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Biomedical subjects

H W Pinotti

Publications and source records attributed to H W Pinotti.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

[Infections of central venous catheters].

The central venous catheter is considered the lifeline of patients requiring long-term parenteral nutrition, and its infectious complications accordingly represent a frequent cause for hospitalization and morbidity. Modern catheters made of Silastic increase the duration and efficiency of venous access, but their substitution is also more complex and expensive. In a small series of patients undergoing home parenteral nutrition due to short bowel syndrome, and carrying. Silastic catheters, infection of the cannula was treated by administration of systemic as well as local antimicrobial agents. The septic process was resolved without the need of removing the catheters, and with excellent tolerance to the medications. It is concluded that in-situ sterilization of long-term catheters should be attempted in selected cases.

Adult↗
PubMedDate not supplied

[Anaphylaxis after dextran 40 infusion: report of a case and review of the literature].

Anaphylactic reactions to colloid volume substitutes, such as dextran, are rare, however, with their increasing utilization in clinical practice an increasing awareness of their potential antigenicity is required. This article reports a severe allergic reaction induced by infusion of dextran 40 during the beginning of a general anesthesia in a 59 year old patient who was going to be submitted to an operation for treatment of chagasic megacolon. The patient died from this complication after 28 days. A review of literature of this complication and a discussion about its physiopathological mechanism and prevention is presented.

Anaphylaxis↗
PubMedDate not supplied

[Simplified model of induction of experimental acute pancreatitis with a supra-maximal dose of cerulein].

The study was performed to compare an usual method of induction of acute experimental pancreatitis with a simplified, easier and faster induction through a subcutaneous and intravenous injection of cerulein, with good reproducibility as compared to the literature. Four groups were studied. In the group I, continuous three hour intravenous injection of 15 micrograms/Kg of cerulein, was given. Group II was a control group with saline infusion. Group III received a subcutaneous injection of 20 micrograms/Kg and an intravenous injection of 20 micrograms/Kg of cerulein one hour later. Group IV was the control group with saline. The results of biochemical measurements, such as tecidual trypsinogen, chimotrypsinogen, proelastase, cathepsin and serum amylase, showed no difference between the two methods. Histologic study revealed edematous pancreatitis in group I and III, with moderate acinar necrose in group III. These results suggest that the proposed simplified method induces enough acute and edematous pancreatitis to allow studies in physiopathology and therapeutics.

Acute Disease↗
PubMedDate not supplied

[Small hepatocellular carcinoma. New concepts on intrahepatic recurrence after hepatectomy in orthotopic liver transplantation].

Hepatocellular carcinoma is one of the most common cancers worldwide. Epidemiologic studies shows a striking correlation between areas where this tumor is prevalent and where hepatitis virus B and C are endemic, contaminations of food with mycotoxin aflatoxin B1, excessive alcohol intake, prolonged cigarette smoking, sexual hormones. Combination of chemical, physical, and genetic insults to individual hepatocytes involve changes in the genome transformed or neoplastic cell, depending to both the activation of oncogenes (e.g., ras) and the inactivation of tumor supressor genes (e.g., p53). Advances in radiologic techniques such as ultrasonography, computed tomography, angiography and dosages of tumor markers like alpha-fetoprotein offers still the best for diagnosis and screening for hepatocellular carcinoma. Then the diagnosis has become possible during the early stages, characterized to be a very well-differentiated tumour that has returned its preexisting liver structure, with a certain proportion have a multicentric origin. Hepatocellular carcinoma carries an extremely poor prognosis, with a median survival between 2-4 weeks, for those without treatment. Surgical resection are the only curative modality for this disease. In these patients two main patterns of intrahepatic recurrence after hepatectomy are defined, and depends on the growth of residual satellite tumours or synchronous and metachronous multicentric carcinogenesis. This evolution is estimated to be nearly 50%, with 5-year survival rate of nearly 30%. The presence of cirrhosis, satellite nodules, venous invasion, the absence of capsule formation and positive surgical margin (< or = 5 mm) were associated with higher intrahepatic recurrence rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Hepatocellular↗
PubMedDate not supplied

[Pyogenic hepatic abscess: report of 51 cases].

Pyogenic hepatic abscesses are uncommon. We report our findings in 51 patients with pyogenic liver abscess treated from 1975 through 1992. Twenty-eight patients were men and twenty-three were women. The median age of patients was 46 years (range, 13 to 77 years). Fever was present in 100% of patients, abdominal pain in 58.8% and jaundice in 39.2%. Twenty eight patients (54.9%) had leukocytosis; 45% hyperbilirrubinemia and 35.3% a high serum level of alkaline phosphatase. The most common cause of abscesses was biliary tract disease (66%). Thirty-three (64.7%) were surgically treated and thirteen underwent percutaneous drainage with 90.4% and 69.2% of good results, respectively. Mortality was 9.6% in the surgical group and 0% in the percutaneously drained group. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Adolescent↗
PubMedDate not supplied

[Chagasic megacolon. Treatment by abdominal recto-sigmoidectomy with mechanical colo-rectal termino-lateral anastomosis. Preliminary results].

Abdominal rectosigmoidectomy with end to side colorectal mechanical anastomosis is proposed as a new technique for surgical treatment of Chagasic megacolon. The rectum is sectioned and closed at the level of the peritoneal reflexion. The end of the descending colon is anastomosed to the posterior surface of the rectum, as distal as possible, using the intraluminal stapler (Ethicon CDH33). The final result of the operation is similar to Duhamel-Haddad technique with the advantage of being a one stage operation. Forty-three patients with chagasic megacolon were operated on during the period 1989-1994. Twenty-seven were female and 16 were male with ages ranging from 23 to 76 and a mean of 46.1 years. Results obtained were satisfactory; there were no deaths; only three postoperative complications occurred (6.9%). Only one of these (dehiscence of the rectal cupula) was specific for the proposed technique. The two others were intestinal obstruction, due to volvulus of the small intestine in one case and to adhesions in the other. All complications were managed by surgery. All patients are being followed regularly and up to the present time they report daily bowel movements, passing well-formed stools. There are no complaints of fecal incontinence sexual function or disturbed formation of fecaloma in the rectal stump. The colorectal anastomosis was ample in all patients. Since this is a one stage operation with a low rate of complications, the short hospital stay largely compensates the cost of the mechanical suturing device. Regarding recurrences, a long follow-up period of at least 10 years is necessary to evaluate the real effectiveness of this technique.

Adult↗
PubMedDate not supplied

[Total regression of advanced gastric lymphoma after drug therapy].

Primary gastric lymphoma is a relatively rare entity that may have several different methods of treatment, including surgery, chemotherapy and radiotherapy. We describe a case of advanced primary gastric lymphoma treated with chemotherapy. A 51-year-old male patient underwent total gastrectomy after two cycles of chemotherapy. The histologic examination of the gross specimen revealed total regression of the lymphoma. Literature review of this condition and a discussion about the diagnosis and treatment are presented.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Duodenal ulcer clinically simulating pancreatic neoplasm].

A small fraction of solid mass in the head of the pancreas are inflammatory rather neoplastic in origin. The failure to recognize the true nature of a solid tumor in the head of pancreas may lead to an incorrect treatment strategy. This is a report of a patient with clinical history of pancreatic cancer which computed tomography showed a mass in the head of the pancreas with radiologic characteristics of malignancy. The patient underwent exploratory laparotomy with the finding of a mass in the head of the pancreas. The inflammatory palpable characteristic of the mass led to a intraoperative biopsy to confirm the preoperative diagnosis. With the benign result of the biopsy, the final diagnosis was duodenal ulcer which penetrates in the pancreatic parenchyma.

Diagnosis, Differential↗
PubMedDate not supplied

[Cervical esophageal membrane and Plummer-Vinson syndrome: report of a caseload and review of the literature].

Esophageal webs are an uncommon group among esophageal diseases. We report our findings in ten patients with membranes in the upper esophagus; seven of them were women. The median age was 48.5 years (range 24 to 73 years). Dysphagia was the main symptom in all patients and anemia was found in six cases. Radiologic and endoscopic studies provided the diagnosis. All patients underwent endoscopic dilatation and/or debridement and good results with this management were achieved. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Adult↗
PubMedDate not supplied

[External jugular vein as central venous access in intensive care patients].

The authors studied 98 patients in need of a central venous line route, joined into two different groups: Group 1 - 62 (63.3%) patients, and Group 2 - 36 (36.7%). All the patients had a visible external jugular vein while on Trendelenburg position. According to the Seldinger technique using a J-wire guided catheter the authors describe a maneuver to make it easy to advance the catheter. Patients from Group 1 had the technique applied by operators with previous experience, and patients from Group 2 by operators with no previous experience, but under supervision. There was no significant difference in the success rate between these two groups: 96.8% in Group 1 and 94.4% in Group 2 (p > 0.5). There was only one case of local bleeding, managed by local compression.

Catheterization, Central Venous↗
PubMedDate not supplied

[Pseudotumor of the stomach: study of 10 cases and review of the literature].

Pseudotumoral form of gastric ulcer is an infrequent clinical presentation of peptic disease. We present the findings in ten patients with this variety of gastric peptic ulcer treated in the last five years. All records including preoperative radiological and endoscopic examinations are reviewed. Five patients were women and five were men. The median age of patients was 62.1 years (range, 45 to 79 years). Epigastric pain was the main symptom in 90% of patients and weight loss in 70%. Six patients underwent surgical treatment. There was no perioperative mortality. A review of literature of this condition and a discussion about the differential diagnosis are presented.

Adult↗
PubMedDate not supplied

[Rectal endometriosis].

Colorectal endometriosis is a relatively rare entity that may have a wide array of clinical symptoms and radiographic findings. A 42-year-old female patient with rectal endometriosis treated with danazol under CA 125, CA 19-9 and estrogen monitoring is described. The treatment was successful and the patient underwent excision of reproductive organs without colorectal excision.

Adult↗
PubMedDate not supplied

[Primary lymphomas of the large intestine].

Primary colorectal lymphomas are rare tumors that comprise 0.5 to 2% of large bowel malignancies and 10 to 20% of gastrointestinal lymphomas. Between 1982-1993 ten patients were treated in the Colorectal Unit of the "Hospital das Clínicas" of the University of São Paulo, representing 2% of the neoplasms in this period. Age varied from 22 to 76 years, with median around 50 years, and male/female ratio 8:2. Weight loss, right iliac palpable mass and bowel habit alterations were the most common symptoms. Definitive diagnostic was only set with histological evaluation of the surgical specimen in all colon tumors. Four patients had advanced disease classified as stages III or IV. The tumors were located in ileocecal region (7 cases), transverse colon (1 case), sigmoid colon (1 case) and rectum (1 case). Colon lymphomas were treated by radical surgical resection and chemotherapy; the patient with rectal lymphoma received radiotherapy and chemotherapy because of local tumor spread. Histological data showed 6 large cell lymphomas and 4 small cleaved cells lymphomas. Lymphnodal involvement and tumor size were the main prognostic factors in the series: 80% of the patients in advanced stage (III or IV) and 66% of those with tumors larger than 10 cm died during the first year of the follow-up.

Adult↗
PubMedDate not supplied

[Conservative treatment of pseudomyxoma peritonei].

Pseudomyxoma peritonei is a clinical entity characterized by gelatinous ascites. It is most often due to a mucinous cystadenocarcinoma of the appendix or ovary. These patients die frequently of bowel obstruction after multiple surgical procedures. A case of pseudomyxoma peritonei treated successfully with intraabdominal infusion of a 2.5% solution of dextrose is reported.

Aged↗
PubMedDate not supplied

[Transformation of hepatic adenoma into hepatocellular carcinoma in patients with prolonged use of oral contraceptives].

Liver cell adenomas were relatively rare until the use of oral contraceptives. Most of these tumors have occurred in otherwise healthy young women who have been exposed to oral contraceptives. The treatment of this condition remained controversial for a long time. However, bleeding is still a frequent complication and can lead to a significant mortality rate. The better surgical results in hepatic resection, due to technological advances, has contributed to the indication of surgical management as therapeutic option in hepatic cell adenoma. Some authors believe that liver cell adenomas were potentially premalignant and could degenerate into hepatocellular carcinoma but there is very few well documented reports of this transformation. We report our experience in the management of liver cell adenoma.

Adenoma, Liver Cell↗