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Biomedical subjects

H Schutte

Publications and source records attributed to H Schutte.

At least 19 recordsLinked to original sources
PubMed1998

Simultaneous analysis of 4- and 5-series lipoxygenase and cytochrome P450 products from different biological sources by reversed-phase high-performance liquid chromatographic technique.

Quantification of lipoxygenase and cytochrome P450 products of both arachidonic acid (AA) and eicosapentaenoic acid (EPA) is of broad interest due to the multiple biological activities of these compounds. We developed a method combining (i) solid-phase extraction, (ii) isocratic reversed-phase high-performance liquid chromatographic separation, and (iii) online photodiode array detection with spectrum analysis for identification and measurement of all main 4- and 5-series eicosanoids (leukotrienes, hydroxyeicosatetraenoic acids/hydroxyeicosapentaenoic acids, epoxyeicosatrienoic acids) within one run. With these procedures, standard mixtures of AA- and EPA-derived lipid mediators were recovered from different biological liquids, like lung perfusate, human bronchoalveolar lavage fluid, and cell supernatant with linear characteristics for each compound. Recoveries of the different lipid mediators exceeded 80% showing excellent reproducibility. Application of the method to isolated, perfused, and ventilated human lungs challenged with the calcium ionophore A23187 and to human neutrophils stimulated in the presence of arachidonic acid and eicosapentaenoic acid with N-formyl-methionyl-leucyl-phenylalanine demonstrated the generation of a large array of lipoxygenase and cytochrome P450 products. Thus, convenient quantification of 4- and 5-series eicosanoids in fluids of biological interest is achieved by a technique comprising solid-phase extraction, isocratic reversed-phase high-performance liquid chromatography, and photodiode array-based online spectrum analysis of eluting compounds.

Arachidonate 5-Lipoxygenase↗
PubMed1994

[Laparoscopic cholecystectomy. 1203 cases with ultraselective cholangiography].

We present our experience at the University of Chile Hospital with 1203 cases of laparoscopic cholecistectomy between April 1991 and July 1993. In only 36 patients ultraselective cholangiography was performed. In 88 cases an endoscopic cholangiography was performed prior to surgery because of suspicion of choledocolithiasis. In 31 of them choledocolithiasis was demonstrated, and was successfully treated by papilotomy in 30 of them. In 5.8% of cases coversion to open surgery was necessary: 1.4% in chronic cholecystitis, 13% in acute cholecystitis and 39% in cases with fibrosis and esclerosis of gallbladder with or without biliary digestive fistula. The intraoperative cholangiography has been advocated as a manner to prevent the common duct injury. In spite of the small number of cases operated on with cholangiography, we haven't seen serious injuries of biliary tract; a carefully disection, as far away as possible of the common duct, is the best way to prevent iatrogenic lesions. Postoperative morbidity was present in 15 cases, 8 of them required a new operation. Two patients died.

Adolescent↗
PubMed1993

Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer.

A prospective randomized clinical trial was performed in order to evaluate the results of three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Ninety patients with clinical and laboratory evidence of gastric retention were enrolled. After laparotomy, patients underwent either highly selective vagotomy (HSV) + gastrojejunostomy, HSV + Jaboulay gastroduodenostomy, or selective vagotomy (SV) + antrectomy. One patient died after HSV + Jaboulay gastroduodenostomy due to postoperative acute pancreatitis. There were no differences in the postoperative course of the three groups. Patients were followed for a mean of 98 months (range: 30 to 156 months). There was a significantly better result after HSV + gastrojejunostomy than after Jaboulay anastomosis (p < 0.01), but not after SV + antrectomy. Gastric acid reduction was similar in the small group of patients studied. We propose HSV + gastrojejunostomy as the treatment of choice in patients with duodenal ulcer and gastric outlet obstruction.

Adult↗
PubMed1992

Gallstone ileus.

A retrospective analysis of 74 patients with gallstone ileus detected during the period between 1975 and 1987 was performed at the Surgical Department. The group comprised 55 females and 19 males, with a mean age of 64.8 years. Previous biliary symptoms had been observed in 76% of the cases and in 58% there had been concomitant disease. The main duration of symptoms previous to admission was 3.4 days. In 85% of the cases complementary diagnostic procedures were performed. The triad of air in the biliary tract, air-fluid levels and ectopic stone was found in only 9.5% of the cases. The preoperative diagnosis of gallstone ileus was made in 31% of the patients. The preoperative period was 2.2 days. The main surgical procedure was enterolithotomy in 92% of the cases, the site of impaction being the terminal ileum in 65%. Only in 1 case was simultaneous biliary tract surgery and enterolithotomy performed. Overall, the 30-day postoperative mortality rate was 13.5%, with intra-abdominal sepsis as the main cause of death. Sixteen patients were submitted to biliary surgery 2 to 6 months later, and no deaths occurred.

Adult↗
PubMed1990

Benign soft-tissue neoplasm simulating sarcoma of spermatic cord.

A large, painless, slow-growing mass arising in the scrotum of a twenty-three-year-old man, which proved to be benign myxoma, simulated a primary sarcoma of the spermatic cord. Only 1 case of myxoma involving the spermatic cord has been reported previously. It is extremely important that multiple microscopic sections of the specimen be examined carefully so that the proper tissue diagnosis can be made. A false diagnosis of malignancy may lead to treatment that is not indicated and that has a high morbidity.

Adult↗
PubMed1990

[A giant diverticulum of the colon].

A male patient complaining of abdominal pain developed rectal bleeding and a painful mass located in the left side of the abdomen. Barium enema revealed a giant diverticulum of the colon. Surgical resection was performed successfully. A brief review of the literature follows.

Colectomy↗
PubMed1989

[Results of the treatment of pyogenic hepatic abscess over a 10-year period].

The experience of the Hospital Clínico de la Universidad de Chile in the treatment of pyogenic liver abscess, during various periods of the last decade is presented. Fifty six cases treated by means of three therapeutic options are reviewed retrospectively. The overall mortality during period was of 27% and it decreased to 19% if only the last three years were taken into account. There were no significant changes comparing surgical treatment in different periods. Fourteen patients were managed with percutaneous drainage, with therapeutic success in 85% of cases and one death. Five cases were treated only with antibiotics; results were good in four of them. The different mortality figures were analyzed concluding that they belonged to man comparable universes because of the unavoidable patient selection. Surgery was reserved for the more severe cases. Percutaneous drainage is the first choice treatment in patient with solitary abscess without a surgically treatable abdominal primary location.

Adult↗
PubMed1989

Treatment of residual common bile duct stones after cholecystectomy.

This study was conducted to determine the occurrence of "open" residual common bile duct stones after cholecystectomy to establish predisposing factors and possible alternative treatments. Correct diagnosis of choledocholithiasis before or during surgery, adequate exploration of the common bile duct, and suitable selection of technical procedures are the most important points in preventing retained CBD stones. If these occur, an adequate alternative treatment may prove helpful. Classical "clysis" of the bile duct is least recommended because of its high failure rate. The best method of chemical dissolution seems to be the use of mono-octanoin with 60% good results and a no-response rate of 30-40%. Instrumental extraction has been reported to be very successful (80-98%). Endoscopic sphincterotomy is currently the most frequently employed procedure for retained CBD stones, especially in poor risk patients. The reported success rate is 82-93% according to literature, with an extremely low mortality (0.2%). Reoperation should be resorted to only if all the other methods fail. Sphincteroplasty or choledochoduodenostomy, whenever indicated, are good alternative operations, with a mortality rate of approx. 3.5%.

Adult↗
PubMed1989

Results of surgical treatment in patients with "western" intrahepatic lithiasis.

The results of the surgical treatment in 251 patients with intrahepatic stones are discussed. The mean age of the group was 48 years, with a predominance of females. Gallstones were observed in 72% of the cases, because 28% had had previous cholecystectomy. Associated common bile duct stones were present in 222 (88%) cases, while primary intrahepatic stones were seen in 29 patients. The intrahepatic stones were usually bilateral. Three main operations were employed. Choledochostomy with or without cholecystectomy was performed in 166 (66%) cases with 6 deaths (3.6%). Bilioenteric anastomosis such as sphincteroplasty or choledochoduodenostomy were used in the rest with similar results. However, residual stones were documented in 32% after choledochostomy, while only 4% were seen after choledochoduodenostomy. In our groups, intrahepatic stones originated from migrated stones from the gallbladder, and surgical treatment should be orientated towards complete extraction of the stones and prevention of their further appearance.

Bile Ducts, Intrahepatic↗
PubMed1989

Indications and results of sphincteroplasty in benign biliary diseases.

A retrospective analysis of 143 patients submitted to sphincteroplasty at the Department of Surgery, University of Chile Clinical Hospital was performed. A significant percentage of these patients (90%) were admitted due to acute biliary tract disease with or without cholangitis. The standard operative procedure was anterior transduodenal sphincteroplasty with supraduodenal choledochal exploration leaving a choledochostomy. A high number of our cases presented with intrahepatic lithiasis (23.8%). The morbidity was 15.4% and the 30 days post operative mortality rate was 4.9%, similar to other reports. Residual stones were observed in 10 patients (7%), and were successfully removed by other procedures. Three patients showed recurrent stenosis of the papilla and were operated on again with good results.

Adolescent↗
PubMed1989

Indications and results of choledochoduodenostomy in benign biliary tract diseases.

During a 12-year period ending December 1987, 17,200 operations for biliary tract disease were performed at the Dept. of Surgery of the University of Chile. Choledochoduodenostomy was performed in 140 of these patients operated upon for benign biliary tract and/or gallbladder diseases. The indications for this procedure were choledocholithiasis, stenosis of the sphincter of Oddi, compression of the extrahepatic biliary duct, stenosis of the distal biliary duct and duodenal diverticula. The postoperative course was uncomplicated in 126 patients (90%). The mortality rate was 4.2%. Although the mortality was somewhat greater in patients with acute cholangitis, the difference was not significant, and no significant relation could be established with other factors that might affect mortality. Choledocholithiasis is the main cause of benign obstruction of the biliary tract in Chile. This is also the most frequent indication for external choledochoduodenostomy and is a promising method even in the presence of an infection of the biliary duct.

Adult↗
PubMed1988

Value of proximal diversion and ureteral stenting in management of penetrating ureteral trauma.

Cases of penetrating ureteral trauma (17 gunshot wounds and 4 stab wounds) seen at two New York City hospitals over a nine-year period were reviewed. Early urologic complications (defined as urine drainage from the wound for greater than 2 weeks or need for a second operation) occurred in 50 percent of patients with a proximal ureteral injury but were less common when a nephrostomy and stent were used in the repair. A similar beneficial effect of stenting was seen in published cases, with a 91 percent complication rate for unstented repairs and a 15 percent rate when stenting and nephrostomy drainage were both used. The effect of stenting on midureteral repairs was less obvious, but the rate of urologic complications was lower in stented cases. None of the patients with distal ureteral injuries suffered a urologic complication. Stenting with and without a nephrostomy tube also produced good results in 2 patients with proximal ureteral injuries diagnosed late. We conclude that repair of penetrating ureteral injuries should include stenting and nephrostomy tube drainage in cases of proximal injuries, as well as generous debridement and water-tight closure. Midureteral injuries accompanied by gastrointestinal, pancreatic, and major vascular injuries should be stented and proximal diversion considered when prosthetic materials are used for vascular repairs.

Adolescent↗
PubMed1988

Bladder neck obstruction secondary to Brunn's cyst.

A large solitary Brunn's cyst caused a ball-valve type of obstruction of the bladder neck in a 29-year-old man without endoscopic or histological evidence of bladder inflammation. Unroofing and drainage restored normal voiding. The histopathological features of Brunn's nests are reviewed.

Adult↗
PubMed1985

Surgical treatment of high gastric ulcer.

The purpose of this study has been to review the late results of surgical treatment of 244 patients with endoscopically proved benign chronic gastric ulcer located 5 cm or less from the cardia. In five patients, a total gastrectomy with esophagojejunostomy was performed. Proximal gastrectomy was used in 3 patients, mesogastrectomy in 5 patients, a partial Schoemaker's procedure in 73 patients, Pauchet's procedure in 70 patients, and Csendes' procedure in 23 patients. Nonresective procedures were employed in 67 patients and included the Kelling-Madlener procedure in 23 patients, pyloroplasty alone in 10 patients, gastrojejunostomy alone in 4 patients, local or wedge excision of the ulcer in 9 patients, and vagotomy and pyloroplasty in 21 patients. The follow-up evaluation was performed in 91 percent of the patients (mean 9 years postoperatively, range 5 to 15 years), with emptying endoscopy in all nonresected patients. A high mortality was observed after total or proximal gastrectomy, as well as after nonresective procedures. After the other resective techniques, low postoperative morbidity and mortality were observed. No recurrent ulcer was seen after the resective procedures. Based on these results, we propose that when the ulcer is located 5 cm below the cardia, Schoemaker's or Pauchet's procedure should be performed; if the ulcer is located 2 cm or less from the cardia, Csendes' procedure or the Kelling-Madlener procedure should be employed.

Adult↗