Biomedical subjects
Publications and source records attributed to H W Pinotti.
Duodenal perforation is a rare complication of endoscopic sphincterotomy and its treatment is controversial. The authors report three cases of duodenal perforation by endoscopic sphincterotomy. In two cases with history of a previous biliary infection, surgical treatment had to been performed because of a peripancreatic abscess.
Three cases of Frantz tumor, a papillary and cystic tumor of the pancreas, are discussed and compared with other cases reported in the literature. The neoplasm behaved in these three cases as a benign tumor. Pancreaticoduodenectomy was performed in one patient and distal pancreatectomy in the other two. C T scan and ultrasonography are useful for the diagnosis of these tumors. Cut surfaces show mostly well encapsulated tumors with the characteristically solid and hemorrhagic-necrotic patterns. Usually they are of a very low-grade malignancy so the complete surgical removal is the treatment of choice.
In 190 patients with malignant gastric neoplasia the value of laparoscopy for diagnosing intra-abdominal metastases was investigated. At the laparoscopic examination the presence of tumoral tissue was appraised on the serosal coat of the stomach, epiploons, parietal and visceral peritoneum, and in the liver. On hand of laparoscopic findings (peritoneal or hepatic metastases) the surgical treatment was discarded in 34 patients (70.6%). In the remaining 29.4% of patients a bad general condition or concomitant diseases contra-indicated surgical intervention. A comparison of laparoscopic and surgical findings showed that correct diagnosis was established by laparoscopy in 61.4% of cases with tumoral invasion of gastric serosa, in 21.4% of cases with involvement of epiploon, in 27% of parietal peritoneum, and in 33.3% of the liver. Falsely positive findings were rare (5% of examinations).
A variety of clinical calculations, including serum cholesterol, have been used as parameters of prognostic value in surgical populations, but there are few studies aimed at patients with esophageal carcinoma. In a set of patients with established esophageal cancer, cholesterol and triglyceride levels were recorded, along with the following parameters: age, sex, body weight, serum albumin, total lymphocytes, and hemoglobin concentration. Manual grip strength was measured, along with delayed cutaneous hypersensitivity response, and the type of surgical treatment was distinguished (palliative versus radical). Total complications and postoperative hospitalisation time are the main indicators used in our study for the surgical results. Patients were divided into two groups: those with serum cholesterol levels over 150 mg/dl (Group I) and those under that figure (Group II). Most nutritional and functional values were lower in Group II patients, for whom the radical surgery rate was also lower, with greater postoperative morbidity. It was concluded that 1): Cholesterol depletion is associated with nutritional and immunological alterations and 2) post-surgical results are poorer in patients with levels below 150 mg/dl.
Antioxidants and free radical scavengers are molecules endowed with the ability of neutralizing reactive oxygen species that may accumulate in the organism during various pathologic processes. In circumstances of peroxidation of lipids and damage to enzymatic chains, cell membranes and other structures may be followed by functional losses and even cell death. Many antioxidants are normal constituents of the diet in the form of vitamins, trace elements and amino acids, and other useful properties cannot be easily distinguished from their free-radical scavenging abilities. Much controversy surrounds also the indications of these substances, both for prophylactic and therapeutic purposes. The first large-scale population studies have only recently been arranged, and additional investigations are required in many promising areas, including cancer patients undergoing chemo and radiotherapy.
Correlations between tomographic findings and the outcome of the disease was made in 49 patients with necrotizing pancreatitis submitted to surgical treatment. Mortality rate was 20.40% resulting mostly from sepsis and multiple organ failures. There was no correlation between APACHE II index and number of necrotic areas diagnosed by abdominal computed tomography although they were closely related with mortality. These findings suggest that different necrotic areas have different prognostic values. The root of the superior mesenteric artery and retropancreatic area were related to worst prognosis with 100% mortality rate. Incomplete necrotic tissue removal is the possible explanation for the high mortality rate.
This study aims to compare gastric emptying of solid meals in two different duodenal ulcer populations and their respective control groups. The same authors, utilized the same methods, but on different occasions. Four study groups were composed as follow: DU I--15 patients, CI--12 patients, DU II--16 patients, C II--15 patients. All individuals underwent high gastrointestinal tract evaluation. Endoscopy was normal in all subjects of the control groups. The ulcers were active but without reducing of the duodenal lumen. Gastric emptying was studied with the use of 30 grams of Tc tagged chicken liver. Measurements of Gastric emptying were taken by a gamma camera Ohio-series ON-150) with 15 minutes intervals during 120 minutes. Emptying rates expressed as percent of the test meal remaining in the stomach were submitted to KRUSKAL-WALLIS STATISTICAL analysis at each time and were identical in the groups, DU I, C I and C II. Emptying rates were significantly lower in the DU II group compared to the others. This study permits us to conclude that the gastric emptying in duodenal ulceration can be normal or delayed for reasons not clearly understood.
Gastric chloride acid plays an important role in pancreatic enzyme synthesis and secretion, mediated by cholecystokinin released in the duodenum. This study was designed to evaluate the influence of gastric acid suppression by omeprazole on pancreatic enzyme content. Eighteen male Wistar rats (180-220 g) were divided in two groups: I--control and II--omeprazole. Animals received by intraduodenal catheter 3 doses of 0.5 ml saline solution (NaCl 0.9%)--Group I or 5 mumol/Kg of omeprazole solution--Group II at 24 h intervals. All animals, after an overnight fasting period, were killed 3 h after the last dose. Serum amylase and pancreatic tissue content of protein, trypsinogen, elastase, lipase and phospholipase A2 were determinated. Omeprazole treated animals (group II) showed statistically significant lower levels of serum amylase and pancreatic trypsinogen content (P < 0.05). We believe that this effect is related with acid secretion suppression by omeprazole and that it may be mediated by cholecystokinin.
A 71-year-old female with a rupture of left intrahepatic artery aneurysm with acute upper abdominal pain, weight loss and fever. The diagnosis was established with doppler ultrasound, contrasted abdominal computer tomography scanning and celiac and mesenteric artery angiography. Prompt recognition and left hepatectomy led to a favourable outcome.
Clinically detectable signs of lung injury develop in up to 70 percent of patients with acute pancreatitis. In order to study the pulmonary injury, experimental haemorrhagic pancreatitis was induced in 63 Wistar rats by intraductal injection of 5 per cent sodium taurocholate. Investigations were carried out 2, 4, 6, 12, 24 and 48 hours after the end of pancreatitis induction. Lung injury was maximal at 12 hours after pancreatitis induction, pancreatic enzymes (amylase and trypsin) in peritonial fluid were maximal early (2-4h) and serum levels were maximal at about 4 hours after induction. In conclusion, in experimental acute pancreatitis pulmonary injury occurs 12 h after the start of infusion with increase in vascular permeability of the lung. This lesion may be related to pancreatic enzymes in peritonial fluid and blood.
This study is to analyze gastric emptying (GE) of 99mTc tagged solid meals in 43 gastric ulcer (GU), 16 duodenal ulcer (DU) patients, and 15 normal subjects. Diagnosis of active ulcers had been made through high gastrointestinal endoscopy. The patients with GU were divided into three groups according to Johnson's classification. Gastric contents were measured at 15 minute intervals over a period of 150 minutes, with the person standing in front of a gamma-counter. The GE curve was obtained from the mean percentile of radioactivity of all the groups measured at 15 minute intervals. Results were submitted to statistical analysis. Significant delay in GE in DU patients compared to normals, type II and Type III group. However, GE of type I GU was not statistically different from the DU group nor of types II and III GU, occupying an intermediate e position.
Enteral alimentation is a commonly employed procedure for pre-operative rehabilitation and nutritional maintenance of depleted patients suffering from esophageal diseases. In a prospective study of 61 cases exhibiting benign (n = 38) and malignant (n = 23) conditions, a commercial polymeric diet was supplied in the proportion of 40 Kcal/kg/day during at least two weeks. The liquid preparation was infused by bolus technique at home, by the patients themselves, via nasogastric (n = 25) or nasoduodenal silastic tube (n = 36). Total food intake, that before treatment had been under 60% of estimated requirements, reached the expected range throughout the therapeutic period, and also iron input was adequate (0.3 mg/kg/day). Standart anthropometric and biochemical assessment of these cases, with included serum iron and hemoglobin concentration, indicated stabilization of general nutritional parameters, but with persistence of moderate anemia(hemoglobin 12.6 +/- 2.0 g/dl; iron 59.2 +/- 35.7 mg/dl). Stratification of the population according to enteral tube position demonstrated similar diagnoses and clinical conditions for both groups. Mean initial iron and hemoglobin concentration was also the same, but final serum iron was increased after gastric administration (p < 0.05) and diminished with duodenal diet (p < 0.05). It is concluded that: home enteral nutrition in malnourished patients with esophageal diseases is consistent with an acceptable nutritional status, but without significant recovery from anemia, serum iron in this population only increases after intra-gastric alimentation; it is probable that this last finding is related to impaired ionization and absorption of dietary iron, when food is introduced in a postpyloric site.
BACKGROUND/AIM: Zenker's diverticulum treatment was done by endoscopic management of the elderly and debilitated patients without general anesthesia. MATERIALS/METHODS: With this technique, the septum between the diverticulum and the esophageal lumen is sectioned with a diathermic knife. Since the upper esophageal sphincter (UES) is certainly included in the mass sectioned, this accounts for the success of the procedure. RESULTS: Manometric assessment of the UES was done in 5 patients before the endoscopic treatment. The mean pressure was 54.6 cm H2O and the mean length of 3 cm. A significant (p < 0.05) reduction in maximum pressure occurred postoperatively--mean 26.8 cm H2O. There was no significant variation in length of the UES. CONCLUSION: The maintenance of this basal pressure may be explained by the preservation of the circular muscle structure of the region, with sphincter-like characteristics.
BACKGROUND/AIMS: Massive ascites and pleural effusions are uncommon but well-documented complications of chronic pancreatitis. The present study reviews the results of surgical management of pancreatic ascites and pleural effusions of pancreatic origin. PATIENTS AND MATERIALS: From forty-nine patients with chronic pancreatitis presenting with ascites and/or pleural effusion of pancreatic origin, 31 were surgically treated. RESULTS: Nineteen had ascites only, ten pleural effusions and two presented with both conditions. Diagnosis of the internal pancreatic fistula was based on the findings of high amylase levels and elevated albumin content of the peritoneal and pleural exudates. Failure of medical therapy was the indication of surgical treatment in all patients. Thirteen were submitted to internal pancreatic drainage, 17 to external drainage and one to distal pancreatic resection. Eight of 17 externally drained patients were reoperated for intraperitoneal abscesses (2), infected pseudocyst (1), pain recurrence (3) and pancreatic fistula (2); whereas reoperation occurred in only one of the 13 patients submitted to internal drainage (p < 0.05). CONCLUSIONS: Internal pancreatic drainage was the ideal surgical treatment for patients with pancreatic ascites and/or pleural effusion that did not respond to medical treatment. When this was not feasible external drainage was successfully used as an alternative to pancreatic resection.
Solitary hepatic cysts an uncommon disease in the past, which incidental diagnosis is increasing with the advent of ultrasound and computed tomography, are nowadays very frequent. Cysts that reach massive proportions often become symptomatic and necessitate surgical intervention. Surgical wide unroofing technique is a simple procedure advocated for the treatment of symptomatic patients. Ten patients with solitary liver cysts were submitted to wide unroofing with good immediate and late results.
Details about the structure of the lower esophageal sphincter and the function of fundoplication are yet unknown. New study is presented about electromanometric examination of the lower esophageal sphincter in 20 chagasic patients with megaesophagus operated on by cardiomyotomy complemented with His angle agudization (Group A-10 patients) or fundoplication (Group B-10 patients). On the 30th postoperative day, the patients, without dysphagia, were submitted to radiologic study, demonstrating valvuloplasty integrity (Group B), and electromanometric study of the esophagus. The comparison between the groups demonstrated: -myotomy does not modify the lower esophageal sphincter extension, but decrease its pressure, not to zero; -fundoplication does not increase the lower esophageal sphincter pressure after myotomy, under resting conditions. These conclusions suggest that: -lower esophageal sphincter is formed by muscular fibers interlacing, configuration that maintains residual regional pressure after myotomy; - in resting state, after myotomy, fundoplication exerts exclusively mechanical function, without increase of the lower esophageal sphincter pressure.
Liver tumors rarely arise in the caudate lobe and resection of such tumors is even more rare. Spigel's lobe resection, first described by Ton Thac Tung, is a very unusual operation and the technique has not been clearly established. Recently, successful resections of the caudate lobe of the liver have been reported. Since Edmonson's first report in 1956, fibrolamellar carcinoma of the liver (FLC) has been recognized as a distinct variant of hepatocellular carcinoma. It occurs, without sexual preference, primarily in adolescents and young adults. Usually, FLC is found in noncirrhotic livers and rarely associated with hepatitis B virus. This tumor presents a high resectability rate (48-100%) with a good prognosis and a mean survival of 68 months. We report a case of fibrolamellar carcinoma arising in the caudate lobe of the liver. Resection of the caudate lobe of the liver was carried out with no morbidity.
BACKGROUND/AIMS: Basal (BAO) and maximum (PAO) hydrochloric acid output after Histalog stimulation, basal pepsinogen (SPL-B), at 60 (SPL-60) and at 90 minutes (SPL-90), and basal gastrin (BG) levels were measured and compared in different gastric (GU) and duodenal (DU) ulcer sites. MATERIAL AND METHODS: Fifty nine patients with peptic ulcer were grouped according to Johnson's classification for gastric ulcers: type I (15), type II (16) type III (12) GU and (16) DU. Fifteen normal subjects were studied as controls. RESULTS: The BAO was greater in the DU than in the control or GU groups. No significant difference was noted in the production of hydrochloric acid after stimulation with Histalog. The SPL-B, at 60 and at 90 minutes was higher in type II GU than in the DU group and controls. The SPL-60 was higher in type II GU patients than in type III GU. Basal gastrin was higher in group DU and types II and III GU compared to the type I GU patients and controls. CONCLUSION: The topographic criteria for differentiating peptic ulcers has low discrimination capacity based on comparison of mean values of HCl acid production, pepsinogen and gastrin serum levels both basal and after stimulation with Histalog due to heterogeneity of these variables in group studies. In these studies, peptic ulcers from different sites should not be grouped as distinct entities except for type II gastric ulcers.