[Azygos-portal disconnection as a treatment in bleeding esophageal varices caused by portal hypertension. Experience in 12 cases].
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Azygos Vein↗
Biomedical subjects
P Burdiles
Publications and source records attributed to P Burdiles.
[Recurrent duodenal ulcer following supraselective vagotomy].
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Adult↗
Laparoscopic highly selective vagotomy: technical considerations and preliminary results in 119 patients with duodenal ulcer or gastroesophageal reflux disease.
The technical considerations and preliminary results of 119 patients submitted to laparoscopic highly selective vagotomy are presented. There were 33 with duodenal ulcers, 31 with duodenal ulcers plus gastroesophageal reflux, and 55 with gastroesophageal reflux. Operating time varied from 120 to 160 minutes. Six complications occurred: four perforations of the gastric fundus and two bleeding episodes. Conversion to open surgery was done in four cases and reoperation in one case. No deaths occurred, and the mean hospital stay was 3 days. The mean follow-up was 16 months, being 94% of the cases with Visick I or II and 6% with Visick III or IV. This technique is completely feasible by laparoscopic procedure and reproduces exactly what has been done with the laparotomy approach.
Adult↗
Anatomic dilatation of the cardia and competence of the lower esophageal sphincter: a clinical and experimental study.
Anatomic and clinical data suggest that the gastroesophageal junction or cardia in patients with gastroesophageal reflux disease GERD) may be dilated. We hypothesized that anatomic dilatation of the cardia induces a lower esophageal sphincter dysfunction that may be corrected by narrowing the gastroesophageal junction (i.e., calibration of the cardia). We measured the perimeter of the cardia during surgery in control subjects and patients with GERD and Barrett's esophagus. We then tested our hypothesis in a mechanical model. The model was based on a pig gastroesophageal specimen with perpendicularly placed elastic bands around the cardia simulating the action of the "sling" and "clasp" fibers. "Dilatation" of the cardia was induced by displacing the sling band laterally and decreasing its tension. "Calibration" of the cardia was performed by reapproximation of the sling band toward the esophagus but maintaining the same tension as the dilated model. In the "basal," "dilated," and "calibrated" states, the perimeter of the cardia was noted and rapid mechanized pullback manometry with a water-perfused catheter was performed. The opening pressure was determined, and three-dimensional sphincter pressure images were analyzed. The average cardia perimeter was 6.3 cm in control subjects, 8.9 cm in GERD patients, and 13.8 cm in patients with Barrett's esophagus. The arrangement of the bands in the experimental model generated a manometric high-pressure zone similar to that in the human lower esophageal sphincter. Dilatation of the cardia resulted in a decrease in the resting pressure, length, and vector volume of the high -pressure zone, and reduced the opening pressure. Calibration restored the resting and opening pressure, and normalized the three-dimensional pressure image. In patients with GERD and Barrett's esophagus, the cardia is dilated. Our model supports the hypothesis that lower esophageal sphincter function is compromised by anatomic dilatation of the cardia and can be restored by approximation of the "sling" fibers toward the lesser curvature "clasp" fibers). This provides evidence for a correlation between gastroesophageal sphincter dysfunction in reflux disease and its correction by antireflux surgery.
Adult↗
Bacteriological studies of bile from the gallbladder in patients with carcinoma of the gallbladder, cholelithiasis, common bile duct stones and no gallstones disease.
OBJECTIVE: To compare the presence of bacteria of bile from the gallbladder in control subjects, patients with gallstones, and patients with carcinoma of the gallbladder. DESIGN: Prospective open study. SETTING: University department of surgery. SUBJECTS: 372 patients of whom 36 had no signs of gallbladder disease; 211 underwent cholecystectomy for either symptomatic gallstone disease (n = 165) or acute cholecystitis (n = 46); 67 had common bile duct stones and 58 were operated on for carcinoma of the gallbladder. INTERVENTIONS: Aspiration of bile from the gallbladder. MAIN OUTCOME MEASURES: Prevalence of pathogenic bacteria in bile from the gallbladder and correlations between the presence of bacteria, the presence of cancer, and age. RESULTS: No pathogenic bacteria were grown from the bile of the patients who had no signs of gallstones disease. Among the 165 with symptomatic gallstone disease 52 (32%) had pathogens in their bile, and among the 46 with acute cholecystitis the corresponding figure was 19 (41%) while among patients with common bile duct stones this figure was 39 (58%). Among the 58 patients with carcinoma of the gallbladder the bile grew organism in 47 (81%). Patients over the age of 60 years tended to be more likely to have organism in their bile than patients aged 60 or less, and the difference was significant for symptomatic gallstone disease (p < 0.003). Significant differences were also found between patients with symptomatic gallstone disease and those with carcinoma of the gallbladder in both age groups (p < 0.002 in each case). Most of the organism were aerobic or anaerobic Gram negative species, irrespective of type of disease or age. CONCLUSION: Bacteria may have a role in the development of carcinoma of the gallbladder.
Adult↗
Prospective study of esophageal motor abnormalities in patients with gastroesophageal disease reflux according to the severity of endoscopic esophagitis.
BACKGROUND/AIMS: This prospective study evaluates the peristaltic activity of the thoracic esophagus in a group of patients with gastroesophageal reflux disease grouping them according to the endoscopic findings. MATERIALS AND METHODS: The peristaltic activity and the manometric features of the lower esophageal sphincter were prospectively evaluated in 109 controls and 321 patients with reflux esophagitis, divided according to the degree of endoscopic esophagitis employing Savary's classification. RESULTS: Gastro esophageal sphincter pressure was progressively lower according to the severity of the tissue damage. Motor peristaltic activity of the thoracic esophagus measured by several different parameters was significantly altered in Grade IV esophagitis compared to other groups (p < 0.01). The manometric changes were more pronounced at the distal esophagus compared to the proximal esophagus. The percentage of patients with severe motor disturbances, defined as lower esophageal sphincter (LES) pressure less than 6 mm, less than 50% of peristaltic waves after swallowing and amplitude of contractile waves of less than 50 mmHg were significantly greater in patients with severe esophageal injury (p < 0.001). CONCLUSION: Gastroesophageal esophageal reflux may exhibit a wide spectrum of motor disturbances in the distal part of the esophagus even before the presence of the tissue damage, but it increases in proportion to the severity of endoscopic esophagitis.
Adolescent↗
Counts of bacteria and pyocites of choledochal bile in controls and in patients with gallstones or common bile duct stones with or without acute cholangitis.
BACKGROUND/AIMS: The number of colonies of bacteria and the number of pyocites present per ml of choledochal bile was studied. PATIENTS AND METHODS: There were 42 controls, 100 patients with symptomatic gallstones, 42 patients with common duct stones without cholangitis and 24 patients with common duct stones and acute cholangitis. RESULTS: Control subjects had no bacteria present at gallbladder bile. Only 3% of patients with gallstones had more than 10(5) colonies per ml which increased to 36% in patients with common duct stones without cholangitis and to 84% among patients with acute cholangitis (p < 0.001). There were more polybacterial flora among patients with acute cholangitis and anaerobic bacteria were not seen in patients with gallstones. Patients with acute cholangitis had significantly more pyocites present at choledochal bile. CONCLUSION: There is a direct correlation between the number of colonies present per ml of choledochal bile and the severity of biliary tract disease. Patients with acute cholangitis had significantly more pyocites present at choledochal bile compared to gallstones or patients with CBD stones without cholangitis.
Acute Disease↗
Prevalence of common bile duct stones according to the increasing number of risk factors present. A prospective study employing routinely intraoperative cholangiography in 477 cases.
BACKGROUND/AIMS: To determine if the use of Intraoperative choliangiography (IOC) should be routinely performed and, if not, which criteria should be used to select patients requiring IOC during open or laparoscopic cholecystectomy. METHODOLOGY: 495 Patients with 1 or more gallstones were included in a two-year study. Twelve clinical, laboratory, ultrasonographic and intraoperative factors were chosen and evaluated in all cases. Prior to cholecystectomy, IOC was performed after having identified the common bile duct (CBD) and cystic duct. The majority of the patients were operated on by the same surgeon to avoid differences in criteria and techniques. Statistical evaluation made use of the exact Fisher test and chi square test and, a p-value less than 0.05 was considered as significant. RESULTS: IOC could be performed in 479 out of the 495 cases. IOC resulted in a normal CBD in 76.0%, had a false positive in 2.7%, a false negative in 0.48%, and a presence of 1 or more stones in the CBD in 20.9%. The study revealed that when none of the 12 risk factors were present, there were no cases with CBD stones. As the number of risk factors increased, so did the number of cases presenting with CBD stones. CONCLUSION: Not all 12 risk factors show the same index of predictability; only 5 in particular (jaundice, ultrasound diameter CBD 7 mm, bilirubin over 26 umol/it, cystic duct > 4 mm and CBI, diameter over 9 mm) showed a high rate of predictability. However, when careful measurement and evaluation of risk factors for CBD stones are undertaken, it is possible to avoid the routine use of IOC.
Adolescent↗