Biomedical subjects

A Jmelnitzky

Publications and source records attributed to A Jmelnitzky.

At least 19 recordsLinked to original sources

PubMed2005

Endoscopic gastroenteric anastomosis using magnets.

BACKGROUND: Current management of malignant obstruction of the upper digestive tract includes surgical gastrointestinal bypass or endoscopic insertion of self-expandable metal stents. The safety, efficacy, and long-term patency rates of anastomoses created using the novel technique of endoscopic gastroenteric anastomosis using magnets (EGAM) are evaluated in this study. PATIENTS AND METHODS: 15 patients (13 men, 2 women; mean age 64.5 years) with malignant obstruction, who underwent EGAM and had monthly follow-up between December 2001 and May 2003, were included in this study. RESULTS: The procedure was successful in 13 patients (88.66 %). The mean survival was 5.23 months. There were four minor complications (30.76 %) during the follow-up period. CONCLUSION: Our results demonstrate the feasibility, safety. and efficacy of this technique for creating a gastroenteric anastomosis. The success rate was 86.6 %, there were no immediate complications, and there was no mortality related to the procedure.

Aged↗

PubMed2003

[Complications of endoscopic retrograde cholangiopancreatography].

INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) FOLLOW-UP: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8%), strictures (18%), pancreatic cancer (4.3%), ampullary cancer (2.3%) and normal ERCP (24.4%). CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53%) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated.

Adolescent↗

PubMed2000

Efficacy of octreotide and sclerotherapy in the treatment of acute variceal bleeding in cirrhotic patients. A prospective, multicentric, and randomized clinical trial.

BACKGROUND: Sclerotherapy is the most widely used method for treatment of acute variceal bleeding. Previous reports have suggested that octreotide infusion is as effective as sclerotherapy. Our aim was to investigate the efficacy and safety of octreotide in comparison with sclerotherapy in controlling variceal bleeding. METHODS: Seventy-six cirrhotic patients were randomized to receive either sclerotherapy (n = 37) or octreotide (n = 39) infusion of 50 microg/h intravenously for 48 h after a bolus of 100 microg, followed by subcutaneous injection of 100 microg/8 h for an additional 72 h. RESULTS: The two groups were similar in base-line data. A similar initial control of bleeding was obtained in 94.6% for sclerotherapy and 84.6% for octreotide (NS). No difference was observed between sclerotherapy and octreotide in rebleeding (23% versus 33%) and treatment failure (22% versus 36%, respectively). Furthermore, the overall success of treatment was 78% for sclerotherapy and 64% for octreotide. No significant difference in mortality was observed between treatments (eight patients for octreotide and three patients for sclerotherapy, NS). CONCLUSIONS: These results show that both treatments present a very high and similar initial and final control of bleeding. However, there is a trend that could be clinically important towards better results in the patients treated with sclerotherapy.

Acute Disease↗

PubMed1998

Hepatic sinusoidal dilatation associated to giant lymph node hyperplasia (Castleman's): a new case in a patient with periorbital xanthelasmas and history of celiac disease.

We present a new case of hepatic sinusoidal dilatation associated to giant lymph node hyperplasia or Castleman's disease in a 23-year-old patient with xanthelasmas and history of celiac disease. He presented with weight loss, hepatomegaly, periorbital xanthomas, anemia, accelerated erythrosedimentation rate, hypoalbuminemia, hypergammaglobulinemia at the expense of immunoglobulin G (IgG), high titers of autoantibodies, and increase of serum alkaline phosphatase and gamma glutamyl transpeptidase activity. A liver biopsy showed sinusoidal dilatation. Fifteen months later, a computed axial tomography showed a retroperitoneal tumor that turned out to be a giant lymph node hyperplasia. After resection of the tumor all clinic and biochemical manifestations had faded, suggesting an association between xanthelasmas, Castleman's disease, sinusoidal dilatation, and celiac disease. A humoral factor produced by the lymph tumor of the patient may have been responsible for the immunologic alterations he presented.

Adult↗

PubMed1996

[Hepatitis B and C virus in chronic alcoholic patients: prevalence and influence on liver injury].

The aim of this prospectively designed study is to analyse the prevalence of HBV and HCV infections in 115 chronic alcohol abusers, their relation to epidemiological variables, and their meaning in pathogenesis and severity of alcoholic liver injury. A prevalence of 13.9% anti-HBc and 20.0% anti-HCV reactivity (EIA II) were found, significantly higher that found in blood donors (3.75 and 0.65% respectively). It is striking our finding of 69.6% "sporadic" type of HCV infection. Histological diagnostic of chronic hepatitis was done in 3 cases, all of them reactive to anti-HCV, enhancing the ethiologic role of HCV in the so called "alcoholic chronic hepatitis". No differences in histological final diagnosis were found related to HBV and HCV markers reactivity, suggesting no clear influence of viral infections on the severity of liver damage in alcoholics in our series. Neither anti-HCV positivity ratio seemed have to influence on these results. Despite a high prevalence of HBV and HCV infection in chronic alcohol abusers, our finding suggest no clear role for them in histological damage.

Adolescent↗

PubMed1996

[Endoscopic treatment of pancreas divisum].

The pancreas divisum is the most frequent congenital anomaly of the pancreas. It is caused by the absence of fusion in the dorsal and ventral pancreatic buds, so that most of the gland drains through the Santorini duct in the minor papilla. It has been suggested that the relative obstruction of the pancreatic pain and pancreatitis in these patients. According to this the treatment consists in facilitating the minor papilla drainage via surgery or endoscopy. Two endoscopic treatment cases are presented. In both pancreatic duct stent and further sphinterotomy were performed. This treatment and their follow-up are evaluated, coming to the conclusion that this method should be taken into account in the future, due to its viability and low morbimortality.

Adult↗

PubMed1994

[Expandable prosthesis of the biliary tract in malignant stenosis: initial experience].

The endoscopic or percutaneous placement of a stent in the palliative treatment of the malignant obstructions of the biliary tract is a very well established and accepted method in our country. In the last few years the placement of metallic stents has been preconized because they offer advantage over the standard ones. The first three cases where this type of material was used by our team are presented. Effectivity and facility of the method is demonstrated and no early complications were related to it. We make a critical analysis of the presentation world it be advisable to write about this analysis?

Aged↗

PubMed1993

[Endoscopic sphincterotomy. Complications and follow-up].

Between April 1981 and April 1991, there were 547 EPT performed, seventy-five of which had in situ gall bladder. They were performed in two groups, who were similar from the technical-anatomical point of view, and sociocultural background. The early morbidity showed 31 complications (5.6%). The most frequent ones were: perforation in 8 cases and haemorrhage in 5. Medical treatment, which included the endoscopic technique in 20 cases (3.7%) and surgical procedures in 11 cases (2.0%) was used. The mortality rate was 1.8% (10 cases), perforation (4) and cholecystitis (3) being the main causes. There were three deaths (0.5%) not related to the method. The morbi-mortality was not significantly increased by the complementary methods. After analysing the complications related to the cause of EPT performance, it was observed that they were more frequently produced in choledochal stones: 20 (3.6%), followed by choledochal and gall bladder stones: 7 (1.3%). However the mortality was 0.7% in the former and 0.5% in the latter. The morbi-mortality of the last two years is compared to that of the preceding ones. The follow-up was done in 114 (20.8%) of the cases with a marked difference between the high sociocultural group (76 cases) and the low one (36). Eighteen pathological cases were found (3.3%). The treatment of each complication in long term is shown.

Follow-Up Studies↗

PubMed1992

Pre-cancerous lesions of the oesophagus in Argentina: prevalence and association with tobacco and alcohol.

The prevalence of pre-cancerous lesions of the oesophagus and their association with alcohol and tobacco were examined in an endoscopic survey carried out in La Plata, Argentina. The study included 406 subjects over 15 years of age attending several gastroenterology clinics because of various gastrointestinal symptoms. Among males, the prevalence rates of chronic oesophagitis, epithelial atrophy and dysplasia were 42%, 3.8% and 2.4% respectively, and in females these prevalences were 36%, 2.5% and 0.0%. The presence of these pre-cancerous lesions was significantly associated with alcohol drinking and tobacco smoking.

Adolescent↗

PubMed1992

[Endoscopic sphincterotomy. Its complications and their follow-up].

Between April 1981 and April 1991, there were 547 EPT performed, seventy-five of which had in situ gall bladder. They were performed in two groups, who were similar from the technical-anatomical point of view, and sociocultural background. The early morbidity showed 31 complications (5.6%). The most frequent ones were:perforation in 8 cases and haemorrhage in 5. Medical treatment, which included the endoscopic technique in 20 cases (3.7%) and surgical procedures in 11 cases (2.0%) was used. The mortality rate was 1.8% (10 cases), perforation (4) and cholecystitis (3) being the main causes. There were three deaths (0.5%) not related to the method. The morbimortality was not significantly increased by the complementary methods. After analysing the complications related to the cause of EPT performance, it was observed that they were more frequently produced in choledochal stones: 20 (3.6%), followed by choledochal and gall bladder stones: 7 (1.3%). However the mortality was 0.7% in the former and 0.5% in the latter. The morbimortality of the last two years is compared to that of the preceding ones. The follow-up was done in 114 (20.8%) of the cases with a marked difference between the high sociocultural group (76 cases) and the low one (36). Eighteen pathological cases were found (3.3%). The treatment of each complication in long term is shown.

Argentina↗

PubMed1991

[Primary risk of hemorrhage due to esophageal varices in cirrhotic patients: significance of the associated endoscopic signs and hepatic functional reserve].

Significance of endoscopic findings associated to esophageal varices (Japanese Research Society for Portal Hypertension) and hepatic dysfunction (Child-Pough classification) as predictive factors of variceal bleeding in cirrhotic patients is analyzed. In a cooperative prospective experience 137 cirrhotic patients with esophageal varices were examined in the period May 1987/89: 83 out of them had never bled from their varices (VENS group) while 54 recently had (VES group). A highly significative association was found between variceal size over 3 mm (grade II-III) and bleeding: 96.3% vs. 34.9% in VENS group (p = 0.01); similar association was found with regard to endoscopic detection of "red signs": 92.6% in bleeding group vs. 20.5% in VENS one (p = 0.01). "Red signs" were found on grade II-III varices in 98.5% of cases, and this association were related to variceal bleeding in 75.5%. Hepatic dysfunction was not directly related to bleeding episodes but "red signs" endoscopic detection in VENS group increased with liver function deterioration: 9.1% in Child A class, 27.3% in Child B, and 41.2% in Child C (p = 0.01). The strong association founded between bleeding and both grade II-III variceal size and "red signs" detection, suggest the possibility to identify a high risk group of cirrhotic patients candidate to prophylactic methodologies.

Adult↗

PubMed1991

[Endoscopic prosthesis of the bile ducts].

During the period 30/5/84-30/7/90, 70 endoscopic prosthesis were settled in 47 patients; 18 men and 28 women; age average 73.17 and ranging 33 to 70. The distribution in ethnic groups showed a top between 70 to 79. The main causes for the implantation were bile ducts cancer, ampullary carcinoma and biliary stones; which were not likely to endoscopic gallstone extraction all of them in 13 opportunities (18.57). The more widely diameter used were 7 and 10 French and the more used was the straight line. Two prosthesis were way implanted without previous sphincterotomy and 1 in Billroth II. The early complications were present in 4 cases (5.7) and all of them led to death independently of the treatment used. The most frequent complication was cholangitis (37.14) most of which were treated by endoscopy, only 2 of them were chirurgical, there was no mortality. The evolution is being analyzed so far.

Adult↗

PubMed1991

[Response of healthy subjects to plasma-derived anti-hepatitis B vaccine].

71 healthy individuals were vaccinated against hepatitis B virus. Each person received 60 mcgrs of HBsAg derived from chronic carriers heat-formalin treated plasma. All the vaccinees were tested for anti-HBs and 94.4% of them reached the protective titer (greater than 10 mUI/ml). There were few and no significant side effects (15.4%). Those vaccines with antibody titers higher than 100 mUI/ml were significantly younger than those with antibody titers lower than 100 mUI/ml. There was no significant difference between the body surface means of both groups. Thus, the vaccine level response is not associated with the body surface but with people's age.

Adult↗

PubMed1990

[Evaluation of esophageal endoprosthesis].

In 60 patients with either non operable esophageal pathology on neighbouring organs pathology with esophageal involvement, esophageal endoprosthesis therapy was assessed. The various implantation techniques are described. Main causes for implantation were epidermoid esophageal carcinoma in 48 instances and gastric adenocarcinoma with esophageal involvement in 9 cases. The causes most frequently associated with early morbimortality were perforation in 4. All cases were medically treated with a 16.9% mortality rate (10 cases), due to broncoaspiration as main cause. Endoscopic reimplantation of the prosthesis was the treatment of choice in perforated cases.

Adult↗

PubMed1990

[Hepatic lesions in acute cardiovascular failure in necropsy specimens].

To evaluate quali-quantitatively ischemic liver injury due to acute cardiocirculatory failure (ischemic hepatitis), and its real clinical signification, 200 out of 1165 autopsy records with ACF clinical diagnosis were selected; 33/200 (16.5%) shown centrilobular necrosis without inflammatory component, accompanied or not by midzonal compromise. Grade IV centrilobular necrosis (50-100% involved lobules) was present in 96.9%, with 15.5% associated midzonal pattern, and 21.2% of confluent type; 2 additional cases with isolated midzonal necrosis (5.7%) were seen. Only six patients (3.0% of ACF patients, and 18.2% of those with histological injury) shown overt clinical liver disease, one of them with a fulminant hepatitis picture (0.5% of ACF, and 3.0% of patients with ischemic necrosis). Bilirubin levels were 3.4-10.2 mg%, and aminotransferases rose up to 540 times over their seric superior normal limits. Centrilobular necrosis involved 100% of lobules in all cases.

Adult↗

PubMed1989

[Long-term course in asymptomatic carriers of HBsAg in an area of low prevalence of hepatocarcinoma].

Data provided by 51 voluntary blood donors identified as asymptomatic HBsAg carriers five to ten years (mean = 7.5 years) before their inclusion in the study are analysed towards their long-term evolution. HBsAg clearance was estimated 2.5% yearly and 83.9% of those remaining positive showed the classical non-replicative serological pattern; another 12.9% were negative for both HBeAg-Anti HBe (seroconversion window?), one of them presenting raised ASAT-ALAT levels and enhanced histological activity (lobular chronic hepatitis). Neither alpha-fetoprotein seric levels (RIA) nor liver ultrasonography demonstrated hepatocellular carcinoma suspicion signs in 35 HBsAg positive cases to this methods; ASAT-ALAT levels raised over two fold the normal superior limit in only 11.4%, and neither aggressive chronic liver disease nor hepatocyte dysplasia was showed in 17 biopsied cases (70.6% normal; 23.6% chronic reactive or chronic persistent hepatitis; 5.8% chronic lobular hepatitis). One out of five patients biopsied with a seven years interval showed histologic worsening.

Blood Donors↗

PubMed1988

Early colorectal cancer--follow-up after endoscopic polypectomy.

Approximately 90% of correctly indicated endoscopic polypectomies for early colorectal cancer, whether invasive or not, are curative, provided strict criteria are adopted in the pathological evaluation of the resected specimen. Unrestricted time surveillance is mandatory since benign (more frequent) or malignant relapses appear in 30-40% of the patients.

Adult↗

PubMed1988

[Value of the endoscopic sphinctero-papillotomy by surgical radiocholangiodebitometry].

First results of a prospective study about behavior evaluation of endoscopic sphincterotomy of the ampulla of Vater (EPE) through a serial surgical debitometric (RCDM) assessment are analyzed. Five patients submitted to an EPE looking for a biliary tract decompression because of clinical reasons, prior their surgical cholecystectomy, are comparatively evaluated by serial RCDM with regard to 24 patients receiving a broad transduodenal sphincteroplasty (EPTD). Normal debitometric values (N greater than or equal to 13 cc/min.) were obtained from a sample of 673 surgically explored patients. Debitometric behavior of EPE were comparable in all cases and over our standard (mean = 18.6 +/- 2.3 cc/min.); they showed no differences to surgical EPTD patients (x = 18.3 +/- 2.0 cc/min.). Despite uniform results in the EPE group, a more extensive sample is necessary for definitive conclusions; serial surgical RCDM in patients who received EPE, in spite of limited indications, seems to be a valuable method to analyze early functional events after the procedure.

Adult↗