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Biomedical subjects

V Moreira

Publications and source records attributed to V Moreira.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy].

The development of laparoscopic cholecystectomy has rekindled the issue of management of choledocholithiasis. A number of options exist including pre or postoperative endoscopic sphincterotomy (ERCP-ES), laparoscopic common duct exploration or open common duct exploration. We present here our experience with the management of choledocholithiasis in patients treated with laparoscopic cholecystectomy. From January 1991 to January 1995, 900 patients underwent laparoscopic cholecystectomy. 71 ERCP were carried out in 71 patients with suspicion or evidence of choledocholithiasis. Common duct stones were detected in 44 patients. Preoperative ERCP was done in 56 patients, with suspicion of choledocholithiasis, based on clinical, laboratory or ultrasonographic findings. 29 of these patients (51.7%) had common duct stones, that were successfully removed by endoscopic sphincterotomy. One patient suffered mild pancreatitis and a second one had transient hyperamylasemia. Postoperative ERCP was performed in 15 patients. Indications for ERCP were the evidence of common duct stones in intraoperative cholangiography in 7 cases, and clinical or laboratory suspicion of choledocholithiasis, 3 months to 3 years after laparoscopic cholecystectomy. Stones were detected in 100% of the patients. In 11 patients (73.3%), the stones were extracted by endoscopic sphincterotomy and 4 patients underwent open common duct exploration. Two patients had transient hyperamylasemia. ERCP is a safe and effective method for detection and treatment of common duct stones. ERCP prior to laparoscopic cholecystectomy in patients suspected of having choledocholithiasis, is safe and offers with good results. Rutinary intraoperative cholangiography is recommended, for the detection of unsuspected choledocholithiasis and as an effective treatment (postoperative-ERCP, open or laparoscopic common duct exploration) can be chosen depending on surgeon's skills and patient's characteristics.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Intestinal and extraintestinal cryptosporidiosis in AIDS patients.

In a prospective study in AIDS patients with chronic diarrhea, the overall prevalence of intestinal cryptosporidiosis was 15.6% (43/275). The prevalence was higher in homosexual patients (33.3%) than in intravenous drug abusers (10.6%) (p < 0.001). Extraintestinal infection was present in 30% (13/43) of the patients with known intestinal cryptosporidiosis. Eight of the 13 (61.5%) patients with extraintestinal cryptosporidiosis had Cryptosporidium in the bile and 7 of 13 (16.28%) had it in the sputum. Of the seven patients with Cryptosporidium in the sputum, four had respiratory symptoms and an abnormal chest radiograph, although another pulmonary pathogen was isolated simultaneously. Two other patients from whom Cryptosporidium was the sole respiratory pathogen isolated had no respiratory symptoms and normal chest radiographs. The seventh patient had pulmonary symptoms, interstitial infiltrate on chest radiograph and excessive activity on a pulmonary Gallium scan; Cryptosporidium was the only organism detected in induced sputum and bronchoalveolar lavage specimens. The mean CD4+ lymphocyte count in patients with extraintestinal cryptosporidiosis was 55 cells/mm3.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Decrease of basal levels of gastrin following H. pylori eradication].

UNLABELLED: Hypergastrinemia has long been considered an important factor in the pathophysiology of duodenal ulcer. Moreover, H. pylori infection has been reported in virtually all duodenal ulcers. AIM: To demonstrate the influence of H. pylori eradication on the basal levels of serum gastrin in patients with duodenal ulcer. METHODS: Seventy-six patients with endoscopically proved duodenal ulcer were prospectively studied. At endoscopy three biopsy samples each were taken from duodenal bulb, gastric antrum, corpus and fundus. Two samples from every location were submitted for conventional histological examination and the other for microbiological examination (Gram staining and culture). Endoscopy was repeated one month after the end of therapy, when endoscopy samples were again obtained from the gastric antrum and corpus. Basal levels of gastrin were measured both at initial and repeat endoscopies. Different therapeutic regimes were used: Amoxycillin/Clavulanate plus omeprazole or ranitidine, and triple therapy. RESULTS: H. pylori eradication was associated with a significant histological improvement (p < 0.001), both in antrum and corpus. In those patients with eradicated H. pylori the differences in basal gastrin levels both at diagnosis and after therapy were 45.4 +/- 11 pg/ml and 36.7 +/- 10 pg/ml, respectively; these differences were statistically significant (p < 0.001). When eradication was not achieved differences were not significant. The area under the ROC curve constructed from the different cutoff points for the gastrin decreases was 0.68 (EE 0.06). CONCLUSION: H. pylori eradication in patients with duodenal ulcer was associated with a significant decrease in basal levels of serum gastrin. Although the verification of such a decrease doesn't have an optimal relationship between sensitivity and specificity, it could be an aid as a useful non-invasive method to monitor the efficiency of therapy, both in H. pylori eradication and in the resolution of the associated gastritis. This procedure is also associated with early results and a low cost.

Adult↗
PubMed1995

[Gastrointestinal lesions produced by nonsteroidal anti-inflammatory agents: the clinical manifestations, risk factors, physiopathology, prevention and treatment].

Nonsteroidal anti-inflammatory drugs are among the most widely used drugs in the world and the major limitation to the use of this compounds are the gastrointestinal tract side effects. Almost all digestive tract could be involved but there are gastroduodenal ulcers and its complications (haemorrhage, perforation) the principal risks of these agents. Symptoms are poorly correlated with endoscopic findings: many patients asymptomatic debut with an ulcer haemorrhage or perforation. Nonsteroidal antiinflammatory digestive side effects is rightly seen as a problem of the elderly (> 60 yrs) women and they are, otherwise, more likely to receive this drugs. The pathogenesis of nonsteroidal antiinflammatory drugs gastropathy is not full understood, although it is generally believed that this agents produce ulcers through a combination of direct topical irritant actions and systemic inhibition of prostaglandin synthesis. General prophylaxis and therapy with synthetic prostaglandins (misoprostol) and gastric secretion inhibitors of nonsteroidal antiinflammatory drug-induced gastroduodenal lesions are the basic strategies to carry out.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

[Training in diagnostic and therapeutic ERCP].

Training in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography procedures is difficult and tedious. Currently, there is no consensus on how to plan and put it into practice. We believe that training in these procedures must be included in the training program of the gastroenterology resident, since the efficiency of these methods (both diagnostic and therapeutic) in biliopancreatic disease including their clinical, social and economic benefits are beyond doubt. Training in diagnostic endoscopic retrograde cholangiopancreatography should be planned for about 3 months including at least 100 procedures under supervision of an experienced endoscopist; on the other hand, training in the therapeutic aspects needs, in our opinion, a longer period, perhaps and additional 3 to 6 month period, although this goal is difficult to achieve in the 4-year program of a gastroenterology resident. A frequent performance of the techniques is required to acquire competence. In this paper, we emphasize the ideal conditions that, must be fulfilled to achieve an appropriate training in the diagnostic and therapeutic aspects of endoscopic retrograde cholangiopancreatography.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1994

[Adult patients with clinically suspected or known biliopancreatic pathology in whom ERCP is not indicated: the 10 most frequent situations].

Endoscopic retrograde cholangiopancreatography is an invasive endoscopic technique widely used in the diagnosis and eventual therapeutic procedures of many biliopancreatic conditions. While endoscopic retrograde cholangiopancreatography indications are well known, it is not the same in those patients with clinically suspected or known biliopancreatic entities in whom endoscopic retrograde cholangio-pancreatography is not indicated because it will not add valuable information with the potential of changing the previous diagnosis or therapy. Ten very common clinical situations in which this technique is not indicated are presented; among them idiopathic abdominal pain, some pancreatic carcinomas, chronic pancreatitis and pancreatic pseudocyst, and some patients awaiting conventional or laparoscopic cholecystectomy. We acknowledge that some aspects of this paper are controversial.

Adult↗
PubMed1994

[Droxicam-induced hepatitis. Description of 3 new cases and review of the literature].

Three new cases of cholestatic hepatitis caused by droxicam are described, along with a revision of the other eight cases published to date. Itching, asthenia, and jaundice were the most common symptoms. Average age was 62.8 years (range: 45-82 years), and the median time of exposition was 22.7 days (range: 5-50 days). Biochemistry of the liver showed primarily cholestasis and in 4/11 cases hypereosinophilia. Two patients presented elevated levels of cholesterol and triglycerides which disappeared within the month. Clinical manifestations persisted in one patient for eight weeks after the cessation of treatment. The three patients presented in the present series presented alteration in the biochemistry of the liver two months after initiation. Liver biopsy in three patients showed centrozonal cholestasis associated with portal inflammatory activity and presence of granulomas consistent with toxic hepatitis.

Aged↗
PubMed1994

[An intrahepatic hematoma secondary to peliosis hepatis in a female patient treated with oral contraceptives].

The case of a patient is reported, who developed peliosis hepatis during contraceptive steroid therapy. This was clinically manifested as a spontaneous hepatic hematoma. No underlying liver tumor could be detected by both invasive and non-invasive investigations. Oral contraceptives should be listed among the potential albeit exceptional cases of liver hematoma, and this clinical presentation of peliosis hepatis added to the possible manifestations of that obscure condition.

Adult↗
PubMed1993

[Choledocholithiasis following cholecystectomy: what is the real effectiveness of endoscopic sphincterotomy?].

AIM: To assess real efficacy of endoscopic sphincterotomy in the setting of postcholecistectomy choledocolitiasis (i.e., without excluding for analysis any patient referred for the procedures) traditionally the evaluation has been done after excluding those cases in which the procedure failed or was not attempted. DESIGN: Retrospective analysis of a series of cholecystectomized patients with choledocolithiasis. Patients were included for analysis on an "intention to treat" basis, without excluding cases in which the procedure either was not attempted or failed. RESULTS: Out of 122 patients (47.1%) with a firm diagnosis of choledocholithiasis, endoscopic sphincterotomy was performed in 108 (88.5%); in the remaining 13 (10.7%), it was not attempted due to various reasons (among other, five cases of unsuccessful diagnostic cholangiography). In one patient, with a previous surgical sphincteroplasty, calculi were directly extracted. On the whole, stone extraction/expulsion was achieved in 92 cases (including the one patient with previous surgical sphincteroplasty), what represents a success rate of 75.4% on 122 cholecistectomized patients with known choledocolitiasis. Morbidity and mortality reached 9% and 1%, respectively. CONCLUSIONS: If each referred patient is included for analysis of the results of endoscopic sphincterotomy for postcholecistectomy choledocolithiasis (independently of technical success), the therapeutic yield of this procedure lowers significantly compared with the usual estimations.

Adolescent↗
PubMed1993

[False pancreatic pseudocyst during endoscopic retrograde cholangiopancreatography (ERCP) in a gastrectomized patient].

Endoscopic retrograde cholangiopancreatography (ERCP) is a very useful procedure for the diagnosis of biliopancreatic disorders. As a mixed endoscopic and radiologic procedure, its diagnostic yield depends heavily on the quality and skillful interpretation of radiological images. Diagnostic pitfalls must be kept in mind and avoided. We report on the case of a gastrectomized patient (Billroth II), in whom the observation during ERCP of two contrast-filled cavities, suggested the diagnosis of pancreatic pseudocysts. Other imaging procedures fully ruled out this diagnosis. The cause of this diagnostic pitfall was the accumulation of contrast in the blind end of the afferent loop. Additionally, we comment on other false cystic images in the ERCP.

Artifacts↗
PubMed1992

[Long-term results of endoscopic sphincterotomy in the treatment of residual/recurrent choledocholithiasis].

Endoscopic sphincterotomy is widely accepted as the technique of choice in the treatment of residual or recidivant choledocholithiasis since the results obtained with this technique are favorable when compared to biliary surgery in most series. However, the experience of long term follow up of patients with choledocholithiasis in whom this technique would have been applied as the only treatment is still scarce up to date. We have studied 40 patients (mean age 65.6 +/- 11.1 years) with residual or recidivant choledocholithiasis who had undergone endoscopic treatment successfully before the 30th of June 1985, who could be contacted by a mailed questionnaire or by phone by August 1990. The follow up time 70.7 +/- 19.4 months (mean +/- typical deviation). Out of them, 36 (90%) had been asymptomatic up to the contact date (30 cases) or up to death due to causes not related to biliary pathology (6 patients). Out of the 4 remaining patients, 2 presented mild dyspepsia and another patient has probably developed recidivant choledocholithiasis (according to I.V. cholangiography). The fourth patient presented a severe episode of cholangitis and acute pancreatitis, related to a new episode of choledocholithiasis and died 5 and a half years after the endoscopic sphincterectomy. This represents a 2.5% mortality. These long term results of endoscopic sphincterotomy in patients with residual or recidivant choledocholithiasis are an other point in favour of using this technique as the single treatment of choice in patients above 60 years old.

Adult↗
PubMed1992

[Endoscopic retrograde cholangiopancreatography in Mirizzi's syndrome].

Mirizzi's syndrome is characterized by compression and or stenosis of the common duct as a consequence of impaction of a stone in the gallbladder neck, the cystic duct and eventually by a cholecystobiliary fistula. Preoperative diagnosis is important to avoid iatrogenic injury of the biliary tree. We present two cases with Mirizzi's syndrome confirmed at operation in whom ERCP was done prior to the operation. In one of them the examination was diagnostic, while in the other, cystic duct compression and absence of the gallbladder image were the non-specific findings.

Aged↗