[Surgical treatment of portal hipertension by means of selective vascular derivations (author's transl)].
Explore the source record for details and available documents.
Arteriovenous Shunt, Surgical↗
Biomedical subjects
H Orozco
Publications and source records attributed to H Orozco.
[A comparative study of complications after vagotomy-pyloroplasty using Sugiura-Futagawa procedure and surgery of acid peptic disease].
BACKGROUND: The frequency of complications of vagotomy and pyloroplasty for treating peptic disease is considerable. The modification of the Sugiura-Futagawa procedure includes bilateral truncal vagotomy and pyloroplasty as part of the devascularization, with a low frequency of related complications. AIM: To study the effects after VP in the outcome of both groups of patients. RESULTS: The results of a retrospective, comparative, not randomized, controlled trial of 153 medical records of patients who underwent our modification of the Sugiura-Futagawa operation (SFO) due to Hemorrhagic Portal Hypertension (HPH), and 100 patients with bilateral truncal vagotomy and pyloroplasty (VP) due to Acid-Peptic Disease (APD) are presented. In both groups VP was done. The first group as part of SFO, and the second to treat their disease. We found 47 complications; 40 (40%) were observed in patients who underwent VP for APD and 7 (4%) in SFO: Post-vagotomy Diarrhea (PVD): 11% after APD and 2% after SFO. Dumping Syndrome (DS): 22% and 1%, and Alkaline Reflux Gastritis (ARG): 7% and 0.5% respectively. The calculated risk of developing complications related to vagotomy and pyloroplasty in peptic ulcer disease was 14 times higher. CONCLUSIONS: The incidence of these post VP complications at the SFO group was low (4%), in relation to 40% for the APD; the outcomes were statistically significative (p < 0.05).
Adolescent↗
[Open cholecystectomy in cirrhotic patients. Experience at the Salvador Zubirán National Institute of Nutrition].
BACKGROUND AIMS: To inform the morbidity and mortality observed in cirrhotic patients who underwent open cholecystectomy. METHODS: We reviewed the clinical records of 31 cirrhotics that underwent open cholecystectomy and they were compared with a control group of the same age and sex. RESULTS: Despite administration of plasma or vitamin K or both, bleeding and transfusions during surgery were observed more frequently in cirrhotics. The morbidity was 13% in the controls and 42% in the cases. Renal failure, cardiac failure and upper gastrointestinal bleeding were present only in the cirrhotics. Mortality was 16% in this group (one Child A patient and four Child B-C patients). The variable related with major morbimortality was Child B or C classification. CONCLUSIONS: Open cholecystectomy was associated with high morbimortality. The valoration and preparation before surgery must be careful, and the indication from this procedure needs to be made with caution.
Adult↗
[Primary cancer of the liver].
The epidemiologic and pathogenic aspects of primary hepatic malignancies are discussed. The role of viruses in the etiology of the disease is stressed. Imageology methods have a preponderant role for diagnosis and treatment options. Liver resection has a one years survival between 60 and 80% and a five years survival of 20 to 40%. A good surgical results is expected for tumors with no more than 5 cm in diameter, encapsulated and without vascular invasion non-cirrhotic livers, large tumors can also be removed. Surgical resection margin should be of 1 cm. For cirrhotic livers, a good liver function is needed (Child A-B) and no safe major resection can be done. History of bleeding portal hypertension has a negative role in the outcome. Liver transplantation should be limited to selected case, in which the tumors are small and asymptomatic (incidental). For larger tumors, long term results are not good with invariable recurrency of the tumor.
Adult↗
[Metastatic disease of the liver: surgical perspective].
Approximately half of patients with colorectal cancer will develop hepatic metastases and it is estimated that up to 10% of that group will have resectable liver disease. Surgical resection remains the first line treatment option of metastatic liver tumors and has yielded a 20 to 40% five year survival rate. Selection of appropriate patients for resection is critical to a successful outcome. The best results are obtained in patients with isolated metastases. Factors that are associated with a poorer results are the presence of four or more lesions or a surgical margin less than 1 cm. Endocrine metastases can be resected in a palliative fashion but each case has to be individualized. This is also true for non colorectal-nonendocrine metastases. For this tumors the experience is anecdotal and confined to limited reported series. Adjuvant treatment (infusional chemotherapy and chemoembolization) can also have a role in treatment as well as cryotherapy.
Antimetabolites, Antineoplastic↗
[Small-diameter portosystemic shunts: indications and limitations].
Low diameter porto-systemic shunts for the treatment of portal hypertension bleeding have emerged as a consequence of the technical development of vascular grafts (PTFE) that allow the use of a narrow lumen. The experience with this kind of operation at the Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City during a 6-year period is reported. There were twenty-seven patients with good liver function (Child-Pugh A-B) were operated or electively, average Age 47.5 years (range 17-71), twenty three patients with liver cirrhosis, one with portal fibrosis and three with idiopathic portal hypertension. Operative mortality: 4%. Rebleeding: 14%. Postoperative encephalopathy was observed in 14 of 27, three of them being grade III-IV (11%). In the remaining 11 cases, it was mild and easily controlled. Postoperative angiography showed shunt patency in 81% of the cases; in 33% of the cases, portal vein diameter reduction was shown, as well as two cases with portal vein thrombosis. In 77% of the cases, adequate postoperative quality of life was observed. Survival (Kaplan-Meier): 86% at 12 months and 56% at 60 months. These kinds of shunts are a good alternate choice for patients considered for surgery, in which other portal blood flow preserving procedures (selective shunts, devascularization with transection) are not feasible.
Adolescent↗