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J C Chiocca

Publications and source records attributed to J C Chiocca.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Esophageal intramural pseudodiverticulosis].

We discuss the features of a case of the unusual entity known as esophageal intramural pseudodiverticulosis. We believe that esophagography is the most appropriate diagnostic method for this disease, whereas endoscopy, electromanometry, computerized tomography and ultrasonography play a secondary role. The findings of esophageal ultrasonography described in our patient are, we believe, the first described in the literature.

Aged↗
PubMed1990

[Treatment of benign esophageal stenosis: re-evaluation after 20 years].

In 1972 we described a method for dilatation of esophageal stenosis. The purpose of this paper is to report the results obtained between 1970 and 1989, the patients were studied by X-Rays, "calibration" of the stenosis, endoscopy, biopsy, cytology, gastric analysis and esophageal motility. One hundred and seven patients were treated (mean 60.5 years, M/F 3.9/1). The most frequent etiology was reflux esophagitis (80.3%). Hiatus hernia was present in 84.9%. The stenosis was in the lower third of the esophagus in 92.5%. The BAO was mean: 3.6 mEq/h, and the MAO mean 16.4 mEq/h with a hypersecretion pattern in 33.1% of the cases. Cytology was negative for malignancy in 100%. Biopsy showed esophagitis in 86.9%, Barrett's epithelium in 12.1%, normal tissue in 6.5% and insufficient material in 1.8%. Endoscopy showed 98.1% of grade IV esophagitis. Esophageal motility showed a HPZ of mean 6.5 mmHg. and varying degrees of aperistalsis in 24.3% of the patients. The total number of dilatations was 555 (mean 5.1/pt). The "calibration" of the stenosis previous to the dilatation was mean 8.6 mm, and post dilatation mean 15.6 mm. The result of the procedure was good in 92.5%, regular in 2.8% and bad in 4.6%. The morbidity was 0.9% and the mortality 0.1%. There was relapse of the stenosis in 42% of the cases, the follow-up was mean 3.2 years. Twenty nine patients were submitted to surgery due to failure of the procedure with 68.1% of good results, morbidity of 9% and mortality of 9%. We conclude that this dilatation procedure offers excellent results with a very low morbi-mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Atypical chest pain: study by the hydrochloric acid provocation test].

Evaluation by means of gastroenterological and cardiological methods. The purpose of this paper was to study the origin of chest pain (CP) in patients with normal and pathological coronary arteries as characterized by coronary arteriogram (CA). Sixteen normal control individuals (X 27 years -7 females and 9 males) were studied by means of esophageal manometry (EM) with a 3 way catheter perfused by a low compliance capillary system. Twenty-one patients with chest pain were studied and divided according to coronary arteriogram in normal (NC) and pathological arteries (PC). They were simultaneously studied by means of EM, heart rate/pressure product (RPP), and 12 lead ECG monitoring. After a basal period they were given a Bernstein's provocative chest pain test, and after each of its stages we determined in a simultaneous fashion CP, EM, ECG and RPP. In 61.9% of the patients abnormal basal EM was found. It was characterized by increase in HPZ, duration, propagation velocity and pressure of the peristaltic waves: as well as an increase in the percentage of aperistaltic waves. In 14.2% of the patients the Hydrochloric provocative test was positive. The only statistically significant datum was the heart rate/RPP relationship. We conclude that in future studies it would be of interest to combine 24 hour monitoring EM and pH as well as a more sensitive provocation test such as edrophonium chloride.

Adolescent↗
PubMed1988

[Esophageal motility dysfunction and radioisotopes. Its modification with a calcium channel blocker].

We described the esophageal radionuclide transit (ERT) of a liquid bolus through 5 areas in pharynx, esophagus (3 levels) and gastric fundus before and after the administration of 30 mg of sublingual nifedipine, in 8 normal individuals and 13 patients with different esophageal motor disturbances. The controls and patients were previously studied by esophageal manometry (EM). The results in control individuals were as follows: 1) the total transit time (TTT) was 11.85 +/- 1.13 sec, 2) the time of beginning of gastric filling (GF) was 3.99 +/- 0.65 sec, 3) the residual activity (RA) was 9.53 +/- 4.64%, 4) nifedipine showed a statistically significant increase of the RA. The ERT detected 100% of the achalasic patients with a TTT that was not greater than 40 seconds and a delayed GF. In the classic achalasia patients nifedipine did not produce significant modifications in the ERT. The only case of vigorous achalasia studied showed an adynamic pattern with activity in peaks which improved after the administration of nifedipine. One of the nutcracker esophagus showed a pattern of sequential peaks with a similar response to nifedipine. The sensitivity of the method was 100%, nifedipine seems to be useful in the sense that improves the esophageal transit. Since the ERT as a non-invasive method and has a 100% sensitivity, we propose it as a step previous to EM in the study of esophageal motor disorders.

Adult↗
PubMed1987

[Treatment of benign esophageal stenosis by prolonged dilatation: re-evaluation after 15 years].

The purpose of this paper is to re-appraise the results of a method for slow continuous dilatation of benign esophageal stenosis comparing previous experience of a decade with that accumulated during the following five-year period. A total of 78 patients were dilated, the average age was 58.1 years, and the M/F dilated, the average age was 58.1 years, and the M/F ratio 3.3/1. Reflux esophagitis was the most frequent etiology when comparing both groups (77.5% and 79.4% respectively). Esophageal hiatus hernia was the most common associated pathology in both groups (83.3% and 87.7% respectively). Gastric analysis showed average values within the limits of normal, 40% of de cases showed a hypersecretion pattern. The mean lower esophageal sphincter pressure was low, and a group of patients showed aperistalsis in more than 50% of the swallows, fact that was thought to be due to esophageal inability to clear the refluxed material. Another important fact was an increase in the frequency of Barrett's epithelium (6.5% to 9.3%). Undoubtedly the most important features were the increase in the number of good results of dilatation (87.7% to 92.3%), the decrease of morbidity (6.1% to 0.7%) and mortality (2% to 0.2%). The follow-up increased from X 27.3 to X 33.8 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Esophageal achalasia: review of the results after 15 years' experience].

The purpose of this paper is to evaluate the experience acquired along a 15 years period (1971-1985) in the treatment of achalasia of the esophagus. One hundred and fifty six patients were evaluated. The average age was 50.8 years, and the M/F ratio 0.9/1. Dysphagia was present in 100%, regurgitation in 78.2%, weight loss in 61.5%, and chest pain in 50% of the cases, being the main symptoms. Serology for Chagas disease was positive in 21.2% of the patients. When classified by radiologic criteria the groups were: grate I 18.5%, grate II 53.8%, grate III 14.7% and grate IV 12.8%. The high pressure zone was X 23 mmHg (N 14.8 mmHg) pre dilatation. The incidence of vigorous achalasia was 5.7% and the urecholine test was positive in 61.1%. Only 95 patients were submitted to pneumatic dilatation, and this is the group that we shall analyze in detail. We performed 110 dilatations, since 80 patients were dilated once and 15 received 2 dilatations. The high pressure zone post dilatations was X 12.5 mmHg. We obtained good results in 82.1%, regular in 3.1% and bad results in 14.7% of the patients. The morbidity was 4.5% (3 perforations and 2 gastroesophageal reflux), and the mortality 0.9%. There was relapse in 26.3% of the cases. In 53.3% of the patients submitted to a second dilatation we obtained good results. The average hospital stay was 2.5 days, and the follow up X 32.4 months. Thirty nine patients were sent to surgery with good results in 82%, regular in 2.5%, and bad in 15.6%. The morbidity was 15.3% and the mortality 5.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Esophageal lesion caused by drugs].

Two cases of esophageal injury secondary to drugs are hereby presented, reviewing the different types of drugs, predisposing factors, physiopathology and complications.

Adult↗
PubMed1984

[Megaesophagus secondary to carcinoma of the cardia: apropos of 4 cases].

Four cases of megaesophagus with esophageal motor disturbances secondary to adenocarcinoma of the cardia are hereby reported. There were common characteristics to all cases such as: 1) short duration of symptoms, 2) grade II megaesophagus by X-Rays with narrowing of the cardia, 3) the endoscopy showed esophageal dilatation and inability to pass the cardia with the endoscope, 4) histology (obtained by endoscopy or surgery) and exfoliative cytology were positive for malignancy, 5) the esophageal motility tests showed aperistalsis of the whole esophagus in all cases, and lack of relaxation of the lower esophageal sphincter in two. The urecholine test was positive in one patient with neoplastic infiltration of the myenteric plexus, 6) in two cases where esophageal resection was performed, infiltration of the Auerbach's plexus by cancer cells was proven. We conclude that in the presence of aperistalsis of the esophagus with or without achalasia of the lower esophageal sphincter, the diagnosis of megaesophagus secondary to cancer of the gastric fundus should be suspected when it is not possible to pass the cardia with the endoscope, even if biopsy and cytology are negative for malignancy.

Adenocarcinoma↗
PubMed1983

[Autoimmunity factor in chronic gastritis: incidence of antiparietal cell antibodies and their relation to antral histology and basal blood gastrins].

In 118 patients with histological proven chronic gastritis, was performed a study of seric antibodies against parietal cells (ACCP), following the indirect inmuno-fluorescence method. The results were positives in 36 cases (30%). Four positives cases were found in 40 normal controls (10%), two of them were compensated diabetics, one have the thyrohyoid Hashimoto's disease, and the remainder, brother of a patient with chronic gastritis, was a positive ACCP. A major positiveness (44.4%) was obtained in 9 cases of gastric atrophy than in 65 cases with atrophic gastritis (32%) and in 44 cases of superficial gastritis (25%); although due to the few cases of gastric atrophy regarding other histological types, conclusions cannot be obtained about the incidence of ACCP and histological variety of chronic gastritis. If we do group the patients according to their acid secretory debit, 53 achlorhydric patients had a positiveness of ACCP of 45%, while over 63 with decreased secretory capability, only 18.4%, was positive. The distribution by age groups, shows a major incidence of ACCP about the 4th and 5th decade of life. Thirty seven patients with chronic atrophic gastritis and achlorhydria, and seven with chronic superficial gastritis and hypochlorhydria, besides the antibodies study were on a basal dosage of gastrinemia and antral endoscopic biopsy, finding out that, achlorhydric patients (15 on 19) with normal or slightly altered antrus, have gastrinemia (222 +/- 123 Pgo/oo) and the majority of patients with normal gastrinemia (32 +/- 16 pgo/oo) have more important antral lesions. The ratio between antral histology and ACCP in auto--immune gastritis (Type A), conciliates only partially with the observation by Strickland et al., as only 52.4% of achlorhydric patients and ACCP have a normal antrus or al least with mild lesions. Our results suggest the possibility of that on auto--immune gastritis could act other pathogenic factors of antral lesion.

Adult↗
PubMed1982

[Esophageal pathology associated with achalasia].

Out of 90 patients with esophageal achalasia seen during the last decade, we found associated esophageal pathology in 46,6% of the cases. The esophagitis occurred with a frequency of 26,6%, whereas esophageal hiatus hernia was found in 14,4%, benign esophageal stenosis in 5,5%, diverticula in 2,2% and tumors in 2,2%. The role of the different ethiopatogeneic factors is discussed as well as the approach to the above mentioned entities.

Adolescent↗
PubMed1981

[Achalasia and elevated pressure at the cricopharyngeal sphincter: comments on a case].

A case of uncommon occurrence, such as the so called primary achalasia and hypertension of the cricopharyngeal sphincter is hereby described, as well as its successful treatment by means of an extramucous miotomy of the cricopharyngeal sphincter. The anatomy and physiology of the upper esophageal sphincter is described, as well as its pathogenesis. The published literature is also reviewed.

Cricoid Cartilage↗
PubMed1979

[Action of metoclopramide bromide and metoclopramide chloride on the lower esophagogastric junction and the peristalsis of the lower 3d of the esophagus].

In 10 patients with esophageal hiatus hernia the effect of metoclopramide bromide and metoclopramide chloride compared with placebo, was studied by the double blind method. Both drugs produced an increase of the lower esophageal sphincter pressure and of the peristalsis of the lower third of the esophagus, only being statistically significative the action of metoclopramide chloride on the perstalsis. No significative side-effects were noted.

Adult↗