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Biomedical subjects

J Arana

Publications and source records attributed to J Arana.

28 records · Page 2Linked to original sources
PubMed1987

[Indications for the surgery of gastroesophageal reflux in children].

A retrospective study based upon 100 consecutive antireflux operations performed in children for gastroesophageal reflux (GER) in the last 9 years enables the authors to elaborate on indications and their timing. The clinical pictures, often combined in this series, were vomiting (85%), respiratory disease (50%), failure to thrive (47%), haemorrhage (25%), brain damage (16%), rumination (6%), oesophageal stenosis (4%), torticollis (3%) and cricopharyngeal dysphagia (1%). Five children had been previously operated upon for oesophageal atresia. Hiatal hernia was found in only 10 instances. Only 9 children were operated upon before the age of 12 months. Overall operative age was high (52.5 months) and that of patients with neurologic disease was even higher (81.3 months) probably as a result of delayed diagnosis. This experience underlines the limitations of medical treatment beyond the age of 12 months, the poor reliability of disappearance of vomiting as an index of cure during the first year and the need for facing operative indications without prejudgements based on traditional ideas that do not take into consideration clinical manifestations of GER disease which are currently well established.

Age Factors↗
PubMed1986

Abnormal preoperative and postoperative esophageal peristalsis in gastroesophageal reflux.

Extended 24-hour pH monitoring and esophageal manometry before and 6 months after Nissen fundoplication in a group of 14 children with symptomatic gastroesophageal reflux (GER), of whom 12 had esophagitis, have shown that all patients were clinically cured and their initially abnormal pH-monitoring parameters significantly decreased to normal values after operation. Whereas lower esophageal sphincter pressure (LESP) was not modified by surgery, lower esophageal sphincter length (LESL) was significantly increased. The percentage of tertiary, nonpropulsive esophageal waves, that was very high in basal conditions (74.9 +/- 34.5%) and following instillation of acid into the esophagus (79.8 +/- 20.2%) remained high (58 +/- 23.2% and 72.1 +/- 18.2% respectively) several months postoperatively. The persistence of abnormal peristalsis after surgical cure of GER suggests that severe symptoms in this group of patients resulted from the simultaneous failure of both components of the antireflux mechanism (LES and esophageal peristaltic "pump"), which led to increased acid exposure. The good results of surgical establishment of an effective valve-like barrier alone illustrate the possibility of compensation by only one of the components when the other fails. According to this interpretation, whereas patients with good peristalsis would tolerate GER fairly well, those with GER and bad peristalsis would have increased acid exposure and, consequently, esophageal damage.

Child↗
PubMed1986

[Gastroesophageal reflux in neurologic patients].

Sixteen among the 129 children operated upon for GER in the last 9 years had neurologic diseases with psychomotor retardation. Average age at diagnosis was advanced (90 months) although most patients vomited since infancy and more than 50% had haemorrhage as a sign of oesophagitis which was endoscopically confirmed in 10 cases. Prolonged acid exposure as proven by extended pH-metry was due to motor failure with incompetence of the LES and abnormal peristalsis (aside with other minor factors) as we could demonstrate manometrically. Surgical treatment achieved good results in almost all cases and we think that there is no reason not to offer its benefits to this group of patients. GER is more frequent and severe in brain damaged patients than it can be judged by the scarce number of them operated upon in our country. It must be looked after in them and treated appropriately whenever complications make it advisable.

Adolescent↗
PubMed1986

[Functional study of gastroesophageal reflux in children with brain diseases].

Aiming to evaluate the participation of oesophageal motor troubles in the pathogeny of gastro-oesophageal reflux in brain-damaged children, we have studied 16 of these patients. Most of them had a more or less severe esophagitis due to excessive acid exposure. We have found a decreased LESP as compared to normal subjects (8.84 +/- 6.20 vs. 18.33 +/- 6.55 mmHg (p less than 0.001)), and high percentages of non-propulsive waves in basal conditions (70 +/- 29.66 vs. 6.25 +/- 9.16 (p less than 0.001)) as well as after serum (66.33 +/- 28.06 vs. 16.66 +/- 13.66 (p less than 0.001) and acid instillation (58.33 +/- 28.91 vs. 26.41 +/- 12.04 (p less than 0.05)). These results demonstrate that motor disturbances are responsible for the severity of GER in this group of patients.

Adolescent↗
PubMed1985

Cricopharyngeal dysphagia and gastro-oesophageal reflux.

Nasal regurgitation of milk and choking after feeding were observed in a 1,450 g newborn boy. A nasogastric tube was inserted and several episodes of aspiration pneumonia occurred after every interruption of gavage. Weight gain was very slow. At the age of 7 months, cineradiographic studies depicted cricopharyngeal spasm and passage of the barium into the nasopharynx and larynx. Pharyngo-oesophageal manometry showed incoordination, high cricopharyngeal pressure and incomplete relaxation of the muscle. Extended lower oesophageal pH-metering revealed severe gastro-oesophageal reflux. After cricopharyngeal myotomy and fundoplication the patient recovered, x-ray findings improved, and so did manometry except for a persistent incoordination. Functional studies are mandatory for diagnosis of this complex clinical pattern. The need for ruling out gastrooesophageal reflux before myotomy in order to prevent subsequent severe aspiration, is pointed out.

Deglutition Disorders↗
PubMed1985

[Esophageal peristalsis and acid clearance. A study method].

Peristaltic waves account for clearance of acid refluxed into the oesophagus, acting as a second anti-reflux barrier. We have developed a system combining oesophageal motor and pH studies. We use a three-lumen, constantly perfused, manometry probe attached to a pH microelectrode. Primary and secondary oesophageal waves are able to clear injected acid from the oesophagus, whilst non-propulsive tertiary waves do not raise pH back to normal levels. Children with severe GER have a high proportion of tertiary waves, and it is tempting to incriminate these motor disturbances as an important for their bad tolerance to GER.

Acids↗
PubMed1984

Human sperm penetration in bovine cervical mucus clinical studies. II. Use of split ejaculates.

Sperm penetration through bovine cervical mucus was determined and correlated with the sperm characteristics in three fractions of the split ejaculate and in the whole ejaculate from 40 men of infertile couples in which a female cause of infertility had been ruled out. Sperm concentration and motility were found to be significantly higher in the first fraction (n = 40) as compared with the rest of the fractions and the whole ejaculate, whereas normal sperm morphology was not significantly different among the various fractions and the whole ejaculate. The bovine mucus penetration (BCMP) test was found to be normal in a significantly high percentage (58%) of samples of the first fraction as compared with the other two fractions (32% and 17%, respectively) and the whole ejaculate (35%) (n = 17). Moreover, in the first fraction of the split ejaculate, the results of the BCMP test were correlated significantly with sperm concentration (P less than 0.01), motility (P less than 0.0001), and morphology (P less than 0.02). The data demonstrate the superiority of the first fraction of the split ejaculate in terms of cervical mucus penetrability and sperm characteristics.

Adult↗
PubMed1982

[Gastroesophageal reflux with respiratory manifestations. Manometric and pH-metric study].

Gastroesophageal reflux can be found in patients with respiratory tract disease even in the absence of vomiting. A manometric and pH-metric study carried out in 69 children with radiologic reflux (of whom 49 had respiratory symptoms) and 10 normal controls has shown: 1. lower esophageal sphincter pressure was lower in refluxing patients than in controls, but values were significant only for those with vomiting; 2. all parameters of prolonged esophageal pH-metry indicating reflux were very significantly abnormal in the group of respiratory patients who were by this respect very similar to vomiting refluxers; 3. nevertheless, one fourth to one third of these patients were manometrically and pH-metrically normal. These data confirm that there is a relationship between gastroesophageal reflux and bronchopulmonary disease. A widening of the field of antireflux therapy can be predicted for the near future, although a further definition of the indications is necessary.

Asthma↗