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Biomedical subjects

M Pera

Publications and source records attributed to M Pera.

71 records · Page 4Linked to original sources
PubMedDate not supplied

Use of a colonic pouch as a rectal substitute after rectal excision.

Mid or distal rectal resection with straight coloanal anastomosis effectively treats distal rectal cancer and avoids a permanent stoma. However, the straight colonic segment is a poor reservoir for stools, and patients usually experience varying degrees of impaired rectal function after operation, including frequent bowel movements, incontinence, tenesmus, and soiling. In contrast, a J-shaped colonic pouch provides an adequate neorectal reservoir after operation. Patients with a colonic pouch-anal canal anastomosis have fewer bowel movements per day than patients with straight colorectal or coloanal anastomosis. Furthermore, the morbidity of the colonic pouch is not greater than that of the straight coloanal anastomosis. An important technical aspect of the colonic pouch procedure is that the limbs used to form the pouch must be no longer than 5 to 6 cm. Patients with larger pouches experience emptying difficulties. Also, the level of the anastomosis between the pouch and the anal canal must be no more than 4 cm from the anal verge, again to avoid problems with defecation. With these caveats, the operation should be considered in patients who require excision of the mid and distal rectum for cancer.

Anastomosis, Surgical↗
PubMedDate not supplied

Nutritional aspects in oesophageal carcinogenesis (review).

The role of diet in carcinogenesis has received much attention in recent years. The incidence of oesophageal cancer varies widely in different geographical regions and oesophageal cancer shows one of the greatest correlations between the diet type and eventual malignant development. Oesophageal carcinogenesis involves the combined action of predispositional, initiatory, and promotional factors. Specific dietary deficiencies (vitamins and minerals) may create a sensitized "environment" for the combined activities of initiatory and promotional factors. Other predispositional factors include physical abrasion (irritant vegetal components, thermal injury) and chemical injuries (alcohol, tobacco). Initiatory factors such as nitrosamines or their precursors in the diet are also considered.

Cocarcinogenesis↗
PubMedDate not supplied

[Splenic rupture in chronic pancreatitis. A clinical case. Observations].

The paper reports a case of splenic rupture during the course of chronic pancreatitis, an event rarely reported in the literature. The anatomical arrangement of organs and peripancreatic vessels is a predisposing factor for this complication. There are essentially three different but correlated pathogenetic hypotheses. The first refers to thrombosis of the splenic vein with portal hypertension documented by some researchers even in angiographical terms: during the course of chronic pancreatitis the spleen is sometimes palpable. Thrombosis and/or vascular compression make the spleen more fragile and its rupture more likely: this is particularly true during the course of calcific chronic pancreatitis and cases involving the tail. An enzymatic factor may also be responsible and this appears more clearly in pancreatitis with pseudocysts. In this case it is the direct action of pancreatic enzymes on the ileum or splenic parenchyma, which may also affect all organs surrounding the pancreas, which leads to hemorrhage or hematoma. Sometimes the cause of bleeding is a pseudoaneurysm of the splenic artery which is eroded by the contents of the pseudocysts themselves. There is also a mechanical hypothesis which some authors consider the sole possibility: in chronic pancreatitis the splenic compartment presents severe perisplenitis which fixes the spleen making it more vulnerable and even a mini-trauma will cause rupture. The patient is almost always an emaciated young alcoholic suffering from chronic pancreatic pathology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Port site metastasis. An unresolved problem in laparoscopic surgery. A review.

After the explosive success of laparoscopic cholecystectomy, great interest has been shown in the laparoscopic treatment of digestive malignancies. Laparoscopy has been proposed for diagnosis and staging, and as a technical option aiming to cure or palliate. But this optimism has been tempered by the doubt about the potential disseminatory role of laparoscopy after the observation of a large number of port site seeding tumors. Since the first laparoscopic cholecystectomy, more than 100 port site metastases have been reported, without a clear explanation for these findings. Port site recurrences have been observed after gynaecologic procedures, laparoscopic cholecystectomy in which an unsuspected gallbladder cancer was found and after laparoscopic operations indicated for oncological treatment of digestive tumors, mainly colorectal cancer. Other cases have been reported after thoracoscopic resection of oesophageal cancer or urologic cancer, even after staging laparoscopy associated with sampling. Possible mechanisms for port site cell implantation are direct implantation in the wound during unprotected and forced tissue retrieval or by contaminated instruments during tumor dissection, the effect of gas turbulence in long laparoscopic procedures and embolization of exfoliated cells during tumor dissection or hematogenous dissemination. Probably, a multifactorial mechanism may be responsible, in which the key factors could be a long operative procedure, the high pressure pneumoperitoneum, tumoral manipulation during dissection and forced extraction of unprotected specimens. Prophylactic measures proposed to avoid this disastrous complication are the use of protective bags for tissue retrieval, peritoneal lavage with heparin in order to avoid adhesion of free cells, or lavage with cytocidal solutions.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Laparoscopic treatment of pancreatic disorders: diagnosis and staging, palliation of cancer and treatment of pancreatic pseudocysts.

After the spread of laparoscopic cholecystectomy, minimally invasive surgery has been applied to other organs such as the pancreas. Diagnostic laparoscopy is a very useful tool which provides information in conjunction with other instruments such as ultrasonography and computed tomography in the study of pancreatic cancer. Laparoscopic ultrasonography improves the sensibility and specificity of laparoscopy alone in predicting resectability. Although experimental cases of pancreatic resection have been described, the majority of patients require palliative treatment. Surgical bypass has a high morbidity rate and nonoperative biliary decompression has become an established treatment for relieving jaundice. However, these techniques are associated with a high rate of recurrent obstruction. Laparoscopic cholecystojejunostomy gives the advantage of definitive bypass with shorter hospital stay, and a gastrojejunostomy can also be performed when duodenal obstruction occurs. Relief of pain is possible with a thoracoscopic splanchnicectomy, which offers good results. Internal drainage for pseudocysts is another new application of laparoscopic surgery which gives excellent results.

Aged↗
PubMedDate not supplied

Conservative pancreatic resection in patients with obstructive chronic pancreatitis.

The purpose of this paper is to present the results of our experience in using a conservative pancreatic resection approach in a certain group of patients suffering from chronic pancreatitis. From January 1988 to December 1995, 110 patients underwent surgical therapy for chronic pancreatitis at the Hospital Clinic of the University of Barcelona. In 35 patients with an inflammatory mass at the pancreatic head, pylorus-preserving duodeno-pancreatectomy was performed. Forty male patients with localized focal pancreatitis at the body or tail underwent distal pancreatectomy and drainage of the pancreatic remnant. In 30 patients with pancreatic ducts greater than 7 mm in diameter, side-to-side pancreaticojejunostomy was carried out. Five patients could not be included in any of these three categories because of their particular characteristics. In all cases, resolution of the symptoms was achieved at the mean follow-up of 18 months (range 12 to 21 months). No patient showed a deterioration of glucose homeostasis, and exocrine dysfunction was not observed. Patients with obstructive chronic pancreatitis by inflammatory cystic mass, short strictures or intraductal stones located in the central pancreas or uncinate process may be surgically managed with conservative pancreatic resection or extraction of the stones from the Wirsung duct. The jejunal interposition and pancreaticojejunal anastomosis achieved pain control without any deterioration of the endocrine or exocrine function.

Cholangiography↗