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Biomedical subjects

H W Pinotti

Publications and source records attributed to H W Pinotti.

At least 253 records · Page 14Linked to original sources

[Lung injury in acute pancreatitis. Influence of pancreatic enzymes reduction].

UNLABELLED: A previous report has show that cerulein in physiological doses reduces the rate mortality of pancreatitis by decreasing the enzyme content of the pancreas. Clinically detectable signs of lung injury develop in up to 50-70 percent of patients with acute pancreatitis. The aim of the present study was to assess the effect of acute reduction of pancreatic enzyme content on the pancreatitis pulmonary injury. Experimental haemorrhagic pancreatitis was induced by intraductal injection of 5 per cent sodium taurocholate in two groups of Wistar rats: group I (pancreatitis) and group II (pancreatitis after decreasing pancreatic enzyme content). Dye Evans blue was used to evaluate the lung injury. The degree of histologically observed lesions were similar in both groups, but the pulmonary lesion was smaller in group II than group I (p < 0.05). IN CONCLUSION: 1) pancreatitis' pulmonary lesion may be related with pancreatic enzymes that reach the blood stream and 2) the reduction of the pancreatic enzyme content has a beneficial effect on acute pancreatitis and reduces its pulmonary injury.

Acute Disease↗

Hematologic disorders in trauma patients during parenteral alimentation with lipids.

Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.

Adolescent↗

[Mesenteric venous thrombosis after azygos-portal disconnection with splenectomy for the treatment of bleeding esophageal varices in mansonian schistosomiasis. Three cases reports].

The consequence of an acute mesenteric venous thrombosis following porta-azygos disconnection for the treatment of bleeding esophageal varices due to mansonian schistosomiasis has not been well defined in the literature. The clinical manifestations reported were fever, spasmodic abdominal pain associated with food intake. We treated three patients with thrombosis of the portal-mesenteric trunk following porta-azygos disconnection and adopted a conservative clinical approach in two patients while one had to have a surgical small bowel ressection.

Adult↗

Angiomyolipoma of the liver.

Angiomyolipoma, a form of mixed mesenchymal tumor, a not uncommon tumor of the kidney, is rarely found in the liver. We report a case of angiomyolipoma of the liver in a 34-year-old woman, in whom diagnosis was made by computed tomography (CT), magnetic resonance imaging, superior mesenteric and celiac trunk angiography and histological examination. The treatment of choice was a successful extended right hepatectomy.

Adult↗

[Distal pancreatectomy with conservation of the spleen].

Conventional resection of the body and tail of the pancreas usually involves splenectomy. There are evidence that spleen removal can lead to septic and hematological complications and should, therefore, be avoided when possible. Distal pancreatectomy with spleen conservation has been described by specialized centers with good results. This report describes our experience in 8 cases with conservation of the spleen during the resection of the body and tail of the pancreas. The technique has been applied in patients with pancreatic neuroendocrine tumors (n = 4), cystic tumors (n = 3) and cystic-papillary tumor (n = 1) with no complications and good late results in all cases.

Adolescent↗

[Results of conventional cholecystectomy. Experience in a university hospital].

The experience with open cholecystectomy in an university affiliated hospital is documented in this report. We studied retrospectively 221 patients operated between 1987 and 1992, type of surgery, morbidity and mortality were analyzed. There were 171 (77.3%) cholecystectomy alone and 50 (22.7%) cholecystectomy with other biliary surgery (BS). Pulmonary, urinary and wound complications were the most common. Overall incidence of complications was 7.2%. For patients with cholecystectomy alone morbidity was 3.5% and for patients with BS morbidity was 20% (p < 0.002). There were no mortality in this group of patients.

Adolescent↗

[Pharyngoesophageal dysfunction: report of case and review of literature].

Buccopharyngeal motor disorders causing difficulties in swallowing are frequently encountered in clinical medicine. Affected patients manifest distinctive clinical features and pose special problems in their management. A case report is described and summarize the pathogenesis, consequences, evaluation, treatment and some selected clinical conditions that are associated with buccopharyngeal dysphagia.

Arnold-Chiari Malformation↗

[Biliary fistula after elective conventional cholecystectomy].

The use or not of drainage after elective cholecystectomy has been recently studied, and we will discuss the real incidence of the subhepatic biliary collection and its clinical significance. In this sense, we studied 20 patients with a mean age of 45 years (4 male and 16 female), submitted to elective cholecystectomy according to selective techniques patterned by our group, where we realized ligature of all vessels of the gallbladder bed, and subhepatic drainage. These patients receibed 99 mTc-DISIDA at the moment we closed the abdomen, and in a period of 24 and 48 hours we studied its presence in the subhepatic bed and in the drainage material. All the patients had not post-operative complications and none biliary drainage or subhepatic collection scanned. We concluded that using our preconized techniques, the subhepatic drainage is unnecessary after elective cholecystectomy.

Adult↗

[Bacterial translocation in acute pancreatitis. Experimental study in rats].

Ninety Wistar rats were studied to confirm if the intestinal tract is a source of infection in acute pancreatitis. Bacterial translocation to the mesenteric lymph nodes, pancreas, peritoneal cavity, and blood was determined at 6 h, 24 h, 48 h and 96 hours after induction of non lethal acute pancreatitis. Bacterial growing was present in 60% (6 h), 90% (24 h), 70% (48 h) and 40% (96 h) (p < 0.05) of the mesenteric lymph nodes. Live bacteria were recovered from 67% (6 h), 90% (24 h), 50% (48 h) and 40% (96 h) (p < 0.05) of the pancreas. Gram-positive bacteria translocate more frequently than Gram-negative bacteria in the early period (6 h). Lately (24-96 h), Gram-negative bacteria were much more frequently isolated (p < 0.05). The most common organism isolated was Escherichia coli. No overgrowth of cecal Gram-negative bacteria was found. It is concluded that bacterial translocation in acute pancreatitis is an early phenomena, initially caused by Gram-positive bacteria and lately by Gram-negative bacteria, and associated with the severity of pancreatic lesions.

Acute Disease↗

Pyogenic liver abscess: the role of surgical treatment.

MATERIALS AND METHODS: We present an analysis of 48 patients with pyogenic liver abscess (PLA) that were treated according to a protocol between 1975 and 1993. In this period, 35 patients with PLA were treated by surgical drainage (SD). The indication for surgical treatment of the abscess were patients in septic conditions, underlying intra-abdominal surgical disease and the failure/contraindication of other therapeutic methods. Thirty-one patients were submitted to surgical treatment as the initial procedure and four patients unsuccessfully treated by percutaneous drainage, underwent SD. RESULTS: The surgical approach was indicated in patients with severe disease and presented 91.5% of good results, and a mortality rate of 8.5%. CONCLUSIONS: These results suggest that surgical treatment is a good alternative as a first step not only for the treatment of the primary cause of the abscess but also in septic patients with severe disease where a delay in adequate drainage, frequent in percutaneous management, can lead to high morbidity and mortality rates.

Adolescent↗

[Protective effect of reduction of pancreatic enzyme content on the pulmonary disease induced by acute pancreatitis].

Lung injury develop in up to 50-70 percent of patients with acute pancreatitis. Cerulein in physiological doses reduces the rate mortality of pancreatitis by decreasing the enzyme content of the pancreas. In order to assess the effect of acute reduction of pancreatic enzyme content on the pancreatitis pulmonary injury, pancreatitis was induced in Wistar rats by intraductal injection of 5 per cent sodium taurocholate: group I, with pancreatitis; group II, pancreatitis after decreasing pancreatic enzyme content; group III, control group. Dye Evans blue was used to evaluate the lung injury. The pancreatitis pulmonary injury was smaller in group II than group I (P < 0.05) but it was similar to control group (group III). In conclusion, it is speculated that the reduction of the pancreatic enzyme content reduces the pancreatitis pulmonary injury by decreasing the quantity of pancreatic enzymes reaching the systemic circulation.

Acute Disease↗

Squamous cell carcinoma of the pancreas with gastric metastasis. Case report.

The squamous cell carcinoma of the pancreas is an uncommon form of pancreatic cancer, with a frequency in the range of 0.5-3.5%. A rare case of a primary squamous cell pancreatic carcinoma, with gastric invasion and upper digestive bleeding, requiring surgical control is reported. The surgical technique to treat the bleeding is also detailed.

Aged↗

[Hepatic dysfunction in myoglobinuric acute renal failure (rhabdomyolysis)--experimental study in rats].

Liver damage as a consequence of rhabdomyolysis (RM) has not been well established on clinical and experimental grounds. Hepatic dysfunction was then investigated in rats 24 h after induction of acute renal failure with glycerol. Forty male Wistar rats (220-270 g) were dehydrated for 24 h and were divided in two group: GI experimental group (n = 14)-50% glycerol was injected (10 ml/Kg, one-half of the dose in each hindlimb muscle) and GII control group (n = 26)-animals received injection of saline solution. Twenty-four hours after the glycerol or saline injection all the animals were killed. Serum urea, creatinine, transaminases (AST, ALT) and CK were measured and significantly high values were obtained in experimental animals. Arterial blood pressure was measured and remained within normal levels in both groups. Hepatocyte mitochondrial respiratory function was estimated polarographically with determination of oxygen consumption without ADP (Basal respiration-State 4) and in the presence of ADP (Activated respiration-State 3). In experimental group (GI) there was significant low values of oxygen consumption in state 3, decrease of respiratory control rate and in ADP/O ratio (p < 0.05). Histological studies of the liver revealed a periportal necrosis and centrilobular degeneration. These studies suggested that hepatic dysfunction is an additional complication of glycerol-induced rhabdomyolysis. The pathogenesis and clinical implications of these abnormalities are discussed.

Alanine Transaminase↗

[Physiopathology of lung injury in acute pancreatitis].

Clinically detectable signs of lung injury develop in up to 50-70 percent of patients with acute pancreatitis. Despite that, the physiopathology of the lung injury associated with acute pancreatitis is unclear so far. Pulmonary edema is the main respiratory complication in acute pancreatitis. Increased permeabilities of the pulmonary endothelial and alveolar epithelial barriers are the causes of the pulmonary edema. Several factors have been regarded as the cause to pulmonary edema: release of pancreatic-derived proteolytic enzymes, oxygen-free radicals, phospholipase A2, free fat acids, tumor necrosis factor, platelet activating factor, arachidonic acid metabolites and pulmonary embolization. Understanding lung injury physiopathology enables physicians to a better therapeutic approach of the patients with acute pancreatitis. The aim of this paper is to expose the theories that explain the pancreatic-derived lung injury.

Acute Disease↗

[Early adenocarcinoma of the duodenum--report of a case].

The early duodenal carcinoma is a very rare type of neoplasia, usually asymptomatic, its surgical treatment remains a controverse issue. In the present case an early duodenal carcinoma was incidentally found at the pathological specimen after a gastrectomy with BII reconstruction for a gastric adenoma unressectable by endoscopy. The patient is now alive for two years, without evidence of recurrence on follow-up.

Adenocarcinoma↗

[Prevalence of anal incontinence in the elderly population: an epidemiological study of the elderly population served at the geriatric ambulatory service of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo].

The aim of the present work was to assess the prevalence of anal incontinence in the elderly population attended in the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo". The method employed was of individual interviews with patient attended in the Geriatric Ambulatory. As part of the assessment patients were classified as to sex, age, color, social-economical class and education, and compared to available data on the elderly population of the State and the City of São Paulo. Besides the question on signs and symptoms related to anal incontinence, associated factors such as bowel habit, sensation of incomplete evacuation, urgency to evacuate and soiling were also analysed, as well as, factors possibly related to anal incontinence such as urinary incontinence, use of medication as laxatives, associated diseases, such as neurological affections and diabetes mellitus, number of child births, and assistance received, previous anorectal or perineals operations, and locomotions limiting factor. The statistical method of test of proportion was used to analyse the proportions of the populations interviewed, as to sex and literacy compared to the elderly population of the State and City of São Paulo. To analyse the social-economical class of the population interviewed compared to the elderly population economically and non economically active, of the State of São Paulo, the test of qui-square adjusted was used. The test of qui-square was used to verify if the population of incontinent and continent, by sex; incontinent and continent in relation to bowel habit, by sex; incontinence sufferer of continuous and descontinuous anal incontinence, by sex; incontinent sufferer of anal incontinence to gas, liquid or solid, and the association of these manifestations, by sex; patients who complained of soiling, by sex; incontinent and continent, previously submitted to anorectal or perineal operations; and continent and incontinent with diabetes mellitus, are equal. To verify the proportions of women who had vaginal delivery in the continent and incontinent group, the test of Mann-Whitney was used. One hundred fourty six patients were interviewed, 43 men of an average 75 years old (62 to 91) and 103 women of an average 72 years old (60 to 88); as to colours, 69.9% were white, 18.5% were mullato, 9.6% were black and 2% were yellow. The comparative analysis with populational data indicated that the population interviewed was representative of the elderly population of the State and the City of São Paulo, as to age, color, social-economical class and education. The prevalence of anal incontinence was of 10.9% with no difference between the sexes, intestinal obstipation referred by 15.4% of the men and 28.1% of the women, sensation of incomplete evacuation referred by 21.2% of the patients, and the association of both referred by 13.7% were the most frequently observed functional gastrointestinal alterations. Soiling was referred by 10.3% of the patients with no difference related to sex. The use of medication or laxatives, the presence of diabetes mellitus, neurological affections, previews anorectal or perineal operations, or locomotion limiting factors, have no relation to anal incontinence. The prevalence of urinary incontinence was of 30.1%, and double continence of 6.3% with no statistical difference between sexes. There was statistical evidence of association between childbearing and anal incontinence.

Aged↗

Achalasia: a prospective study comparing the results of dilatation and myotomy.

BACKGROUND/AIMS: In a prospective and randomized clinical study, the operative method and dilatation in the initial stage of megaesophagus were evaluated. METHODOLOGY: Forty patients in the initial stage of megaesophagus, managed by forced hydrostatic dilatation of the cardia (20 patients-DILAT Group) or by esophagocardiomyotomy associated with esophagofundopexy (20 patients-Group OP) were followed-up for three years, in terms of clinical, radiographic, endoscopic, manometric and pH monitoring. RESULTS: 1) Both procedures can be performed without significant morbidity or mortality. 2) The two procedures are similar regarding ongoing suppression of dysphagia. 3) Radiologically, the methods are equivalent, since they promote significant elimination of contrast stasis and maintenance of the esophageal diameter. 4) Endoscopic follow-up did not differentiate the procedures in terms of the development of reflux esophagitis, with a rate of only 5% for each group of patients. 5) Manometry demonstrated that surgery produced a significantly greater reduction of the LESP as compared to dilatation, although the latter also determined a marked drop in the maximum basal pressure of the LES. 6) Neither procedure altered the length of the LES. 7) With prolonged esophageal pH monitoring, dilatation demonstrated a greater propensity for reflux as compared to surgery. CONCLUSION: Both methods offer benefits in the treatment of the initial stage of megaesophagus, although esophageal pH monitoring indicates that dilatation provokes a greater index of esophageal acid exposition time.

Adult↗

[Surgical treatment outcome of hemorrhoidal in 475 patients].

Despite feared by patients and reserved for the minority of patients suffering from hemorrohoids, hemorrhoidectomy remains as the most effective approach to this condition. To analyse results from 475 hemorrhoidectomies performed at University of São Paulo Hospital das Clínicas between 1984 and 1995, a retrospective chart review regarding gender, age, associated anorectal conditions, surgical technique, complications and their management and follow-up was addressed. Two hundred and seven (43.6%) were male. Age between fourth and sixth decades were observed for 70.8%. Associated anorectal conditions were diagnosed in 18.9%. Chronic anal fissure was the commonest one. Milligan-Morgan operation was performed in the majority of patients (91.2%) and Ferguson technique in 6.7%. There were no intraoperative complications postoperative complications occurred in 38 (8%) patients regardless of employed surgical technique. Urinary retention was the commonest postoperative complication. Mean follow-up was 5.8 years for 70% of patients. Surgical hemorrhoidectomy remains as a treatment with excellent results in the management of hemorrhoid disease for selected patients. Produces erradications of the disease in all cases in spite of low morbidity.

Adolescent↗