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Attila Csendes

Publications and source records attributed to Attila Csendes.

50 records · Page 3Linked to original sources
PubMed2002

Clinical, endoscopic, and functional studies in 408 patients with Barrett's esophagus, compared to 174 cases of intestinal metaplasia of the cardia.

OBJECTIVE: The pathophysiology of gastroesophageal reflux disease (GERD) has been studied extensively in patients with long-segment Barrett's esophagus (LSBE), but few reports have explored GERD pathophysiology in patients who have short-segment Barrett's esophagus (SSBE) or intestinal metaplasia at the cardia (IMC). We aimed to compare clinical, endoscopic, histological, and functional features in patients with LSBE, SSBE, and IMC. METHODS: We identified 582 patients who had intestinal metaplasia at the squamocolumnar junction in the distal esophagus and divided them into three groups based on the extent of columnar-lined esophagus observed endoscopically: 1) patients with IMC who had no columnar-lined esophagus (i.e., the squamocolumnar and gastroesophageal junctions coincided), 2) patients with LSBE who had >3 cm of columnar-lined esophagus, and 3) patients with SSBE who had <3 cm of columnar-lined esophagus. All patients had esophageal manometric evaluation, and 24-h esophageal pH monitoring was performed to determine the extent of acid and bile (bilirubin) reflux. RESULTS: There were 174 patients with IMC, 155 with LSBE, and 25 with SSBE. Compared to patients with LSBE and SSBE, patients with IMC had significantly lower frequencies of GERD symptoms, hiatal hernia, and erosive esophagitis; significantly higher lower esophageal sphincter pressures; and significantly shorter durations of acid and bile reflux. Between patients with SSBE and LSBE, significant differences were found in the frequency of hiatal hernia and duration of acid reflux (both greater in the patients with LSBE). Also, dysplasia was significantly more frequent in patients with LSBE than in those with SSBE or IMC. CONCLUSION: GERD symptoms, signs, and physiological abnormalities are found more often in patients with Barrett's esophagus than in those with IMC, and the duration of acid reflux in patients with LSBE is greater than that in patients with SSBE. These findings suggest that the extent of intestinal metaplasia in the esophagus is related directly to the severity of underlying GERD.

Adult↗
PubMed2002

[Incidental finding of inguinal hernia sac cancer].

The presence of cancer in a hernia sac is uncommon. The tumor can involve the hernia sac, the herniated mass or be external to the hernia sac. We report two cases with this condition. A 68 years old male was operated of a right inguinal hernia. During surgery, several white nodules were noted in the internal side of hernia sac. The same lesions were present in the mesentery. Pathological study revealed an adenocarcinoma. The primary tumor was not located and the patient died one and a half years after the procedure. A 62 years old male was operated due to an irreducible inguinal mass, seven months after a subtotal gastrectomy for gastric cancer. During the resection of the mass, metastasis implants in the mesenteric adipose tissue were noted. A mini laparotomy was performed and an extensive peritoneal tumor dissemination was found. The patient died two months after surgery.

Adenocarcinoma↗
PubMed2002

[Obesity: risk factor for steatohepatitis and hepatic fibrosis].

BACKGROUND: Nonalcoholic fatty liver (NAFL) has been recognized as a cause of chronic liver disease. Its main risk factor is obesity. AIM: To describe the clinical and liver pathological findings in a group of patients who underwent surgery as obesity treatment. PATIENTS AND METHODS: Sixty eight patients with severe or morbid obesity were subjected to surgery as obesity treatment. Each patient was evaluated with a complete clinical and laboratory medical assessment. A wedge of liver was excised during surgery. Liver biopsies were analyzed without knowledge of clinical and laboratory findings. The presence of steatosis, inflammation (portal or lobular), fibrosis and cirrhosis were recorded in the pathological analysis. Age and body mass index (BMI) were correlated with pathological data. Significance was set at a p value of less than 0.05. RESULTS: Ninety one percent of patients had steatosis, 45% inflammation and 47% fibrosis. One patient had cirrhosis (1.4%). There was a statistically significant association between BMI and moderate or severe steatosis (p < 0.03). There was also an association between BMI and portal (p = 0.017) and lobular inflammation (p = 0.034). A BMI over 40 kg/m2 (morbid obesity) was significantly associated with the presence of fibrosis (p = 0.032). Moreover, the presence of moderate or severe steatosis was a risk factor for the development of hepatic fibrosis (p = 0.026). CONCLUSIONS: Obesity is a major and independent risk factor for steatohepatitis and fibrosis. The degree of steatosis in the liver biopsy, is a risk factor for the development of fibrosis.

Adolescent↗
PubMed2002

[Gastric neuroendocrine tumors: clinical, endoscopic presentation and alternatives of treatment].

BACKGROUND: Gastric neuroendocrine tumors correspond to less than 1% of all gastric tumors. These tumors can be of three types. Seventy five percent are type I and are associated to chronic atrophic gastritis type A (CAG-A). Half of them are associated with pernicious anemia. Type II tumors are associated with Zollinger Ellison syndrome and type I multiple endocrine neoplasia. Type III are sporadic tumors. AIM: To report the clinical, endoscopical features and response to the treatment of gastric neuroendocrine tumors. PATIENTS AND METHODS: A retrospective study of eleven patients (seven male, aged 38 to 72 years old) with a pathological diagnosis of gastric neuroendocrine tumor. Their clinical presentation, associated diseases, treatment and follow up were reviewed. RESULTS: Epigastric pain was present in eight patients, weight loss in three, epigastric pain and weight loss in one and post prandial abdominal pain in two. At endoscopy, multiple polyps in the fundus were observed in six, verrucose gastritis in one, polyps in the antrum in one, two subcardial polyps in 1, a fundus ulcer in one and a Bormann III type lesion in one. Chronic atrophic gastritis was diagnosed in seven patients and pernicious anemia in five. Serum gastrin levels were determined in 4 patients and were high in all. Four subjects were treated with endoscopic polipectomy only. A partial or total gastrectomy was done in seven patients. No complications or mortality occurred during the follow up. CONCLUSIONS: Abdominal pain is a common presentation of patients with gastric neuroendocrine neoplasia. Polyps predominantly in the fundus are the most common endoscopic finding. Surgical treatment or endoscopical polypectomy, depending of the extension of the disease, yield satisfactory results.

Adult↗
PubMed2002

[Current management of achalasia of the esophagus: critical review and clinical experience].

The therapeutic options for treatment of Achalasia of the esophagus include medical treatment, endoscopic and surgical procedures. The latter can be either conservative, such as cardiomyotomy or more aggressive, such as cardioplasty or esophageal resection. In this article, we discuss the early and long term results after the different therapeutic options. We also present the results of our recent surgical experience. The definitive results seem to be better after surgical treatment compared to medical management or endoscopic procedures.

Catheterization↗
PubMed2002

[Early enteral nutrition in cancer patients subjected to a total gastrectomy].

BACKGROUND: Total parenteral nutrition has a high cost and frequency of complications. Enteral feeding is a feasible alternative that can be started early in the postoperative period. AIM: To assess digestive tolerance to early enteral feeding in cancer patients undergoing total gastrectomy and to compare early enteral feeding (EEF) with total parenteral nutrition plus enteral feeding (TPN + EF), initiated after overcoming postoperative ileus. PATIENTS AND METHODS: Subjects with a resectable gastric cancer were considered eligible for the study. During surgery a nasoenteral tube was placed and patients were prospectively randomized to EEF or TPN + EF. Digestive tolerance, effectiveness, complications and costs between both modalities of nutritional support were compared. RESULTS: Twenty eight patients (15 male, aged 63 +/- 14 years old) were studied. Fourteen patients were randomized to EEF and 14 to TPN + EF. Diarrhea occurred in 14 and 29% of EEF and TPN + EF patients respectively, (p: NS). Patients with TPN + EF received an average of 28 Cal/kg/day and 1.1 g/kg/day proteins. Patients with EEF received an average of 29 Cal/kg/day and 0.8 g/kg/day proteins. At the eighth postoperative day, serum albumin was 3.9 +/- 0.7 and 3.2 +/- 0.5 g/dl in EEF and TPN + EF patients respectively (p < 0.05), serum prealbumin was 16.9 +/- 5 and 12.3 +/- 4.3 mg/dl in EEF and TPN + EF patients respectively (p < 0.05) and nitrogen balance was +2.4 +/- 1.5 and -1.6 +/- 0.6 g/24 h in EEF and TPN + EF patients respectively (p < 0.05). Postoperative hyperglycemia was observed with a lower frequency and nutritional support costs and length of hospital stay were significantly lower in the EEF group. CONCLUSIONS: After total gastrectomy EEF is well tolerated, safe and effective, even during the early postoperative ileus. This therapeutic modality could be the first choice for nutritional support in these patients.

Aged↗
PubMedDate not supplied

Adenocarcinoma appearing very late after antireflux surgery for Barrett's esophagus: long-term follow-up, review of the literature, and addition of six patients.

Antireflux surgery is supposed to prevent the development of adenocarcinoma in patients with Barrett's esophagus. The purpose of this study was to determine the prevalence of adenocarcinoma late after antireflux surgery. A total of 161 patients with long-segment Barrett's esophagus had antireflux surgery and were followed for a mean of 148 months (range 54 to 268 months) Clinical, endoscopic, histologic, and functional studies were performed. Of the original 161 patients, 147(91.3%) completed long-term follow-up. Six patients (4.1%) developed adenocarcinoma 4,5,6,9,17, and 18 years, respectively, after surgery. Five were men. Two of them were asymptomatic for 12 and 17 years. Three of them had extra-long-segment Barrett's esophagus. Five underwent manometric evaluation with only one showing an incompetent lower esophageal sphincter. In two cases, 24-hour pH studies showed massive acid reflux. Two patients had early adenocarcinoma, whereas four had advanced carcinoma. Adenocarcinoma in long-segment Barrett's esophagus seems to develop mainly in patients with recurrence of pathologic reflux, especially among men. A review of the English language literature during the last 23 years found 25 articles dealing with Barrett's esophagus and antireflux surgery. Most of these reports had only a few patients with short-term follow-up (<60 months). To determine the true prevalence of this complication, a long-term objective follow-up is necessary.

Adenocarcinoma↗
PubMedDate not supplied

Mirizzi syndrome and gallstone ileus: an unusual presentation of gallstone disease.

We discuss the case of a man with an unusual complication of gallstone disease. An 85-year-old patient presented to the emergency department with a 3-week history of abdominal pain in the right upper abdominal quadrant. Thoracoabdominal radiography demonstrated that the whole extrahepatic biliary tree, including the common bile duct, common hepatic duct, gallbladder, and left and right hepatic ducts, were visibly delineated by air. The operative findings revealed a small shrunken gallbladder, a fistula between the gallbladder fundus and the gastric antrum, and a cholecystohepatic fistula, corresponding to Mirizzi syndrome, type II. A large gallstone was found impacted in the jejunum. This patient seems to have developed initially a cholecystohepatic fistula. Due to the acute inflammatory process, the stone eroded through the gallbladder wall and into the gastric antrum, passing from the antrum into the small bowel, where it became impacted. We suggest that the natural history of Mirizzi syndrome does not end with a cholecystobiliary fistula but that the continuous inflammation in the triangle of Calot may result in a complex fistula involving not only the biliary tract but also the adjacent viscera.

Abdominal Pain↗
PubMedDate not supplied

Laparoscopic Nissen fundoplication: the "right posterior" approach.

The main steps for performing a laparoscopic Nissen fundoplication are described: They start with a "right approach" by dissection of the high lesser curve, near the esophagogastric junction. Then the posterior surface of the stomach is easily visualized by the "posterior approach." The fat pad and both vagal trunks are displaced to the right, avoiding any vagal injury. Two to three short gastric vessels are divided, leaving a loose gastric fundus. A 360 degrees total symmetric and geometric fundoplication is then performed, including the esophageal wall in the most proximal and distal stitch. A final stitch for an anterior fundophrenopexy is performed. This surgical approach has been used in 225 patients with severe chronic pathologic reflux with a 1.3% conversion rate, no mortality, and only one significant postoperative complication. Late evaluation at 5 years after surgery has shown excellent or good results in 85% and fair or poor results in 15% of the patients.

Adipose Tissue↗
PubMedDate not supplied

Effect of duodenal diversion on low-grade dysplasia in patients with Barrett's esophagus: analysis of 37 patients.

It is well known that in patients with Barrett's esophagus (BE), even after antireflux surgery, intestinal metaplasia can progress to dysplasia or even adenocarcinoma. However, the opposite-that is regression of dysplastic changes to intestinal metaplasia after antireflux surgery-has been documented in only a few reports. The objective of this study was to determine the effect of a duodenal diversion operation on low-grade dysplasia in patients with BE. Thirty-seven patients with either short-segment (n = 12) or long-segment (n = 25) BE underwent antireflux surgery plus either a duodenal switch procedure (13 patients) or a partial distal gastrectomy with Roux-en-Y gastrojejunal anastomosis (24 patients). All of them were subjected to complete clinical, endoscopic, histologic, manometric, and 24-hour pH testing, and 24-hour monitoring of the bile exposure in distal esophagus. There were no deaths in this series, and morbidity occurred in only one patient (2.7%). Manometric assessment after surgery showed a significant increase in sphincter pressure, abdominal length, and total length (P < 0.001). Acid reflux showed a significant decrease after surgery, and duodenal reflux was completely abolished in all except one patient. Follow-up in all patients was longer than 24 months (mean 60 months). Three to four endoscopic procedures were performed after surgery in each patient, and several biopsy specimens were taken distal to the squamo-columnar junction during each endoscopic procedure. Eleven patients (91%) with short-segment BE demonstrated histologic regression to either cardiac mucosa or nondysplastic intestinal metaplasia. Among the 25 patients with long-segment BE, there was a 62.5% rate of histologic regression to nondysplastic epithelium when the length of BE measured between 31 and 99 mm and 33% histologic regression when the length of BE was 101 mm or more. There were no cases of progression to high-grade dysplasia or adenocarcinoma. The endoscopic length of the columnar-lined esophagus did not change late after surgery. In 65% of patients with BE, antireflux surgery, gastric acid reduction, and duodenal diversion produced histologic regression of low-grade dysplasia to nondysplastic mucosa. This effect was even more pronounced when the length of BE was shorter. It seems to be permanent, and no progression to high-grade dysplasia or adenocarcinoma has occurred.

Adult↗
PubMedDate not supplied

Histologic findings of gallbladder mucosa in 87 patients with morbid obesity without gallstones compared to 87 control subjects.

Obesity is an important risk factor for the development of gallstones. The purpose of this study was to determine histologic alterations in the gallbladder mucosa and the prevalence of gallstone disease in patients with severe and morbid obesity compared to histologic findings in the gallbladder mucosa of control subjects. Two groups were studied: 125 severely obese patients (38 with and 87 without gallstones) and 87 control subjects. Ultrasonography was performed in all of them before surgery. During surgery, cholecystectomy was performed in 87 obese patients with a "normal" gallbladder and in all 87 control subjects. Specimens were immediately sent for histologic analysis. The prevalence of gallstones was twice as high among obese women compared to obese men (P < 0.001). Normal gallbladder mucosa was found in 28.7% of obese women compared to 34.2% of control women (P > 0.59). Findings were similar among the men. The most frequent histologic abnormality in the gallbladder mucosa among obese women was cholesterolosis (37%), followed by chronic cholecystitis and cholesterolosis (18%), with frequencies of 23% and 12%, respectively, in control women (P > 0.1). Among men, a similar proportion of histologic abnormalities was seen in obese men and control subjects. In our population of obese patients compared to control subjects, a similarly high proportion of histologic abnormalities of the gallbladder mucosa was found in the absence of stones. These findings could have been attributed to the fact that the Chilean population has a high incidence of gallstones.

Adolescent↗
PubMedDate not supplied

Management of common bile duct stones: the state of the art in 2000.

Biliary lithiasis is a widespread disease all over the world; one-third of the white population presents with stones in the biliary ducts. In Chile, it is present in 47% of adult females. The most common complications of this pathology are acute cholecystitis, choledocholithiasis, acute pancreatitis, retained common bile duct (CBD) stones, and gallbladder cancer; these constitute a serious health problem in Chile. The aim of this study was to update the information related to choledocholithiasis after 10 years of laparoscopic biliary surgery. To achieve this objective, we retrospectively analyzed the last 100 cases of choledocholithiasis admitted to the University of Chile Clinical Hospital in 2000. Prevalence by sex and age was determined. Clinical diagnosis was demonstrated to be effective in 92.3% of the cases; laboratory tests and ultrasound were effective in 81% and 90% of the cases, respectively. Diagnosis of cholelithiasis and choledocholithiasis as one unique entity corresponded to 53% of the sample; 47% of the remaining choledocholithiasis cases corresponded to retained CBD stones in patients previously cholecystectomized. Time of appearance of symptoms of this residual pathology was reviewed. All methods or procedures employed to treat this pathology were studied, and it was found that endoscopic cholangiography (ERCP) was the most frequently used procedure. Also, results of other alternative procedures, such as open surgery or ERCP combined with laparoscopic cholecystectomy, were considered. Finally, this study was complemented with a thorough bibliographic review of more than 100 publications on the subject that were published in high-impact surgical reviews, emphasizing the course of treatment followed during the last 7 years.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

Anatomical deformities after laparoscopic antireflux surgery.

Laparoscopic Nissen, Nissen-Rossetti, cardial calibration with gastropexy, and other modifications are the procedures commonly used for surgical treatment of gastroesophageal reflux disease. Postoperative failures have been reported ranging from 10% to 15% associated with postoperative symptoms or recurrent gastroesophageal reflux. In this paper, we present 38 patients submitted to different procedures in which different "abnormal" deformities were found during the postoperative radiological evaluation with barium swallow. The symptoms associated with these deformities were pain (62%), dysphagia (43%), early satiety (37%), postprandial discomfort (35%), and recurrent postoperative reflux (30%). Dysphagia and pain were frequently observed after the Nissen-Rossetti technique, in which a bilobed stomach and stricture (46%) were confirmed. Hiatal hernia was observed in two patients, and slipped Nissen in one patient associated to pain and early satiety. Patients were submitted to conservative treatment (endoscopic dilatation, proton pump inhibitors, and prokinetics), but 10 patients were submitted to redo surgery. There were no complications, and good results were obtained after redo operations.

Esophagogastric Junction↗