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Biomedical subjects

B Zilberstein

Publications and source records attributed to B Zilberstein.

53 records · Page 3Linked to original sources
PubMedDate not supplied

[Spontaneous perforation of the cecum without colonic obstruction. Report of 3 cases].

Spontaneous perforation of the colon without obstruction is related to intestinal and extra intestinal diseases, mainly gynecological procedures. Its etiology is unknown, and there are many theories. Because of its diagnosis peculiarities, as well as its rarity, and mainly the severity of the disease, the authors describe three cases, relating the necessity of early diagnosis and correct surgical treatment.

Adult↗
PubMedDate not supplied

Regeneration of esophageal epithelium in the presence of gastroesophageal reflux.

The esophageal mucosa in twelve dogs was excised from the distal third of the esophagus together with a surgical procedure to provoke gastroesophageal reflux. A longitudinal segment containing all the layers of the wall of the esophagogastric junction was removed intraoperatively in all dogs. It was determined that in this segment, the transition of the columnar and squamous epithelia and the apex of the inferior sphincter of the esophagus, which is perfectly individualized in the dog except for few variations, were at the same level. During the postoperative period, the dogs were randomly divided into two groups according to the time of sacrifice. Group I was killed after 30 days and Group II after 60. Serial sections of the autopsy specimen were taken at the level of the esophagogastric junction, in order to determine the way in which the esophageal epithelium regenerates in the presence of gastroesophageal reflux. The apex of the inferior sphincter of the esophagus was used as a fixed parameter of the esophagogastric transition, even in the absence of its epithelial lining. Postoperatively the dogs presented varying lengths of the inferior third of the esophagus relined with columnar epithelium. The epithelium originates either from the gastric epithelium itself, or from the ducts of the submucosal glands of the esophagus. The histologic aspect of the regenerated columnar epithelium varied from simple columnar epithelium to a well-differentiated epithelium resembling gastric mucosa. These studies reinforce the concept that columnar epithelium lining the terminal esophagus may be acquired due to reepithelization in an acid medium, of a previously injured esophageal epithelium.

Animals↗
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Histopathology of the common bile duct in choledocholithiasis.

The histology of the common bile duct was studied in 45 patients with choledocholithiasis and/or papillitis and compared with a control group of ten cadavers without hepatic or biliary disease. Choledochitis was diagnosed in 44. Only one patient presented a histologically normal duct. The inflammatory process was characterized by proliferation of connective tissue and loss of elastic fibers, cellular infiltration of lymphocytes and polymorphonuclear leukocytes, and atrophic dilatation or hyperplasic glandular changes. Choledochitis was divided in two types: chronic and acute-chronic, and according to the intensity of the inflammatory process was also classified in slight, moderate or severe. No correlation was found between choledocholithiasis and/or papillitis and type and intensity of choledochitis.

Adult↗
PubMedDate not supplied

Esophagogastric anastomosis with valvuloplasty: an experimental study.

Twenty dogs divided into two equal groups were studied by the authors in order to evaluate the functional activity and the occurrence of reflux and esophagitis after esophagogastrectomy followed by a simple esophagogastric anastomosis (group A) and associated with an anti-reflux valve mechanism (group B). The functional activity was studied by manometry at the esophagogastric junction and the occurrence of esophagitis by histologic examination of the esophagus after 25 days of histamine gastric acid stimulation. In group A, no high pressure zone between the gastric and esophageal tracings were verified. Reflux and esophagitis which, occurred in all animals, was severe in 70%. In group B, manometry demonstrated that esophagogastropexy creates a high pressure zone. At deglutition this zone showed positive deflections, corresponding to the propagation of the peristaltic wave in the segment of esophagus, encircled by the stomach. Esophagitis, which was detected in 30%, was less severe than that observed in group A.

Animals↗
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[Cervical esophageal membrane and Plummer-Vinson syndrome: report of a caseload and review of the literature].

Esophageal webs are an uncommon group among esophageal diseases. We report our findings in ten patients with membranes in the upper esophagus; seven of them were women. The median age was 48.5 years (range 24 to 73 years). Dysphagia was the main symptom in all patients and anemia was found in six cases. Radiologic and endoscopic studies provided the diagnosis. All patients underwent endoscopic dilatation and/or debridement and good results with this management were achieved. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Adult↗
PubMedDate not supplied

[The prognostic value of cholesterol levels in malnourished patients with esophageal carcinoma].

A variety of clinical calculations, including serum cholesterol, have been used as parameters of prognostic value in surgical populations, but there are few studies aimed at patients with esophageal carcinoma. In a set of patients with established esophageal cancer, cholesterol and triglyceride levels were recorded, along with the following parameters: age, sex, body weight, serum albumin, total lymphocytes, and hemoglobin concentration. Manual grip strength was measured, along with delayed cutaneous hypersensitivity response, and the type of surgical treatment was distinguished (palliative versus radical). Total complications and postoperative hospitalisation time are the main indicators used in our study for the surgical results. Patients were divided into two groups: those with serum cholesterol levels over 150 mg/dl (Group I) and those under that figure (Group II). Most nutritional and functional values were lower in Group II patients, for whom the radical surgery rate was also lower, with greater postoperative morbidity. It was concluded that 1): Cholesterol depletion is associated with nutritional and immunological alterations and 2) post-surgical results are poorer in patients with levels below 150 mg/dl.

Adult↗
PubMedDate not supplied

Achalasia: a prospective study comparing the results of dilatation and myotomy.

BACKGROUND/AIMS: In a prospective and randomized clinical study, the operative method and dilatation in the initial stage of megaesophagus were evaluated. METHODOLOGY: Forty patients in the initial stage of megaesophagus, managed by forced hydrostatic dilatation of the cardia (20 patients-DILAT Group) or by esophagocardiomyotomy associated with esophagofundopexy (20 patients-Group OP) were followed-up for three years, in terms of clinical, radiographic, endoscopic, manometric and pH monitoring. RESULTS: 1) Both procedures can be performed without significant morbidity or mortality. 2) The two procedures are similar regarding ongoing suppression of dysphagia. 3) Radiologically, the methods are equivalent, since they promote significant elimination of contrast stasis and maintenance of the esophageal diameter. 4) Endoscopic follow-up did not differentiate the procedures in terms of the development of reflux esophagitis, with a rate of only 5% for each group of patients. 5) Manometry demonstrated that surgery produced a significantly greater reduction of the LESP as compared to dilatation, although the latter also determined a marked drop in the maximum basal pressure of the LES. 6) Neither procedure altered the length of the LES. 7) With prolonged esophageal pH monitoring, dilatation demonstrated a greater propensity for reflux as compared to surgery. CONCLUSION: Both methods offer benefits in the treatment of the initial stage of megaesophagus, although esophageal pH monitoring indicates that dilatation provokes a greater index of esophageal acid exposition time.

Adult↗
PubMedDate not supplied

[Hyperdynamic circulation in Manson's hepatosplenic schistosomiasis].

Twenty two patients having indication for surgical treatment of portal hypertension due to hepatoesplenic schistosomiasis were prospectively studied. Each patient was submitted to preoperative monitoring with pulmonary artery catheterization. The results showed hemodynamic alterations characterized by an increase of cardiac index (4.50 +/- 0.96 l/min/m2) associated to a decrease of systemic vascular resistance index (1638.60 +/- 441.86 dyn.s/cm5.m2). The stroke index and all right and left cardiac work indeces were increased. The pulmonary artery mean pressure was increased (17.23 +/- 8.63 mmHg) and the pulmonary vascular resistance index was decreased (147.95 +/- 126.21 dinas.seg/cm5.m2). We concluded that hepatoesplenic schistosomiasis determines hyperdynamic systemic circulation, probably correlated with portosystemic shunt, and pulmonary hypertension.

Adult↗
PubMedDate not supplied

[Esophageal intubation for palliative treatment in advanced carcinoma of the esophagus and cardia].

This is a report of 121 cases of advanced esophageal and cardia cancer managed by endoscopic and surgical esophageal intubation. They were submitted to surgical intubation 69 (53%) patients, and 52 (47%) to endoscopic intubation. There were 32.5% of technical complications in endoscopic intubation and 26.5% in surgical intubation. Perfuration was more frequent (11.5%) in endoscopic intubation than surgical group. Mortality rate was 17.3% for endoscopic and 5.8% for surgical intubation. Perfuration was the main cause of death in endoscopic intubation. Survival rate was 3.5 months for endoscopic and 4.7 months for surgical intubation. The majority of patients died of cancer evolution--caquexia (55.5%), carcinomatosis (4.5%) and brain methastasis (1.1%). The results of endoscopic and surgical intubation in this group of patients recommend its use in patients with advanced esophageal and cardic cancer.

Adenocarcinoma↗