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Biomedical subjects

E Garnica

Publications and source records attributed to E Garnica.

16 recordsLinked to original sources
PubMedDate not supplied

[Colonic polyps: an analysis of the endoscopic and histopathological aspects].

The present study is a retrospective analysis of the endoscopic and histologic features of 728 polyps resected from 422 patients during the years 1980 to 1991. Mean age of the patients was 52 years (5 to 87), 63% male and 37% female. The histology of the lesions showed: adenoma: 60.3%, hyperplastic: 31.7; juvenile: 2.3% and miscellaneous: 5.7%. The 439 adenomas where found in 270 patients of which 151 (55.9%) were male and 119 (44.1%) female. The 231 hyperplastic polyps where found in 113 patients: 66 (58.4) male and 47 (41.6) female. All the hyperplastic polyps where less than 20 mm in diameter. Of the adenomas, 385 (87.7%) where less than 20 mm in diameter and had macroscopic appearance similar to the hyperplastic polyps. Of the 439 adenomas, 218 (49.6) where pediculated and 221 (50.4%) sessile. Of the hyperplastic polyps 53 (22.9%) where pediculated and 178 (77%) sessile. Of the adenomas, 351 (80%) where tubular and 88 (22%) had a villous component, most of the tubular adenomas where less than 15 mm in diameter and the villous component was more frequent as the polyps increased in size. Of the adenomas, 139 (30%) had dysplasia and of these 10% had cancer which represents a total of 3% of all the adenomas in this series. The grade of dysplasia was more severe as the adenomas was larger in size or had villous component. The polyps were located: 69.6 in the distal colon at the reach of the flexible sigmoidoscope and 30.4% in the proximal colon.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Diagnostic accuracy of fine needle aspiration cytology guided by ultrasonography in intra-abdominal and retroperitoneal lesions].

UNLABELLED: Evaluation of the fine needle aspiration cytology guided by ultrasonography in the diagnosis of abdominal and retroperitoneal tumors. DESIGN: Transversal study of diagnostic standard-criterion test. PLACE: Ultrasonographic Unity Digestive Disease Department. Hospital Oncológico Padre Machado. SAMPLE: 98 patients with intraabdominal and retroperitoneal lesions. INTERVENTION: Fine needle aspiration cytology guided by Ultrasonography. INDICE TEST: Laparoscopy and/or laparotomy. MEASUREMENTS: Estimation of sensibility (S), Specificity (E), Efficacy (Ef), positive predictive value (VPP), negative predictive value (VPN), measure of false positives (TFP) and measure of false negatives (TFN) by diagnosis method. RESULTS: VP: 81%; VN: 12%; FP: 1%; FN: 6%; S: 93%; E: 92.3%; Ef.: 97%; VPP: 98.7%; VPN: 66%; TFP: 1.25%; Benign lesions: 22.5%; Malignancy lesions: 65.5%; non lesions: 12%; complications: severe: 1%, non significance: 5%. CONCLUSIONS: Fine needle aspiration cytology guided by ultrasound has high sensibility, specificity, efficacy, with low value of false positive. However, it has high incidence of false negatives and negative predictive value. We recommend diagnostic procedures when the suspicion of tumor is high did the cytology is negative.

Abdominal Injuries↗
PubMedDate not supplied

[Multi-technical management of biliary fistula].

Biliary fistula is an occasional complication of cholecystectomy and are usually associated to retained biliary stones, surgical trauma of the biliary ducts and local infection. They were mainly treated by surgical methods up to the acquisition of the new endoscopic and percutaneous techniques used together with parenteral and enteral nutrition and new antibiotics. A total of seven patients with diagnosis of biliary fistula were seen between 1984 and 1990 at the "Unidad de Gastroenterología y Cirugía Digestiva" of the Clínica Sanatrix en Caracas. Average age was 50 with ranged between 31 and 76, 4 were male and 3 female. The fistulas were in 1 due to necrotizing pancreatitis, in 3 to lost of the ligation of the cystic duct, 2 were due to accidental injury of the common duct and the last case was a partial dehiscence of a choledoco-jejunostomy after the resection of a common duct cyst. Four of the cases were choledoco-cutaneous fistula, one hepatocutaneous, two hepatoduodenal. All the seven patients had subhepatic collections, one had a retroperitoneal collection, two had subdiaphragmatic collections and one had multiple hepatic abscesses. The abdominal collections were treated by percutaneous drainage using mainly the Ring-McLean and Van Sonnenberg tubes. The fistula was occluded with biliary prosthesis in four cases, using either endoscopic, percutaneous or mixed technique to place the stent. Patency of the stents ranged between 2 weeks and 24 months. Control time was from 2 to 40 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Biliary lithiasis. Non-surgical treatment].

Between 1979 and 1989, forty-six patients with biliary lithiasis were treated by non-surgical methods. Jaundice was present in 32 (70%) patients. In five patients (11%), the bile stones were found during the routine ERCP for cholelithiasis. Five patients (11%) had stones with diameter of 30 mm and over. Clearing of biliary ducts was achieved in 44 patients (95.7%). Forty-five patients required endoscopic sphincterotomy, the other one, had a surgical sphincteroplasty performed at the time of cholecystectomy. The stones passed spontaneously in eight patients (17.4%), Dormia basket, shock-wave and mechanical lithotripsy, and contact chemical dissolution, alone or combined, were the methods of treatment. There were two faults (4.3%). In the first case, after the attempt to retrieve the stone with a Dormia basket, as no other method was available (1979), surgical treatment was done. The other case had multiple stones in the biliary tree located in both, intra and extrahepatic ducts. In this case, the use of all available procedures did not clear the biliary tract, so a surgical procedure was ordered. There was one complication (2.2%), a retroduodenal perforation that was treated medically. There was no mortality.

Adolescent↗
PubMedDate not supplied

[Puncture-aspiration biopsy with fine needle].

The results of one hundred and sixty nine fine needle aspiration biopsy procedures with complete follow-up are evaluated. The biopsies were performed with a 21G needle with a slight modification at the distal end. For breast, a 21G 1-1/2'' hypodermic needle was used. Samples were taken mostly from breast (34.3%), lung/mediastinum (32.5%) and liver (18.3%). Guide method was determined by the location of the lesion. Palpation was preferred for breast and superficial tumors, fluoroscopy for lung and bone and ultrasound for any other. Malignancy was diagnosed in 98 (57.99%), non-malignancy in 61 (36.09%) and 10 (5.92%) were suspicious for malignancy. All malignant cases correlated with final diagnosis. Out of 10 suspicious cases, 8 proved to be malignant and the two others were benign, they were considered as false positive. Of the 61 cases diagnosed as benign, 50 were confirmed and in 11 the diagnosis of malignancy was established representing the false negative. Correlation rate was estimated in 92.31%; sensibility in 90.6% and specificity in 96.15%. The malignant predictive value was 99% and benign predictive value 79%. The management of fine needle biopsy specimen with appropriate histotechnics procedures, can produce a very rich preparation that can give us a detailed histological diagnosis that correlates exactly in 75% of the cases. The method was especially helpful as the first approach in patients with metastases of unknown primary. Complications occurred only in thoracic punctures where they reach 20.88% of the thorax cases. No fatalities were registered.

Adolescent↗
PubMedDate not supplied

[Colitis caused by radiation: 20 years' experience].

The 20 year experience with diagnosis and management of radiation colitis at the Gastroenterology Department of the Hospital Oncológico "Padre Machado" is presented. Of 404 cases, 98% were treated for carcinoma of the cervix. The most frequent symptoms were rectal bleeding (71%) and changes in the intestinal habitus (27.2%). Symptoms were present from one month to one year prior to radiation. Flexible sigmoidoscopy in 77.5% of patients showed Grade I and II actinic disease, and X Ray studies sowed Grade II and III in 80%. Thirty eight patients required surgical treatment.

Adult↗
PubMedDate not supplied

[Cancer of the ampullar region].

The clinical-pathological spectrum of ampullary cancer in 18 patients studied at the Department of Gastroenterology (Hospital Oncológico Padre Machado) during the last decade (1980-88) is presented. Involvement of the extrahepatic bile ducts was due to cancer of the ampullary region. In all cases diagnosis was confirmed by pathology. The value of ERCP is presented and the need to set apart this tumors from carcinoma of the head of the pancreas is emphasized. None of the nine cases treated with radical resection (Whipple) had operative mortality, and although follow-up for all cases is not long enough, two patients are alive and free of disease, five years after surgery. The value of prosthesis and biliary drainage for palliation is commented upon. Emphasis is placed on the need of using the term ampullary cancer in its proper connotation. Criteria for differentiating periampullary tumors (specially cancer of the head of the pancreas) are presented.

Adenocarcinoma↗
PubMedDate not supplied

[Colonoscopy as primary procedure in the diagnosis of colonic neoplasms].

Experience with colonoscopy as an initial procedure in the study of the colon is presented. 3.450 colonoscopies in patients with GI symptoms were performed by trained endoscopists using the intermediate length scopes (130cm) without fluoroscopy. In 90% of the cases the whole colon was studied in a mean time of 20 minutes. 382 neoplasms (11.07%) were diagnosed. Polips represented 90% of the lesions and 34.3% of them were adenomas. 30% of the adenomas and 34.4% of the malignant tumors were localized in the right colon. We emphasise that 82.7% of the polips found in the right colon were adenomas. As a side effect we had a sigmoid perforation, it represents 0.03%. Colonoscopies performed by a trained endoscopist is a highly diagnostic method with low degree of complications, making it the procedure of choice in the study of the colon in specialized centers.

Adenoma↗
PubMedDate not supplied

[Routine preoperative cholangiopancreatography?].

Since the early 50s, the routine use of operative cholangiography in biliary surgery has decreased the rate of negative choledochotomy and retained stones. In the last twenty years no further progress has occurred and negative choledochotomy rate remains at 30% and for retained stones at 1.3%. Modern endoscopic technology has improved the diagnosis and treatment of biliary diseases so we think that the routine use of endoscopic retrograde cholangiopancreatography (ERCP) as a preoperative study for patients to be surgically treated of biliary disease can reduce the incidence of negative choledochotomies, retained stones and duodenostomies that are the most important sources of biliary surgery complications. The results of ERCP as routine preoperative study in patients with diagnosis of symptomatic gallstones selected for surgical treatment are discussed. From June 1988 to June 1989 56 patients who filled the requirements were included. Ultrasound scan, laboratory test. EKG and complete digestive studies were performed at admission. ERCP was done immediately before surgery. Abnormalities on biliary tract were seen in 10 cases (17.9%). Six (10.7%) had stones in the common duct, in 4 of these patients (7.1%) the lithiasis was unsuspected, Four cases (7.1%) had dilated ducts, three of them with narrowing of the distal end of the choledochus. In 5 cases with duct stones and 3 with dilated ducts an endoscopic sphincterotomy was performed at the same time of the study, stones were withdrawn and biliary system cleared before laparotomy. Only one choledochotomy was done in a patient with a carcinoma of the gallbladder and a big stone impacted in cystic duct that produced compression of the common bile duct (Mirizzi Syndrome).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Biliary extracorporeal shockwave lithotripsy. Preliminary communication].

Shock wave lithotripsy has been successfully used in the treatment of urinary stones. Since 1985, it has also been applied in the management of gallbladder and biliary duct stones. The preliminary experience in Venezuela with the shock wave technology for the treatment of biliary stone disease is presented. The facilities of the Unit for the Treatment of Lithiasis. UNILIT of Venezuela, in Caracas were used. This unit is equipped with a Siemens Lithostar, that operates with an electromagnetic shock wave generator guided by a very accurate computerized biplane fluoroscopic system. Symptomatic gallstones with functioning gallbladder and radiolucid stones smaller than 3 cm, were the most important inclusion criteria. For duct stones, all cases that could not be managed by endoscopy were included. Fifteen cases have been treated from April 1988. Ten with gallstones and 5 with biliary duct stones. Success rate for gallstones, clarifications of gallbladder within a 12 month follow-up, was achieved in 40%. In the cases of biliary duct lithiasis, the aim was to reduce the stone to smaller fragments that could pass spontaneously or be retrieved by endoscopic maneuvers. In all the five cases treated, the stones could be crushed into small fragments and in four, they were easily withdrawn by endoscopic ballooning. Preliminary results and published data suggest that shockwave lithotripsy is a valuable method of treatment for selected cases of gallbladder stones and it is specially useful in the management of biliary duct stones where the endoscopic maneuvers have failed.

Adult↗
PubMedDate not supplied

[Ambulatory laparoscopy].

We present our experience with laparoscopy in 600 outpatients with several diseases in seven years (1982-1988). We performed 707 studies in 594 patients (99%), in six cases (1%) the examination was not feasible because of intra-abdominal adhesions. In 235 patients (39.16%) previous abdominal surgery was not considered a contraindication for the examination. We performed 295 hepatic biopsies, 69 adhesions cuts, 9 laparoscopic placement of Tenckhoff catheter and other procedures. The incidence of complications was 5.23%, related to laparoscopy 3.67% and to procedures 1.55%. Major complications occurred in four patients (0.56%), surgical intervention was required in one patient (0.14%). We neither had infectious complications, nor mortality. We conclude that laparoscopy can be an ambulatory procedure, because it has a low incidence of complications in skilled hands and is well tolerated.

Adolescent↗
PubMedDate not supplied

[Ultrasound, computed tomography and laparoscopy. Efficacy in the detection of primary and metastatic hepatic tumors. Comparative study].

OBJECT: To compare ultrasound, computed tomography and peritoneoscopy in the diagnosis of primary and metastatic hepatic tumors. DESIGN: Prospective trial of a cohort patients during a year. PLACE: Digestive Disease Department in a National referral Cancer Center. PATIENTS: Forty five patients with intraabdominal tumors for pretreatment evaluation. Intervention; Ultrasonography, computed tomography and peritoneoscopy performed in a period of ten days. MEASUREMENTS: sensibility, specificity and efficiency comparison of results by Chi square test, with Yates correction (X2 Yates), measure of pre test and post test probabilities using Bayes theorem. RESULTS: In hepatic humors, peritoneoscopy was the most sensitive, specificity was similar for the three procedures (p greater than 0.1), in the detection of hepatic metastases peritoneoscopy was the most sensitive 91.6% vs 50% (p less than 0.05) similar specificity and high positive predictive value for the three procedures, comparable with the post test probabilities. CONCLUSIONS: In the detection of focal hepatic lesions, peritoneoscopy was the best method; in case of doubt, failure of non invasive procedures or the need of biopsy samples must be considered the procedure of choice.

Adolescent↗