Biomedical subjects

I Braghetto

Publications and source records attributed to I Braghetto.

At least 37 records · Page 2Linked to original sources

PubMed1994

[Patients with pathologic gastroesophageal reflux without erosive esophagitis: correlation of the endoscopic and histological aspect of the esophagus].

Eighty four patients with chronic gastroesophageal reflux in whom endoscopy showed a normal or minimally altered esophageal mucosa (hyperemia, erythema or mucosal congestion) were prospectively studied. In each patient, two esophageal biopsies were obtained (1 and 3 cm above the mucosal change zone). Histological esophagitis was found in 28% of patients with endoscopically normal mucosa and in 26% of patients with minimal endoscopical mucosal alterations. It is concluded that the description of these minimal esophageal alterations during endoscopy is subjective, unreproducible and do not clearly indicate the presence of esophagitis. A classification of endoscopical findings is proposed, based on the presence of objective lesions such as erosions or Barrett esophagus.

Adult↗

PubMed1993

Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer.

A prospective randomized clinical trial was performed in order to evaluate the results of three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Ninety patients with clinical and laboratory evidence of gastric retention were enrolled. After laparotomy, patients underwent either highly selective vagotomy (HSV) + gastrojejunostomy, HSV + Jaboulay gastroduodenostomy, or selective vagotomy (SV) + antrectomy. One patient died after HSV + Jaboulay gastroduodenostomy due to postoperative acute pancreatitis. There were no differences in the postoperative course of the three groups. Patients were followed for a mean of 98 months (range: 30 to 156 months). There was a significantly better result after HSV + gastrojejunostomy than after Jaboulay anastomosis (p < 0.01), but not after SV + antrectomy. Gastric acid reduction was similar in the small group of patients studied. We propose HSV + gastrojejunostomy as the treatment of choice in patients with duodenal ulcer and gastric outlet obstruction.

Adult↗

PubMed1993

Location of the lower oesophageal sphincter and the squamous columnar mucosal junction in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis.

In this study the location of the lower oesophageal sphincter measured by manometry and the location of the squamous columnar junction measured by endoscopy were determined in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis. No significant differences in the prevalence and severity of the heartburn and regurgitation were observed when different degrees of oesophagitis were compared but dysphagia was more common and severe in patients with complicated Barrett's oesophagus (p < 0.001). This group also showed a male predominance and older age compared with other groups. The total length of the oesophagus, measured by the location of the distal end of the lower oesophageal sphincter was similar in all patients; however, the location of the squamous columnar junction extended more proximally and was related to the increasing severity of endoscopic oesophagitis. The manometric defects at the cardia were more frequent in severe oesophagitis (p < 0.001). These results suggest that, during the course of oesophagitis, the squamous columnar junction is displaced proximally. This displacement is limited to the mucosa, however, and does not involve the muscular layer, because the lower oesophageal sphincter undergoes no dislocation.

Cardia↗

PubMed1992

Histological studies of Auerbach's plexuses of the oesophagus, stomach, jejunum, and colon in patients with achalasia of the oesophagus: correlation with gastric acid secretion, presence of parietal cells and gastric emptying of solids.

Histological changes in the Auerbach's plexuses of the oesophagus, stomach, jejunum, and colon were analysed in a prospective study in 34 patients with achalasia of the oesophagus. At the distal end of the oesophagus ganglia cells were absent in 91% of cases as well as in the middle third of the stomach (20%). The Auerbach's plexuses were normal in the jejunum and colon. The results of gastric acid secretion showed that the peak acid output was significantly lower in achalasia patients compared with controls (p less than 0.001). There was no correlation between the mean ganglion neuronal count in the gastric plexuses and the rate of gastric acid output (r = 0.33). Gastric emptying of solids was also evaluated, but there was no correlation between gastric emptying and the mean ganglion neuronal count in the gastric Auerbach's plexuses. The rate of gastric emptying of solids was similar in controls and patients with achalasia. These studies suggest that denervation of the oesophagus in patients with achalasia, which is a constant finding in several previous reports may extend beyond the oesophagus to the stomach in nearly half the cases.

Adult↗

PubMed1992

[A cooperative study on early and intermediate gastric cancer: clinical, diagnostic and therapeutic aspects].

A cooperative study involving 13 hospitals in Chile allowed the analysis of 353 patients with gastric cancer in early stages. 82 cancers were located at the mucosal level, 151 at the submucosa and 120 reached the muscular layer. There were no differences in age and sex among these groups. Compared to early stage, patients with intermediate stage had a greater incidence of bleeding, anemia and undernutrition and exhibited lower body weight. Endoscopy had a higher diagnostic yield compared to radiological study. The diagnosis was confirmed by biopsy in 95% of patients. Total or subtotal gastrectomy was performed according to the location of the lesion, with a low operative mortality rate. Early gastric cancer accounts for 8 to 10% of all patients with gastric cancer undergoing surgical treatment.

Adult↗

PubMed1992

[Characteristics of severe esophagitis in patients with collagen diseases].

Connective tissue disease may alter esophageal function generating symptoms due to gastroesophageal reflux and motor disturbances. Fifteen patients with connective tissue diseases and severe esophagitis defined by the presence of esophageal stenosis or ulcerations were studied. Diagnosis was made with radiologic, endoscopic and manometric studies. Dysphagia was present in 11 and gastroesophageal reflux in all. All patients has an hypotensive and shorter lower esophageal sphincter. Better therapeutic results were obtained with surgical treatment.

Adult↗

PubMed1992

Surgical management of esophageal strictures.

Benign esophageal strictures may be caused by numerous disorders, but more than 90% of them are due to severe gastroesophageal reflux or ingestion of lye. A new classification of the severity of the stricture is proposed, based on the endoscopic and radiological evaluation of three parameters: internal diameter, length of the stricture and ease or difficulty of dilatation. In patients with strictures secondary to reflux, initial treatment includes periodic dilatation. Grade I and II strictures require esophageal resection. In grade III patients, bile diversion or esophageal resection should be performed. Caustic ingestion produces a wide spectrum of tissue damage in the upper digestive tract ranging from minimal chemical burn to an extensive and massive necrotic lesion. The basic and main treatment in patients with an established esophageal stricture is periodic dilatation avoiding, if at all possible, any kind of surgery. In patients with grade III stricture, colonic interposition between cervical esophagus and stomach or duodenum is preferred, treating the damaged esophagus by resection or leaving it "in situ". Psychiatric evaluation is mandatory in these cases.

Burns, Chemical↗

PubMed1992

Gallstone ileus.

A retrospective analysis of 74 patients with gallstone ileus detected during the period between 1975 and 1987 was performed at the Surgical Department. The group comprised 55 females and 19 males, with a mean age of 64.8 years. Previous biliary symptoms had been observed in 76% of the cases and in 58% there had been concomitant disease. The main duration of symptoms previous to admission was 3.4 days. In 85% of the cases complementary diagnostic procedures were performed. The triad of air in the biliary tract, air-fluid levels and ectopic stone was found in only 9.5% of the cases. The preoperative diagnosis of gallstone ileus was made in 31% of the patients. The preoperative period was 2.2 days. The main surgical procedure was enterolithotomy in 92% of the cases, the site of impaction being the terminal ileum in 65%. Only in 1 case was simultaneous biliary tract surgery and enterolithotomy performed. Overall, the 30-day postoperative mortality rate was 13.5%, with intra-abdominal sepsis as the main cause of death. Sixteen patients were submitted to biliary surgery 2 to 6 months later, and no deaths occurred.

Adult↗

PubMed1991

Comparison of forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus.

In the present paper we have reviewed the results of forceful dilatation as compared with surgical esophagomyotomy in patients with achalasia. The review of 4 retrospective and uncontrolled studies revealed that in all, surgery produced a more effective late result than dilatation, with minimal side effects and very low or no mortality. In the only prospective randomized study comparing both treatments by the same group, good late results were seen after surgery in 95% of the cases, as compared with 65% after dilatation (p less than 0.001). The resting gastroesophageal sphincter pressure was predictive of the quality of the late results. Reflux occurred in 8% of the dilated and in 19% of the operated group as measured by standard acid reflux test. The old, classical concept that dilatation is the first choice and preferable method of treatment for patients with achalasia should be reviewed, and the idea that surgery should be reserved only for patients in whom dilatation has failed should be abandoned. We propose that surgical treatment should be the initial choice in the majority of patients with achalasia of the esophagus.

Catheterization↗

PubMed1991

[Clinical characteristics of patients with multiple or giant peptic ulcers].

The incidence and clinical characteristics of multiple or giant ulcers (over 20 mm for duodenal ulcer or 25 mm for gastric ulcer) was evaluated among 1434 patients with peptic ulcers. For gastric ulcers, multiple and giant lesions were found in 27% and 14% of patients respectively. Among duodenal ulcers the corresponding figure were 16% and 2.4%. Patients with triple gastric ulcers have a greater incidence of massive bleeding. Patients with triple duodenal ulcers are older, have more massive bleeding and have a greater incidence of gastric retention and hypersecretion when compared to patients with single or double duodenal ulcers. Giant gastric ulcer was associated to a shorter history and more massive bleeding; giant duodenal ulcer was associated to older age, more massive bleeding and gastric retention, when compared to patients with common size ulcers.

Adult↗

PubMed1991

[Gastric neurofibroma. Report of 2 cases].

Two patients consulting for upper gastrointestinal bleeding, associated to impaired gastric emptying in one, were studied with X rays and endoscopy. A gastric neurofibroma was confirmed by histologic study in both patients. One patient was submitted to subtotal gastrectomy. An endoscopic resection of the tumor was performed in the other.

Aged↗

PubMed1991

[Incipient and intermediate gastric cancer II. Anatomo-pathological and surgical aspects. Cooperative study in 13 hospitals].

Anatomic and surgical characteristics of 233 pts with early, and 120 with intermediate gastric cancer, from 13 hospitals in Chile are analyzed. 63% had depressed or excavated lesions. Most of the tumors were located in the inferior or middle third, while only 17% of the early carcinomas were found in the superior third of the stomach, specially in the lesser curvature. 5% had residual tumor in the gastric remanent. Histologically, tubular adenocarcinoma was the most common finding. According to Lauren's classification intestinal carcinoma was more frequent than the diffuse type. Surgeons underestimated lymphatic node involvement (macroscopic appreciation) in up to 58% of the cases when compared to the pathologists observation (microscopic appreciation). This was specially true in muscular carcinomas. The incidence of lymphatic metastases was 6% in mucous, 12% in submucous and 57% in muscular carcinoma. The need of complete lymph node dissection of all the lymphatic barriers is emphasized.

Carcinoma↗

PubMed1990

Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma.

A new classification of anastomotic fistulas of esophagojejunostomy after total extended gastrectomy for advanced gastric carcinoma is presented. In a group of 230 consecutive patients submitted to total gastrectomy within a 10-year period, there were 20 patients with Type I fistula (8.8%) and 18 cases with Type II (7.8%). Type I or subclinical fistula corresponded to a local leakage around the anastomosis, with no septic complications, which heals with prolongation of enteral feeding up to 20 days after surgery. The mortality rate was 5% in this group. Type II or clinical leakage corresponded to patients with early septic manifestations after surgery, in whom the methylene blue test was positive, that is, immediate appearance of the stain in any drain was observed after oral ingestion, confirmed by radiological studies. The mortality rate in this group was 78%. Resuturing of the fistula was a complete failure. Cervical lateral esophagostomy produced complete healing in two cases. Parenteral and enteral feeding, antibiotics and successful surgical drainage are measured that can provide good results in these cases.

Anastomosis, Surgical↗

PubMed1990

[A giant diverticulum of the colon].

A male patient complaining of abdominal pain developed rectal bleeding and a painful mass located in the left side of the abdomen. Barium enema revealed a giant diverticulum of the colon. Surgical resection was performed successfully. A brief review of the literature follows.

Colectomy↗

PubMed1990

[Dieulafoy's vascular malformation as a cause of massive and recurrent gastric hemorrhage].

We demonstrated a Dieulafoy-type vascular malformation in 10 patients with upper gastrointestinal bleeding. Most patients had a history of prior bleeding and were older than 60 years of age. A mean of 2.6 endoscopic examinations had been performed, and a mean of 2500 ml of blood transfused per patient. A localized resection of the lesion was performed in 9 patients and a partial gastrectomy in the remaining. Surgery was performed as an emergency in 5 patients. The lesion was a small, 2 to 5 mm, erosion localized in the subcardial region. The vascular nature of the lesion was confirmed by histologic study in all cases. Postoperative course was uneventful in all patients and no recurrences have been observed.

Acute Disease↗

PubMed1989

Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia.

Late results in 81 patients with achalasia treated in a prospective randomised study comparing forceful pneumatic dilatation with the Mosher bag and surgical anterior oesophagomyotomy by abdominal route, are reported. There were no deaths from either of the treatments. Two patients (5.6%) had a perforation of the abdominal oesophagus after pneumatic dilatation and were excluded from late follow up. In patients having surgery at radiological evaluation there was gullet diameter significantly increased at the oesophagogastric junction and decreased at the middle third of the oesophagus. One patient was lost from follow up and one died of an oesophageal carcinoma, leaving 95% of excellent results at the late follow up (median 62 months). Resting gastro-oesophageal sphincter pressure decreased significantly to approximately 10 mmHg; this was maintained five years after surgery. By contrast, in patients having pneumatic dilatation, there were good results in only 65% (follow up median 58 months), with 30% failures. One patient was lost from follow up and one developed oesophageal carcinoma. Measurement of resting gastro-oesophageal sphincter pressure after dilatation was highly predictive of the outcome. The study shows that surgical treatment offers a better final clinical result than pneumatic dilatation with the Mosher bag.

Adolescent↗

PubMed1989

[Primary motor disorders of the non-achalasic esophagus: a manometric analysis].

We studied 85 patients with esophageal symptoms of a motor abnormality in whom esophagitis, achalasia or other organic lesions were ruled out by endoscopy. Main symptoms were dysphagia and severe retrosternal pain. Cardiac origin of the pain was ruled out by clinical and EKG evaluation in 72% of patients. Mean age was 43 years and female to male ratio was 3:1. Manometric study, performed in all patients, revealed diffuse spasm in 42, hypertensive sphincter in 16, nutcraker esophagus in 11 and nonspecific motor abnormalities in 16 patients. Only manometric studies can identify these esophageal disturbances. These studies should be performed in patients with non cardiac retrosternal pain.

Esophageal Motility Disorders↗

PubMed1989

[Diagnosis of gastroesophageal reflux by radioisotopic techniques].

We evaluated 148 patients (mean age 45 years) with clinically evident gastroesophageal reflux. A radioisotopic test with 99mTc sulphur-colloid was performed in all; endoscopy in 146, biopsy in 24, acid reflux test and manometric evaluation in 141 and radiologic studies in 85. Sensitivity of the different techniques was: radioisotopes 92%, radiology 87%, acid reflux test 84%; endoscopy 63% and manometric studies 61%. Severity of reflux and esophagitis was adequately predicted from radioisotopic evaluation. We conclude that this radioisotopic test is highly reliable for the diagnosis of gastroesophageal reflux.

Adolescent↗