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G V Aranha

Publications and source records attributed to G V Aranha.

At least 19 recordsLinked to original sources
PubMed2001

Pancreaticogastrostomy following pancreaticoduodenectomy: review of 102 consecutive cases.

Disruption of the pancreatic anastomosis with resultant sepsis is the cause of nearly 50% of deaths following pancreaticoduodenectomy (PD). Traditionally, the pancreatic remnant is anastomosed to the jejunum. Pancreaticogastrostomy (PG) was introduced as an alternative by Waugh and Clagett in 1946 and by Park, Mackie, and Rhoads in 1967. The purpose of this retrospective review was to assess the safety of PG at a single institution. Between 1986 and 1998 a total of 102 patients underwent PG following PD. The indications for PD were periampullary carcinoma (n = 89), pancreatitis (n = 7), and miscellaneous (n = 6). Altogether, 80 patients underwent the traditional Whipple procedure and 22 the pylorus-preserving Whipple (PPW) procedure. The PG was performed by a single-layer invagination technique to the posterior gastric wall using interrupted silk sutures. Leaks from the pancreatic anastomosis were detected by measuring amylase in fluid obtained from surgically placed drains. Operative mortality was 3.9% (4/102). The cause of death was uncontrolled upper gastrointestinal hemorrhage, sepsis, pulmonary embolus, and cardiac failure secondary to myocardial infarction. The mean operating time was 6.8 hours. Blood transfusion was given in 43 patients (42%), and the mean amount of the transfusion was 2.6 units. Nonfatal complications occurred in 35 patients (34%), and included leaks from the pancreatic anastomosis in 9 (8.8%), leaks from the biliary-enteric anastomosis in 4 (3.9%), and gastric paresis 7 (6.9%). Other complications included abscess, wound infection, colitis, delirium tremens, and hyperbilirubinemia. Discharge occurred 6 to 47 days (median 12 days) postoperatively and was prolonged in patients suffering from a complication. PD is associated with significant morbidity. PG is a safe alternative to pancreaticojejunostomy for managing the pancreatic remnant.

Adenocarcinoma↗
PubMed2001

Age is not a contraindication to pancreaticoduodenectomy.

The incidence of pancreatic cancer has increased threefold over the last 40 years with the greatest rate of growth occurring in the elderly. In the past it was suggested that elderly patients tolerated pancreaticoduodenectomy less well than younger patients with higher mortality rates. This single-institution experience examines the question of whether age is a significant factor in relation to morbidity and mortality in patients undergoing pancreaticoduodenectomy. Between 1994 and 1999 outcomes of 122 patients who underwent pancreaticoduodenectomy were reviewed. There were 48 patients 70 years of age and older and 74 patients less than 70 years of age. Both groups were compared with respect to preoperative clinical prognostic determinates and perioperative factors affecting morbidity and mortality. There was no significant difference between the two groups comparing their comorbidities, use of preoperative antibiotics, intraoperative blood loss, or length of hospital stay (11.9 and 10.8 days respectively). The two groups were also similar with regard to pathologic diagnosis with pancreatic adenocarcinoma being the most frequently encountered neoplasm. There was one death in the less-than-70-year-old group and none in the older group. No significant difference in the rate of complications was appreciated. These data demonstrate that pancreaticoduodenectomy can be performed safely in patients 70 years of age and older with morbidity and mortality rates similar to those of younger individuals.

Adenocarcinoma↗
PubMed2000

Defining a role for endoscopic ultrasound in staging periampullary tumors.

BACKGROUND: The goal of the preoperative workup in patients with suspected periampullary carcinoma is to establish the diagnosis with a high degree of certainty. In this study we compared endoscopic ultrasonography (EUS) and computed tomography (CT) scans for the detection of tumor, lymph node metastasis, and vascular invasion in patients with suspected periampullary carcinoma in order to define a role for EUS in the preoperative staging of these patients. METHODS: Thirty-seven consecutive patients received EUS and CT scanning followed by operation for presumed periampullary carcinoma during a 30-month period. Both imaging modalities were reviewed in a blinded fashion and the results compared with pathology and operative reports on all patients. RESULTS: Sensitivity, specificity, positive predictive value, and negative predictive value for tumor detection by EUS were 97%, 33%, 94%, and 50%, respectively, compared with 82%, 66%, 97%, and 25% for CT scan. For lymph nodes the values were 21%, 80%, 57%, and 44%, respectively, for EUS compared with 42%, 73%, 67%, and 50% for CT. For vascular invasion, the values were 20%, 100%, 100%, and 89%, respectively, for EUS, compared with 80%, 87%, 44%, and 96% for CT. CONCLUSIONS: CT is the initial study of choice in patients with suspected periampullary tumors. EUS is superior for detecting tumor and for predicting vascular invasion. Therefore, EUS should be used for patients in whom CT does not detect a mass and for those with an identifiable mass on CT in whom vascular invasion cannot be ruled out.

Adult↗
PubMed2000

How well do third-year medical students learn key objectives in a case-based surgical lecture series?

Faculty members were asked to list major and minor concepts of their case-based session presented during the 12-week 3rd-year surgical clerkship. After each session, students were queried to list the key concepts presented. Data were collected from two groups: one at the end of an academic year and a second at the beginning of the next academic year. Faculty members listed a median of 10 major and 15 minor concepts. The mean number of matched major concepts ranged from 0.2 to 4, and from 0.2 to 3.4 for minor concepts. In a comparative analysis, the end-of-the-year students listed a higher number of matched concepts for 17 of the 20 sessions than the beginning of the year students (8 sessions reached statistical significance, P < 0.05). The current case-based teaching method is not effective in emphasizing key concepts to students. Reformatting cases to better align with key concepts may be one solution to enhance a student's ability to grasp key concepts. Students at the end of the academic year outperformed those at the beginning of the year. This additional variable needs to be considered by faculty and incorporated into their teaching techniques.

Clinical Clerkship↗
PubMed1999

Adenosquamous carcinoma of the pancreas.

BACKGROUND: Adenosquamous carcinoma of the pancreas most probably represents squamous metaplasia of an adenocarcinoma. Metastases are typically an admixture of both elements, but more frequently, adenocarcinoma. METHODS: A review of 102 pancreaticoduodenectomies for masses of the head of the pancreas done between 1994 and 1998 revealed two patients with adenosquamous carcinoma of the pancreas. RESULTS: Both patients underwent successful pancreaticoduodenctomy, but were found to have nodal metastasis. One patient lived 13 mo and the other lived 14 mo with both dying from metastatic disease. CONCLUSION: Adenosquamous carcinoma of the pancreas is a rare tumor, and because its presentation, clinical features, and course are identical to adenocarcinoma of the pancreas, it should be considered in the differential diagnosis for any mass of the head of the pancreas. Survival is poor for these patients. In this series, it was 13 and 14 mo, respectively.

Carcinoma, Adenosquamous↗
PubMed1999

Successful nonoperative management of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

BACKGROUND/AIMS: To report the management of a hepatic artery pseudoaneurysm presenting 35 days following a Whipple procedure. METHODS: The case study of a patient with a bleeding pseudoaneurysm is presented. RESULTS: Computed tomography demonstrated a pseudoaneurysm which was successfully embolized. CONCLUSIONS: Acute gastrointestinal bleeding from a pseudoaneurysm in the hepatic artery following Whipple procedure can be successfully managed with transcatheter embolization.

Aged↗
PubMed1999

Predictors of axillary lymph node metastasis in T1 breast carcinoma.

This study was designed to determine the predictors of axillary lymph node metastasis in T1a (< or =0.5 cm), T1b (>0.5 cm and < or =1.0 cm), and T1c (>1.0 cm and < or =2.0 cm) breast cancers. The charts of 204 patients who underwent axillary lymph node dissections for T1 breast carcinomas at our institution were reviewed. Of these, 23 (11%) patients had T1a cancers, 55 (27%) patients had T1b cancers, and 126 (62%) patients were diagnosed with T1c lesions. Fifty patients (24.5%) had axillary node metastases. Of those with T1a lesions, one (4.3%) patient had axillary node involvement, compared with 9 (16.4%) patients with T1b and 40 (31.7%) patients with T1c lesions. Nodal involvement was significantly increased in T1c cancer compared with either T1a (odds ratio = 8.24; P < 0.05) or T1b (odds ratio = 2.73; P < 0.05). Similar results were found in tumors with grade 3 nuclear pleomorphism (odds ratio = 10.45 versus grade 1 and 3.46 versus grade 2; P < 0.05). The presence of lymphovascular invasion was also associated with an increased likelihood of nodal involvement (odds ratio = 3.15; P < 0.05). Predictors of axillary lymph node metastasis in T1 breast carcinomas include increasing tumor size, grade 3 nuclear pleomorphism, and the presence of lymphovascular invasion. These predictors may have a role in stratifying patients with T1 breast carcinomas into subgroups that may benefit from less invasive methods of evaluating axillary lymph node status.

Axilla↗
PubMed1998

The international medical graduate in US academic general surgery.

OBJECTIVES: To identify graduates of medical schools outside of the United States who are on academic general surgical faculties in the United States and to determine their contribution to surgery in the United States. DESIGN: A questionnaire was sent to the departments of general surgery of 128 medical schools and clinics with independent surgical training programs. SETTING: All the departments of surgery affiliated with medical schools and clinics in the United States. PARTICIPANTS: All department chairpersons of the general surgical services in the United States. MAIN OUTCOME MEASURE: To identify graduates of foreign medical schools who had their training in the United States, their area of expertise, and their present positions. RESULTS: One hundred twenty-two (95.3%) of the 128 medical schools and clinics replied to the questionnaire. Of the 122, 108 (88.5%) had at least 1 international medical graduate (IMG) on their faculty; 572 IMGs were identified on the surgical faculty, of which 538 were men and 34 were women. These individuals represent 72 countries or colonies and most continents and regions of the world. Fourteen are or have been department chairpersons. Asia, with 172 medical graduates, contributed the highest number of graduates, followed by North, Central, and South America, with 136 total, and Europe, with 123. India, followed by Canada, South Africa, the United Kingdom, and the People's Republic of China, accounts for a large number of the individuals. The states with the most IMGs were California, 78; New York, 75; and Illinois, 42. CONCLUSIONS: International medical graduates account for 10% of the academic surgical faculty in the United States. These graduates come from all countries and regions of the world. International medical graduates occupy faculty positions commensurate with experience. Fourteen are or have been department chairpersons. Since 1960, there has been an increasing number of appointments of IMGs to faculty of the departments of surgery. The results of this survey suggest that the experience of the IMG in US surgery has been quite favorable.

Academic Medical Centers↗
PubMed1998

A technique for pancreaticogastrostomy.

A technique for pancreaticogastrostomy is presented. The technique is a one-layer, invaginated anastomosis of the pancreatic remnant to the posterior gastric wall following a Whipple resection of the pancreatic head. Key steps to achieve a successful anastomosis are described. Using this technique, there have been no pancreatic anastomotic leaks in 29 consecutive patients.

Gastrostomy↗
PubMed1998

Assessing the resectability of pancreatic carcinoma: the value of reinterpreting abdominal CT performed at other institutions.

OBJECTIVE: The purpose of this study was to determine the value of reinterpreting abdominal CT performed at other institutions when assessing the resectability of pancreatic carcinoma. MATERIALS AND METHODS: Fifty-three patients (30 men, 23 women; mean age, 62 years) referred to our tertiary care institution with newly diagnosed pancreatic carcinoma had formally reinterpreted abdominal CT scans and available initial reports. CT was performed at community hospitals (n = 47), university hospitals (n = 4), an outpatient clinic (n = 1), and an imaging center (n = 1); reinterpretation was performed by university radiologists with subspecialty expertise in abdominal imaging. On the basis of the initial and reinterpretation reports, the patients were categorized as having resectable or nonresectable disease. Medicare reimbursement rates were assessed. RESULTS: The initial and reinterpretation reports agreed in 36 (68%) of the 53 patients, with the disease of 16 patients considered resectable and 20 unresectable by both reports. In 17 patients (32%), we found discrepancies between the initial and the reinterpretation reports. All discrepancies involved the initial report indicating resectability and the reinterpretation report consistent with nonresectable disease. Discrepancies were resolved by findings at surgery (n = 9), percutaneous biopsy (n = 3), dedicated pancreatic CT (n = 3), dedicated liver CT (n = 1), and follow-up abdominal CT (n = 1); the reinterpretation reports were correct in 16 (94%) of 17 patients. Reimbursement for outside CT reinterpretation, repeated abdominal CT, and an exploratory laparotomy were estimated at $46.45, $414.47, and $16,996.44, respectively. CONCLUSION: Reinterpretation of outside abdominal CT was valuable for determining pancreatic carcinoma resectability and inexpensive when compared with repeating the CT examination or performing an exploratory laparotomy.

Adenocarcinoma↗
PubMed1996

Factors influencing bowel function following total abdominal colectomy.

PURPOSE: The purpose of this study was to determine which factors influenced bowel function following total abdominal colectomy. METHODS: Thirty-two patients who had undergone total abdominal colectomy were studied with regard to factors that are classically thought to influence bowel function, namely, residual stump length, transit time, and rectal stump manometry. In a limited subset of patients, anal manometry was done also. RESULTS: Transit time was the best predictor of bowel function following total abdominal colectomy. This was followed by stump length. If transit time was short, then stump length became important in predicting the occurrence of diarrhea following total abdominal colectomy. CONCLUSIONS: Two factors have an important influence on bowel function following total abdominal colectomy: transit time and rectal stump length. Rectal stump length is an anatomic factor that can be controlled by the surgeon. In total abdominal colectomy, rectal stump length of at least 20 cm is necessary if the patient is to have satisfactory postoperative bowel function. This may not always be possible. In these patients, modification of diet to influence transit time and methods to increase rectal compliance will be necessary.

Colectomy↗
PubMed1995

Leiomyosarcoma of the pancreas.

A 45-yr-old female patient was admitted with signs and symptoms of acute pancreatitis. She had no history of gallstones, alcohol, or trauma. Her CT scan was consistent with a cystic lesion of the pancreas. Because of her presenting symptoms and signs, she was initially treated as an acute pancreatitis. Followup CT scan showed absolutely no change in the cyst. Surgical consultation was requested. A diagnosis of a neoplastic cyst was made, and the patient was taken to surgery where a distal pancreatectomy and splenectomy was performed. Pathology revealed a leiomyosarcoma of the pancreas. Only 15 other cases of leiomyosarcoma of the pancreas have been reported thus far in literature.

Diagnostic Errors↗
PubMed1994

Computed tomography or endoscopic ultrasonography in preoperative staging of gastric and esophageal tumors.

BACKGROUND: Accurate preoperative staging of tumors of the esophagus and stomach is important in selecting treatment and determining prognosis. To date, no exact preoperative test has been useful in assessing stage of these tumors. Until recently, computed tomographic (CT) scanning has been the most frequently used examination to predict operative findings. Endoscopic ultrasonography (EUS) is a relatively new modality used by some centers to assess extramural anatomy of tumors in these two locations. METHODS: We described 28 patients with tumors involving the esophagus and gastroesophageal junction, and the stomach, who underwent both EUS and CT before surgical exploration. We compared these two tests with the final pathologic interpretation and paid particular attention to presence of lymph nodes and wall penetration by primary tumor. RESULTS: For wall penetration by an esophageal-gastroesophageal junction carcinoma, EUS was 85% accurate versus 15% for CT. For absence of nodal spread by these tumors, EUS was 100% accurate versus 67% for CT. In the presence of nodal spread EUS was 60% accurate versus 50% for CT. For wall penetration by a gastric carcinoma, EUS was 71% accurate versus 0% for CT. In the absence of nodal spread EUS and CT were both 100% accurate. In the presence of nodal spread EUS was 50% accurate versus 25% for CT. CONCLUSIONS: EUS is more accurate than CT in the preoperative staging of upper gastrointestinal malignancies.

Aged↗
PubMed1994

Fecal occult blood testing: a false sense of security?

BACKGROUND: Recent screening studies with fecal occult blood testing (FOBT) report that one of three patients with colorectal cancer (CRC) can be cured of the disease; minimal attention has been given to the two of three patients who despite repeated screening go on to die of silent CRC. We report the known "miss rate" (known false negatives) of our 14-year ongoing program of FOBT that was organized in 1979 to detect early CRC. METHODS: From October 1979 through December 1993, 36,034 FOBT kits were distributed to patients who were without gastrointestinal complaints at Hines Veterans Affairs Hospital. The test was considered positive if at least one result of the six tests was positive and negative if the test result was equivocal. Patients with negative FOBT received a new test kit each year by mail. A positive test was followed by full colonoscopy or an air contrast barium enema if a full colonoscopy was not possible. RESULTS: The overall return rate was 47.8%. CRC was detected in 115 patients: 94 had a favorable and 21 had an unfavorable Duke's C or D or lymphoma prognosis. Of 21 patients 13 (62%) had initially tested FOBT negative (missed lesion). Of the 21 cases of advanced CRC 15 (71.43%) were in the descending, sigmoid, or rectosigmoid colon or rectum. CONCLUSIONS: (1) The majority (82%) of all CRC detected by FOBT screening are diagnosed at a favorable stage. (2) The majority of known advanced CRC (62%) escape early detection with FOBT. (3) Five (62.5%) of eight of the advanced CRC cases discovered on initial FOBT and 10 (76.9%) of 13 of advanced CRC cases missed on initial FOBT but detected in subsequent years were in the left colon and most likely in the range of the flexible sigmoidoscope. (4) FOBT as a sole screening test may provide a false sense of security, especially in patients with advanced left-side CRC.

Aged↗