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Biomedical subjects

I Braghetto

Publications and source records attributed to I Braghetto.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Early complications of caustic injuries of the digestive tract].

We retrospectively analyzed the gastrointestinal complications observed in 119 patients who had ingested corrosive agents. Hydrochloric acid and sodium hydroxide were the agents involved in 62% of patients. Women predominated over men (p less than 0.001); mean age was 36 for males and 29 for women (p less than 0.05). Endoscopy was performed in 55% of patients and revealed acute lesions in 69%. Complications were observed in 18% of patients requiring surgery in 12 (10%). Main complications included sepsis of abdominal or mediastinal origin and gastrointestinal bleeding. Mortality among these patients was 73%.

Adolescent↗
PubMed1989

[Clinical and laboratory correlation of severe esophagitis compared to mild or moderate esophagitis].

Between 1976-1987, 408 patients were studied for Reflux Esophagitis. Clinical, endoscopic, manometric characteristic were analyzed, and scintigraphic studies for gastroesophageal and duodenogastric reflux were done. Esophagitis was classified according endoscopic findings in Esophagitis grade I (non confluent erosion), grade II (confluent erosions), grade III ("uncomplicated Barrett syndrome") and grade IV (esophageal ulcer or stricture ("complicated Barrett syndrome"). Fifty six (56) patients with mild (grade I), 52 with moderate (grade II) and 146 patients with severe esophagitis (56 grade III, and 90 grade IV) were included in this protocol. No significative differences were found in clinical feature except dysphagia and bleeding, symptoms more frequent in severe esophagitis than mild or moderate grades. Lower esophageal sphincter pressure was similar in both groups of patients, but the frequency of motor disorders was significative higher in severe esophagitis. Scintigraphic gastroesophageal reflux was positive in all patients and no differences in gastric emptying and duodenogastric reflux were detected. In conclusion, the differences in subjective and objective analysis between different grade of esophagitis suggest to employ different models of management.

Adult↗
PubMed1989

Treatment of residual common bile duct stones after cholecystectomy.

This study was conducted to determine the occurrence of "open" residual common bile duct stones after cholecystectomy to establish predisposing factors and possible alternative treatments. Correct diagnosis of choledocholithiasis before or during surgery, adequate exploration of the common bile duct, and suitable selection of technical procedures are the most important points in preventing retained CBD stones. If these occur, an adequate alternative treatment may prove helpful. Classical "clysis" of the bile duct is least recommended because of its high failure rate. The best method of chemical dissolution seems to be the use of mono-octanoin with 60% good results and a no-response rate of 30-40%. Instrumental extraction has been reported to be very successful (80-98%). Endoscopic sphincterotomy is currently the most frequently employed procedure for retained CBD stones, especially in poor risk patients. The reported success rate is 82-93% according to literature, with an extremely low mortality (0.2%). Reoperation should be resorted to only if all the other methods fail. Sphincteroplasty or choledochoduodenostomy, whenever indicated, are good alternative operations, with a mortality rate of approx. 3.5%.

Adult↗
PubMed1989

Indications and results of sphincteroplasty in benign biliary diseases.

A retrospective analysis of 143 patients submitted to sphincteroplasty at the Department of Surgery, University of Chile Clinical Hospital was performed. A significant percentage of these patients (90%) were admitted due to acute biliary tract disease with or without cholangitis. The standard operative procedure was anterior transduodenal sphincteroplasty with supraduodenal choledochal exploration leaving a choledochostomy. A high number of our cases presented with intrahepatic lithiasis (23.8%). The morbidity was 15.4% and the 30 days post operative mortality rate was 4.9%, similar to other reports. Residual stones were observed in 10 patients (7%), and were successfully removed by other procedures. Three patients showed recurrent stenosis of the papilla and were operated on again with good results.

Adolescent↗
PubMed1989

Histological analysis of liver parenchyma and choledochal wall, and external diameter and intraluminal pressure of the common bile duct in controls and patients with common bile duct stones with and without acute suppurative cholangitis.

The purpose of this prospective controlled study was to determine the changes in intraluminal pressure and diameter of the common bile duct in a total of 121 bile patients with choledocholithiasis, and the consequences of these alterations for choledochal mucosa and liver histology. In fact, the reflux of bacteria from the obstructed biliary tract into the bloodstream is responsible for producing the clinical syndrome of acute suppurative cholangitis. Group I (26 patients) served as controls, Group II (50) had choledocholithiasis with clear green bile, and Group III (45) were patients with acute suppurative cholangitis with pus in the biliary tract. Ultrasonography revealed gallstones in all the patients. The external diameter of the common bile duct in patients with choledocholithiasis and acute suppurative cholangitis was significantly greater than in those of the other groups. Patients with acute suppurative cholangitis also had a higher intraluminal pressure than those of Groups I or II.

Acute Disease↗
PubMed1989

Indications and results of choledochoduodenostomy in benign biliary tract diseases.

During a 12-year period ending December 1987, 17,200 operations for biliary tract disease were performed at the Dept. of Surgery of the University of Chile. Choledochoduodenostomy was performed in 140 of these patients operated upon for benign biliary tract and/or gallbladder diseases. The indications for this procedure were choledocholithiasis, stenosis of the sphincter of Oddi, compression of the extrahepatic biliary duct, stenosis of the distal biliary duct and duodenal diverticula. The postoperative course was uncomplicated in 126 patients (90%). The mortality rate was 4.2%. Although the mortality was somewhat greater in patients with acute cholangitis, the difference was not significant, and no significant relation could be established with other factors that might affect mortality. Choledocholithiasis is the main cause of benign obstruction of the biliary tract in Chile. This is also the most frequent indication for external choledochoduodenostomy and is a promising method even in the presence of an infection of the biliary duct.

Adult↗
PubMed1989

Late subjective and objective evaluations of antireflux surgery in patients with reflux esophagitis: analysis of 215 patients.

The results of late subjective and objective evaluations of antireflux surgery in 215 patients with reflux esophagitis who were included in a prospective, controlled study are reported. A special protocol--including analysis of reflux symptoms, radiology, endoscopy, esophageal manometry, and standard acid reflux test--was designed. The surgical technique used was as follows: (1) highly selective vagotomy, (2) closure of the hiatus, (3) calibration of the cardia, (4) posterior gastropexy, and (5) fixation of the gastric fundus to the diaphragm. The operative mortality rate was 0.4%, and postoperative complications occurred in 5% of the patients. Only 5% of the patients were lost from the late follow-up. A total of 150 patients with more than 5 years since operation were completely evaluated. Reflux symptoms greatly decreased after surgery. Radiologic studies were normal in 93% of the patients, and endoscopy showed a long-standing healing of macroscopic esophagitis in 83% of the cases. Manometric features were analyzed in 159 patients before and in 115 patients 1 year after surgery. A significant increase in lower esophageal sphincter pressure was demonstrated, as well as an increase in the total length and abdominal length of this sphincter (p less than 0.0001). The increase in gastroesophageal sphincter was evaluated in 46 patients 1 year and 5 years after surgery, and this showed a maintenance of sphincter competence. Esophageal clearance markedly improved after surgery, and the standard acid reflux test, which was positive in 100% of cases before surgery, persisted positive in 16% (p less than 0.001). Final clinical evaluation 5 years after surgery demonstrated excellent and good results in 85% of the patients and failure or reoperation in 8% of the patients.

Adolescent↗
PubMed1988

Common bile duct pressure in patients with common bile duct stones with or without acute suppurative cholangitis.

Resting common bile duct pressure was measured in three groups of patients: group 1, 53 patients with gallstones but without common duct stones; group 2, 35 patients with common bile duct stones unaccompanied by cholangitis; and group 3, 36 patients with common duct stones and acute suppurative cholangitis. A significantly higher pressure in the common bile duct was documented in patients with cholangitis when compared with the other two groups. Twenty-four patients with cholangitis had common duct pressure values above 20 cm H2O, the maximal values of normal. Additionally, patients with cholangitis with pressure values over 30 cm H2O (nine patients) showed absence of green bile in the extrahepatic biliary tract, suggesting cessation of bile excretion into biliary duct. In all these cases, an impacted stone at the distal end of the common bile duct was documented.

Acute Disease↗
PubMed1988

A prospective, randomized study comparing highly selective vagotomy and extended highly selective vagotomy in patients with duodenal ulcer.

The recurrence rate of duodenal ulcer after highly selective vagotomy is nearly 10 percent. To diminish this percentage, extended highly selective vagotomy with sectioning the gastroepiploic nerves has been proposed in order to reduce postoperative gastric acid secretion. We have prospectively compared the decrease in gastric acid secretion through measurement of basal acid output, maximal acid output, and peak acid output in patients who underwent highly selective vagotomy or extended highly selective vagotomy. No significant differences in postoperative gastric acid secretion were found and, therefore, no changes in the probability of postoperative recurrence of duodenal ulcer were seen.

Adolescent↗
PubMed1988

Triglyceride and cholesterol content in bile, blood, and gallbladder wall.

Cholesterol gallstone disease is frequent in Chile compared with other countries, as is cholesterolosis of the gallbladder. The purpose of this study was to determine any differences in bile composition and cholesterol content in the gallbladder wall and serum of patients compared with findings in patients with gallstones and control subjects. In control subjects, cholesterol content of the gallbladder wall was determined in autopsy material. Patients with cholesterolosis had bile composition similar to that of patients with gallstones, with supersaturation of cholesterol in the bile. Also, these patients had increased levels of cholesterol in the gallbladder wall but normal serum cholesterol levels. These findings suggest that altered bile composition occurs in patients with cholesterolosis and gallstones.

Adult↗
PubMed1988

Late subjective and objective evaluation of the results of esophagomyotomy in 100 patients with achalasia of the esophagus.

One hundred patients with achalasia of the esophagus were analyzed at a late follow-up by means of subjective and objective parameters. The surgical technique consisted of an anterior esophagomyotomy (6 cm long, not extending into the stomach more than 5 to 10 mm) with the addition of an anterior hemi-Nissen or Dor procedure, similar to the Thal serosal patch. No operative deaths occurred. The mean follow-up was 6.8 years, and only 1 patient was lost from this follow-up. Preoperative dysphagia, which was present in 100% of the patients, persisted only occasionally in 8%, and a significant gain in weight was recorded in 90% of the patients. In three patients epidermoid carcinoma developed 5 to 9 years after surgery. In one patient a severe gastroesophageal reflux with an esophageal ulcer developed. Radiologic studies demonstrated a significant increase in the diameter at the gastroesophageal junction and a decrease at the middle third of the esophagus (p less than 0.0001). The resting pressure of the lower esophageal sphincter showed a significant decrease, from 37 mm Hg to 10 mm Hg, after surgery (p less than 0.0001), when we analyzed 84 patients before and 68 patients after operation. The total length of this sphincter also decreased. The manometric evaluation of the lower esophageal sphincter pressure in the same 42 patients before, 2 months after, and 5 to 7 years after surgery demonstrated persistence of the low sphincter pressure. There was a significant increase in the amplitude of the esophageal waves, and the standard acid-reflux test demonstrated reflux into the esophagus in 19% of the patients. Final clinical evaluation showed excellent and good results in 92 of the 94 controlled patients.

Adult↗
PubMed1987

Postoperative acute acalculous cholecystitis.

A 5-year experience with postoperative acute acalculous cholecystitis is reported. The series concerns 9 male patients ranging in age from 28 to 69 years, with a mean age of 46 years. All underwent major surgical procedures and complications appeared in the postoperative course. Clinically, 89% of patients developed sepsis and 66% jaundice. Klebsiella pneumoniae was the microorganism most frequently isolated from the blood, intraabdominal and wound fluid collections. It is emphasized that the diagnosis of this form should be clinical and it should be immediately suspected whenever intraabdominal signs develop. A review of the international literature on the subject is presented. The etiology and pathogenetic mechanisms of postoperative acute acalculous cholecystitis are discussed.

Acute Disease↗
PubMed1987

A prospective study of intraoperative histologic antrum and corpus boundary in patients undergoing highly selective vagotomy for duodenal ulcer.

The results of the present study demonstrate that, at the level of the proximal branch of Crow's foot of Latarjet, parietal cells are found, and therefore, it must be sectioned when performing highly selective vagotomy. At the level of the distal branch, antral mucosa is found. At the level of the middle branch, in almost one-half of the instances, parietal cells are found, and its section must be evaluated with gastric emptying studies.

Adult↗