubMed1989

Formalin-induced experimental sclerosing cholangitis in the rat.

The few reported cases of sclerosing cholangitis following removal of an echinococcus cyst are thought to be a consequence of the chemical action of formalin used for sterilization of the residual cavity. The aim of this study was to assess this hypothesis. We injected 0.15ml of 2% buffered formalin solution into the central hepatic lobe of five rats, after a midline laparotomy. At 6, 12, 18 and 24 weeks after formalin injection all rats were reoperated upon and a sample of hepatic parenchyma from both the central and the left hepatic lobe was obtained for microscopic evaluation. Our findings, dilatation of portal tracts and bile canaliculi, thickening of the pericanalicular cytoplasm, portal and periportal inflammatory cell infiltration and fibrosis and enlargement of the perisinusoidal space of Disse, suggest that 2% formalin solution leads to the development of essential phenomena of cholestasis and sclerosing cholangitis in the rat, so thus it should be avoided in liver hydatid disease surgery.

Animals↗
PubMed1988

Endoscopic observations of the residual cavity after liver hydatid disease surgery.

Endoscopic inspection of the residual cavity after liver hydatid disease surgery has the potential of determining the cause of delayed cavity obliteration by providing information about the inner surface condition. We therefore performed endoscopy whenever there was an unsatisfactory rate of reduction of the residual cavity size. Over the last 6 years, 72 patients have been operated upon for liver hydatid disease. Of these, 42 had wide-bore catheter drainage of the echinococcal cavity and 30 had primary surgical closure. In 17 of 42 patients, endoscopy was performed 3-14 months postoperatively, because the cavity showed no evidence of reduction in size. A flexible choledochoscope was passed through the transcutaneous drainage fistula. Silk sutures were found four times and residual parasitic elements were found 3 times. These were all removed. In 13 patients, the cavity was inspected within 6 months postoperatively; their inner cavity surfaces were covered with white soft areolar tissue. The other 4 patients' cavities were examined within 6-14 months; hard fibrous connective tissue was found. Two patients required reoperation, and in both cases the cavity collapsed within 3-12 months postoperatively. We conclude, that endoscopy of the residual cavity is a useful procedure for both recognition and removal of the cause of delay in the cavity obliteration and can lead to collapse of the cavity.

Echinococcosis, Hepatic↗
PubMed1988

Common bile-duct mucosa in choledochoduodenostomy patients--histological and histochemical study.

We describe the histological and histochemical changes of the common bile-duct mucosa in specimens obtained by means of peroral cholangioscopy, 1-12 years after choledochoduodenal anastomosis. Our findings--hyperplasia of the superficial epithelium, metaplastic goblet cells containing predominantly acid sialomucins, and pyloric-like gland formation containing neutral mucins--express a morphological and functional differentiation of the common bile-duct mucosa that probably facilitates its survival in a different environment. We consider that these adaptive changes may explain the uneventful long-term postoperative period of choledochoduodenostomized patients.

Choledochostomy↗
PubMed1987

Choledochoscopy in intrabiliary rupture of hydatid cyst of the liver.

From 1981-1985, 62 patients have been operated upon for hydatid disease of the liver. Nine patients presented with hepatic colic, chill and fever; seven cases also showed obstructive jaundice, as their cysts had ruptured into the biliary tree. A large communication between the pericyst cavity and the bile ducts was confirmed at operation. The common bile duct was explored in all nine patients and laminated membranes and daughter cysts were found in three cases. Following this, choledochoscopy was performed. Retained membranes and a stone were revealed in one of these three patients. In two other cases from the remaining six negative explorations, laminated membranes were also found. We therefore recommend choledochoscopy not only in biliary lithiasis, but in every case of intrabiliary rupture of a hydatid cyst of the liver.

Adult↗
PubMed1986

Dumb-bell intrathoracic and intraspinal neurofibroma. Report of a case.

Neurogenic tumors of the posterior mediastinum commonly constitute an extraspinal portion of a dumb-bell tumor affecting the spinal canal. In a 42-year-old man with a history of back pain for more than 6 months and severe lower-limb paralysis and impaired urinary voiding for 20 days, chest radiography showed a posterior mediastinal mass and thoracic myelogram a total extradural defect at the level of T10. A computed tomography scan showed extension of this intrathoracic mass into the intraspinal space through the spinal foramen. In a single-stage operation, posterolateral thoracotomy and laminectomy were performed. This surgical approach avoids complications, notably from traction on the spinal cord.

Adult↗
PubMed1986

Endoscopic anatomy of choledochoduodenostomy in relation to clinical observations.

Thirty patients having undergone choledochoduodenostomy for benign biliary diseases were studied by means of endoscopy. The endoscopic anatomy of the anastomosis was classified into two types. Inflammatory changes of the choledochal mucosa adjacent to the stoma were found in nine cases. Endoscopy of the proximal and distal (blind) segment of the common bile duct was accomplished in 19 and nine patients, respectively. It is very probable that these inflammatory mucosal changes could lead to complications.

Biliary Tract Diseases↗
PubMed1985

Rigid or flexible choledochoscopy?

This is a comparative study of two types of choledochoscopes: The Wolf rigid scope and the flexible CHF B3 Olympus scope. These were used for the exploration of 120 consecutive cases of common bile duct disease covering a 4-year period. The rigid and the flexible choledochoscopes were used in 30 and 88 cases, respectively, while in another 2 cases both scopes were used to complete the examination. We established that the Wolf scope does not provide ease of handling in inexperienced hands. Its low price and durability under rough handling should not be an excuse for recommending it for beginners. On the other hand, the Olympus scope is an expensive and delicate instrument, which is much easier to handle. Both choledochoscopes can, however, equally provide good results in experienced hands.

Common Bile Duct Diseases↗
PubMed1982

Pancoast's syndrome following an intrapleural rupture of a hepatic echinococcus cyst.

A case of Pancoast's syndrome due to a hydatid cyst is described. The cyst developed secondarily, after intrapleural rupture of an echinococcus cyst situated in the liver. The patient was operated and the cyst excised. After the operation the pain in the shoulder and the arm disappeared immediately. The Horner's syndrome needed longer to subside. Three years after the operation there is still some constriction of the pupil of the right eye. The development of Pancoast's syndrome due to hydatid disease is very rare and this case--caused by a secondary cyst after intrapleural rupture of a similar hepatic echinococcus cyst--is the first described in the literature.

Echinococcosis↗
PubMed1982

A new method of repairing extensive tubular tracheal defects. Experimental work.

After a short review of several surgical methods used for the reconstruction of long tubular tracheal defects a new surgical method that was carried out on 36 dogs is described. Seven dogs were excluded from the experiment because of failure in the creation of the 'graft' consisting of heavy Marlex mesh and fascia lata, 'biologically' organized together during the first-stage operation. Twenty-nine dogs were subjected to the second-stage operation during which a tracheal defect, created after removing 5 to 11 cartilaginous tracheal rings, was bridged with the 'graft' taken from the site of implantation of heavy Marlex mesh and formed in a cylindrical fashion. The period and the rate of survival were both significant in many instances. The main characteristics were the relative lack of granulation tissue, usually developing at the lines of anastomoses in other series, and the appearance of new epithelium which, in a good number of cases, partially or almost completely covered the lumen of the new trachea.

Animals↗