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Biomedical subjects

J M Sarmiento

Publications and source records attributed to J M Sarmiento.

15 recordsLinked to original sources
PubMed2001

Periampullary cancers: are there differences?

Our review supports the clinical impression that periampullary cancers vary in outcome after resection. Overall survival after pancreaticoduodenectomy is greatest for patients with ampullary and duodenal cancers, intermediate for patients with bile duct cancer, and least for patients with pancreatic cancer. Moreover, survival for each tumor stage is greater for nonpancreatic periampullary cancers than for pancreatic cancers. Invasion of the pancreas by nonpancreatic periampullary cancers is a major factor adversely affecting survival. Recent data suggest that inherent differences in tumor biology rather than embryologic, anatomic, or histologic factors probably account for these differences in survival. Finally, although pancreaticoduodenectomy remains the procedure of choice for resectable periampullary cancers, further increases in survival will likely evolve through more effective neoadjuvant or adjuvant therapies rather than modifications in the surgical approach.

Ampulla of Vater↗
PubMed2001

Chronic renal failure secondary to oxalate nephropathy: a preventable complication after jejunoileal bypass.

Enteric hyperoxaluria is a commonly seen adverse event after the jejunoileal bypass procedure. The increased concentration of urinary oxalate predisposes bypass patients to various renal complications such as nephrolithiasis and oxalate nephropathy. If not diagnosed and appropriately treated, these complications can lead to irreversible renal damage. We describe 3 patients in whom severe renal complications developed with irreversible compromise of renal function after a jejunoileal bypass. Patients who undergo a jejunoileal bypass require lifelong follow-up with close monitoring of their renal function. Marked decline in renal function mandates prompt investigation and aggressive intervention, including reversal of the jejunoileal bypass if necessary. Chronic renal failure secondary to oxalate nephropathy is preventable and treatable but may require conversion of a jejunoileal bypass to a more current form of bypass.

Aftercare↗
PubMed2000

Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients.

The impact of cytomegalovirus (CMV) infection post-transplantation is in part influenced by the degree of immunosuppression. While mycophenolate mofetil (MMF) does not increase the overall incidence of CMV infection, we have questioned whether or not it increases its severity. Using a case control study design in which 29 renal transplant patients developed CMV disease [17 (59%) of which received azathioprine (AZA) and 12 (41%) received MMF], increases in the frequency of organ involvement with CMV (58 vs. 18%; p = 0.03) and in the number of organs involved with CMV were noted in the MMF versus the AZA group (2.0 vs. 1.0; p = 0.015). These results indicate that the increased immunosuppressive activity of MMF impacts the morbidity of CMV infection, thus warranting the use of effective anti-CMV preventive regimens while patients are treated with MMF.

Acyclovir↗
PubMed1998

Is cytomegalovirus infection related to mycophenolate mofetil after kidney transplantation? A case-control study.

Three multicenter studies have shown that the addition of mycophenolate mofetil (MMF) to an immunosuppressive regime consisting of cyclosporin A (CSA) and prednisone (PRED) decreases the incidence of acute rejection episodes when compared with azathioprine (AZA) or placebo (1-3). In those patients receiving 3 g/d of MMF, the highest dose used in the studies, there was a trend towards an increased incidence of cytomegaloviral sepsis (CMV). We postulated therefore that MMF may represent an independent risk factor for the development of CMV infection in patients receiving renal allografts and MMF at our institution. Having altered the triple drug regime from CSA, AZA (2-2.5 mg/kg/d) and PRED to CSA, MMF (2 g/d) and PRED in July 1995, we elected to study all patients undergoing kidney transplantation for the 33-month period January 1994-September 1996, by undertaking a case control analysis to determine independent risk factors for the development of CMV infection, as defined by CMV viremia or tissue-invasive CMV. Three CMV disease-free control patients were matched to each case, these patients having been randomly selected from the entire pool of patients in the observation period. There were 31 CMV case patients and 102 control patients. Univariate analysis indicated that gender, a concomitant pancreas transplant, acute rejection and CMV seropositivity in the donor were risk factors. However, multivariate analysis indicated that only acute rejection and donor CMV seropositivity were independently linked (p < 0.05) to CMV disease in this sample. Specifically, the odds ratio (OR) for CMV disease between MMF and AZA was 1.0 (95% confidence interval (CI): 0.46-2.18). Therefore, in this case control study we find no evidence that MMF at a dose of 2 g/d is an independent risk factor for primary CMV viremia or tissue invasion in renal allograft recipients.

Adult↗
PubMed1997

Perianal Bowen's disease: associated tumors, human papillomavirus, surgery, and other controversies.

BACKGROUND: Perianal Bowen's disease (BD) is an intraepithelial nonkeratinizing carcinoma, associated historically with internal tumors. METHODS: A review of patients with perianal BD presenting consecutively during a 25-year span was undertaken, excluding Bowenoid papulosis and contiguous genital BD. Histologic slides were resubmitted for review by an experienced pathologist, in a "blind" fashion among other slides. Follow-up was updated in every patient. Survival and recurrence curves were generated by the Kaplan-Meier method and were compared with a normal age-matched population (log-rank test). RESULTS: Nineteen patients were identified; 15 of them were females. Mean age +/- standard deviation was 49.6 +/- 10.6 years. Five patients had a coincidental diagnosis (hemorrhoidectomy or wart excision). No associated carcinomas were found; however, eight patients had isolated BD of the vulva. Eleven patients had a history of anal warts, cervical/vulvar dysplasia, or both. Wide resection, including V-Y flaps, was performed in 18 patients without dysfunction. One-year and five-year recurrence was 16 and 31 percent. Recurrence was treated in all but one case by wider resection. Mean follow-up was 8.4 years. Five-year survival was 75 percent, lower than the matched population (P = 0.001); however, only one death was related to BD. CONCLUSIONS: Perianal BD has no association with internal tumors. Despite a high rate of recurrence, perianal BD can be treated by local excision. An increased rate of human papilloma virus-related entities was found, which could suggest a causative role.

Anus Diseases↗
PubMed1997

Paget's disease of the perianal region--an aggressive disease?

BACKGROUND: Perianal Paget's disease is a rare entity, often associated with internal malignancies and a poor prognosis. METHODS: A chart review of patients with perianal Paget's disease who presented consecutively to Mayo during 25 years (starting in January 1970) was made. Patients included had Paget's disease located in or around the anus (3 cm). Patients were excluded for evidence of spread of vulvaperineal lesions or pagetoid extension of a rectal adenocarcinoma. Histology slides were reviewed, and immunohistochemistry was applied to confirm diagnoses. Follow-up was updated in all patients. Recurrence and survival curves were generated by the Kaplan-Meier method. Survival was compared with an age-matched population by the log-rank test. RESULTS: Thirteen patients, eight females, were diagnosed (age +/- standard deviation of 68.3 +/- 10.6 years). All histologic diagnoses were confirmed with immunohistochemical staining results. Mean follow-up was 6.7 years, 8.8 for living patients. One patient had associated extramammary Paget's disease (scrotum). Lesions were located randomly at the dentate line, anal verge, and/or perianal area. Four patients had associated carcinomas; none of them were visceral. Eleven patients underwent local resection, without adjuvant therapy. Almost all recurrences were treated by wider local excision. The five-year recurrence rate was 61 percent. Overall five-year and ten-year survival was 67 percent, no different from the age-matched population (P = 0.546). CONCLUSIONS: These results do not reflect an aggressive nature of perianal Paget's disease, despite a high rate of local recurrence. Both primary lesions and recurrences are susceptible to treatment by wider local resection. Long-term survival is no different from that of the normal age-matched population.

Aged↗
PubMed1997

Computer-based desktop system for surgical videotape editing.

BACKGROUND: The educational role of surgical video presentations should be optimized by linking surgical images to graphic evaluation of indications, techniques, and results. We describe a PC-based video production system for personal editing of surgical tapes, according to the objectives of each presentation. METHODS: The hardware requirement is a personal computer (100 MHz processor, 1-Gb hard disk, 16 Mb RAM) with a PC-to-TV/video transfer card plugged into a slot. Computer-generated numerical data, texts, and graphics are transformed into analog signals displayed on TV/video. A Genlock interface (a special interface card) synchronizes digital and analog signals, to overlay surgical images to electronic illustrations. The presentation is stored as digital information or recorded on a tape. RESULTS: The proliferation of multimedia tools is leading us to adapt presentations to the objectives of lectures and to integrate conceptual analyses with dynamic image-based information. We describe a system that handles both digital and analog signals, production being recorded on a tape. Movies may be managed in a digital environment, with either an "on-line" or "off-line" approach. System requirements are high, but handling a single device optimizes editing without incurring such complexity that management becomes impractical to surgeons. CONCLUSIONS: Our experience suggests that computerized editing allows linking surgical scientific and didactic messages on a single communication medium, either a videotape or a CD-ROM.

Analog-Digital Conversion↗
PubMed1996

Conservative management of penetrating hypopharyngeal wounds.

OBJECTIVE: To demonstrate the applicability of nonoperative treatment to penetrating hypopharyngeal wounds. DESIGN: A prospective study. MATERIALS AND METHODS: An analysis of patients with penetrating hypopharyngeal wounds who were treated nonoperatively at the Hospital Universitario del Valle (Cali, Colombia) during 4 years (beginning January 1990) was performed. Patients older than 13 years with proven lesions produced by penetrating trauma were included. Patients with foreign-body-induced or iatrogenic lesions (orotracheal intubation, endoscopy) or immediate need for surgery (for associated lesions) were excluded. Nonoperative management consisted of nasogastric tube for feeding, suspension of oral intake, and parenteral antibiotics for 7 days. MEASUREMENTS AND MAIN RESULTS: Fourteen patients met the above criteria. Gunshot wounds (n = 11) were the most common trauma. An esophagogram/endoscopy demonstrated the lesions. The only complication in the group consisted of a cervical abscess, which presented in a patient during the first week of treatment. There were no complications such as fistula, leakage, and Horner's syndrome. CONCLUSIONS: Conservative management is a good and safe alternative when indicated in penetrating hypopharyngeal wounds.

Adolescent↗
PubMed1996

An atraumatic technique to fix the omentum after partial splenectomy.

During a partial splenectomy, the resultant bleeding of the remaining spleen is difficult to control; some techniques have been described to achieve complete hemostasis. The omentum has been traditionally used to promote hemostasis on raw surfaces of solid viscus, particularly during the repair of liver injuries. We present here a technique to fix the omentum to the spleen after partial resections; emphasis is made to perform it in an atraumatic way to avoid additional damage to the splenic capsule.

Blood Loss, Surgical↗
PubMed1995

Unnecessary use of pelvic x-ray in blunt trauma.

Pelvic radiography in blunt trauma patients is routinely used in most trauma centers. The purpose of this review was to evaluate the ability of physical examination alone to detect pelvic fractures. Among patients with blunt trauma admitted to the University Hospital del Valle in Cali, Colombia, over a 3-month period, 608 adult patients, with hemodynamic stability, without spinal involvement, and with a Glasgow Coma Scale score greater than 10 were evaluated. All patients had physical examination, pelvic x-ray and adequate follow-up. Fifty-nine (9.7%) patients had pelvic fractures, with 57 of these fractures detected by physical findings. The remaining two patients had stable fractures that required no treatment. After careful analysis, we conclude that a negative physical examination following blunt trauma has a negative predictive value of 99% probability in excluding pelvic fracture, provided that the patient is not a child, is not in coma, is hemodynamically stable without evidence of blood loss, and has no spinal cord injury. A selective use of pelvic x-ray in patients with blunt trauma is a cost-effective policy.

Adolescent↗
PubMed1994

Pulmonary embolism following laparoscopic cholecystectomy: report of two cases and review of the literature.

Laparoscopic abdominal surgery is considered a low-risk procedure for postoperative thromboembolic disease. We report two cases of pulmonary embolism following laparoscopic cholecystectomy, review the incidence of deep venous thrombosis and pulmonary embolism in laparoscopic cholecystectomy, and suggest a specific prophylactic scheme for patients undergoing laparoscopic cholecystectomy. In spite of the low incidence of postoperative thromboembolic disease following minimally invasive procedures, the risk of pulmonary embolism must not be underestimated and its symptoms must not be underdiagnosed.

Adult↗
PubMed1994

Prophylactic antibiotics in abdominal trauma.

The study reported here evaluated the efficacy of antibiotics administered in two periods: preoperative only and additional doses postoperatively. There was no difference in developing surgical sepsis between the groups when they included antibiotics preoperatively and the severity of the trauma was minor (Abdominal Trauma Index [ATI] value < 25). Additionally, the result was the same when one of the injured organs was the colon, in contrast with past studies. One interesting point is related to the association of a Revised Trauma Index value > 20 with a colon wound: in the present study, this combination had a deleterious effect on the patients, always resulting in abdominal sepsis. Emphasis is placed on the economic benefits of the abolition of postoperative antibiotic use in patients with ATI score less than 25.

Abdominal Injuries↗
PubMedDate not supplied

Bullets and their role in sepsis after colon wounds.

The objective of this study was to determine the relation between the presence of a bullet (gunshot) after injury to the colon and the incidence of sepsis in its track and the soft tissue where it is retained. A retrospective review was carried out of the charts of consecutive patients admitted for abdominal gunshot wounds with proved colon injury during laparotomy where the bullet was either retained in the soft tissue or exited the body. The review covered a period of 4 years beginning January 1, 1990. Three groups were identified for analysis: (1) patients from whom the bullet was surgically removed, with additional cleansing and debridement of the area (n = 21); (2) patients who did not undergo surgical removal of the bullet (n = 81); and (3) patients in whom the bullet exited spontaneously and in whom only débridement of the skin was carried out (n = 83). Similar risk factors were noted among the groups (age, ATI score, colostomy rate), except for a higher incidence of shock in group 3 (p = 0.003). The incidence of sepsis in soft tissue was least in group 1. It was five and seven times greater in groups 2 and 3, respectively. After an abdominal gunshot with colon injury, the missile should be removed if feasible and the local tissue débrided. If the bullet has exited spontaneously, its internal track must be débrided and lavaged extensively.

Adolescent↗
PubMedDate not supplied

Physiologic determinants of nocturnal incontinence after ileal pouch-anal anastomosis.

The goals of the ileal pouch-anal anastomosis (IPAA) operation are the construction of a fecal reservoir and the preservation of anal function, without compromising continence. Some of the patients are incontinent at night. The aim of our study was to identify the mechanisms responsible for nocturnal incontinence. We analyzed patients undergoing IPAA for ulcerative colitis, who underwent anorectal tests between 1993 and 1995. All patients were subjected to pull-through manometry and pelvic floor function studies, and 33 patients underwent overnight ambulatory manometry. Among 44 patients (27 men and 17 women), 22 had complete continence, whereas 22 had nocturnal incontinence. Mean age was 40 +/- 1 years. There were no differences with regard to sex, age, stool consistency, and ability to differentiate gas from stool between groups; only stool frequency was lower in the continent group (median [range] 6 [3 to 10] vs. 8 [5 to 25] stools/24 hours; P = 0.011). Resting and squeezing anal canal pressure did not differ (P = 0.42 and P = 0.73, respectively). Resting, squeezing, and defecating anorectal angle, percentage of pouch evacuation, and perineal descent, all measured scintigraphically, did not differ between groups (all P >0.05). Ambulatory manometry showed that the mean anal canal pressure was higher in continent patients compared to incontinent patients, both during awake (88 +/- 11 vs. 62 +/- 8; P = 0.032) and sleep (81 +/- 14 vs. 49 +/- 9; P = 0.029) periods. The motility index was similar (awake, P = 0.88; sleep, P = 0.95), as was the number of episodes where the pouch pressure was greater than the anal canal pressure (P = 0.28). In otherwise continent patients after IPAA, the combination of high stool frequency and low basal anal canal pressure may be related to nocturnal incontinence. Moreover, standard anorectal physiology tests cannot identify these subtle differences.

Adult↗