Biomedical subjects
Publications and source records attributed to A M de Lacy.
The established management of epiphrenic diverticula combines diverticulectomy with myotomy of the distal esophagus including the lower esophageal sphincter. We report a patient with prompt recurrence of an epiphrenic diverticulum after laparoscopic transhiatal diverticulectomy associated with esophagomyotomy and partial posterior fundoplication due to an incomplete myotomy.
UNLABELLED: No data are available on the use of the Internet by Spanish patients with chronic diseases. AIM: To determine the extent to which patients with inflammatory bowel disease (IBD) in Barcelona (Spain) make use of the Internet and the relationship between Internet use and demographic characteristics. METHOD: A questionnaire on Internet use was administered to 200 patients attending an information session on IBD organized by the Gastroenterology Department of a university referral hospital in the city of Barcelona. RESULTS: Replies were received from 86% of those surveyed. The mean age was 40 years and 60% were women. Sixty-eight percent had home computers and 49% had an Internet connection. Forty-four percent sporadically or regularly obtained information on IBD from the web. A positive correlation was found between availability and Internet use and young age and higher educational level. No differences were found between men and women. Eighty-four percent expressed interest in having a web site on IBD supported by the physicians of their referral center and 65% were prepared to pay a subscription for this service. CONCLUSION: Patients with IBD from Barcelona frequently looked for information on their disease on the Internet and were receptive to initiatives concerning electronic information from physicians of their local referral center.
BACKGROUND: Patients with cirrhosis exhibit splanchnic, peripheral and pulmonary vasodilation, which are thought to play a role in increasing portal pressure, promoting sodium retention and determining arterial hypoxaemia. The present study investigated whether these abnormalities are influenced by portal hypertension or by portal systemic shunting. METHODS: Sixty-one patients with cirrhosis who had haemodynamic measurements before and after end-to-side portacaval shunt (n = 30) or distal splenorenal shunt (n = 31) were evaluated. RESULTS: End-to-side portacaval shunts were more effective than distal splenorenal shunts in decompressing the portal system (portocaval pressure gradient 3.2 +/- 2.5 vs splenocaval gradient 6.5 +/- 3.2 mmHg, P < 0.0001), because of a greater shunt blood flow (33 +/- 12 vs 21 +/- 12 mL/min per kg, P < 0.005). Azygos blood flow and hepatic blood flow decreased significantly after both surgical shunts. However, end-to-side portacaval shunts caused a greater decrease in peripheral resistance than distal splenorenal shunts (-23 +/- 18 vs -11+/- 27%, P < 0.05). Mean arterial pressure and pulmonary vascular resistance were significantly reduced after an end-to-side portacaval shunt (-7 +/- 10%, P < 0.001 and -14 +/- 33%, P < 0.004, respectively), but not after splenorenal shunt. CONCLUSIONS: These results show that end-to-side portacaval shunts, despite normalizing portal pressure, worsen the peripheral and pulmonary vasodilatation. The splenorenal shunt that maintained a higher portal pressure, caused less peripheral vasodilatation and did not enhance pulmonary vasodilatation. These findings suggest that portal systemic shunting is more important than increased portal pressure in determining peripheral vasodilatation in cirrhosis.
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The case of a bisexual male patient with acquired immunodeficiency syndrome (AIDS) and an infected abdominal aortic aneurysm requiring surgery is presented. Attention is drawn to the fact that an unpredictable number of operations will be needed in AIDS patients in the next future.
Propranolol decreases portal pressure by reducing portal blood inflow. Studies in rats with prehepatic portal hypertension due to portal vein stenosis (a model with extensive portosystemic shunting) have shown that propranolol increases the portocollateral resistance, which hinders the fall in portal pressure. The present study examined the effects of propranolol on splanchnic and systemic hemodynamics in rats with portal hypertension due to cirrhosis of the liver, a model which is characterized by mild portosystemic shunting. Two groups of rats with CCl4-induced cirrhosis were studied: the propranolol group (n = 8), which received a propranolol infusion of 2 mg per 15 min, and controls (n = 9), which received a placebo (saline) infusion. Hemodynamic measurements were done using radiolabeled microspheres. Propranolol-treated rats had significantly lower cardiac output (-31%) and heart rate (-26%) than controls (p less than 0.001). Hepatic artery flow was not modified by propranolol. Propranolol caused splanchnic vasoconstriction, manifested by increased splanchnic resistance (+57%) and by a significant fall in portal blood inflow (4.8 +/- 0.4 vs. 6.3 +/- 0.5 ml per min.100 gm in controls, p less than 0.05). In contrast with rats with prehepatic portal hypertension, propranolol did not increase portal resistance in cirrhotic rats [2.0 +/- 0.2 vs. 2.0 +/- 0.1 mmHg per ml per min.100 gm body weight (not significant)]. Hence, the fall in portal pressure (-19%) was expected from the decrease in portal inflow (-24%). These results suggest that increased portal resistance in rats with prehepatic portal hypertension may represent an intrinsic effect of propranolol on the portocollateral vessels, since beta-blockade does not modify portal vascular resistance in cirrhosis.
The authors present the results of a therapeutic trial of the conservative or surgical management of penetrating abdominal stab wounds (PASW) based on clinical criteria. In a prospective series of 100 patients, 70 were treated non-operatively. Thirty patients were operated upon, twenty-one immediately and nine during the 48 h observation period. In five laparotomies no significant injuries were found. Morbidity was similar in both immediate and delayed laparotomy groups (3/21 versus 1/9). Acute alcoholic intoxication identifies a subgroup of patients that are difficult to evaluate and hence are more likely to be managed by laparotomy (chi 2 = 4.056, P less than 0.05). The authors conclude that selective surgical management of PASW based on clinical criteria is an accurate and safe procedure.
We report the results of a prospective and randomized trial designed to study the incidence of abdominal and pulmonary complications in gallstone surgery comparing subcostal (SI) with midline incision. The need for postoperative analgesia was lower in the SI group. There was no difference in the degree of hypoxaemia in the first two postoperative days, but there was less impairment of pulmonary function in terms of vital capacity and forced expiratory volume in 1 s (P less than 0.0001) in the SI group. SI patients also had a lower incidence of pulmonary or abdominal complications but the difference was not significant. Finally, we found a reduced hospital stay for the SI patients (P less than 0.01), probably related to a reduced postoperative analgesic requirement and an improved pulmonary function. We conclude that subcostal incision is a better approach for biliary tract surgery and should be used whenever possible.
A generalized state of immunosuppression during surgery has been implicated in the development of septic complications postoperatively. We studied 18 patients operated upon for benign diseases, to examine the influence of surgical trauma on circulating lymphocyte subpopulations in man. Additionally, we evaluated the effect of thymostimulin on these changes, in another group of 10 patients. Our results suggest that the total number of lymphocytes, as well as lymphocyte subpopulations CD3+ and CD4+, fell significantly following surgery. This reduction in cell number is more pronounced on the helper/inducer lymphocytes. The CD4+/CD8+ ratio decreases significantly after operation. For patients with no complications, the immunosuppression in terms of peripheral lymphocyte population, seen in the postoperative period is usually reversible around the seventh day. On the other hand, peripheral blood lymphocyte changes in the postoperative period were less pronounced in patients treated with thymostimulin. Thymostimulin's action is predominantly on T lymphocytes, and within these, on the T helper/-inducer subpopulation. And finally, thymostimulin is capable of maintaining a normal relationship between helper/inducer and suppressor/cytotoxic cells (CD4+/CD8+ ratio) during the postoperative period, suggesting a better immune state.
Intractable recurrent ascites usually is treated by peritoneovenous shunting. Several complications can occur after shunt implantation. One such complication, right ventricular thrombosis, was managed with atrioventricular thrombectomy and tricuspid valvectomy.
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