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Biomedical subjects

P Burdiles

Publications and source records attributed to P Burdiles.

At least 55 records · Page 3Linked to original sources
PubMed1992

Indications and results of hepaticojejunostomy in benign strictures of the biliary tract.

The postoperative and late results of 99 patients with benign strictures of the biliary tract are presented. Patients were classified according to Bismuth into 24 cases with lesion type I, 36 cases with type II, 35 cases with type III and 4 patients with type IV. All were submitted to hepaticojejunostomy with a long Roux-en-Y loop. The etiology of the strictures varied according to the type of stricture. In patients of type I, inflammatory and iatrogenic causes were observed. Among type II and III patients, previous cholecytocholedochal fistulas were the main cause, together with accidental section or ligature of the common bile duct. Operative mortality was absent in strictures of types I and II, while it was around 25% in cases of types III and IV. At late control, the best results were seen among patients with strictures of types I and II. We believe that the main factor determining the early and late outcome of these cases with benign strictures is the location of the stricture and the quality of the proximal duct.

Adult↗
PubMed1991

Comparison of forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus.

In the present paper we have reviewed the results of forceful dilatation as compared with surgical esophagomyotomy in patients with achalasia. The review of 4 retrospective and uncontrolled studies revealed that in all, surgery produced a more effective late result than dilatation, with minimal side effects and very low or no mortality. In the only prospective randomized study comparing both treatments by the same group, good late results were seen after surgery in 95% of the cases, as compared with 65% after dilatation (p less than 0.001). The resting gastroesophageal sphincter pressure was predictive of the quality of the late results. Reflux occurred in 8% of the dilated and in 19% of the operated group as measured by standard acid reflux test. The old, classical concept that dilatation is the first choice and preferable method of treatment for patients with achalasia should be reviewed, and the idea that surgery should be reserved only for patients in whom dilatation has failed should be abandoned. We propose that surgical treatment should be the initial choice in the majority of patients with achalasia of the esophagus.

Catheterization↗
PubMed1990

Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma.

A new classification of anastomotic fistulas of esophagojejunostomy after total extended gastrectomy for advanced gastric carcinoma is presented. In a group of 230 consecutive patients submitted to total gastrectomy within a 10-year period, there were 20 patients with Type I fistula (8.8%) and 18 cases with Type II (7.8%). Type I or subclinical fistula corresponded to a local leakage around the anastomosis, with no septic complications, which heals with prolongation of enteral feeding up to 20 days after surgery. The mortality rate was 5% in this group. Type II or clinical leakage corresponded to patients with early septic manifestations after surgery, in whom the methylene blue test was positive, that is, immediate appearance of the stain in any drain was observed after oral ingestion, confirmed by radiological studies. The mortality rate in this group was 78%. Resuturing of the fistula was a complete failure. Cervical lateral esophagostomy produced complete healing in two cases. Parenteral and enteral feeding, antibiotics and successful surgical drainage are measured that can provide good results in these cases.

Anastomosis, Surgical↗
PubMed1990

[Dieulafoy's vascular malformation as a cause of massive and recurrent gastric hemorrhage].

We demonstrated a Dieulafoy-type vascular malformation in 10 patients with upper gastrointestinal bleeding. Most patients had a history of prior bleeding and were older than 60 years of age. A mean of 2.6 endoscopic examinations had been performed, and a mean of 2500 ml of blood transfused per patient. A localized resection of the lesion was performed in 9 patients and a partial gastrectomy in the remaining. Surgery was performed as an emergency in 5 patients. The lesion was a small, 2 to 5 mm, erosion localized in the subcardial region. The vascular nature of the lesion was confirmed by histologic study in all cases. Postoperative course was uneventful in all patients and no recurrences have been observed.

Acute Disease↗
PubMed1989

Mirizzi syndrome and cholecystobiliary fistula: a unifying classification.

A new classification of patients with Mirizzi syndrome and cholecystobiliary fistula is presented. Type I lesions are those with external compression of the common bile duct. In type II lesions a cholecystobiliary fistula is present with erosion of less than one-third of the circumference of the bile duct. In type III lesions the fistula involves up to two-thirds of the duct circumference and in type IV lesions there is complete destruction of the bile duct. A total of 219 patients were identified with these lesions from 17,395 patients with benign biliary tract diseases undergoing surgery. The incidence of type I lesions was 11 per cent, type II 41 per cent, type III 44 per cent and type IV 4 per cent. The majority had obstructive jaundice. In type I lesions, cholecystectomy plus choledochostomy is effective. In type II lesions, suture of the fistula with absorbable material or choledochoplasty with the remnant of gallbladder can be performed. In type III lesions suture is not indicated and choledochoplasty is recommended. In type IV lesions, bilioenteric anastomosis is preferred. Operative mortality rate increases according to the severity of the lesion, as does postoperative morbidity. During cholecystectomy, partial resection is recommended in order to extract the stones, visualize the common bile duct and define the type and location of the fistula. T tubes should be placed distal to the fistula.

Adult↗
PubMed1989

[Primary motor disorders of the non-achalasic esophagus: a manometric analysis].

We studied 85 patients with esophageal symptoms of a motor abnormality in whom esophagitis, achalasia or other organic lesions were ruled out by endoscopy. Main symptoms were dysphagia and severe retrosternal pain. Cardiac origin of the pain was ruled out by clinical and EKG evaluation in 72% of patients. Mean age was 43 years and female to male ratio was 3:1. Manometric study, performed in all patients, revealed diffuse spasm in 42, hypertensive sphincter in 16, nutcraker esophagus in 11 and nonspecific motor abnormalities in 16 patients. Only manometric studies can identify these esophageal disturbances. These studies should be performed in patients with non cardiac retrosternal pain.

Esophageal Motility Disorders↗
PubMed1989

Bacteriological study of choledochal bile in patients with common bile duct stones, with or without acute suppurative cholangitis.

Acute suppurative cholangitis is a serious complication in extrahepatic biliary tract obstruction. Bacteriological studies have shown that in these patients the bile cultures usually present several kinds of bacteria, especially Gram-negative aerobic bacteria such as E. coli and Klebsiella sp. The mortality rate in our patients with common bile duct stones and acute suppurative cholangitis is enhanced 5- to 10-fold. The aim of the present study was to analyse the bacterial properties of choledochal bile in a large number of patients with common bile duct stones, with or without acute suppurative cholangitis, and to determine the sensitivity of the isolated bacteria to several antibiotics used in clinical practice. The greatest sensitivity of the bacteria isolated from the common bile duct was seen for aminoglycosides (gentamicin and amikacin) and for cephalosporins, especially of the third generation (cefotaxime, ceftazidime, ceftriaxone and cefoperazone). Ampicillin showed a low sensitivity rate. The appropriate selection of the antibiotics used in acute suppurative cholangitis depends not only on the concentration of the antibiotic in the bile; a high plasma concentration is even more important to control the septic manifestations. A high excretion to the bile can affect the intestinal flora, leading to diarrhea (e. g. with cefoperazone). Ampicillin has been giving contradictory results in respect of bile and plasma concentrations. Gentamicin attains 30-40% of the plasma concentration in the bile, but persists for as long as 8 hours with excellent sensitivity and clinical efficacy. Amikacin reaches 44% of the plasma concentration with a very high sensitivity (96%).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

Treatment of residual common bile duct stones after cholecystectomy.

This study was conducted to determine the occurrence of "open" residual common bile duct stones after cholecystectomy to establish predisposing factors and possible alternative treatments. Correct diagnosis of choledocholithiasis before or during surgery, adequate exploration of the common bile duct, and suitable selection of technical procedures are the most important points in preventing retained CBD stones. If these occur, an adequate alternative treatment may prove helpful. Classical "clysis" of the bile duct is least recommended because of its high failure rate. The best method of chemical dissolution seems to be the use of mono-octanoin with 60% good results and a no-response rate of 30-40%. Instrumental extraction has been reported to be very successful (80-98%). Endoscopic sphincterotomy is currently the most frequently employed procedure for retained CBD stones, especially in poor risk patients. The reported success rate is 82-93% according to literature, with an extremely low mortality (0.2%). Reoperation should be resorted to only if all the other methods fail. Sphincteroplasty or choledochoduodenostomy, whenever indicated, are good alternative operations, with a mortality rate of approx. 3.5%.

Adult↗
PubMed1989

Results of surgical treatment in patients with "western" intrahepatic lithiasis.

The results of the surgical treatment in 251 patients with intrahepatic stones are discussed. The mean age of the group was 48 years, with a predominance of females. Gallstones were observed in 72% of the cases, because 28% had had previous cholecystectomy. Associated common bile duct stones were present in 222 (88%) cases, while primary intrahepatic stones were seen in 29 patients. The intrahepatic stones were usually bilateral. Three main operations were employed. Choledochostomy with or without cholecystectomy was performed in 166 (66%) cases with 6 deaths (3.6%). Bilioenteric anastomosis such as sphincteroplasty or choledochoduodenostomy were used in the rest with similar results. However, residual stones were documented in 32% after choledochostomy, while only 4% were seen after choledochoduodenostomy. In our groups, intrahepatic stones originated from migrated stones from the gallbladder, and surgical treatment should be orientated towards complete extraction of the stones and prevention of their further appearance.

Bile Ducts, Intrahepatic↗
PubMed1989

Factors affecting mortality in patients over 70 years of age submitted to surgery for gallbladder or common bile duct stones.

Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of the women and 25% of the men over 20 years of age have gallstones. Biliary tract surgery accounts for about 35% of all the operations performed in Chilean general hospitals. The present paper aims at assessing the risk factors associated with a higher mortality in patients over 70 years of age subjected to elective or emergency surgery for gallstones or common bile duct stones. No specific factors of mortality were found in the group of elderly patients subjected to elective cholecystectomy. There was also no correlation between types of cholecystitis and postoperative mortality. However, acute suppurative cholangitis made the postoperative mortality rate increase almost 20-fold in patients with common bile duct stones. The mortality also shows a steep increase (up to 12%) if cholecystectomy is performed in acute cholecystitis. Cholecystostomy seems to be associated with a low mortality risk and hence should be appropriate in exceptionally high-risk patients, but is not considered useful by the authors in necrotic or gangrenous cholecystitis, or in cases with common bile duct stones and cholangitis. Postoperative mortality in patients submitted to cholecystectomy alone seems to depend exclusively on the concomitant presence of medical complications, mainly of a respiratory and cardiovascular nature. Septic complications are important causes of postoperative mortality in emergency cholecystectomy. Patients at high surgical risk are those suspected of cholangitis, those over 80 years of age, and those suffering from Charcot's triad, anemia, uremia, leukocytosis, hyperbilirubinemia or hypoprothrombinemia; in these, an endoscopic procedure could be chosen.

Age Factors↗
PubMed1989

Indications and results of sphincteroplasty in benign biliary diseases.

A retrospective analysis of 143 patients submitted to sphincteroplasty at the Department of Surgery, University of Chile Clinical Hospital was performed. A significant percentage of these patients (90%) were admitted due to acute biliary tract disease with or without cholangitis. The standard operative procedure was anterior transduodenal sphincteroplasty with supraduodenal choledochal exploration leaving a choledochostomy. A high number of our cases presented with intrahepatic lithiasis (23.8%). The morbidity was 15.4% and the 30 days post operative mortality rate was 4.9%, similar to other reports. Residual stones were observed in 10 patients (7%), and were successfully removed by other procedures. Three patients showed recurrent stenosis of the papilla and were operated on again with good results.

Adolescent↗
PubMed1989

Histological analysis of liver parenchyma and choledochal wall, and external diameter and intraluminal pressure of the common bile duct in controls and patients with common bile duct stones with and without acute suppurative cholangitis.

The purpose of this prospective controlled study was to determine the changes in intraluminal pressure and diameter of the common bile duct in a total of 121 bile patients with choledocholithiasis, and the consequences of these alterations for choledochal mucosa and liver histology. In fact, the reflux of bacteria from the obstructed biliary tract into the bloodstream is responsible for producing the clinical syndrome of acute suppurative cholangitis. Group I (26 patients) served as controls, Group II (50) had choledocholithiasis with clear green bile, and Group III (45) were patients with acute suppurative cholangitis with pus in the biliary tract. Ultrasonography revealed gallstones in all the patients. The external diameter of the common bile duct in patients with choledocholithiasis and acute suppurative cholangitis was significantly greater than in those of the other groups. Patients with acute suppurative cholangitis also had a higher intraluminal pressure than those of Groups I or II.

Acute Disease↗
PubMed1989

Indications and results of choledochoduodenostomy in benign biliary tract diseases.

During a 12-year period ending December 1987, 17,200 operations for biliary tract disease were performed at the Dept. of Surgery of the University of Chile. Choledochoduodenostomy was performed in 140 of these patients operated upon for benign biliary tract and/or gallbladder diseases. The indications for this procedure were choledocholithiasis, stenosis of the sphincter of Oddi, compression of the extrahepatic biliary duct, stenosis of the distal biliary duct and duodenal diverticula. The postoperative course was uncomplicated in 126 patients (90%). The mortality rate was 4.2%. Although the mortality was somewhat greater in patients with acute cholangitis, the difference was not significant, and no significant relation could be established with other factors that might affect mortality. Choledocholithiasis is the main cause of benign obstruction of the biliary tract in Chile. This is also the most frequent indication for external choledochoduodenostomy and is a promising method even in the presence of an infection of the biliary duct.

Adult↗
PubMed1989

Late results of immediate primary end to end repair in accidental section of the common bile duct.

The late results of 43 patients with accidental section of the common bile duct are presented. Injuries located high at the hepatic duct were three times more frequent than those located more distally. A complete section occurred in 36 while incomplete section was observed in seven patients. The final results of end to end repair revealed good late results in eight while 29 had a benign stricture four years postoperatively.

Adolescent↗
PubMed1988

Common bile duct pressure in patients with common bile duct stones with or without acute suppurative cholangitis.

Resting common bile duct pressure was measured in three groups of patients: group 1, 53 patients with gallstones but without common duct stones; group 2, 35 patients with common bile duct stones unaccompanied by cholangitis; and group 3, 36 patients with common duct stones and acute suppurative cholangitis. A significantly higher pressure in the common bile duct was documented in patients with cholangitis when compared with the other two groups. Twenty-four patients with cholangitis had common duct pressure values above 20 cm H2O, the maximal values of normal. Additionally, patients with cholangitis with pressure values over 30 cm H2O (nine patients) showed absence of green bile in the extrahepatic biliary tract, suggesting cessation of bile excretion into biliary duct. In all these cases, an impacted stone at the distal end of the common bile duct was documented.

Acute Disease↗