PubMed Health⌕ Search

Biomedical subjects

L Mascarenhas

Publications and source records attributed to L Mascarenhas.

9 recordsLinked to original sources
PubMed1992

A comparison of perinatal outcome, antenatal and intrapartum care between England and Wales, and France.

OBJECTIVE: To compare the national statistics of England and Wales with the national statistics of France, and see if there are significant differences in obstetric care resulting in a significantly different perinatal outcome. DESIGN: Retrospective analysis of national statistics 1970-1989 (latest available figures) relating to perinatal outcome, antenatal and intrapartum care. SETTING: HIPE and DoH statistics (England and Wales); INSERM statistics (France). SUBJECTS: Pregnant women residents of England and Wales, and of France. INTERVENTIONS: Different aspects of obstetric care for which comparable data were available from national statistics. MAIN OUTCOME MEASURES: Perinatal mortality rate, incidence of low birth weight and preterm delivery; type of antenatal care, number of antenatal visits and in-patient admission rate; induction of labour rate, incidence of acceleration of labour with oxytocin, incidence of spontaneous and operative deliveries and person undertaking delivery; episiotomy rate and postnatal in-patient stay. RESULTS: More antenatal intervention and marginally less intrapartum intervention in England and Wales as compared with France. No significant difference in the perinatal mortality rate, in the incidence of low birth weight or preterm delivery, with similar trends being observed over the two decades. CONCLUSION: Significant differences in obstetric practices between the two countries without a major difference in perinatal outcome.

England↗
PubMedDate not supplied

[Roux-en-Y gastrectomy. A 12 years' experience].

A review of 161 patients who underwent Roux-en-Y biliary diversion and truncal vagotomy from 1978 to 1989 is performed under the double perspective: clinical and functional (using radionuclide semi-solid and liquid gastric emptying (GE) studies). In 46 patients this solution was adopted to treat different kinds of post-gastrectomy syndromes and in 115 to solve the esophageal-duodeno-gastric peptic disease. Some technical details are considered very important to prevent the nominated post Roux-en-Y Syndrome in relationship with the gastroparesis and gastric retention. The overall operative mortality was 2.5%. Five patients were reoperated: two, to complete vagotomy; 2, to solve gastric retention and one with sub-occlusion due to jejunal stricture. Forty one patients with 7.4 +/- 1.3 years after surgery were graded Visick I or II in 82.9% of the cases and 17.1% Visick III or IV. Gastric emptying studies demonstrated that the problems of gastric fullness detected in the immediate post operative period are quite similar to those observed after other kinds of sub-total gastrectomies. After 6 months, the gastric emptying change to a more rapid pattern in the large majority of patients. In the late post operative period is quite common to have no agreement between gastroparesis complains and the objective measurements of the GE, in symptomatic patients. Roux-en-Y gastrectomy solve the problems of post gastrectomy syndromes in 80% of the cases and in our experience, is a method that can be used with advantage to treat the ulcerative peptic disease resistant to the medical treatment in patients with less than 50 years.

Adult↗
PubMedDate not supplied

[Total gastrectomy with creation of a new stomach using the jejunum. A retrospective study of 120 patients].

Results obtained in 120 patients with gastric carcinoma, and submitted between 1982 and 1989, to a total gastrectomy and a new technique of reconstruction with jejunum, are analyzed retrospectively. This technique associates, a jejunoplication around the terminal esophagus with the purpose to eliminate the entero-esophageal reflux and the risk of dehiscence, and a double jejuno-jejunostomy with the target to delay the emptying of foods and to increase the reservoir function of the neo-stomach. In 63 of these patients a lymphadenectomy type R2-R3 has been held and in the remainder a type R1 lymph node dissection. Pre-operative chemotherapy was done when there was significant weight loss or proved obstruction of the cardia or pylorus by a radioisotopic method. Post-operative chemotherapy was continued immediately after operation in all the patients with pre-operative improvement. Operative mortality until the 60th day of Hospital stay was 5.8% and was mainly related with the advanced age of the patients and the spread and localization of the tumor. Operative morbidity was also more marked in tumors spreading to the cardia. The five years actuarial survival rate was 17.2% to the stage III and IV and 38.8% to the stage I and II. The quality of life of the patients has been favored by the kind of gastric reconstruction that has been used: Jejunoplication reduce the entero-esophageal reflux to nearly 20% and the double enterostomy, specially if the duodenal transit is maintained, induce a more slow post-operative emptying than other kinds of reconstruction. This fact is related with a more physiologic absorption of glucose and to a more favorable nutritional condition.

Adult↗
PubMedDate not supplied

[Surgical therapy of reflux esophagitis in patients with normal lower esophageal sphincter pressure].

In a group of 12 patients with reflux esophagitis resistant to the medical treatment and normal LES pressure, gastric emptying and bile-gastric (B.G.) reflux (HIDA-CCK test) were determined. All of the patients had delayed gastric emptying associated in seven with high levels of B.G. reflux. Two of the patients had an unsuccessful fundoplication two years ago and five have been cured of duodenal 3 or gastric 2 ulcer with antacids. Although there was an evolution to an ulcer scar in all of these patients the abdominal post-prandial pain persisted and some of them maintained occasional bilious vomiting. Deep gastritis with dysplasia and metaplasia of the gastric mucosa was demonstrated in all of these five patients. The esophagitis was an isolated phenomenon in 3 patients, one had a peptic esophageal stricture above de cardia, and another one a Barrett esophagus. A proximal gastric vagotomy (PGV) and pyloroplasty was performed in patients with delayed gastric emptying without BG reflux. The other 7 patients with concomitant high BG reflux were treated by a duodenal diversion to a Roux-en-Y loop and P.G.V. Esophageal and gastric symptoms disappeared soon after surgery. Esophageal biopsies were normal six months after surgery and the intense gastritis changed to a less serious form of superficial gastritis. It is concluded that delayed gastric emptying associated or not with high values of BG reflux can be the most important pathogenic factor that cause reflux esophagitis in this group of patients. The improvement of gastric emptying and elimination of BG reflux can be the proper method to treat these situations.

Adult↗