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Biomedical subjects

L Allende

Publications and source records attributed to L Allende.

29 records · Page 2Linked to original sources
PubMed1991

Exteriorized colonic anastomosis.

The risk of anastomotic failure in the unprepared colon is generally high. Therefore, Hartmann's operation is frequently employed in emergencies. We present an alternative technique, the exteriorized anastomosis described until now only for cases of perforation. Exteriorized anastomosis was performed in 14 patients. The preoperative diagnosis was occlusive neoplasm, perforated diverticulitis or traumatic performation of the sigmoid colon. Four patients subsequently developed partial anastomotic dehiscence, but without the consequences of intraperitoneal dehiscence. We think that exteriorized anastomosis is a useful alternative in high risk situations.

Aged↗
PubMed1991

[Hemoperitoneum caused by spontaneous rupture of hepatocarcinoma. Apropos of 8 cases].

Spontaneous rupture of hepatoma is very rare in our means. We present 8 cases collected in our hospital. The treatment performed was direct hemostasis and packing of the bleeding area in 4 patients, ligature of the hepatic artery in two other patients and finally an hepatectomy in the remaining two. The 4 patients in whom we performed an hemostasis died during the postoperative period. The other 4, instead have a normal postoperative course. We think that the treatment of a bleeding hepatoma is hepatectomy, and when is not possible, the ligature of hepatic artery.

Carcinoma, Hepatocellular↗
PubMed1990

Long term survival and severe rebleeding after variceal sclerotherapy.

Of 197 consecutive patients with cirrhosis admitted because of bleeding from esophageal varices, 133 were included in a prospective study of elective sclerotherapy. We evaluated the incidence of extensive rebleeding and mortality rate. The period of study was 54 months and the mean follow-up period was 21 months. Forty-one patients had severe rebleeding and a majority of the episodes occurred during the first year. Only four patients had more than five sessions of sclerosis when rebleeding occurred. The probability rate for patients to be free of severe rebleeding after 48 months, according to Pugh's classification, was 88 per cent for those with grade A, 50 percent for grade B and 43 percent for grade C. The over-all mortality rate was 38.8 per cent (53 patients), with the highest rate noted during the first year. The mortality rate of patients with severe rebleeding was much higher than that of those who did not rebleed. Kaplan-Meier survival analysis at four years was 52 per cent, and survival rates in relation to Pugh's classification were 73 per cent for A, 53 per cent for B and 34 per cent for C. Differences between the three groups were statistically significant. Therefore, because of the high mortality rate associated with patients with cirrhosis and extensive rebleeding during the first year, it is important to achieve, as soon as possible, eradication of esophageal varices.

Adult↗
PubMed1989

The influence of age on early surgical treatment of acute cholecystitis.

This study was undertaken to assess the influence of age on the early surgical treatment of acute cholecystitis. One hundred consecutive patients who had early operations for acute cholecystitis were divided into two groups according to age. Group 1 consisted of 41 patients who were younger than 60 years of age, and group 2 was made up of 59 patients who were more than 60 years of age. Shock, leukocytosis, hyperglycemia and uremia were more common in those patients in group 2 (p less than 0.05). The over-all diagnostic effectiveness was 94 per cent. The mortality rate was 4.1 per cent (n = 4). There were no significant differences in morbidity and mortality between both groups. In conclusion, advanced age is not a contraindication for early surgical treatment of acute cholecystitis.

Acute Disease↗
PubMed1986

Meckel's diverticulum: value of ectopic tissue.

Cases of symptomatic Meckel's diverticulum treated surgically on an emergency basis during the last decade are reviewed. A series of 18 patients were divided into two groups depending on the presence or absence of ectopic tissue in the diverticulum. Group 1 consisted of five patients (28 percent) without ectopic tissue, and Group 2 consisted of 13 patients (72 percent) with ectopic tissue (8 gastric ectopia, 2 pancreatic ectopia, and 3 both gastric and pancreatic ectopia). Previous clinical records related to Meckel's diverticulum were found for 54 percent of the patients in Group 2 and for none of those in Group 1. The most common acute manifestations were intestinal occlusion (seven patients), digestive hemorrhage (five patients), and peritonitis (three patients). The postoperative course was 7 days in Group 1 and 15 days in Group 2 regardless of the surgical technique used. We conclude that the presence of ectopic tissue in patients with Meckel's diverticulum seems to be the main risk for occurrence of an acute nonmechanical complication. This complication appears more frequently and with more severity in young patients.

Adult↗
PubMedDate not supplied

Acute appendicitis complicating infectious mononucleosis: case report and review.

Acute appendicitis is an uncommon complication of infectious mononucleosis (IM) and can readily be misdiagnosed because of the acute abdominal pain with which patients with IM occasionally present. A case report is presented of a patient with IM who developed acute appendicitis during the acute phase of the illness. The appendicitis progressed to the formation of an abscess, which was evacuated at surgery. Histologic examination of the appendix showed absence of lymphoid follicles in the mucosal layer and intense lymphoid infiltration of the mucosa and submucosa by a mixed diffuse proliferation of lymphoid cells with groups of immunoblasts scattered among them. The lymphoid infiltrate was mainly composed of T lymphocytes; the anticomplementary immunofluorescent staining of the appendix for EBNA (Epstein-Barr nuclear antigen) was negative. Three cases of appendicitis complicating IM published in the literature are reviewed. All had clinical and histopathologic features similar to those of our patient and were cured after surgery. Our case report together with the literature review confirms that appendicitis in the acute phase of IM has distinct clinical and histopathologic features and thus has to be considered a true complication of IM rather than merely a simultaneous disease.

Acute Disease↗
PubMedDate not supplied

[Strongyloides stercoralis and HIV: a case report of an indigenous disseminated infection from non-endemic area].

Strongyloides stercoralis affects people who live in the tropics, but it also extends to temperate regions where its low incidence rate may lead to misdiagnose it. Inside the host this nematode may remain silent for many years, nevertheless, in patients infected with HIV its reactivation leads to a disseminated infection in ectopic sites. This report presents the case of a 34 years-old man infected with HIV who lived in a highland area in the province of Córdoba, Argentina. He was admitted to the hospital because of a complicated Pneumocystis jiroveci pneumonia, receiving trimethoprim-sulfamethoxazole and prednisone treatment. A few days after admission his conditions deteriorated badly, a sputum examination revealed filariform larvae of S. stercoralis, he was then given oral ivermectin medication (200 microg/kg/d). Malabsorption and ileus were installed and he died from multiorganic failure. The evolution of HIV infection to AIDS, a steroids treatment and therapy failure despite oral ivermectin triggered larvae proliferation and lead to disseminated hyperinfection until he died. This report presents not only the first case of disseminated strongyloidiasis detected in our Hospital but also an indigenous infection acquired in a non-endemic area. An awareness of an increased predisposition to this infection, especially in immunocompromised patients with malabsorption and ileus is of paramount importance, since failure to initiate appropriate therapy can lead to catastrophic outcomes, as illustrated in this case report.

Adult↗
PubMedDate not supplied

Perineal necrotizing infection.

Perineal necrotizing infection is a severe disease that ever since its first description by Fournier in 1883 has been referred to by many names prompted by its protean nature in terms of location and suspected etiology. We treated nine patients with PNI. The infection began as a perineal abscess of long evolution (7 days +/- 2 SD) in eight patients. The ninth patient had had an inguinal herniorrhaphy 3 days before. The cultures of the exudates and tissues always yielded aerobic and anaerobic mixed flora of colorectal origin, except in one instance, in which S. aureus and hemolytic streptococcus A were identified. The treatment was medical support and wide surgical debridement of the infected tissues. In six patients a left transverse colostomy was performed. Only one patient died, of septic shock. On the basis of the results in our series and on a review of the literature, it is our opinion that PNI is a mixed bacterial infection that despite its origin, clinical appearance and microbiologic findings, is highly uniform in terms of clinical course and treatment. Therapy is based on radical surgical debridement with excision of all necrotic tissue. The current plethora of terms seems impractical and confusing. We propose a rather comprehensive term perineal necrotizing infection for the sake of clarity.

Adult↗