Biomedical subjects

M A Machado

Publications and source records attributed to M A Machado.

At least 73 records · Page 4Linked to original sources

PubMedDate not supplied

[Videolaparoscopy gastrectomy for complicated peptic ulcer: technique and case report].

Since the introduction of H2 receptor antagonists and inhibitors of the acid pump, the indications for the surgical management of peptic disease have decreased significantly. However some patients presenting bleeding, perforation, gastric outlet obstruction and intractable peptic ulcer still need surgical treatment. The first laparoscopic Billroth II gastrectomy was performed in 1992. To date, laparoscopic gastrectomy has been performed by a small number of surgeons around the world. The aim of this study was to present a case of totally laparoscopic Billroth II gastrectomy and to describe an alternative technique using endoscopic stapling devices. We present a case of a 48-year-old man, complaining of severe epigastralgia, who had a 20-year history of peptic ulcer. Gastroscopy had revealed a duodenal ulcer and a deformity of the bulbus. A diagnosis of intractable peptic ulcer was made, and the patient underwent laparoscopic Billroth II gastrectomy with side-to-side intracorporeal gastrojejunostomy using endoscopic stapling devices. On postoperative day 1, he was able to walk. On postoperative day 3, he started on a clear liquid diet and was discharged on postoperative day 6. During his postoperative recovery, the patient experienced little pain and did not request narcotic analgesia. Laparoscopic gastric resection is an alternative to open procedure in well selected cases.

Gastrectomy↗

PubMedDate not supplied

Insulinoma: diagnostic strategies and surgical treatment. A 22-year experience.

BACKGROUND/AIMS: The efficacy of preoperative localization methods and the results of the surgical treatment of insulinoma were studied. METHODOLOGY: Fifty-nine patients referred for surgical treatment were studied and the results of the diagnostic tools for tumor localization were compared with findings at surgical intervention. The influence of the type of surgical procedure in the immediate and late postoperative course was also studied. RESULTS: Ultrasonography had a sensitivity of 30%, computed tomography 25%, angiography 54%, portal vein sampling 94%, endoscopic ultrasonography 27% and magnetic resonance 17%. Intraoperative palpation localized 98.2% of the tumors and by the addition of intraoperative echography, all lesions were identified. In 55 patients with benign lesions, 22 enucleations, 25 distal pancreatectomies, 7 pancreatectomies plus enucleation and one duodenopancreatectomy were performed. Malignant tumors were treated by pancreatic resection, postoperative hepatic artery embolization and systemic chemotherapy. There was no postoperative mortality. Pancreatic fistula was the most common complication. Three patients who underwent distal pancreatectomy developed late diabetes (9.3%). CONCLUSIONS: Extensive preoperative investigation, mainly with invasive methods, is not indicated and by combining intraoperative palpation and echography most of the cases can be adequately dealt with. Preservation of pancreatic tissue with enucleation and preservation of the spleen are the best choice for treatment of benign insulinomas.

Adolescent↗

PubMedDate not supplied

Absorbable versus nonabsorbable membranes and bone grafts in the treatment of ligature-induced peri-implantitis defects in dogs: a histometric investigation.

The purpose of this study was to histometrically evaluate an absorbable collagen membrane (Bio-Gide) and a nonabsorbable polytetrafluoroethylene membrane (PTFE), associated with or without bone grafts, regarding "re-osseointegration" after treating ligature-induced peri-implantitis defects in dogs. All mandibular premolars were removed from five 2-year-old mongrel dogs. After 3 months of healing, 3 titanium implants were placed on each side of the mandible. Experimental peri-implantitis was induced with ligatures after abutment connection. Ligatures and abutments were removed after 1 month and the bone defects were randomly assigned to one of the following treatments; debridement alone (DB), debridement plus PTFE membrane associated with mineralized bone graft (Bio-Oss) (GBR+BG-I), debridement plus collagen membrane (Bio-Gide) associated with mineralized bone graft (GBR+BG-II), debridement plus PTFE membrane (GBR-I), debridement plus collagen membrane (GBR-II), or debridement plus mineralized-bone graft (BG). The dogs were sacrificed after 5 months. Data analysis did not reveal significant differences among the treatments regarding the percentage of bone-to-implant contact ("re-osseointegration") within the limits of the threads of the implant (P = .997). Thus, in the treatment of peri-implantitis, debridement alone as well as grafting alone had the same effect as did either membrane.

Absorbable Implants↗

PubMedDate not supplied

Pancreatic head tumors with portal vein involvement: an alternative surgical approach.

BACKGROUND/AIMS: One of the determining factors for the unresectability of pancreatic head tumors is the involvement of the portal venous system. Recent reports show that the resection of tumors with portal vein involvement has similar results to lesions with same stage without portal vein invasion. The aim of this study is to present a technique that allows the resection of portal vein segments without the use of grafts and with a shorter period of intraoperative venous occlusion. METHODOLOGY: Fifteen patients with pancreatic head tumors and portal vein involvement were submitted to pancreaticoduodenectomy according to this technique. The main feature of the technique is starting the pancreatic dissection at the posterior aspect of the head of the pancreas. The superior mesenteric artery is completely dissected from the pancreatic tissues leaving the section of the pancreas and the resection of the portal vein to the last step. RESULTS: Portal vein flow occlusion did not exceed 10 minutes. There were no major postoperative complications or mortality. CONCLUSIONS: This maneuver allows an easier resection of the mobilized portal vein with a shorter period of venous clamping and reconstruction without the need of venous graft.

Adenocarcinoma↗

PubMedDate not supplied

[Cholecystectomy in patients with sickle-cell anemia].

The surgical treatment of cholelithiasis in patients with sickle cell anemia is rather frequently followed by the operative complications. In order to study the influence of pre-operative factors and post operative complications, 31 consecutive patients distributed in two groups has been studied. In group I, all the patients have been operated by conventional procedures with 43.75% of complications. In group II, a more appropriated technique and a better metabolic control ensured a lower morbidity (6.67%). There was no pos operative death in this series. Pre operative bilirubin levels was the only condition associated with increased pos operative morbidity.

Adolescent↗

PubMedDate not supplied

Gallbladder injuries due to blunt abdominal trauma: report on five cases and review of the literature.

Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of São Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature.

Abdominal Injuries↗

PubMedDate not supplied

[Carcinoid tumor of the duodenal papilla].

Carcinoid tumor of the duodenal papilla is very rare. The authors report the case of a 17 years old male with a carcinoid tumor at this site in whom a partial pancreatoduodenectomy was performed and who is well and asymptomatic 13 years after the surgical intervention. A review of literature of this unusual condition and a discussion about the treatment are presented.

Adolescent↗

PubMedDate not supplied

[Influence of diet composition on the late course of acute pancreatitis. Experimental study in rats].

Acute pancreatitis was induced with sodium taurocholate 1% in two lots of rats fed during 21 days with diets that differed in lipid composition. Serum amylase, pancreatic tissue enzymes (trypsinogen, chymotrypsinogen and amylase), pancreatic tissue nucleotides (RNA and DNA) and biopsies for histological study were collected in normal pair fed animals, and in the experimental lots 1, 4, 7 and 15 days after AP was induced. ANOVA and Student t-test were used for the comparison of biochemical data (p less than 0.05). They showed that acute pancreatitis aggravated progressively until the fourth day independently of the regimen. On the 15th day, the histological and biochemical parameters reached normal values. The authors concluded that high lipidic diet was not the main factor responsible for progressive injury of the pancreas.

Acute Disease↗

PubMedDate not supplied

[Acute abdomen in elderly patients].

Seventy nine elderly patients with acute abdominal conditions were operated on in the Emergency Service of the Hospital das Clinicas of the University of São Paulo from 1981 to 1985. Total mortality rate was 58.23%. In patients with acute vascular abdominal conditions it was 100%, in inflammatory conditions 55.17% and in intestinal obstruction 47.83%. The lowest mortality was observed in traumatic conditions (27.27%). Procrastination of operations was followed by higher mortality. In operations lasting more than three hours the mortality was significantly higher than in those lasting less than three hours. Associated diseases as well as reoperations increased the postoperative mortality.

Abdomen, Acute↗

PubMedDate not supplied

[Focal nodular hyperplasia of the liver observed in a patient undergoing prolonged therapy with ketoconazole].

The authors report on a 44 year old man presenting focal nodular hyperplasia of the liver associated with prolonged ketoconazole therapy in the absence of known intake of either estrogens of androgens as well as of any factor that could cause hyperproduction of estrogens. It seems possible the existence of an etiopathogenic relationship between prolonged ketoconazole therapy and focal nodular hyperplasia of the liver since ketoconazole inhibits steroidogenesis and can also increase the estradiol-testosterone ratio (E/T). This hormonal alteration is known to play an important role in the pathogenesis of several hepatic neoplasms, including focal nodular hyperplasia.

Adult↗

PubMedDate not supplied

[Internal biliary fistula: study of 13 cases and review of the literature].

Between 1986 and 1994 13 patients with spontaneous internal biliary fístula were operated at the Hospital das Clínicas of the University of São Paulo. Ten were patients women and three were men. Their mean age was 55.2 years (range 30 to 87 years). The etiology was cholelithiasis in all cases and the most frequent type of fístula was cholecystoduodenal. There was no mortality. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Adult↗

PubMedDate not supplied

[Anaphylaxis after dextran 40 infusion: report of a case and review of the literature].

Anaphylactic reactions to colloid volume substitutes, such as dextran, are rare, however, with their increasing utilization in clinical practice an increasing awareness of their potential antigenicity is required. This article reports a severe allergic reaction induced by infusion of dextran 40 during the beginning of a general anesthesia in a 59 year old patient who was going to be submitted to an operation for treatment of chagasic megacolon. The patient died from this complication after 28 days. A review of literature of this complication and a discussion about its physiopathological mechanism and prevention is presented.

Anaphylaxis↗

PubMedDate not supplied

[Traumatic injuries of the gallbladder and of the extrahepatic biliary tract: analysis of 45 cases].

Injury of the extra-hepatic biliary tract is infrequent, occurring in approximately 3.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury caused by blunt abdominal trauma is rare. PURPOSE--Retrospective analysis of 5069 patients with abdominal trauma treated at the Department of Surgery University of São Paulo School of Medicine over a six-year period from 1986 through 1991. METHODS--Forty five patients with gallbladder and extra-hepatic ducts injury were identified (0.89%) and divided in two groups according to the nature of trauma: 12 caused by non-penetrating injuries and 33 to penetrating injuries. Records, including operative and pathology reports, were reviewed to study the site of injury, associated intra-abdominal injuries, incidence, trauma scores, treatment, morbidity, mortality rates and correlated with the nature of the trauma. RESULTS--Overall mortality was 24.4%. The incidence was greater in patients sustaining penetrating abdominal trauma (p < 0.05). Forty of the 45 patients (88.9%) had liver lacerations, the most commonly seen injuries. The patients with blunt abdominal trauma had significant different trauma scores (p < 0.05) than those with penetrating trauma, indicating greater severity in this group of patients. CONCLUSION--There is a relation between severity of trauma and incidence of extra-hepatic biliary tract injury. However, in the penetrating trauma, the incidence of trauma is correlated with the direction of the wound and there is no relation with the severity of trauma. The greater mortality seen in the patients sustaining non-penetrating injury (p < 0.05) supports this observation.

Adolescent↗

PubMedDate not supplied

[Pyogenic hepatic abscess: report of 51 cases].

Pyogenic hepatic abscesses are uncommon. We report our findings in 51 patients with pyogenic liver abscess treated from 1975 through 1992. Twenty-eight patients were men and twenty-three were women. The median age of patients was 46 years (range, 13 to 77 years). Fever was present in 100% of patients, abdominal pain in 58.8% and jaundice in 39.2%. Twenty eight patients (54.9%) had leukocytosis; 45% hyperbilirrubinemia and 35.3% a high serum level of alkaline phosphatase. The most common cause of abscesses was biliary tract disease (66%). Thirty-three (64.7%) were surgically treated and thirteen underwent percutaneous drainage with 90.4% and 69.2% of good results, respectively. Mortality was 9.6% in the surgical group and 0% in the percutaneously drained group. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Adolescent↗

PubMedDate not supplied

[Traumatic injuries of the pancreas: report of 65 cases].

With the aim of aiding the accurate diagnosis and treatment of patients with pancreatic injuries, we reviewed the medical records of sixty-five patients, treated for traumatic pancreatic lesions at the Department of Surgery of the University of São Paulo in the 5-year period from 1989 through 1993. Records, including operative and pathology reports, were reviewed and the location of the pancreatic injury, associated intra-abdominal injuries, type of injury, trauma scores, treatment, complications and mortality rates recorded. There were 58 male and seven female patients with a mean age of 28.3 years (range, 2-77 years). Of the 65 pancreatic injuries, 45 (69.2%) were caused by penetrating wounds and twenty by blunt trauma. The most frequent site of lesion was the head of the pancreas (38.5%). Associated injuries were found in all but five of the patients. In the 65 patients, 170 intra-abdominal injuries were found (2.6 per patient). Twenty-eight of the 65 patients (43.1%) had liver lacerations. Lacerations of major abdominal vessels (27 patients), gastric lacerations (25 patients) and colorectal lacerations (17 patients) were the next most frequent injuries. Fifteen out of twenty patients died within two days after the accident from severe concomitant injuries. Simple drainage was performed in 33 patients, distal pancreatectomy in 17 and duodenopancreatectomy in six patients. Pancreas-related complications occurred in 20 (30.7%) out of 57 patients who survived the initial operation. We concluded that the type of repair employed in our series was related to the class of injury and clinical conditions (based on trauma scores). Therefore, whenever possible, conservative management (no pancreatic resection) was employed in patients that sustained class I and II injuries and pancreatic resection in class III and IV injuries.

Abdominal Injuries↗

PubMedDate not supplied

[Cystic neoplasm diagnosed as pancreatic pseudocyst: report of 5 cases and review of the literature].

The majority of cystic lesions of the pancreas are pseudocysts. Nine to thirteen per cent of pancreatic cyst are neoplastic, benign or malignant. Failure to recognize neoplastic nature of a cyst leads to an improper management. The authors present five cases of cystic tumors mistaken for pancreatic pseudocysts, including three mucinous cystadenomas and two mucinous cystadenocarcinomas. Four were drained by cystojejunostomy and one cystogastrostomy. One patient with no metastases at first operation had metastatic spread at reoperation. In the other four cases, subsequent resection was possible and probably curative. Review of the literature and guidelines are given for the purpose of differential diagnosis between theses entities.

Adult↗

PubMedDate not supplied

[Bouveret's syndrome: a case report].

A patient with duodenal obstruction resulting from passage of a gallstone through the wall of the gallbladder into the duodenum is reported. The patient was successfully treated by removal of the gallstone. A review of literature concerning the diagnosis, treatment and etiopathogenesis is presented.

Aged↗

PubMedDate not supplied

[Cystic neoplasm of the pancreas: analysis of 24 cases].

Cystic neoplasms are an uncommon group among pancreatic tumors. These lesions are seen more frequently in recent surgical practice, probably because of advances in diagnostic and surgical techniques. We report 24 patients with cystic tumors of the pancreas, including twelve patients with serous cystadenoma, ten with mucinous cystadenoma and two patients with mucinous cystadenocarcinoma. Twenty-two patients were women and two were man. The median age of patients was 53.5 years (range, 21 to 80 years). Mild abdominal pain was the main symptom; in 71% of patients and weight loss in 29% of patients. The lesions were incidental findings 8% of patients. The mean size of the cysts was 7.8 cm (range, 2.3 to 15cm). Eleven cystic neoplasms were located in the head, three in the neck, five in the body, two in the tail of pancreas and three in the body and tail. All patients underwent surgical exploration. There was no perioperative mortality. Total tumor resection provides the best chance of cure and may remove the risk of malignant transformation of the cystadenomas, particularly of the mucinous type.

Adult↗