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Biomedical subjects

J Ponce

Publications and source records attributed to J Ponce.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1989

Endoscopic biliary manometry in patients with suspected sphincter of Oddi dysfunction and in patients with cystic dilatation of the bile ducts.

We studied the motility of the sphincter of Oddi in 12 patients with suspected sphincter of Oddi dysfunction, in four patients with cystic dilatation of the bile ducts (two Caroli's cases and two fusiform choledochal cyst cases), and in 33 patients with retained common duct stones. In these last 33 patients, the motor activity of the sphincter of Oddi was similar to that recorded in nine control subjects without pancreatic or biliary diseases. In the suspected Oddi dysfunction cases, both the basal sphincteric pressure and the frequency of the phasic contractions were significantly elevated (P less than 0.001). Patients with biliary cystic dilatation showed an increased basal pressure, but the frequency of the contractions was elevated in only those with choledochal cysts and the amplitude in only one of the two patients with Caroli's disease. Motor disorders of the sphincter of Oddi provide a basis for an alternative etiopathogenesis of cystic disease of the biliary system and a possible explanation for pain and dilatation of the bile duct in patients with suspected sphincter of Oddi dysfunction.

Adult↗
PubMed1989

Therapeutic failure and relapse in peptic ulcer.

The objective of peptic ulcer (PU) treatment is to cure the ulcer, as no therapy exists for the disease itself. However, not all patients can be cured. The causes of therapeutic failure are not precisely known, and there is no easy way to identify failure-prone cases before commencing treatment. It is known that such patients do not show different gastric acid secretion patterns or alterations in drug absorption. Nevertheless, the inhibition achieved in nocturnal secretion is less than in patients who respond favorably to treatment. The therapeutic strategy to be followed has not been clearly defined, although a number of observations are of practical interest in designing therapeutic protocols. An increase in the doses of H2-antagonists administered is unable to enhance the antisecretory effect or improve the cure rate. On the other hand, prolonging the administration of the same or a different H2-antagonist is capable of curing many patients, but not all. Recently, it has been found that prolonging treatment with cytoprotective drugs would be more advantageous. This suggests that an alteration in the defensive mechanisms of the gastric mucosa may be the main cause of PU among these patients. In contrast, it has also been found that healing is practically universal on administration of a more potent antisecretory drug such as omeprazole. These observations suggest that a bivalent drug combining antisecretory and cytoprotective effects could reduce the number of failures; nevertheless, the ideal objective would be to treat the disease itself and not just the ulcer.

Anti-Ulcer Agents↗
PubMed1989

Therapeutic approach to peptic ulcer relapse.

The ideal aim of ulcer treatment is to avoid relapse. However, to date it has only been possible to reduce the annual number of relapses following maintenance therapy using different drugs. All prolonged treatments using drugs at doses usually below those used in treating acute outbreaks have shown statistically significant differences in the number of resulting relapses when compared with placebo trials. Reports comparing the results obtained with the different drugs available are contradictory. However, at present the H2 antagonists agents constitute the treatment of choice in preventing relapse, in view of their easy administration and single nocturnal dose requirements. Moreover, there are monitored groups of patients with over five years administration of these drugs, with results being satisfactory and secondary effects very few. Elective surgery to counter relapse is currently less common in cases of uncomplicated ulcers, as the less aggressive and more functional forms of surgery lead to an important percentage of relapse that tends to increase with time. Because of discomfort to the patient, little experience has been accumulated on the administration of associated drugs. In the future, the ideal drug will not only exhibit antisecretory activity, but will also protect the gastric mucosa and prevent ulcer relapse once administration is discontinued.

Anti-Ulcer Agents↗
PubMed1988

Motor pattern of the sphincter of Oddi in patients with bilioenteric shunt: a manometric study.

An endoscopic biliary manometry was performed on 11 patients with a surgical bilioenteric shunt--choledochoduodenostomy--and no pressure gradient between common bile duct and duodenum. Basal pressure and frequency of the phasic waves of the sphincter of Oddi were significantly higher in these patients than in controls or in patients with retained common bile duct stones. These results suggest a functional adaptation of the sphincter of Oddi in an attempt to recover the normal pressure in the biliary tract.

Aged↗
PubMed1986

Return of esophageal peristalsis after Heller's myotomy for idiopathic achalasia.

A 23-year-old male was diagnosed as having idiopathic achalasia on the basis of clinical, radiologic, endoscopic, and manometric evaluation. He underwent a Heller's myotomy with 180 degrees posterior fundoplication as an antireflux procedure, and he did well subsequently. On reexamination one month later, return of peristaltic activity throughout the body of the esophagus was shown on manometric studies. Two years after the operation, peptic esophagitis was diagnosed by esophagoscopy, and the acid reflux test confirmed the existence of gastroesophageal reflux. To our knowledge, this represents the first reported case of return of esophageal peristalsis in idiopathic achalasia after surgical myotomy.

Adult↗
PubMed1986

Effects of atropine and pirenzepine on sphincter of Oddi motility. A manometric study.

We studied the Oddi sphincter motility by endoscopic manometry in 10 consecutive patients randomized in a double-blind fashion, after i.v. administration of two anticholinergic compounds (0.5 mg atropine sulfate and 10 mg pirenzepine). Pirenzepine significantly decreased the basal sphincteric pressure, as well as the amplitude and frequency of the phasic contractions. The only significant effect of atropine was the modification of the frequency of the phasic contractions, but only for a short period of time. Our results suggest that muscarinic innervation must be present for a normal sphincter of Oddi motility.

Adult↗
PubMed1986

The effect of 180 degree anterior fundoplication on gastroesophageal reflux.

Sixty-seven patients with symptoms of gastroesophageal reflux not responsive to medical therapy were treated by 180 degree anterior fundoplication. The operative mortality was 1.5% (one patient). The follow-up period ranged from 6 to 132 months and averaged 3 1/2 yr. The overall clinical results were satisfactory in 94% of the cases; one patient had mild retroesternal heartburn after operation, and three patients had recurrence of symptoms with persistent reflux in two of them. Among the improved patients, one experienced a transient gas-bloat syndrome. In 41 patients manometric evaluation of the gastroesophageal high pressure zone showed a significant increase in both the pressure and the length below the respiratory inversion point (p less than 0.001) but not in the total length. The standard acid reflux test carried out on 47 patients after surgery was found to be negative in all of them. We conclude that in patients with severe gastroesophageal reflux, 180 degree anterior fundoplication achieved good clinical results confirmed by objective methods.

Adult↗