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B Sastre

Publications and source records attributed to B Sastre.

102 records · Page 6Linked to original sources
PubMedDate not supplied

Experimental approach to prevention of catheter-related central venous thrombosis.

The role of catheter material in the formation of deep venous thrombosis during parenteral nutrition has been widely emphasized. Systematic venograms show central venous thrombosis in 20 to 33% of cases with polyethylene catheters and in 4% of cases with silicone catheters. Heparin infusion through the catheter diminishes but does not totally eliminate the risk of thrombosis. The aim of this study was to define the conditions under which the risk of thrombophlebitis was minimal. Four series of experiments were carried out, each on five rabbits. Catheters were inserted into the vena cava and, after 10 days, venograms were performed. The animals were then sacrificed, and the vena cava was macroscopically and microscopically studied. Plastic catheters were used in the first series, heparin-Benzalkonium-bonded plastic catheters in the second, silicone catheters in the third, and heparin-Benzalkonium-bonded silicone catheters in the fourth. The results revealed thrombosis of the vena cava and a fibrin sleeve around the catheters in series 1; thrombosis of the vena cava in series 2; a fibrin sleeve around the catheters in series 3; and neither thrombosis nor a fibrin sleeve in series 4. In conclusion, heparin-Benzalkonium-bonded silicone catheters appear to provide the best protection against thrombophlebitis by reducing the damage caused to the intima by the catheters and by slowing down platelet-aggregation around them.

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Mechanism of thrombogenesis during total parenteral nutrition: role of catheter composition.

Catheter material is considered as one of the main factors of deep venous thrombosis during parenteral nutrition. The effects of five types of catheters (polyethylene, polyurethane, silicone, TFE Teflon, and FEP Teflon) on the vein wall and on the blood flow were compared. Experiments were performed on rabbits in which catheters were inserted into the vena cava. Five series of experiments were performed, each including five animals with the same type of catheter. After 10 days, venograms of the vena cava were performed, animals were then killed and the vena cava was removed with the catheter in situ. The vein and the catheter were macroscopically examined; in cases with thrombosis the clot was weighed. The vein wall and the catheter were examined by conventional microscopy and by electron microscopy, respectively. Obstruction of the venous lumen were significantly more frequent with the rigid catheters than with the soft catheters (p less than 0.001). The most extensive thromboses occurred with the Teflon catheters. The incidence of fibrin sleeves was significantly higher with the soft catheters than with the rigid ones (p less than 0.01). The venographic and macroscopic findings were in agreement in 60-100% of the cases according to the degree of venous obstruction. Catheter surfaces remained unchanged in all cases. The polyethylene catheters induced the most severe intimal inflammatory reactions. Thrombus formation was caused by two mechanisms depending on catheter composition: (1) turbulence caused by the catheter in the blood stream, and (2) platelet aggregation and subsequently, fibrin deposition on the surface of the catheter.

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PubMedDate not supplied

Mucinous cystadenocarcinoma of the pancreas. Ultrasonographic findings in 5 cases.

The ultrasonographic findings in 5 patients (4 males, 1 female, mean age 70 years) presenting with mucinous cystadenocarcinoma of the pancreas are described. The lesion was located in the head and body of the pancreas in 2 cases, in the head alone in 2 others, and in the tail in one. The size ranged from 40 to 85 mm (mean 64 mm). Internal septa were seen in 5 patients, endocystic proliferation in 2, parietal calcifications in 1 and mixed cystic-solid areas in 3. The estimation of CEA in the fluid collected by sonographic guided puncture may be useful in diagnosis. Guided microbiopsy and fine needle cytology performed in 3 cases confirmed the diagnosis. Moreover, ultrasonography clearly showed the modifications of the vessels (splenic and portal veins, inferior vena cava) secondary to the tumor. It is concluded that ultrasonography with guided puncture is a simple, inexpensive and effective method for the diagnosis of mucinous cystadenocarcinoma of the pancreas.

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[Splanchnicectomy by Dubois' transhiatal approach. Technics, indications and results. Apropos of 25 nerve sections for visceral abdominal pain].

Splanchnicectomy through Dubois, transhiatal approach was performed in 25 patients with abdominal pain of mainly pancreatic origin. The four stages of the operation are described and are facilitated by the use of a Fruchaud type of retractor and rigid, long, narrow valves to enable lateral displacement of the aorta and abdominal esophagus. After dissection of the esophageal hiatus, the Xth nerves and abdominal esophagus are isolated and the pleura detached, beginning with the anterior surface of the aorta. The greater splanchnic nerves are then isolated and sectioned and a final-stage esophageal hiatus reconstruction performed. This simple, rapid technique produces immediate, total, lasting pain relief, particularly spectacular in patients with cancer of the body of the pancreas, this representing the indication of choice for this neurectomy. Splanchnicectomy does not affect survival duration but improves the comfort and quality of this period. In hyperalgic forms of chronic pancreatitis, this nerve section can be combined with conventional surgery. There was no operative mortality in this series of 25 cases.

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