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Biomedical subjects

O Jurim

Publications and source records attributed to O Jurim.

64 records · Page 4Linked to original sources
PubMed1993

Radical resection combined with liver transplantation for foregut tumors.

Between February 1984 and July 1992, six adults with advanced pancreatic adenocarcinoma (n = 1), pancreatic neuroendocrine tumor (n = 2), and cholangiocarcinoma (n = 3) underwent radical foregut resections (n = 3) or radical pancreaticoduodenectomy (n = 3) combined with liver transplantation. The major postoperative complications included diarrhea (n = 4), pancreaticojejunostomy leak (n = 3), infection (n = 7), malnutrition (n = 3), refractory ascites (n = 2), and late hepatic artery thrombosis (n = 1). Tumor recurrence occurred in one patient. The actuarial survival for the group is 82 per cent at 1 year and 55 per cent at 2 years. The results demonstrate that radical pancreaticoduodenectomy/foregut resections combined with liver transplantation offer potential surgical cure of malignancies involving these organs. However, the procedure is formidable, with frequent complications.

Adenocarcinoma↗
PubMed1993

Subtotal colectomy with primary ileocolonic anastomosis for obstructing carcinoma of the left colon: valid option for elderly high risk patients.

During a period of 4 years, 20 patients with obstructing carcinoma of the left colon were treated by subtotal colectomy with primary ileocolonic anastomosis. Thirteen patients (65%) were 65 years of age or older. All patients presented to the emergency room with large bowel obstruction. Twelve patients (age > 65) suffered other systemic diseases (chronic obstructive pulmonary disease, ischemic heart disease, morbid obesity), placing them in a high risk category. The mortality rate was 5% (1/20), 7.6% if only high risk patients are considered. The one-stage procedure in the treatment of obstructing carcinoma of the left colon offers the patient a number of advantages over stage intervention elimination of colostomy, namely removal of occult lesions in the resected colon, shorter hospitalization and low morbidity and mortality. We found this procedure to be a valid option also in the elderly (> 65) high risk patient. Metastatic disease in our view is not a contraindication, since the elimination of colostomy will improve the quality of life of these patients.

Adult↗
PubMed1992

Biliary strictures complicating liver transplantation. Incidence, pathogenesis, management, and outcome.

Six hundred sixty-six patients received 792 liver transplants between February 1, 1984 and September 30, 1991. Biliary reconstruction was by choledochocholedochostomy (CDCD) with T-tube (n = 509) or Roux-en-Y choledochojejunostomy (CDJ) (n = 283). Twenty-five patients (4%) developed biliary strictures. Anastomotic strictures were more common after CDJ (n = 10, 3.5%) than for CDCD (n = 3, 0.6%). Intrahepatic strictures developed in 12 patients. Six patients had occult hepatic artery thrombosis (HAT). The other six patients received grafts in which cold ischemia time exceeded 12 hours. Anastomotic strictures were successfully managed by percutaneous dilation (PD) in five patients (n = 10), operation in three (n = 6), with retransplantation required in two patients. Intrahepatic strictures were managed by PD in seven, retransplantation in one, and expectantly in four patients. Of 25 patients, 19 (76%) are alive with good graft function. In three of six deaths, the biliary stricture was a significant factor to the development of sepsis and allograft failure. The authors conclude that (1) anastomotic strictures are rare after LT; (2) the development of biliary strictures may signify occult HAT; (3) PD is effective for most strictures; and (4) extended cold graft ischemia (less than 12 hours) may be injurious to the biliary epithelium, resulting in intrahepatic stricture formation.

Adult↗
PubMed1992

Case report: the management of penetrating cardiac trauma with major coronary artery injury--is cardiopulmonary bypass essential?

Major coronary artery injury in penetrating cardiac trauma is relatively uncommon and is associated with a poor prognosis. However, for a variety of reasons, the outcome for such patients has been improving during the last two decades. The main factor responsible for this change is, according to some authors, the use of emergency cardiopulmonary bypass (CPB). We present a case of complete transection of the LAD coronary artery managed by primary ligation of the vessel, but because of progressive signs of extensive myocardial infarction, the patient underwent emergency CPB and an aortocoronary bypass graft. The patient experienced a good cardiac recovery but died 5 days later of irreversible anoxic brain damage. In reviewing the literature concerning the absolute need for emergency CPB in the management of penetrating coronary artery injury (PCAI), we found that the overall outcome for patients treated with emergency CPB was not significantly better than for those treated with ligation alone. We believe that CPB is not always essential in the management of PCAI and should be instituted only when the injury to a main coronary artery is very proximal, whenever associated intracardiac injuries exist, or when the patient develops extensive myocardial infarction or uncontrolled arrhythmias following ligation of the injured coronary vessel.

Adult↗
PubMed1992

[Diathermy-induced gas explosion in the intestinal tract].

Surgical diathermy is widely used in modern operating rooms, although explosion in the gastrointestinal tract is a known serious complication. We report a case of colonic explosion following use of diathermy. Based on our experience and the available data, it is recommended that in cases of gastrointestinal tract obstruction, poor bowel preparation or following use of oral mannitol for bowel preparation, diathermy should be avoided in opening the gastrointestinal lumen.

Aged↗
PubMed1990

Experimental model of acute appendicitis in the rabbit with determination of leucine amino peptidase (LAP) and acid phosphatase (acid-P) activities in portal blood samples.

The activities of leucine amino peptidase (LAP) and acid phosphatase (Acid-P), conceivable markers of acute appendicitis, were determined in the portal blood of rabbits with acute appendicitis. An experimental model of acute appendicitis was established using No.-O silk ties to block the base of the appendix. The clinical and histopathological picture of acute appendicitis was seen after 12 hr in all the rabbits in the model group (9/9) and in none of the control group. Catheterization of the superior mesenteric vein was performed in rabbits with acute appendicitis, and portal blood samples were taken at 0, 6, and 12 hr for assay of LAP and Acid-P activities. No statistically significant difference between the experimental group and the control group, in the activities of LAP and Acid-P, was found at any time interval. The experimental model of acute appendicitis in the rabbit which is described here is simple and carries a high rate of success. This is probably the first report of using continuous catheterization and repeated sampling of portal blood, for the measurement of enzyme activities, in an experimental model of acute appendicitis. It was concluded that serum LAP and Acid-P activities cannot be used as markers for acute appendicitis.

Acid Phosphatase↗
PubMed1988

Sonographic demonstration of hepatic venous gas in mesenteric arterial thrombosis.

Hepatic portal venous gas is an ominous prognostic sign in bowel necrosis from mesenteric arterial occlusion. Ultrasonic examination is a sensitive and accurate method of demonstrating portal venous gas. We describe a case where the ultrasonic diagnosis of portal venous gas led to the rapid diagnosis of bowel infarction. Ultrasound is an appropriate emergency examination in all patients with suspected mesenteric artery occlusion.

Aged↗
PubMed1987

Nodular regenerative hyperplasia with portal hypertension in a patient with myasthenia gravis.

Nodular regenerative hyperplasia of the liver is a rare cause of portal hypertension and bleeding esophageal varices, occurring mainly in association with collagen vascular diseases. The patient described herein had both myasthenia gravis and nodular regenerative hyperplasia. To the best of our knowledge, this is the first report of this association.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Volvulus of the Roux-en-Y hepaticojejunostomy. A rare complication manifested by recurrent ascending cholangitis.

A case of volvulus of a Roux-en-Y hepaticojejunostomy causing recurrent ascending cholangitis is reported. This rare complication of biliary reconstruction was diagnosed preoperatively by percutaneous transhepatic cholangiogram, and successfully treated by resection of the involved segment. The impaired myoelectric activity of the isolated Roux limb may contribute to this pathology.

Anastomosis, Roux-en-Y↗