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Biomedical subjects

J Ponce

Publications and source records attributed to J Ponce.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Esophageal pseudoachalasia related to a neoplasm].

Differential diagnosis between idiopathic achalasia and esophageal pseudoachalasia is difficult to perform. One hundred and forty-four consecutive patients with a clinical diagnosis of primary esophageal motor disorder have been evaluated for pneumatic dilatation of the cardias. Of them, 6 (4.1%) have been finally diagnosed of esophageal pseudoachalasia with carcinoma of the cardias, although in four cases more than one biopsy procedure was needed to establish the diagnosis. The clinical data--higher age, shorter clinical history and higher weight loss--, the higher pressure of the lower esophageal sphincter and the failure of the dilatation suggested the diagnosis, but were uncertain findings. Esophageal biopsy is the only objective method to obtain a definitive diagnosis and should be performed in every patient with an esophageal motor disorder evaluated for dilatation of the cardias and, if negative, it should be repeated when malignancy is suggested by available data.

Aged↗
PubMed1993

[Prevalence of gastroesophageal reflux in patients with primary motor disorder of the esophagus treated with endoscopic pneumatic dilatation].

The prevalence of gastroesophageal reflux after successful pneumatic dilatation was investigated in 30 patients with primary esophageal motor disorder. After a median follow-up period of 377 days, three patients presented symptoms of acid reflux and five patients had endoscopic esophagitis (grade I, 3 patients; grade II, one patient; and grade III, one patient). Ambulatory 24 hr. esophageal pH monitoring was positive in 20% and 30% of the patients compared to our normal values and to those from other series from the literature, respectively. The concordance between pH results and symptoms and/or endoscopic esophagitis was very low. It is concluded that 24 hr. esophageal pH monitoring is frequently abnormal after pneumatic dilatation, but its clinical significance is low, because very few patients have symptoms and/or severe esophagitis.

Adolescent↗
PubMed1992

Effect of selective and nonselective muscarinic blockade on cholecystokinin-induced gallbladder emptying in man.

In this study we investigated the effect of selective (M1) and non-selective (M1 and M2) pharmacologic blockade of muscarinic receptors on cholecystokinin-induced gallbladder emptying. After validating the method of study, the gallbladder function was evaluated in 15 normal volunteers by quantitative biliary scintigraphy, and the effect of intravenous atropine (0.15 mg/10 kg) and pirenzepine (10 mg) was analyzed in each subject. Atropine significantly reduced the ejection period and the ejection fraction of gallbladder evacuation. Pirenzepine reduced the ejection period, but the ejection fraction remained unchanged. We conclude that the effect of cholecystokinin on gallbladder motility is mediated through muscarinic receptors. Our results suggest that M2 receptors, but not M1 receptors, are involved in this response.

Adult↗
PubMed1992

Does endoscopy improve prediction of the prognosis in upper gastrointestinal bleeding?

To evaluate the prognostic value of the endoscopic examination, we included 189 consecutive patients with upper gastrointestinal bleeding, in a prospective study. Rebleeding was more frequent in patients with endoscopic stigmata of hemorrhage. The prognostic prediction given by the physician was slightly, but not significantly, improved after the result of the endoscopy was available. However, when the clinical data were evaluated by computer, using the Bayes' theorem, the endoscopic findings provided no additional prognostic value. We conclude that the endoscopic findings have intrinsic prognostic value, but add little to clinical data obtained on admission.

Adolescent↗
PubMed1991

[Substances harmful for the gastric mucosa].

Gastroduodenal mucosa has a self-defense capacity against a wide range of potentially harmful exogenous and endogenous agents. It has been proven that certain diet compounds damage gastric mucosa, which explains--at lest partially--the regional variations in the incidence of peptic ulcer. Ethanol blocks the defense mechanisms of gastric mucosa and induces the onset of acute lesions, but there is no definite proof to show that ethanol ingestion helps produce the onset of peptic ulcer. It has been confirmed that tobacco negatively affects the healing and relapse of ulcers. From an epidemiological point of view, the controversy of the relationship between tobacco abuse and peptic ulcer genesis is still ongoing. Non-steroid anti-inflammatory non-acid soluble produces lesions acute and chronic) in gastroduodenal mucosa. They can reactivate old lesions and increased the risk of complications. Aspirin is the most harmful compound in this pharmacologic group. Paracetamol is the compound which has the safest spectrum. The harmfulness of steroids is still being discussed, however, it is accepted that they have a rapid effect on gastric mucosa in relation to dosage and duration of treatment.

Condiments↗
PubMed1991

[Dysphagia of vascular origin].

Three adult patients presented with dysphagia due to vascular compression of the esophagus. In one case, a dysphagia aortica was diagnosed. In the remaining two cases a congenital vascular anomaly--aberrant right subclavian artery and right aortic arc, respectively--was proved by arteriography. The final diagnosis was suspected after the barium meal and confirmed by computarized tomography in each case.

Adult↗
PubMed1991

[Defense mechanisms of the gastroduodenal mucosa].

A better knowledge of the mechanisms implicated in maintaining the integrity of gastroduodenal mucosa, suggests that apart from gastric acid, other--maybe equally important--factors are implicated in the genesis of acute and chronic lesions. Several intra and extracellular mechanisms have been identified which play a role in the "cytoprotection" phenomenon. More recently, the importance of the enteric nervous system, immune-mucosal system and motility of gastrointestinal tract, in all processes of defense and cellular restitution, has been pointed out. The effects on treatment derived from this knowledge are evident, even though the majority of them are hypothesis. They are an important line of pharmacology research. Further definition of the role in prevention and treatment of peptic ulcer disease of selective vasodilators, immunomodulators and mitotic agents as the epidermal growth factor needs to be carried out.

Animals↗
PubMed1990

Motor pattern of the sphincter of Oddi in patients with juxtapapillary diverticula.

In 15 patients with duodenal diverticula close to the papilla of Vater we evaluated the motor activity of the sphincter of Oddi by endoscopic biliary manometry. Both basal pressure and phasic activity were similar to those in nine patients without biliopancreatic disease and in 60 patients with common bile duct stones. The anatomical relationship between the papilla and diverticula did not lead to any change in the motor pattern. If juxtapapillary diverticula are associated with a higher prevalence of biliopancreatic disease, dysfunction of the sphincter of Oddi does not seem to play a pathogenic role.

Adult↗
PubMed1990

[The high pressure zone at the esophagogastric junction after 180 degree anterior fundoplication].

Twenty-nine patients in whom 180 degrees fundoplication was performed were studied manometrically before and 6-12 months and 6-13 years (mean 9.5 years) after operation. The resting pressure of the HPZ was 6.44 +/- 4.74 mmHg before operation, 12.72 +/- 6.17 mmHg at 6-12 months and 11.37 +/- 4.55 6-13 years later. The postoperative increase was significant in both early and late measurements. The slight decrease observed in late examinations was not significant. The length of the HPZ was not modified by surgery. However, the length below the point of respiratory inversion increased significantly from 1.06 +/- 1.04 cm before operation to 2.65 +/- 0.85 postoperatively and 2.24 +/- 0.68 in long term measurements. These changes occurred in the majority of patients but were unrelated to the clinical situation. Sixty-one patients who had manometry after 6-12 months were controlled clinically during 9.5 years. In 7 patients there was a symptomatic recurrence. Manometric values were similar to those found in assymptomatic patients. Anterior fundoplication (180 degrees) increases the tone and the length of the HPZ below the respiratory inversion point. On the other hand, the manometric changes observed do not have individual prognostic value.

Adolescent↗
PubMed1990

[Hemobilia in patient with hemophilia].

A case is reported of minor hemobilia in a patient with hemophilia. The form of presentation of the clinical picture with abdominal pain, nausea, vomiting and jaundice suggested a biliary origin and echographic evidence of an anomalous content in the bile tract that was not of lithiasic nature suggested the diagnosis of hemobilia. This was confirmed by retrograde cholangiography, which showed the expulsion of a clot from the papilla and was followed by spontaneous remission of the clinical picture.

Hemobilia↗
PubMed1990

[Thoracic pain possibly of esophageal origin. Results of a prospective study].

We have studied the prevalence of esophageal pathology, by means of esophagogram, esophagogastroscopy, manometry, 24-hours ambulatory pH measurement and acid perfusion of the esophagus, in 44 patients with thoracic pain suggestive of angina. Esophageal pathology was demonstrated in 30 (68.3%) cases; 25 patients were diagnosed of reflux and 5 of primary motor alteration. All the patients received specific treatment; the response to treatment was good in 22 of them (17 with reflux and 5 with motor alterations). In conclusion, esophageal pathology is a common cause of thoracic pain, and reflux is the most frequent finding.

Adult↗
PubMed1990

[Early complications of pneumatic dilatation in the treatment of primary motility disorders of the esophagus].

We analyze the incidence and evolution of the early complications of 96 consecutive patients with primary esophagus motor disorders, treated with pneumatic dilatation under endoscopic control (1.4 sessions per patient). In 4 (0.042/patient, 0.029/dilatation) patients the esophagus was perforated; the diagnosis was made in the first 24 hours; pneumomediastinum was a constant finding in the radiological exploration. In three cases the complication was suspected because of the apparition of sustained thoracic pain after the dilatation maneuver and in one case the presentation symptom was bleeding of cardial mucosa, larger than usual, at the end of the dilatation. The four patients evolved favorably with conservative treatment (avoidance of oral food intake, gastroesophageal aspiration, antibiotic therapy and parenteral nutrition).

Adolescent↗
PubMed1989

Effect of intravenous glucagon and glucagon-(1-21)-peptide on motor activity of sphincter of Oddi in humans.

Glucagon-(1-21)-peptide, the peptide containing the amino acid sequence (1-21) of glucagon, has the same spasmolytic effect as the complete molecule, without its metabolic action. The effect of glucagon and glucagon-(1-21)-peptide on sphincter of Oddi motor activity was evaluated in 20 patients undergoing ERCP and endoscopic biliary manometry. Glucagon produced a nonsignificant decrease in basal pressure, but significantly reduced both frequency and amplitude of phasic activity of the sphincter of Oddi. Glucagon-(1-21)-peptide showed no effect on basal pressure and amplitude of phasic activity, but provoked a significant reduction of frequency of phasic contraction.

Adult↗