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Biomedical subjects

L Uscanga

Publications and source records attributed to L Uscanga.

At least 19 recordsLinked to original sources
PubMed2006

[Predictive factors for portal hypertension in patients with primary sclerosing cholangitis].

BACKGROUND: Primary sclerosing cholangitis (PSC) is characterized by progressive destruction of bile ducts, which may lead to cirrhosis and portal hypertension. The factors associated with the presence of esophageal varices (EV) and the risk of bleeding have not been well defined. AIM: To determine the factors associated with the presence of EV and risk of bleeding in a cohort of patients with PSC. MATERIAL AND METHODS: We analyzed the demographic, biochemical and endoscopic characteristics, and follow-up of 32 patients with a diagnosis of PSC. All patients underwent endoscopic evaluation to determine the presence of EV at diagnosis and annually during follow-up. RESULTS: There were 24 men (75%) and 8 women (25%). The mean age was 40.2 years (range, 19-66). At diagnosis, none of the patients had a previous history of variceal bleeding and 4 (13%) had EV on endoscopic examination. In bivariate analysis, the factors associated with the presence of EV were: splenomegaly (4/6 vs 0/26; p < 0.001), ascites (2/4 vs 0/24; p < 0.001), thrombocytopenia (96 +/- 27 vs 299 +/- 135 x 10(3), p < 0.001), and hypoalbuminemia (2.4 +/- 0.6 vs 3.5 +/- 0.6 g/dl; p = 0.005). During a mean follow-up period of 7 years (range, 2-15 years), 6 patients developed EV and 7 patients had at least one episode of variceal bleeding. In logistic regression analysis, the factors independently associated with the presence of EV at diagnosis were thrombocytopenia (p = 0.001) and splenomegaly (p = 0.01). The factors associated with variceal bleeding were worsening of liver function (p = 0.01) and splenomegaly (p = 0.02). CONCLUSIONS: There are noninvasive indicators of portal hypertension that could predict the presence of EV and risk of bleeding in patients with PSC. The presence of thrombocytopenia, splenomegaly or worsening of liver function should be detected in these patients, as they could benefit from endoscopic surveillance.

Adult↗
PubMed2000

Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis.

HYPOTHESIS: A worse clinical outcome might be expected in patients with acute pancreatitis (AP) who receive intravenous contrast medium for a nondynamic contrast-enhanced computed tomographic (CECT) study early during hospital admission. DESIGN: Cohort analytic study. SETTING: Tertiary care center. PATIENTS: Of 126 patients with mild AP, 52 patients underwent CECT to establish AP diagnosis (group 1), and the remaining 74 did not (group 2). MAIN OUTCOME MEASURES: Survival and development of local or systemic complications during the hospital stay. Potential confounders were demographic, clinical, and biochemical data, as well as therapeutic measures. The Atlanta classification was used to define local and systemic complications. RESULTS: Mean age, etiology of AP, prognostic score on admission, and pharmacologic treatment were similar between groups. Local and systemic complications were more frequently observed in patients who underwent CECT (odds ratio, 11.4; 95% confidence interval, 2.0-64.8; P =.008). Six patients, all in group 1, developed a pancreatic abscess (odds ratio, 20.8; P =.004). In 5 of them, a second CECT showed more severe AP changes. The association between CECT and abscess development was more apparent in patients with a body mass index of 25 or more and/or nasogastric suction. Six patients in group 1 and 1 in group 2 had systemic complications (odds ratio, 9. 5; P =.01). There were no deaths. CONCLUSIONS: The observed increased incidence of local and systemic complications in patients with mild AP who undergo CECT, particularly in those with a body mass index of 25 or more, suggests a potentially harmful effect of intravenous contrast medium. Until this issue is clarified, it seems reasonable to restrict the use of dynamic CECT to patients with severe AP, protracted clinical course, or suspected local septic complication.

Acute Disease↗
PubMed2000

Toxic pseudomembranous colitis in a patient with ulcerative colitis.

UNLABELLED: Toxic colitis is a severe disease that may be caused by several inflammatory and/or infectious diseases. Ulcerative colitis is one of the most frequent causes of toxic colitis in the United States. Toxic megacolon complicating Clostridium difficile colitis is a rare occurrence with significant morbidity and mortality. CASE REPORT: A 52-year-old male presented with rectal bleeding and tenesmus. He had been treated for amebiasis with metronidazole, and had improved. Two weeks later, symptoms recurred, and he was referred to our hospital. A sigmoidoscopy and biopsies demonstrated mucosal ulcerative colitis. He underwent treatment with systemic prednisone, mesalamine, and hydrocortisone enemas with adequate response. He was asymptomatic for 2 months, but later presented with a tender abdomen and rectal bleeding. Plain abdominal and thorax films showed colonic distention and free intraperitoneal air. Emergency laparotomy was performed, and an inflamed and distended colon, with free inflammatory liquid in the peritoneum, was found. A total abdominal colectomy with temporary ileostomy and Hartmann's pouch was performed. The histopathology analysis demonstrated a Clostridium difficile pseudomembranous colitis. CONCLUSION: The presence of toxic megacolon due to Clostridium difficile in patients with ulcerative colitis is a rare complication that may be suspected in patients with initial relapse who are on antibiotics.

Abdominal Pain↗
PubMed1997

Pain relief in chronic pancreatitis by pancreatico-jejunostomy. An institutional experience.

Effective pain control in chronic pancreatitis can be accomplished by pancreatic resection or decompression. Pancreatico-jejunostomy (PJ) has been reported to be effective for relieving pain in 70-80% of cases. The present study analyzes the authors' long-term results with PJ in the treatment of pancreatic pain. From 1963 to 1993, 49 patients with chronic pancreatitis underwent PJ for uncontrollable pain. General and radiologic characteristics, intraoperative findings and outcome were analyzed. Mean age was 35 +/- 13 years, 34 were male and 15 female. Alcoholic etiology was documented in 23 patients. Multiple pancreatic calcifications were found in 33 patients. Pancreatic biopsy confirmed chronic pancreatitis in all patients. There was one operative mortality, 12 minor, and 4 major complications. In a mean follow-up of 6.5 years, 98% of the total group was found to be free of pain. Pancreatic function remained stable in most patients. PJ is an excellent procedure for pain control that allows stable pancreatic function.

Adult↗
PubMed1995

Clinical behavior and prognostic factors of periampullary adenocarcinoma.

OBJECTIVE: The authors evaluated the outcome and potential prognostic factors of 60 patients with surgically resected periampullary tumors. SUMMARY BACKGROUND DATA: Periampullary carcinomas exhibit different clinical behaviors according to their site of origin. There are no prognostic factors for deciding the type of surgery to be used or for choosing patients with tumors that have a poor prognosis for adjuvant treatment. METHODS: A retrospective review was performed of 15 clinical and pathologic variables encountered among 60 patients with periampullary tumors. Tumors were divided into four groups according to their site of origin. Kaplan-Meier survival curves of the four groups were plotted and differences were evaluated with the log-rank test. Cox's proportional hazards model was used to test for separate and combined independent predictors of disease-free survival. RESULTS: Twenty-nine ampullary carcinomas, 20 ductal pancreatic carcinomas, 7 distal common bile duct carcinomas, and 4 carcinomas of the periampullary duodenum were found. Five-year disease-free survival was 43%, 0%, 0%, and 75%, respectively. According to the Cox analysis, absence of neural invasion and use of adjuvant chemotherapy were significant factors for longer survival of patients with ampullary tumors. Lymphatic invasion was related to a shorter survival in patients with pancreatic carcinoma. CONCLUSIONS: Five-year disease-free survival of patients with periampullary tumors is related to tumor type. Prognosis was better for ampullary tumors if neural invasion was absent and if adjuvant chemotherapy was used. Lymphatic invasion was associated with a shorter recurrence-free survival among patients with pancreatic carcinoma.

Adenocarcinoma↗
PubMed1990

Chronic pancreatitis in Mexico City.

The incidence, etiology, clinical characteristics, and long-term outcome of patients with chronic pancreatitis (CP) studied at the Instituto Nacional de la Nutrición in a 12-year period were retrospectively analyzed. One hundred fifty cases were identified, with an overall incidence of 4.4 per 1,000 hospital admissions and of 5.4 per 1,000 in the last 6 years. In 68% of the cases, CP was secondary to alcoholism, in 29% it was idiopathic, and in the rest it was secondary to other causes. Overall, 74% of patients had pancreatic calcifications at time diagnosis was established, and 21% were asymptomatic regarding pain. Patients with idiopathic CP had an earlier age of onset than did patients with alcoholic CP, and in addition the former developed symptoms of diabetes or pancreatic exocrine insufficiency less frequently than alcoholic patients did (p less than 0.05). The sex ratio was different in both groups, with a marked male predominance in alcoholic CP and an equal distribution in the idiopathic group. A 30% actuarial mortality was found in the first 10 years after the onset of the disease, which remained the same at 20 years with a tendency to better survival in nonalcoholic patients. Five patients developed pancreatic cancer throughout the study period.

Adult↗
PubMed1987

Sequential connective matrix changes in experimental acute pancreatitis. An immunohistochemical and biochemical assessment in the rat.

The effects of acute pancreatitis on the rat pancreatic connective tissue matrix were studied following intraductal pancreatic injection of trypsin solution and serial killing of the animals. Pancreatic tissue was examined using light microscopy, hydroxyproline measurement and indirect immunofluorescence, using antibodies against collagen types I, III, IV, procollagen III, fibronectin and laminin. Light microscopy revealed that acute pancreatitis was present for up to four days after injection and that perilobular and intralobular fibrosis appeared at four days and subsequently regressed. Immunofluorescence studies demonstrated an abnormal fibronectin deposit at one day in acute pancreatitis. At four days this deposit was co-located with fibrosis which was composed of collagen and procollagen type III. By eight days the immunofluorescence and light microscopic changes were minimal. Biochemical analysis confirmed a significant rise in hydroxyproline concentration at four days, which was maximal at eight days, subsequently decreasing. This peak at eight days probably reflects collagen breakdown products.

Acute Disease↗
PubMed1987

Pancreatic extracellular matrix alterations in chronic pancreatitis.

The proliferation of pancreatic extracellular matrix, which characterizes chronic pancreatitis, has been analysed using immunohistochemistry. The relationship of matrix components to intraductal precipitates and the presence of serum proteins in precipitates were also studied to investigate the suggestion that ductal permeability increases in chronic pancreatitis. Pancreatic tissue from organ donors was compared with that from patients with chronic calcifying or chronic obstructive pancreatitis. Frozen sections were labeled with monospecific antibodies to collagen types I, III, pro-III and IV, laminin, fibronectin, IgG, IgA, and IgM and then visualized by indirect immunofluorescence. In chronic pancreatitis, interstitial collagens and fibronectin appeared increased and disorganized in both fibrous tissue and areas that appeared histologically normal. Type IV collagen distribution was abnormal and in some sites was present with interstitial collagen. In addition, intraductal precipitates were shown to contain immunoglobulins, and defects were identified in the duct basal lamina associated with precipitates. These results demonstrate that in chronic pancreatitis interstitial collagens are extensively disorganized, the fibrosis possibly being relatively labile. The presence of serum proteins in intraductal precipitates confirms an increase in ductal permeability, and associated defects in the basal lamina appear to define a route via which serum proteins may enter the intraluminal compartment.

Adult↗
PubMed1985

Nutritional data and etiology of chronic pancreatitis in Mexico.

Alcoholism and malnutrition have been implicated commonly in the etiology of chronic pancreatitis (CP). The geographical distribution and clinical and nutritional features differ between the alcoholic and tropical forms of CP. This work presents the etiology and nutritional characteristics of CP in Mexico, a country in which both alcoholism and childhood malnutrition are common. Two well-defined groups of patients have been identified: an alcoholic group composed mainly of males with a mean age at clinical onset of 41 years and a high dietary intake of fat, protein, carbohydrates, and calories; and a nonalcoholic group with a female preponderance, a mean age at onset of 23 years, and a higher intake of protein than controls. We conclude that alcoholic chronic pancreatitis in Mexico is similar to that reported in other temperate countries. Although the nonalcoholic group resembles that observed in tropical countries in many ways, our patients are not malnourished, further questioning the role of childhood malnutrition in the pathogenesis of this type of chronic pancreatitis.

Adolescent↗
PubMed1984

Immunolocalization of collagen types, laminin and fibronectin in the normal human pancreas.

In order to define the connective matrix organization of the normal human pancreas collagen types I, III, pro-III and IV, laminin and fibronectin were labeled using specific, antihuman antibodies. Visualization was by indirect immunofluorescence. Collagen types I, III and pro-III were present within lobules: around acini, ducts and small vessels. Their immunofluorescence reaction was particularly obvious in septa and it also outlined interlobular vessels and ducts. The type III and pro-III fractions possessed a characteristic, branched appearance in many situations, when compared to the more linear type I reaction. Collagen type IV, laminin and fibronectin were closely applied to acini, ducts and vessels, but in contrast to the other collagen types were absent from septa.

Antibodies↗
PubMed1981

Dissolution of cholesterol ductal stones in the biliary tree with medium-chain glycerides.

In vitro and in vivo experiments were carried out with medium-chain glycerides. In vitro, cholesterol gallstones were rapidly dissolved by medium-chain glycerides; control experiments with saline solution failed to modify the size of the stones. In vivo, medium-chain glycerides were instilled through an intraductal tube in 12 patients with retained bile duct stones. Perfusions lasted 2-10 days. After perfusion, stones disappeared in six cases, were reduced in size in one case, and remained unchanged in five cases. In five cases, nausea, vomiting, diarrhea, or pain were observed. Medium-chain glyceride infusion rapidly dissolves cholesterol gallstones, but is commonly associated with mild to severe side effects.

Cholesterol↗
PubMedDate not supplied

[Dissolution of pancreatic calcifications with oral citrates in a woman with chronic idiopathic pancreatitis].

Pain control is one of the most important objectives in the medical treatment of patients with chronic calcifying pancreatitis (CCP). It is generally accepted that pain in CCP is secondary to the obstruction of the pancreatic duct by calcifications, protein plugs and stenotic areas. Experimental studies have shown that calculi and protein plugs are soluble in citrates. We report here the case of a young non alcoholic woman with idiopathic CCP who after a pancreatojejunostomy developed again pain and pancreatic calcifications which were dissolved with oral citrates. The case confirms previous observations and illustrates the potential use of citrates in subjects with CCP.

Abdominal Pain↗
PubMedDate not supplied

[Pancreatic phlegmon: a potentially fatal form of acute pancreatitis].

AIM: To report the clinical characteristics of a group of patients with pancreatic phlegmon (PF) seen at the Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City. MATERIAL AND METHODS: We reviewed all the cases of acute pancreatitis hospitalized from January 1981 to December 1989. The diagnosis of pancreatic phlegmon was established when the CT scan showed a solid mass in the pancreas and peripancreatic region with more than 20 Hounsfield units without liquid collections or a fibrous capsule. We analyzed clinical, biochemical, and radiological data. RESULTS: Acute pancreatitis was diagnosed in 132 patients. In 14 a pancreatic phlegmon was observed (10.6%). Twelve were men; the mean age was 44.7 years. In six cases acute pancreatitis was secondary to alcohol abuse and in four to gallstones. Abdominal pain was present in all patients. Ten had leucocitosis and seven fever and/or jaundice. An abdominal mass was detected in three cases. The severity of pancreatitis was graded according to our institutional criteria as mild (0-2 signs) or severe (3-5 signs). In 10 patients AP was graded as mild: no mortality was observed in this group but three presented complications (two liquid collections and one an abscess). The four patients with severe pancreatitis presented complications and three died (one abscess, two multiorgan failure). Five patients were operated on. In three an abscess was drained. CONCLUSIONS: Pancreatic phlegmon is a potentially severe form of AP. All patients who died presented, in addition to PF, clinical criteria of severe pancreatitis.

Acute Disease↗
PubMedDate not supplied

[4 cases of annular pancreas at the Instituto Nacional de la Nutrición Salvador Zubirán].

Annular pancreas (AP) is a rare congenital anomaly due to malrotation of the pancreatic ventral yolk. Although it has been described in young and middle age adults it predominates in children. Its clinical picture is that of duodenal obstruction or acute pancreatitis episodes. In this paper we report four cases of AP that were seen at the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. Three were females and three were less than twenty years old. In one case the diagnosis was established at birth and the operation done in another hospital. In another patient a diagnosis of pyloric hypertrophy was made and a pyloroplasty was performed. This young man was admitted in our hospital because of abdominal pain and hyperamylasemia. An eighty four year old woman was seen due to abdominal pain, nausea and vomit. In all cases the diagnosis of AP was carried out with radiological studies and confirmed by laparotomy. Surgical procedures consisted of duodenal-duodenal anastomosis in two, sphincteroplasty in one, and gastrojejunoanastomosis in the other. Two patients are asymptomatic, one died in the postoperative period, and one was lost for follow up. These four cases represent all the experience of our institute and correspond to one case in 36,735 admissions.

Abdominal Pain↗
PubMedDate not supplied

[Late complication of diabetes mellitus of pancreatic origin].

At Instituto Nacional de la Nutrición SZ in Mexico City, we reviewed 30 years of experience and selected 46 patients with Pancreatic Diabetes (PD), without family history of Diabetes Mellitus (DM) with at less two years of follow-up. Alcoholic chronic pancreatitis (CP) was found in 36 patients, in seven it was idiophatic and in three was secondary to pancreatectomy. We compared the evolution of this patients with a group of (DM) patients similar in age, sex, glucemic control and time of onset. There were no statistical differences between groups in the follow-up of diabetic complications, only it was found a tendency to have higher lipid levels, macroangiopathy and retinopathy in those with DM. We concluded that CP have similar evolution as DM and could have deleterous complications in the large follow up.

Adult↗
PubMedDate not supplied

[Serum macroamylase in a subject with non-Hodgkin's lymphoma].

Macroamylasemia (MA) is a rare condition characterized by an active macromolecular complex formed by normal amylase with abnormal proteins; to our knowledge, it has not been previously described in Mexico. The size of the macromolecular complex precludes its renal excretion; thus MA is characterized by high levels of amylase in serum with normal amylasuria. We report a 53-year-old male with abdominal pain and hyperamylasemia who was erroneously diagnosed as pancreatitis. Amylase in urine was normal and a protein electrophoresis demonstrated hyperglobulinemia. Several months after the initial work-up, the diagnosis of non-Hodgkin's lymphoma was established. Serum pancreatic amylase was again found elevated with normal urinary amylase. Precipitation of amylase with polyethylene-glycol was of 81% (normal: less than 70%). This established the diagnosis of MA associated to non-Hodgkin's lymphoma. After chemotherapy, the abnormal macroamylasemia and hyperglobulinemia disappeared.

Alcoholism↗
PubMedDate not supplied

[Physiopathology of cholesterol biliary calculi].

The development of gallstones into the gallbladder is a dynamic event that comprises many contributing factors. In this work we reviewed the main factors such as physico-chemical properties of the major components of bile, with the purpose of obtain better understanding of the pathogenesis of cholesterol gallstones.

Bile↗