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J I Landa García

Publications and source records attributed to J I Landa García.

At least 19 recordsLinked to original sources
PubMed2006

[National project for the clinical management of healthcare processes. The surgical treatment of cholelithiasis. Development of a clinical pathway].

INTRODUCTION: Because surgical treatment of gallstones is highly prevalent, this topic is particularly suitable for a national study aimed at determining the most important indicators and developing a clinical pathway. OBJECTIVES: To analyze the results obtained during the hospital phase of the process. To define the key indicators of the process. To design a clinical pathway for laparoscopic cholecystectomy. PATIENTS AND METHODS: A multicenter, prospective, cross-sectional, descriptive study was performed of patients who consecutively underwent surgery for gallstones in 2002. The sample size calculated with data provided by the National Institute of Statistics was 304 patients, which was increased by 45% to compensate for possible losses. Inclusion criteria consisted of elective cholecystectomy for gallstones, without preoperative findings suggestive of common duct stones. A database was designed (Microsoft Access 2000) with 76 variables analyzed in each patient. RESULTS: Completed questionnaires were obtained from 37 hospitals with 426 patients. The mean age was 55.69 years, with a predominance of women (68.3%). The most frequent symptom was biliary colic (23%). A total of 20.3% of the patient had prior episodes of cholecystitis and 18% had a history of mild pancreatitis. Diagnosis was given by ultrasonography in 93.2% of the patients. Informed consent was provided by 93.2%. The intervention was performed on an inpatient basis in 96.1% and in the ambulatory setting in the remainder. Antibiotic and antithrombotic prophylaxis was administered in 78.9% and 75.1% of the patients respectively. The laparoscopic approach was used in 84.6%, with a conversion rate of 4.9%. Intraoperative cholangiography was performed in 17.8% of the patients and common duct stones were found in 7 patients. The most frequent complication was surgical wound infection (1.1%). Possible accidental lesion of the biliary tract occurred in 0.7% of the patients and was described as biliary fistula. There were four reinterventions: biliary fistula (1), hemoperitoneum (2) and cause unknown (1). The mean surgical time was 73.17 minutes, with a median of 60 minutes. Postoperative length of stay was 4.75 days in open surgery and 2.67 days in laparoscopic surgery. Ninety-nine percent of the patients were satisfied or highly satisfied with the healthcare received. CONCLUSIONS: Analysis of the process and review of the literature identified a series of areas requiring improvement, which were gathered in the clinical pathway developed. These areas consisted of increasing the number of patients with correctly indicated antibiotic and antithrombotic prophylaxis, increasing the percentage of patients providing informed consent and undergoing adequate preoperative tests, limiting intraoperative cholangiography to selected patients, and reducing the number of patients with an overall stay of 3 days.

Cholecystectomy↗
PubMed2002

Protective effect of vagotomy on the gastric mucosa in a stress model in rats.

INTRODUCTION: The use of vagotomy is classically based on its inhibiting effects on acid secretion. Vagotomy induces both cellular and endocrine changes that may be involved in protective actions. Our aim was to study morphologic changes induced by vagotomy on the gastric mucosa and their relation to stress protection in the short, medium and long term. MATERIAL AND METHODS: An immobilization and cold stress model was used with 80 Wistar rats divided into two groups--control (with and without stress) and vagotomy (at 7, 30 and 120 days). Changes induced in the gastric mucosa by stress were studied with and without vagotomy, as well as relationship between these changes and the intended protective action. RESULTS: Bleeding showed a very significant relation to stress (p < 0.0001). Bleeding incidence exhibited a significant difference between vagotomised and non-vagotomised rats (p < 0.0001) in the short, medium and long term (vagotomy was protective against stress). Regeneration signs related significantly to vagotomy (p < 0.0001) but not stress (p = 0.208). However, no significant relationship was found between the protective action and the presence of regeneration signs (p = 1). CONCLUSIONS: Vagotomy has tropic effects on the gastric mucosa and is protective against stress. This protective action is maintained in the short, medium and long term. However, these changes are not sufficient to explain protection. An adaptation phenomenon mediated by hormonal and peptidic factors may be involved in this action.

Animals↗
PubMed1997

Evaluation of scolicidal agents in an experimental hydatid disease model.

INTRODUCTION: The treatment of hydatid disease is largely surgical, with medical treatment being reserved as coadjuvant treatment. The scolicidal agents have been, and are being used mainly during surgical manipulation of the cysts, with the object of avoiding relapses and peritoneal dissemination. OBJECTIVE: Evaluation of the scolicidal agents used in surgery in a hydatid disease model in the mouse. MATERIAL AND METHODS: We have used 85 Swiss OF1 mice, weighing more than 30 g, of 90 +/- 10 days of age, in which a picture of hydatid sowing was reproduced by means of intra-peritoneal inoculation with 0.2 ml of a suspension which contained approximately 1,200 viable protoscolex of Echinococcus granulosus which came from the livers of parasite-infested sheep. 24 h after the inoculation, the mice were subjected to a median laparotomy for the introduction of 1 ml of the scolicidal solution to be evaluated: physiologic saline (n = 10); 10% povidone iodine (n = 15); praziquantel (n = 15); 10% hydrogen peroxide (n = 15); 10% hypertonic saline (n = 15); simulated operation (n = 15). After 7 months of follow-up, the mice were sacrificed and the following was evaluated: number of isolated cysts, cyst masses, and total cysts. RESULTS: The number of isolated cysts which developed was significantly lower in the hydrogen peroxide group (tF 2.14 < RC 3.29). The number of cyst masses was significantly reduced in the hydrogen peroxide group (tF 2.14 < RC 2.18), in the povidone iodine group (tF 2.17 < RC 3), and in the hypertonic saline group (tF 2.11 < RC 2.77). The total number of cysts which developed decreased significantly in the hydrogen peroxide (tF 2.14 < RC 2.84) and the povidone iodine (tF 2.17 < RC 3.79) groups. CONCLUSIONS: Hydrogen peroxide and povidone iodine show a greater protoscolicidal effect than simple cleansing with physiological saline, hypertonic saline, or praziquantel.

Animals↗
PubMed1997

Octreotide: effects in experimental severe acute pancreatitis. Analysis of survival, biochemical findings and histomorphometry.

OBJECTIVE: The effect of octreotide in acute experimental pancreatitis was examined. EXPERIMENTAL DESIGN: Acute pancreatitis was induced in 70 male Wistar rats by retrograde injection of 5% sodium taurocholate into the pancreatic duct. Octreotide (50 micrograms = 0.5 ml) or isotonic saline was administered subcutaneously every six hours for 24 hours, beginning at the time of induction of pancreatitis (groups 1 and 2) or 12 hours later (groups 3 and 4). Six hours after the last dose of octreotide or saline, the rats were sacrificed. Ten additional rats were used for basal biochemical determination. For the analysis of survival, another 10 rats were included. The survival rate, serum concentrations of amylase, lipase and lactate dehydrogenase (LDH) and morphometric studies (total area of the pancreas and percentage necrosis) were examined. Statistical analysis involved Student's t test, ANOVA and the Mantel-Haenszel test. RESULTS: No significant differences existed among the groups with respect to survival, morphometric analysis or biochemical determinations, except for a minor increase in LDH levels in the group treated with octreotide at the time of induction. CONCLUSIONS: Octreotide administration has almost no impact on mortality in experimental severe acute pancreatitis. Biochemical and morphometric changes are minimal. Therefore, according to the present study, the efficacy of octreotide administration is very low.

Acute Disease↗
PubMed1991

[Somatostatin in the treatment of established and severe acute pancreatitis in the rat].

The effects of somatostatin (SS) on the treatment of acute pancreatitis were studied in rats. Acute pancreatitis was established by injecting 5% sodium taurocholate in the biliopancreatic duct. Previously, pancreatic necrosis was determined in this experimental model at several intervals without treatment. Treatment was started according different groups: at 12, 16 and 20 hours after induction of acute pancreatitis (IV bolus of 4 ug/kg body weight followed by a 24h continuous infusion of 4 ug/kg body wt/hour). When somatostatin was initiated at 12 or 16h a decrease in serum amylase and lactodehydrogenase was observed, as well as in pancreatic necrosis resulting in 0% mortality after 24h of treatment. When somatostatin was started at 20h there was no changes in the lethal outcome of the disease.

Acute Disease↗
PubMed1991

[Experimental acute pancreatitis in the rat. The quantification of pancreatic necrosis after the retrograde ductal injection of sodium taurocholate].

Acute haemorrhagic pancreatitis was induced in rats by injecting 5% sodium taurocholate into the common biliopancreatic duct. The condition was associated with an increase in the serum amylase levels as well as progressive pancreatic necrosis resulting in 100% mortality before 36 hours. This experimental model was documented by quantifying nine different parameters of pancreatic necrosis and giving more information about the induced lesion. The extent of pancreatic necrosis was evaluated at different intervals, 5.77% at 12 hours, 14.9% at 24 hours, and the rats died before 36 hours of pancreatitis induction with an average percentual necrosis of 29.9%. This model seems suitable for more pathogenic as well as therapeutic studies on acute pancreatitis in the rat.

Acute Disease↗
PubMed1989

[Initial results of restoration of bile flow in liver transplant].

The initial results of biliary reconstruction in 72 liver transplants realized in 62 patients, 50 adults and 12 children, are presented. Three reconstruction techniques were used: end-to-end choledocho-choledochostomy on a Kehr tube in 44 transplants (61.1%); choledocho-jejunostomy on a Roux-en-Y loop in 24 transplants (33.3%); double derivation cholecysto-choledocho-jejunostomy in 2 transplants (2.7%). The number of early complications related to biliary reconstruction was 5 (7.14%): 3 fistulas in the choledocho-choledochostomy series (6.8%) and 2 fistulas among the choledocho-jejunostomies (8.3%). All complications required reoperation and mortality was nil. Thirty-two months after the onset of the program, no late complications of the biliary anastomosis have been registered.

Adolescent↗
PubMed1989

[Role of liver transplant in the treatment of hepatic hydatidosis].

Three patients are reported who had liver hydatidosis that was not resolved by conventional surgery and who eventually underwent liver transplantation. In view of the satisfactory results obtained, with 100% postoperative survival, possible indications for liver transplant in this type of patients are discussed, fundamentally for secondary sclerosing cholangitis, secondary biliary cirrhosis and acute Budd-Chiari syndrome.

Adult↗
PubMed1985

Surgical management of liver hydatidosis. 10-year experience with 269 patients.

A series of 269 patients with 371 surgically treated hydatid cysts of the liver is reported. Cystopericystectomy was performed in 45.2% of cases, liver resection in 7%, subtotal cystectomy in 26.9%, cystojejunostomy in 1.8% and drainage in 9.7%. Overall mortality and morbility were 2.9% and 31% respectively, with a mean hospital stay of 29 days. The highest mortality (6%) and morbility (45%) were observed in patients undergoing subtotal cystectomy. In the group of patients treated by conservative surgery the overall mortality was 32.5%, while in the group treated by radical surgery it was 27% (p less than 0.05). These data suggest that in the treatment of hydatid disease radical resection is followed by the lowest complication and mortality rates.

Drainage↗
PubMed1984

Resection of suprarenal inferior vena cava and dacron graft replacement without right nephrectomy for echinococcal cyst. Case report and review of the literature.

A case of a hepatic echinococcal cyst of the right lobe (diam. 16 cm.) involving the anterior wall of the retrohepatic inferior vena cava is reported. During surgery, the vein was occasionally damaged and suture of the lesion was not possible. Therefore resection of the retrohepatic vena cava was performed and the segmental continuity was replaced with a dacron graft (1,6 X 5 cm.). The patient had an uneventful recovery. The controls at 6, 12 and 24 months showed excellent permeability of the prosthesis. This report represents the second long-term survival case of the literature. The indications for graft replacement of the inferior vena cava, are discussed.

Adult↗