Abdominal cocoon syndrome.
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Abdominal Pain↗
Biomedical subjects
Jose Carlos Del Grande
Publications and source records attributed to Jose Carlos Del Grande.
Obesity and symptomatic achalasia.
Weight loss is a frequent finding in achalasia because of the difficulty in swallowing. Although manometric findings compatible with achalasia have been found in morbidly obese patients, all of them were asymptomatic. The authors report a case of symptomatic achalasia and morbid obesity in a 38-year-old woman. A mental disorder become manifested after the patient was submitted to an esophageal myotomy and fundoplication. With weight gain, postoperative gastroesophageal reflux developed. Drawbacks of further operative procedures in such a patient are discussed.
Adult↗
Anatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese Society for Diseases of the Esophagus.
PURPOSE: Extended mediastinal lymphadenectomy is gaining popularity in the treatment of esophageal cancer, but lymph node nomenclature and classification is still not standardized. The normal mediastinal lymph node distribution according to the classification of the Japanese Society for Esophageal Diseases has never been studied. METHODS: We dissected 20 fresh adult cadavers to examine the mediastinal lymph nodes. RESULTS: We found an unpredictable and inconstant distribution. CONCLUSION: Previous papers have evaluated the number and distribution of normal mediastinal lymph nodes, clinically, radiologically, and anatomically, but the results are conflicting and inconsistent.
Adult↗
Short esophagus or bad dissected esophagus? An experimental cadaveric study.
Short esophagus is defined as the inability to reduce the gastroesophageal junction below the diaphragm. One of the factors responsible for this inability can be inadequate esophageal mobilization. We evaluated esophageal lengthening achieved by means of dissection in a cadaveric model. Fifty-one cadavers were dissected (27 transthoracically and 24 transhiatally). Abdominal esophageal length was assessed before and after dissection of the esophagus from the hiatus to the carina. In the transthoracic group, a mean of 1.7+/-1.3 cm (range 0.3 to 5.0 cm) was gained with dissection. In the transhiatal group, a mean of 1.8+/-0.8 cm (range 0 to 3.0 cm) was gained with dissection. In a comparison of results of transthoracic and transhiatal approaches, the difference was not statistically significant. We concluded that a significant increase in esophageal length was achieved after dissection; however, the access route (thorax or abdomen) did not influence the results.
Adult↗
Safety of cystic duct clipping in healthy and cirrhotic livers: a cadaveric study.
BACKGROUND AND OBJECTIVES: Biliary leakage through the cystic duct stump due to clip dislodgement has been a concern since the advent of the laparoscopic cholecystectomy. The authors proposed a cadaveric model to test the safety of cystic duct clipping in a hypertensive biliary tract in healthy and cirrhotic livers. METHODS: Twenty fresh cadavers were studied (5 cirrhotic, 15 healthy). Open cholecystectomy was performed and the cystic duct clipped with commercially available titanium clips. The distal common bile duct was catheterized to allow infusion of water and pressure measurement. RESULTS: Increased pressure in the bile duct resulted in back diffusion into the liver, preventing reaching high-pressure levels. Only 1 clip was dislodged in this situation, in a cirrhotic liver with a large cystic duct. As a second experiment, the hepatic hilum was clamped to allow higher pressures of the biliary tree (500 mm Hg). In this situation, no clip was dislodged. CONCLUSIONS: We have established the safety of cystic duct clipping in healthy and cirrhotic livers; however, bigger clips or alternative methods to seal the duct may be necessary in larger ducts.
Adult↗