Biomedical subjects
Publications and source records attributed to M C Machado.
A patient with duodenal obstruction resulting from passage of a gallstone through the wall of the gallbladder into the duodenum is reported. The patient was successfully treated by removal of the gallstone. A review of literature concerning the diagnosis, treatment and etiopathogenesis is presented.
Cystic neoplasms are an uncommon group among pancreatic tumors. These lesions are seen more frequently in recent surgical practice, probably because of advances in diagnostic and surgical techniques. We report 24 patients with cystic tumors of the pancreas, including twelve patients with serous cystadenoma, ten with mucinous cystadenoma and two patients with mucinous cystadenocarcinoma. Twenty-two patients were women and two were man. The median age of patients was 53.5 years (range, 21 to 80 years). Mild abdominal pain was the main symptom; in 71% of patients and weight loss in 29% of patients. The lesions were incidental findings 8% of patients. The mean size of the cysts was 7.8 cm (range, 2.3 to 15cm). Eleven cystic neoplasms were located in the head, three in the neck, five in the body, two in the tail of pancreas and three in the body and tail. All patients underwent surgical exploration. There was no perioperative mortality. Total tumor resection provides the best chance of cure and may remove the risk of malignant transformation of the cystadenomas, particularly of the mucinous type.
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Up to 70% of the patients with acute pancreatitis suffer a sort of pulmonary dysfunction. Twenty-nine rats with pancreatitis induced by 2.5% taurocholic and solution have been studied by whole body plethysmography in order to evaluate pulmonary volumes and expiratory flows. They were divided into three groups: a sham operation control group-10 rats,a two pancreatitis group-10 rats and eight hours pancreatitis group-9 rats. The results showed a significant decrease of expiratory reserve volumes and forced vital capacity (FVC) and also a significant increase of expiratory flow in the 2 and 8 hours pancreatitis groups. These findings indicate a restrictive pneumopathy.
We report two cases one a primary non Hodgkin lymphoma of the hepatic common duct and the other a secondary involvement of the biliary tract in a patient with a Hodgkin's disease. In the first case a local resection of the biliary lymphoma was undertaken being the patient alive six months after the procedure. The second case died early after the operative biliary external drainage in a septic shock before any specific treatment could be initiated.
A small fraction of solid mass in the head of the pancreas are inflammatory rather neoplastic in origin. The failure to recognize the true nature of a solid tumor in the head of pancreas may lead to an incorrect treatment strategy. This is a report of a patient with clinical history of pancreatic cancer which computed tomography showed a mass in the head of the pancreas with radiologic characteristics of malignancy. The patient underwent exploratory laparotomy with the finding of a mass in the head of the pancreas. The inflammatory palpable characteristic of the mass led to a intraoperative biopsy to confirm the preoperative diagnosis. With the benign result of the biopsy, the final diagnosis was duodenal ulcer which penetrates in the pancreatic parenchyma.
The authors studied 98 patients in need of a central venous line route, joined into two different groups: Group 1 - 62 (63.3%) patients, and Group 2 - 36 (36.7%). All the patients had a visible external jugular vein while on Trendelenburg position. According to the Seldinger technique using a J-wire guided catheter the authors describe a maneuver to make it easy to advance the catheter. Patients from Group 1 had the technique applied by operators with previous experience, and patients from Group 2 by operators with no previous experience, but under supervision. There was no significant difference in the success rate between these two groups: 96.8% in Group 1 and 94.4% in Group 2 (p > 0.5). There was only one case of local bleeding, managed by local compression.
Approximately 50 to 70% of the patients with acute pancreatitis (AP) have suffered hypoxia and 1/3 of the pulmonary lesions could progress to a clinical respiratory insufficiency. The respiratory mechanics has been studied by Amdur and Mead (1958) method in the rat with acute pancreatitis induced by taurocholate acid injection into hepatic duct. It has been measured dynamic elastance and pulmonary resistance. Three groups were studied: control group "sham operation"-12 rats; 2 hours pancreatitis group-10 rats and 8 hours pancreatitis group-8 rats. There was no significant increase on dynamic elastance in 2 hours AP group and also no tendency of normalization of this parameter in 8 hours AP group. The pulmonary resistance shows no significant increase in 2 and 8 AP groups (p). The pulmonary resistance alterations show that AP does not lead to an obstructive pneumophathy and if correlated with the decrease of total pulmonary capacity observed in the volume/pressure curves one could conclude that AP probably is associated with a restrictive pneumophathy.
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Liver cell adenomas were relatively rare until the use of oral contraceptives. Most of these tumors have occurred in otherwise healthy young women who have been exposed to oral contraceptives. The treatment of this condition remained controversial for a long time. However, bleeding is still a frequent complication and can lead to a significant mortality rate. The better surgical results in hepatic resection, due to technological advances, has contributed to the indication of surgical management as therapeutic option in hepatic cell adenoma. Some authors believe that liver cell adenomas were potentially premalignant and could degenerate into hepatocellular carcinoma but there is very few well documented reports of this transformation. We report our experience in the management of liver cell adenoma.
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The induction of pancreatitis by injecting the taurocholate acid 2.5% solution into the rat's hepatic duct. Ten rats formed the normal control group, nine rats the two hours pancreatitis group and eight rats the eight hours pancreatitis group. The comparison of the groups has shown a significant increase in the numbers of macrophages, neutrophils and lymphocytes in the broncho-alveolar lavage of pancreatitis group (p < 0.05) indicating an acute inflammatory pneumopathy.
Duodenal perforation is a rare complication of endoscopic sphincterotomy and its treatment is controversial. The authors report three cases of duodenal perforation by endoscopic sphincterotomy. In two cases with history of a previous biliary infection, surgical treatment had to been performed because of a peripancreatic abscess.
Three cases of Frantz tumor, a papillary and cystic tumor of the pancreas, are discussed and compared with other cases reported in the literature. The neoplasm behaved in these three cases as a benign tumor. Pancreaticoduodenectomy was performed in one patient and distal pancreatectomy in the other two. C T scan and ultrasonography are useful for the diagnosis of these tumors. Cut surfaces show mostly well encapsulated tumors with the characteristically solid and hemorrhagic-necrotic patterns. Usually they are of a very low-grade malignancy so the complete surgical removal is the treatment of choice.
In Brazil, the incidence of IPF due to alcohol-induced CP seems to be higher than in other countries. The authors analysed some general, epidemiologic, laboratory and radiologic features in 98 patients with CP, all of them alcoholics, divided in two groups: 49 patients without IPF (I) and 49 patients with IPF (II). The authors first analysed the following parameters in each group and then comparatively in both groups: age, sex, race, smokers and daily consumption of cigarettes, daily consumption of alcoholic beverages, years of alcohol consumption, and mortality. The authors concluded that pancreatic fistula plays in effusions the main role, secondary to cysts disruption or necrosis of the main pancreatic duct.
This study was performed to assess the effects of the reduction of pancreatic enzymatic content in the evolution of acute pancreatitis (A.P.) in rats. We hypothesized that cerulein in physiologic dose reduces the enzymatic content of the pancreas and may decrease the mortality of A.P.. Four groups of rats have been studied. In the group I cerulein in a total dose of 8 ug/Kg was given, Group II was a control group, Group III received cerulein in inframaximal dose (0.4 micrograms/Kg) and Group IV was a control group with free access to diet and water. Acute pancreatitis was induced by retrograde injection of taurocholic acid into the pancreatic duct. The mortality was 60% in group I, 56% in group II, 23% in group III and 34% in group IV. These results suggest that by decreasing enzymatic content of the pancreas the severity of acute pancreatitis may be reduced.
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Correlations between tomographic findings and the outcome of the disease was made in 49 patients with necrotizing pancreatitis submitted to surgical treatment. Mortality rate was 20.40% resulting mostly from sepsis and multiple organ failures. There was no correlation between APACHE II index and number of necrotic areas diagnosed by abdominal computed tomography although they were closely related with mortality. These findings suggest that different necrotic areas have different prognostic values. The root of the superior mesenteric artery and retropancreatic area were related to worst prognosis with 100% mortality rate. Incomplete necrotic tissue removal is the possible explanation for the high mortality rate.