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A Oría

Publications and source records attributed to A Oría.

8 recordsLinked to original sources
PubMed2000

Internal drainage of giant acute pseudocysts: the role of video-assisted pancreatic necrosectomy.

BACKGROUND: Internal drainage of giant pancreatic pseudocysts secondary to acute pancreatitis is frequently complicated with postoperative retroperitoneal infection and hemorrhage. Recent data suggest that the risk factor is unrecognized pancreatic necrosis; presumably, pancreatic necrosis becomes infected with bacteria introduced by the cystoenteric anastomosis. HYPOTHESIS: Video-assisted pancreatic necrosectomy, performed at the time of internal drainage, may prevent postoperative retroperitoneal complications in patients with giant acute pseudocysts. DESIGN: A consecutive case-series. SETTING: An urban, university-affiliated, tertiary referral center. PATIENTS: Ten consecutive patients with acute pseudocysts measuring 10 cm or more in major diameter. The mean extent of pancreatic necrosis, as shown by contrast-enhanced computed tomography, was 50%. All patients were operated on electively, at an average time of 7.7 weeks from onset of the attack to surgical treatment. INTERVENTION: Through a midline incision, a 4-cm opening is made at the base of the pseudocyst. Standard laparoscopic instruments are introduced into the pseudocyst and video-assisted pancreatic necrosectomy is performed. The opening is then anastomosed to a Roux-en-Y limb of the jejunum. MAIN OUTCOME MEASURES: Feasibility and safety of video-assisted pancreatic necrosectomy, postoperative morbidity and mortality, hospital stay, and resolution of pseudocysts. RESULTS: Complete necrosectomy was safely performed throughout. There were neither postoperative retroperitoneal complications nor mortality. Mean hospital stay was 8.2 days and all pseudocysts resolved at a mean follow-up of 6.9 months. CONCLUSIONS: Video-assisted pancreatic necrosectomy at the time of internal drainage seems to prevent postoperative retroperitoneal complications in patients with giant acute pseudocysts. Depending on appropriate surgical timing, video-assisted necrosectomy is a feasible and safe procedure.

Adult↗
PubMed1991

Choledocholithiasis in acute gallstone pancreatitis. Incidence and clinical significance.

A prospective study of choledocholithiasis was performed using 110 patients with presumptive diagnoses of acute gallstone pancreatitis. The incidence of migrating and persistent bile duct stones was determined using stool screening and intraoperative cholangiography, and the clinical significance of continued stone obstruction of the papilla was investigated using ultrasound assessment of migration time and a second evaluation of prognostic signs. Pancreatic inflammation was confirmed at surgery in 51 patients, of whom only 27 had stones in the stools (n = 22) or the bile duct (n = 5), suggesting that choledocholithiasis may not be the sole triggering factor of acute gallstone pancreatitis. Neither delayed migration nor persistent stone obstruction of the papilla promoted pancreatic inflammation.

Acute Disease↗
PubMed1989

Risk factors for acute pancreatitis in patients with migrating gallstones.

Stool screening for gallstones and ultrasound monitoring of diameter changes of the biliary and pancreatic duct were performed in 129 patients with choledocholithiasis. Gallstone migration was found in 44 patients, all of whom were operated on electively. At surgery, acute pancreatic lesions were found in 16 patients; in the remaining 28 there was no evidence of pancreatic inflammation. There were no significant differences among patients in both groups regarding sex, age, stone size, shape or number found in stools, interval between admission and migration, or the presence of a dilated pancreatic duct before migration. Pancreatic duct reflux, however, was significantly more frequent in cholangiograms of patients with acute pancreatitis, implying that a common channel may be a major factor relating to acute pancreatitis in patients with migrating gallstones.

Acute Disease↗
PubMed1988

Biliary and pancreatic obstruction during gallstone migration.

A prospective study on biliary and pancreatic obstruction during gallstone migration was performed in patients without acute pancreatitis. From January to October 1986, 125 patients with upper abdominal pain due to cholelithiasis were admitted to the hospital. Ultrasonography performed in all patients at admission demonstrated a distal bile duct measuring 7 mm or more in 39 patients, who were monitored for diameter changes of the biliary and pancreatic duct every 24 h and their stools screened for gallstones. Patients underwent surgery at least 8 days after admission. Gallstone migration was found preoperatively in 10 patients, of whom 6 had total serum bilirubin values lower than 2 mg/100 ml. Migration time was accurately determined by the sudden decrease in bile duct caliber. Simultaneous dilatation of biliary and pancreatic duct was found in 4 out of 10 patients with migrating gallstones and in 7 out of 23 patients without gallstone migration, though differences proved non-significant. Acute pancreatitis developed in 2 patients with lithiasis of the distal bile duct who ingested a fatty meal against medical advice. Gallstone migration, even of small stones, was preceded by a period of biliary obstruction. Pain and jaundice before migration were not as frequent as expected.

Acute Disease↗
PubMed1981

[Acute suppurative cholangitis].

1) Acute suppurative cholangitis is the most severe clinical form of bacterial biliary infection. 2) During a 14 year period, 29 patients were treated at the General Surgery Division A, of the Cosme Argerich General Hospital. 3) Patients were divided in two groups; a) acute suppurative cholangitis with (n:100 or b) without (n:19) evidence of biliary obstruction. In the former group, in addition to Charcot's triad, we found mental confusion and septic shock among clinical signs. 4) Gall stones were the most common cause of obstruction, followed by pancreatic and biliary carcinoma. 5) Diagnosis on admission was correct in 40% of patients. Charcot's triad was present in 19 of the 29 patients. 6) All 22 operated patients survived whereas 7 non operated patients died. 7) The high mortality observed was similar to that reported in other publications and could be partly due to delayed diagnosis, and the high frequency of multiple liver abscesses found at autopsy. 8) Newer diagnostic procedures have improved the differential diagnosis of obstructive jaundice. It is hoped that they will help in the earlier recognition of acute suppurative cholangitis and decrease the incidence of severe complications.

Adult↗
PubMedDate not supplied

[The diagnostic efficacy of ultrasonography-guided puncture cytology in hepatic masses].

The aim of this work was to evaluate the diagnostic reliability of fine needle cytology guided by ultrasonography in hepatic masses. One hundred and fifty nine patients underwent this procedure. The final diagnosis was confirmed by histology obtained by percutaneous biopsy, surgery, laparoscopy and necropsy or adequate clinical follow-up in 139 cases. Twenty cases were excluded since no final diagnosis was available. In 102 cases the method was applied on an outpatient basis, while the remainder were hospitalized. There were 9 (6.4%) false negatives, whose final diagnosis were hepatocarcinoma in 4, adenocarcinoma in 3, cholangiocarcinoma in 1 and in a non Hodgkin lymphoma. The global sensitivity of the method was 93.5%, the specificity 100% and the efficiency 93.5%. In hepatocarcinomas the sensitivity was 73.3%, the specificity 100% and the efficiency 73.3%. In metastatic adenocarcinomas the sensitivity was 96.2%, the specificity 100% and the efficiency 73.3%. Except for a single hepatocarcinoma patient who developed hemoperitoneum and 2 patients who required parenteral analgesics, complications were entirely lacking. Fine needle cytology guided by ultrasonography in hepatic masses is a highly efficient method to confirm, rule out and stage liver malignancy and benign lesions in a fast low-cost fashion. The low sensitivity in hepatocarcinomas is attributable to tumor size and histological differentiation.

Adult↗