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J Tocornal

Publications and source records attributed to J Tocornal.

18 recordsLinked to original sources
PubMed1983

Radiology of the Mirizzi syndrome: diagnostic importance of the transhepatic cholangiogram.

The essential feature of the MIrizzi syndrome is partial common hepatic duct obstruction due to an impacted cystic duct stone. This entity has rarely been reported but is apparently more common than previously thought. Our review of the world literature shows 42 proven cases in 18 publications from 7 different countries. We are adding 11 further cases with surgical proof. The preoperative x-ray diagnosis of the Mirizzi syndrome was established in 10 of the 42 previously reported cases. This diagnostic problem was probably due to limitations of plain film and intravenous cholangiography techniques. The preoperative diagnosis was possible in 8 of our 11 cases, primarily with the use of transhepatic cholangiography. The preoperative diagnosis is important and can lead to a decrease in surgical complications, particularly if stone penetration, fistula formation, and adjacent inflammatory masses are demonstrated.

Cholangiography↗
PubMed1981

Portosystemic shunts for extrahepatic portal hypertension in children.

Twenty-three children with prehepatic portal hypertension and hemorrhage due to ruptured esophagogastric varices had portosystemic shunts. Their ages ranged from two years and seven months to 15 years. Eleven were less than eight years of age. Twenty patients had portal vein cavernomatosis and three patients had double portal veins. In 21 patients, a mesocaval type of shunt was done. A splenorenal shunt was performed in two. There was no surgical mortality. Two shunts occluded, both in rather young infants--two years and seven months and three years of age. In all the others, there was no further bleeding, and the shunts remained patent, as shown by abdominal angiograms. Neuropsychiatric disorders, probably due to hepatic encephalopathy, occurred in only one patient. On the basis of this favorable experience, we believe that an elective portosystemic shunt should, in general, be performed upon children with prehepatic portal hypertension after one major variceal hemorrhage. We favor a mesocaval type of shunt in these children because of the larger diameter of the vessels involved in the anastomosis and because it preserves the spleen, maintaining defense against subsequent infection.

Adolescent↗
PubMed1981

Hepatic cholesterogenesis in Chileans with cholesterol gallstone disease. Evidence for sex differences in the regulation of hepatic cholesterol metabolism.

To test the hypothesis that hepatic cholesterol synthesis and concentration are specifically increased in women and men with cholesterol gallstone disease, we studied in a series of 24 surgical liver biopsy specimens, the rate of acetate incorporation into cholesterol and CO2, and the concentration of free and esterified cholesterol. There were 6 women in each group of 12 control and 12 gallstone patients. Therefore, hypersecretion of biliary cholesterol, a common finding in Chileans with gallstones, is not pathologically linked to a basic biochemical abnormality in the hepatic cholesterogenic pathway. The concentrations of hepatic cholesterol were similar in patients with and without gallstones. However, there were significant increments of 37% in the free fraction and 78% in the esterified fraction of hepatic cholesterol in female subjects, irrespectively of the presence of cholelithiasis. These results suggest that the flux of lipoprotein cholesterol to the liver is increased in women. The regulatory mechanism of hepatic cholesterogenesis is less sensitive to cellular cholesterol in women than in men, as the fluxes of acetate into cholesterol are similar to both sexes, in spite of the significant increase of hepatic cholesterol in females. These findings demonstrate that sex factors play a fundamental role in the regulation of cholesterol metabolism in the human liver.

Adult↗