[Congenital dilatation of the bile ducts. Analysis of 11 patients].
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Biomedical subjects
Publications and source records attributed to M C Machado.
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Obstructive jaundice in patients with chronic pancreatitis still constitutes a surgical problem deserving the attention of many specialized centers throughout the world. Out of a series of 149 patients operated upon for chronic pancreatitis, 45 (30.2%) with common duct stricture secondary to pancreatic disease have been studied in this series. Eleven patients (24.4%) had transient jaundice, eleven (24.4%) persistent cholestasis and six patients (13.3%) presented cholestasis with cholangitis. Seventeen patients (37.7%) were considered to have asymptomatic biliary tract stenosis. In 37 patients, pancreatic and biliary tract surgery were performed at the same time. There were two postoperative deaths (4.4%) and the late mortality was 9.3%. Choledochojejunostomy was preferred in the treatment of biliary stricture associated with pancreatitis. Cholecystojejunostomy provides inadequate biliary decompression and should not be used in the treatment of these patients. When a pancreatojejunostomy needs to be performed in association with biliary tract decompression, a double intestinal loop technique should be used because it is associated with less morbidity and mortality.
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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.
The study was performed to compare an usual method of induction of acute experimental pancreatitis with a simplified, easier and faster induction through a subcutaneous and intravenous injection of cerulein, with good reproducibility as compared to the literature. Four groups were studied. In the group I, continuous three hour intravenous injection of 15 micrograms/Kg of cerulein, was given. Group II was a control group with saline infusion. Group III received a subcutaneous injection of 20 micrograms/Kg and an intravenous injection of 20 micrograms/Kg of cerulein one hour later. Group IV was the control group with saline. The results of biochemical measurements, such as tecidual trypsinogen, chimotrypsinogen, proelastase, cathepsin and serum amylase, showed no difference between the two methods. Histologic study revealed edematous pancreatitis in group I and III, with moderate acinar necrose in group III. These results suggest that the proposed simplified method induces enough acute and edematous pancreatitis to allow studies in physiopathology and therapeutics.
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The authors present three cases of splenic artery aneurysm in a group of 96 patients with portal hypertension due to Schistosomiasis mansoni. Etiology, diagnosis and treatment are discussed.
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.
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.