PubMed Health⌕ Search

Biomedical subjects

J S Aldrete

Publications and source records attributed to J S Aldrete.

At least 19 recordsLinked to original sources
PubMed1992

Cytomegalovirus colitis presenting as hematochezia and requiring resection.

Cytomegalovirus infection is one of the most prevalent viral infections affecting recipients of cardiac allografts. Of the various severe systemic manifestations, those in the gastrointestinal tract have a unique way of presenting, specifically in the colon where a process related to cytomegalovirus infection that involves all layers, with dilatation as a prominent clinical feature, has been suggested. We report herein a case of patient with a heart allograft who had severe episodes of rejection that responded to boosting doses of steroids. Because of persistent fever, diarrhea, hematochezia, and computed tomographic findings of the abdomen that showed a highly abnormal appearance of the ascending and transverse segments of the colon, this patient subsequently underwent celiotomy. The involved segment of the colon was found to have severe inflammation with mucosal necrosis; a subtotal colectomy was done. The abundant cytomegalovirus inclusions found in the vascular endothelium of the removed damaged segment of the colon suggest that cytomegalovirus may have been a causal factor in this form of colitis. The patient recovered uneventfully.

Colitis↗
PubMed1991

Choledochoduodenostomy. Analysis of 71 cases followed for 5 to 15 years.

To investigate the long-term effectiveness of choledochoduodenostomy (CDD), the experience with 71 patients followed for 5 or more years after CDD was analyzed retrospectively. From 1968 to 1984, 134 patients underwent CDD. Eight patients (6%) died in the immediate postoperative period, 55 left the hospital, 8 of them were lost to follow-up, and 47 were followed but died before 5 years elapsed after CDD. The remaining 71 patients form the data base for this analysis: 38 were followed for more than 5 years, 25 were followed for more than 10 years, and 8 were followed for more than 15 years (mean 12.1 years +/- 1.3 SEM). Choledocholithiasis, chronic pancreatitis, and postoperative stricture were the indications for CDD. Cholangitis was observed in only three patients. The diameter of the common bile duct (CBD) was large in most patients (mean 18 mm +/- 0.9 SEM). These results infer that CDD is effective to treat non-neoplastic obstructing lesions of the distal CBD on a long-term basis and that the presence of a dilated CBD (more than 16 mm) that allows the construction of a CDD more than 14 mm is essential to obtain good results.

Aged↗
PubMed1990

Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988.

Potentially curative radical pancreaticoduodenectomy for ampullary adenocarcinoma was performed in 24 patients over a 35-year period. The overall operative mortality was 12.5%. Actuarial survival rate at 5 years was 61% +/- 13.4 standard error of the mean (SEM) and subsequently remained unchanged. In the same time period, 21 patients underwent potentially curative radical pancreaticoduodenectomy for periampullary tumors of pancreatic origin. Similar analysis showed an overall operative mortality of 23.8% and a survival rate at 5 years of 27% +/- 12.5 SEM. The results of radical pancreaticoduodenectomy for ampullary carcinoma in the most recent years (1976 to 1988) were compared with those of former years (1953 to 1975). There were no statistically significant differences in the 5-year survival rate; however, the operative mortality decreased from 25% in the former period to 6.3% in the recent period. Survival was dependent on nodal status. The 5-year survival rate was 78% +/- 11.5 SEM in the absence of nodal metastasis versus 50% +/- 25 SEM in the presence of regional nodal metastasis. These findings support the concept that radical pancreaticoduodenectomy offers a realistic probability for cure in a selected group of patients with carcinomas of the ampulla of Vater.

Actuarial Analysis↗
PubMed1990

Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention.

Acute gastrointestinal (GI) illnesses are unusual but potentially fatal complications following cardiac transplantation. A retrospective study was performed to analyze the frequency, etiology, and severity of GI complications and the potential impact of early diagnosis and prompt surgical intervention when appropriate. Between 1981 and July 1, 1988, 31 GI complications (pancreatic, 6; colonic, 6; gastroduodenal, 6; biliary, 5; esophageal, 3; appendiceal, 2; hernia, 2; and splenic, 1) occurred in 26 patients undergoing 32 cardiac transplants. Complications were most common (14 of 31 patients, 45%) within the first 30 days after transplantation. Seventeen GI complications were treated medically (2 deaths), 2 with elective surgery and 12 with emergent operations (3 deaths). The overall mortality rate was 16%. All patients who underwent emergent operations within 3 days of onset of symptoms survived; the mean interval of onset between symptoms and operation in the nonsurvivors was 10 +/- 3.8 days. We infer that among patients requiring urgent surgical intervention, successful outcome is enhanced by intense surveillance for early symptoms, prompt diagnostic evaluation, and early surgical intervention.

Acute Disease↗
PubMed1989

Peritoneovenous shunt for intractable ascites of hepatic, nephrogenic, and malignant causes.

A retrospective analysis of 54 patients with a peritoneovenous shunt inserted to control massive ascites refractory to conventional medical treatment is presented. The cause of ascites was hepatic in 29 patients (Group 1, 54 percent), malignant in 13 (Group 2, 24 percent), and nephrogenic in 12 (Group 3, 22 percent). The peritoneovenous shunt failed in 11 patients (20 percent): 6 in Group 1, 3 in Group 2, and 2 in Group 3. Shunt outflow obstruction (thrombosis) was the principal cause. Systemic sepsis in five patients and variceal hemorrhage in three were the factors responsible for most of the deaths (22 percent). Of the 42 patients who survived operation, the peritoneovenous shunt was effective in controlling the massive ascites in 37 (86 percent). Eight patients (15 percent), four with hepatic and four with nephrogenic ascites, survived 3 years or more without ascites. Removal of at least 50 to 70 percent of ascitic fluid at the time of shunt insertion was considered an important factor in decreasing morbidity and mortality. A peritoneovenous shunt can be effective for a long-term period in controlling massive ascites with an hepatic or nephrogenic cause in a selected group of patients; however, in patients with malignant ascites, although the benefit was substantial in half, the survival period did not exceed 6 months.

Adult↗
PubMed1989

Hepatic resection of metastasis from colorectal carcinoma. Morbidity, mortality, and pattern of recurrence.

To identify the factors that determine the morbidity and mortality of liver resection of metastases from colorectal carcinoma and the variables that may influence the pattern of recurrence, the survival time and the disease-free rate, a univariate and-multivariate statistical analysis (30 variables using Student's t-test, Fischer's exact test, and chi square test) was performed. Intraoperative blood loss of greater than 3500 ml was found to be a significant risk factor to developing postoperative complications (p less than 0.05 by x2). After a mean follow-up of 25.8 months, 26 of the 35 patients studied (74%) had recurrent disease. In the univariate analysis, the following factors appear to be reliable predictors of early recurrence: poor degree of differentiation of the primary colorectal tumor, the presence of multiple liver metastases, the male gender, and the presence of tumor at the margin of the resected hepatic tissue (p less than 0.05). However, only the latter two factors appeared also to affect the survival time and the disease-free rates at 2 years after hepatic resection of metastases (p less than 0.05). In the multivariate analysis (factors tested simultaneously), presence of an advanced liver metastatic disease (Stage II or III) consistently indicated early recurrence and poor survival (p less than 0.005). The liver was the most common site of recurrence as the sole site of recurrence (54%) or in combination with other sites (88%)--followed by the lungs (31%) and the site of colonic resection (8%). Twenty-nine (83%), 14 (40%), and nine (26%) patients survived without recurrent disease at 1, 2, and 3 or more years, respectively, after hepatic resection of metastases. In six patients (17%), no significant palliation was noted, primarily because of early recurrence (less than 6 months). From this data, resection of hepatic metastases from colorectal cancer appears to offer a realistic therapeutic option to a selected group of patients, but only if the resective procedure can be performed with an operative mortality rate of less than 5%.

Adenocarcinoma↗
PubMed1989

Total gastrectomy for gastric carcinoma.

We retrospectively analyzed experience with total gastrectomy (TG) for gastric carcinoma in 23 patients. The TNM stage was I in one patient, II in one patient, III in eight patients, and IV in 13. Linitis plastica was found in ten patients. The operation was considered curative in only eight patients (35%). There were 13 complications in eight patients. There were no operative deaths. The survival ranged from three to 36 months. The survival for curative TG was a mean of 21.2 months +/- 3.3 SEM; for palliative TG, mean survival was 10.1 months +/- 1.1 SEM (P less than .001). These results suggest that gastric carcinoma that extensively involves the fundus and/or the corpus continues to be highly lethal, even when these tumors can be resected with a TG. Furthermore, even when the operation is considered "curative" and can be done with little or no operative mortality, the average survival was at best 21 months.

Adenocarcinoma↗
PubMed1989

Abdominoperineal resection for rectal carcinoma: perioperative risk factors.

This retrospective review of 37 cases of abdominoperineal resection for adenocarcinoma sought to correlate preoperative clinical characteristics and intraoperative events with the likelihood of subsequent development of specific complications in the postoperative period. Mortality was 3% (1/37), and the complication rate was 76% (28/37), with urologic (49% [18/37]) and pulmonary (30% [11/37]) complications being the most common. Significant perioperative risk factors included a history of cardiac disease, current cardiac medications, diabetes mellitus, an abnormal preoperative electrocardiogram, and extended operation. Factors not associated with an increased risk included age, sex, a history of pulmonary disorders, previous abdominal operations, operative time, and need for transfusions, management of the pelvic peritoneum, or perineal drainage. Such information should reliably identify high-risk patients and therefore should be useful for selecting such patients for palliative or other limited techniques of tumor control.

Abdomen↗
PubMed1989

Short- and long-term effectiveness, morbidity, and mortality of peritoneovenous shunt inserted to treat massive refractory ascites of nephrogenic origin analysis of 14 cases.

The experience with 14 patients with end-stage renal disease (ESRD), 13 of them maintained on chronic hemodialysis (x 20.4 months +/- 2.9 SEM) and one following successful renal transplantation, underwent placement of a peritoneovenous shunt (PVS) for refractory ascites that had been present before insertion from two to 15 months (x 5.3 +/- 0.8 SEM). A "specific" cause for the ascites could not be identified in any of the 14 patients. The ascites was an exudate in every patient (protein content greater than 3.5 gm/dl). Twelve patients (86%) obtained significant relief of the discomfort and all effects of the ascites, and objective clinical improvement persisted for at least six months. Nine patients (75%) survived one year and six (50%) survived three or more years. Three patients (21%) had recurrence of ascites because of shunt malfunction; however, two of them were successfully treated with placement of a second shunt. Eight (57%) patients have died since the onset of their ascites (x 14.1 months +/- 3.5 SEM); one death was attributable to PVS placement, while the other seven deaths were due to complications of their ESRD. Insertion of a PVS is an effective therapeutic alternative to palliate the discomfort and ill effects of massive nephrogenic ascites that is often refractory to hemodialysis with ultrafiltration.

Adult↗
PubMed1989

Response of glucagonomas to surgical excision and chemotherapy. Report of two cases and review of the literature.

The glucagon-producing pancreatic tumors or glucagonomas are among the rarest forms of islet cell tumors; most are malignant and usually produce a definite clinical syndrome. Mild diabetes mellitus, weight loss, and anemia usually accompany the syndrome. However, only the presence of a peculiar cutaneous rash (necrolytic migratory erythema) and the finding of hyperglucagonemia on assay are reliable diagnostic features of the syndrome. Selective, celiac axis arteriography is the most valuable preoperative technique for localizing these neoplasms and their common liver metastases. Immunohistochemical and ultrastructural examinations are particularly helpful in defining the tumor cell nature (alpha-2 islet cell) and the peptide content (glucagon). When the tumor is benign (less than 30%), complete operative removal results in lasting cure; for malignant forms, surgical therapy is mainly palliative, and adjunctive chemotherapy should be administered. In this report, the importance of clinical recognition and operative and chemotherapeutic responses is illustrated in two patients. In each case, the characteristic dermatitis, diabetes mellitus, weight loss, anemia, and elevated plasmatic glucagon were present. Both patients had their tumors localized by selective angiography and underwent operative removal of the primary pancreatic lesion. In the case of benign glucagonoma, surgical excision was curative. In the malignant one, cytoreductive surgery plus adjunctive chemotherapy (dimethyltriazenomidazole-carboxamide resulted in prolonged survival and significant clinical improvement. Follow-up with serum glucagon assay has been useful in monitoring recurrence.

Adenoma, Islet Cell↗
PubMed1988

Diaphragmatic rupture due to blunt trauma: morbidity and mortality in 42 cases.

We present an analysis of 42 cases of acute rupture of the diaphragm by blunt trauma. There were 31 men (74%) and 11 women (26%); the mean age was 32.8 years +/- 2.4 SEM. At admission, hypovolemic shock was present in 45% of the cases, pelvic fracture in 36%, and severe respiratory distress in 21%. Diaphragmatic rupture was suggested before operation by unilateral elevation of the diaphragm, supradiaphragmatic densities, and displacement of abdominal organs into the thorax, as shown by chest films and GI series in 18 cases (43%). The left hemidiaphragm was injured in 24 cases (57%), the right in 15 (36%), and both sides in three (7%). Of the 17 patients (40%) found to have an abdominal organ in the thorax, 12 had had a left-sided rupture. Only four patients (10%) had solitary diaphragmatic injuries. Associated injuries (usually two or more) occurred in 38 cases (90%); they were abdominal in 34, musculoskeletal in 26, neurologic in 16, and thoracic in nine. The injuries were repaired through a celiotomy in 33 cases, by thoracotomy in six, and by separate celiotomy and thoracotomy in three. Postoperative complications occurred in 29 cases, the most common being pulmonary (18), systemic sepsis (six), and recurrent bleeding (three). There were 14 deaths, for a mortality of 33%. Seven were operative and due to massive hemorrhage; the late deaths were caused by systemic sepsis in five and neurologic trauma in two. We conclude that (1) diaphragmatic rupture after blunt trauma must be suspected when specific radiologic findings are present; (2) solitary diaphragmatic injuries seldom occur; (3) in most cases, morbidity or mortality is caused by the severity of the associated injuries; and (4) most diaphragmatic injuries can be repaired through a celiotomy, and all of them should be repaired to avoid the sequela of entrapment of abdominal organs in the thorax.

Accidents, Traffic↗
PubMed1988

Bronchobiliary fistula: complete percutaneous treatment with biliary drainage and stricture dilation.

Percutaneous transhepatic cholangiography was performed on an 18-year-old man who presented with jaundice and cholangitis 19 months after right hepatic lobe resection. The cholangiogram demonstrated a bronchobiliary fistula and a stricture of the common hepatic duct. Percutaneous therapy consisting of biliary drainage and balloon dilation cholangioplasty was successful in eradicating the fistula and reestablishing normal bile flow.

Adult↗
PubMed1986

Lateral pancreaticojejunostomy for pain relief in chronic pancreatitis: analysis of effectiveness in 19 patients.

To assess the relief of pain provided by a side-to-side lateral pancreaticojejunostomy (LPJ), we analyzed 19 patients with chronic pancreatitis operated on from 1973 to 1983. Fourteen patients were chronic alcoholics; abdominal pain was the indication for the operation in most patients; one patient died postoperatively. The pain was relieved in all 18 survivors, from 12 to 72 months in 15; in three the pain has recurred, suggesting that LPJ is effective in ablating the pain in patients with chronic pancreatitis, provided the pancreatic duct measures more than 6 mm in diameter, the length of the LPJ is at least 6 cm, and patients abstain from alcohol ingestion. CT adequately assesses pancreatic duct dilatation. One fourth of the patients also required choledochoduodenostomy to relieve biliary obstruction caused by the chronic pancreatitis.

Adolescent↗