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Biomedical subjects

J F Patiño

Publications and source records attributed to J F Patiño.

At least 19 recordsLinked to original sources
PubMed2001

Surgical management of benign strictures of the biliary tract.

Benign strictures of the biliary tract are difficult to treat surgical complications. Most biliary strictures result from injuries during cholecystectomies, and their initial management is a major determining factor of the long-term outcome. Only surgeons well trained and experienced in their management should treat this entity. The affected patients present various signs and symptoms depending on the time the lesion is detected, and the treatment modality largely depends on such timing. The success of surgical treatment with its attendant low morbidity and mortality makes it the preferred modality over transhepatic image-guided or endoscopic balloon dilatation, with or without the insertion of stents. Surgical treatment is based on three principles: good exposure for internal drainage of the intrahepatic biliary tract, mucosa-to-mucosa anastomosis, and prevention of the risk of reoperation for recurrent stenosis. Roux-en-Y hepaticojejunostomy with a blind subcutaneous jejunal loop seems to comply with these three principles. Transanastomotic stents are not necessary. We have analyzed our experience from 1988 to 1999 with 65 consecutive patients referred to us for biliary reconstruction. We used the Roux-en-Roux-en-Y hepaticojejunostomy with a blind subcutaneous jejunal loop, performed by the same surgical group in all cases.

Anastomosis, Surgical↗
PubMed1999

Hypocaloric support in the critically ill.

The critically ill patient exhibits a well defined endocrine and metabolic adaptive response to stressor agents, characterized by incremented resting energy expenditure (hypermetabolism, which is believed to signify increased energy requirements), accelerated whole-body proteolysis (hypercatabolism), and lipolysis. These phenomena occur in the acute stage, which is also characterized by hyperglycemia, typically accompanied by a hyperdynamic cardiovascular reaction manifested by high cardiac output, increased oxygen consumption, high body temperature, and decrease peripheral vascular resistance. High provisions of glucose-derived calories tend to accentuate these reactions and increase the degree of hyperglycemia. We have adopted a hypocaloric-hyperproteic regimen which is provided only during the first days of the flow phase of the adaptive response to injury, sepsis, or critical illness. Our regimen includes a daily supply of 100 to 200 g of glucose and 1.5 to 2.0 g of protein (synthetic amino acids) per kilogram of ideal body weight. We have analyzed the data on 107 critically ill patients, 70 men and 37 women, who were admitted to the surgical intensive care unit and who received nutritional support by the TPN hypocaloric modality for a minimum of 3 days. We found that the high caloric loads contained in TPN regimens results in additional metabolic stress, with consequent hyperdynamic cardiorespiratory repercussion, high CO2 production, and frequently hepatic steatosis. In contrast, our hypocaloric-hyperproteic approach has resulted in a more physiologic clinical course and considerable reduction in cost. The infusion of high glucose loads, such as those used in hypercaloric TPN, does not seem to suppress the excessive endogenous production of glucose but instead markedly exacerbates the hyperglycemia of the postinjury and acute stress condition. We believe that the hypocaloric-hyperproteic regimen we utilize during the first few days of the stress situation is more in accordance with the inflammatory and hormonal mediator climate of the initial stages of the flow phase and thus appears to be beneficial vis-à-vis the hypercaloric loads that many use as routine metabolic support in critically ill patients.

Adolescent↗
PubMed1998

Asymptomatic cholelithiasis revisited.

Elective cholecystectomy in the asymptomatic patient has elicited considerable controversy, going back to the prelaparoscopy cholecystectomy era. Surgical services often see patients with known or unidentified cholelithiasis who, having been asymptomatic, present with serious complications, potentially lethal, in whom emergency operations are associated with technical difficulties that lead to high conversion rates and significant mortality and morbidity. Elective cholecystectomy is a safe procedure associated with low morbidity and no mortality. Based on an analysis of our experience and a review of the literature, we discuss the indications for elective laparoscopic cholecystectomy in asymptomatic patients at high risk of developing complications of their asymptomatic disease. The following high-risk criteria are proposed for elective cholecystectomy: life expectancy > 20 years; calculi > 2 cm in diameter; calculi < 3 mm and a patent cystic duct; radiopaque calculi; polyps in the gallbladder (GB); nonfunctioning GB; calcified ("porcelain") GB; concomitant diabetes; women < 60 years; and individuals in geographic regions with a high prevalence of GB cancer.

Cholecystectomy, Laparoscopic↗
PubMed1998

Inguinal hernia repair. The Nyhus posterior preperitoneal operation.

The posterior preperitoneal approach for prosthetic hernioplasty is a safe and sound procedure for the repair of adult groin hernias. The authors' results, 0 mortality, 2.1% minor morbidity, and 2.1% overall recurrence rate (1.26% for mesh hernioplasty), compare favorably with results in contemporary literature. This operation can be performed as an outpatient procedure or 1-night stay surgery. Pain is significantly less than with the traditional anterior Cooper's ligament repair, and rapid return to ordinary daily activities is possible. The authors favor the use of mesh prostheses in most cases of adult Nyhus types 2, 3 (not necessary in crural hernias), and 4 hernias. The authors recognize the value of two new approaches to hernia repair, that is, the laparoscopic extraperitoneal method and the tension-free mesh-plug hernioplasty, which share many of the anatomophysiologic principles with the posterior preperitoneal mesh repair.

Adult↗
PubMed1996

[Suitability of laparoscopic cholecystectomy in the asymptomatic cholelithiasis patient].

Cholelithiasis is a disease of high prevalence in the adult population. Prevalence increases with age; the incidence of complications, such as choledocholithiasis, acute pancreatitis, and cancer of gallbladder, also increase with age. Cholecystectomy has been considered as the gold standard in the treatment of symptomatic or complicated cholelithiasis. Laparoscopic cholecystectomy has become the new gold standard. Our Department of Surgery has adopted a policy of advising laparoscopic cholecystectomy in all patients with symptomatic cholelithiasis, but also subpopulation of high risk asymptomatic patients. This subgroup is made up by patients with long life expectancy, radioopaque stones, small calculus with patent cystic duct, nonfunctioning or calcified gall bladder, and patients with concomitant diabetes, cirrhosis, chronic hemolytic anemia, those that are candidates for kidney or heart transplantation, and those with underling degenerative diseases that are more likely to develop severe complication of cholelithiasis. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia. He considers that cholecystectomy is indicated in asymptomatic patients as a "prophylactic" measure. Our group agrees that this is a valid indication in areas or populations groups where gallbladder cancer is of high prevalence.

Cholecystectomy, Laparoscopic↗
PubMed1994

The current management of gastric cancer.

Gastric cancer remains a serious public health problem in many regions of the world. The failure to improve results following surgical resection and adjuvant therapy in the West has led to an increased interest in the Japanese approach to the management of gastric cancer. The detailed staging system proposed in Japan permits a more rational, type-oriented therapy and a better anatomic planning of the operation. However, experience in the West indicates that radical operations have not yielded the excellent results reported from Japan, neither in terms of morbidity and mortality nor in 5-year survival. It is possible that early diagnosis, the variable virulence of the diverse types of tumors, and other not well-defined factors have importance in determining the striking differences in results reported from Japan and from the Western countries. The surgeon must weigh the potential increased morbidity and mortality of radical surgery vs. its potential benefits in terms of locoregional control of the disease. Intraoperative radiotherapy may permit better local and regional control of disease; it must be further evaluated. Endoscopic ablation of early gastric cancer may be increasingly utilized in the future through improved selection of patients. DNA ploidy studies may reveal patients at variable risk, so that more rational individualized therapy can be implemented. Increased detection of early cancers through more aggressive endoscopic examination of populations at high risk, and improved systemic therapy, are the most immediate desirable goals in the management of this very serious, highly lethal disease.

Adenocarcinoma↗
PubMedDate not supplied

Necrotizing lesions of soft tissues: a review.

Necrotizing lesions of the soft tissues are grave entities not infrequently seen in daily surgical practice. They may occur with epidemic proportions after natural disasters, representing a serious challenge to the surgeon since they are characteristically associated with high mortality rates unless an early diagnosis is made and prompt aggressive surgical management is initiated. Necrotizing fasciitis is the currently accepted generic term to encompass into a single category the diverse syndromes of progressive gangrenous infections of the skin and subcutaneous tissues. Necrotizing fasciitis must be viewed as a clinical entity rather than a specific type of infection: it is a clinical infection most commonly caused by a mixed aerobic/anaerobic synergistic polymicrobial combination. Zygomycetes may appear as major causal organisms (mucormycosis) and they should be actively searched for. Initial diagnosis of necrotizing fasciitis is established through the characteristic physical signs. Gram stain, and, in some doubtful cases, through frozen-section tissue biopsy. Aggressive and urgent radical debridement is the key to survival, combined with wide-spectrum antibiotic therapy.

Fasciitis↗
PubMedDate not supplied

Necrotizing soft tissue lesions after a volcanic cataclysm.

A volcanic cataclysm of major proportions, the fourth largest in terms of total casualties in the history of mankind, wiped out the town of Armero, Colombia, in 1985 resulting in over 23,000 deaths and 4,500 wounded. Among the hundreds of survivors who were transferred to hospitals in the capital city of Bogotá, there was as overwhelming number who developed necrotizing fasciitis. These patients constitute, perhaps, the single largest group of this type of lesions in the recorded literature. Thirty-eight patients with well established necrotizing fasciitis were identified at 4 selected hospitals in Bogotá; 8 of them presented with zygomycetic infection (mucormycosis), a highly lethal entity. Many additional cases were treated at other hospitals in Bogotá and several cities in Colombia. The main clinical features of these 38 patients affected by necrotizing fasciitis are reviewed, with special emphasis on the patients with mucormycosis. Patients with necrotizing fasciitis had an overall mortality rate of 47.7%; patients with mucormycosis, 80%. A plea is made for an early diagnosis, utilizing tissue sampling and microbiological studies, so that prompt and radical treatment can be instituted. This is especially pertinent in situations of natural disasters resulting in massive numbers of casualties and seriously injured survivors.

Amputation, Surgical↗
PubMedDate not supplied

Roux-en-Y hepaticojejunostomy with subcutaneous access and the use of Gianturco stents for the management of biliary tract strictures.

The need to control recurrent biliary strictures implies the practice of repeated major surgical procedures. The hepaticojejunostomy with subcutaneous jejunal access (Chen's procedure) allows the permanent option of a non-operative management of recurrent biliary tract anastomosis complications. Through the subcutaneous jejunal access, the application of a Gianturco metallic prosthesis is permitted and the correction of biliary-intestinal anastomosis strictures with non-operative methods is possible. This report is a review of a series of 20 patients treated with the Chen procedure, of whom 3 patients also had implantation of Gianturco stents via hepaticojejunostomy with subcutaneous access.

Adult↗