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M J Varas

Publications and source records attributed to M J Varas.

At least 19 recordsLinked to original sources
PubMed2006

Endoscopic staging of low-grade gastric MALT lymphoma.

INTRODUCTION: Endoscopic ultrasonography (EUS) has already proven useful in the assessment of submucosal lesions, and the staging of gastrointestinal cancer, particularly gastric MALT-type lymphoma. The goal of this paper was EUS staging. PATIENTS AND METHOD: 24 patients (10 females, 14 males) with a median age of 56 years and possibly gastric MALT lymphoma (25 cases) were studied using videoendoscopy, biopsies, and echoendoscopy with 7.5- and 20-MHz radial EUS, and also with 12- and 20-MHz miniprobes (MPs). Nineteen patients were definitely evaluated (7 females, 12 males) as having 20 MALT-type lymphomas, as five patients were post-hoc disregarded when an invasive, high-grade gastric lymphoma (3c) or plasmocytoma (2c) was subsequently demonstrated. Of these 19 patients, all had T1 lesions except for two with T2 lesions; one patient had a gastroduodenal T1 lymphoma. Echographic findings with MPs were compared to EUS (gold standard) and histology both before and after eradication. Then, patients were followed up every 1-3-6 months using videoendoscopy and MPs. RESULTS: Echoendoscopy correctly identified T stages in 90% of cases. MPs identified T stages in 88% of cases, and N stages in 33% of cases, with results being slightly inferior to those obtained with conventional EUS (91 vs. 45%); they were consequently used for follow-up. After eradication, all but two patients are in complete remission and have been followed every 1-3-6 months using MPs without echographic abnormalities, except for a patient who relapsed.

Adolescent↗
PubMed2005

Our cumulative experience with transendoscopic miniprobes.

INTRODUCTION: Transendoscopic miniprobes (TEMPs) have nowadays precise indications, but may become a diagnostic alternative to both radial and sectorial endoscopic ultrasonography (EUS) in the near future. PATIENTS AND METHODS: From November 1996 to July 2004 we carried out 620 examinations using TEMPs (124 during the last 12 months in 2003, with currently a mean of 11 examinations/month). Twenty explorations were performed with radial, 12.5 MHz (20 mm penetration), 6.2 F (2 mm diameter), 950 mm or 2000 mm Microvasive Endosound probes. Twenty explorations were performed using a 12 MHz (29 mm mean penetration) or 20 MHz (18 mm penetration) Olympus UM-2R/3R, or with a 12 MHz UM-DP12-25R or 20 MHz UM-DP20-25 R DPR-fitted Olympus probe, 2.5 mm in diameter and 2050 mm in length. A 20 MHz, 2.2 mm, wire-guided G20-29R was used for intraductal studies. In all, 580 examinations were carried out with both radial and linear, 12 MHz (240 E) or 20 MHz (60 E) Fuji probes, 2.6 mm in diameter and 1900 mm in length; and with a 7.5 MHz, 2.6 mm radial balloon microprobe with the well-known "preload" system that we have been using during the 1999-2004 period (280 E). Here we used a 3.2 mm working channel, whereas a 2.8 mm working channel was used with the remaining TEMPs. RESULTS: Twenty GI-tract examinations were performed with one Microvasive probe, which broke down when attempting its passage through the papilla. Currently we use a 20 MHz, 2.2 mm Olympus G20-29R guided microprobe for intraductal studies. We performed 100 gut examinations using one single Fuji TEMP (12 or 7.5 MHz). Organs explored included: esophagus and stomach, 60%; rectum and colon, 30%; other (duodenum, papilla, bile ducts), 10%. INDICATIONS: cancer staging, 35%; submucosal lesions, 30%; other, 35% (including 20% of esophageal non-tumoral conditions). COMPLICATIONS: aspiration, perforation, and mortality, 0%. Morbidity, 10%, at the expense of abdominal pain as induced by endoscopy itself. All strictures were successfully passed, except for one malignant stenosis in the rectum. CONCLUSIONS: During a 93-month period (1996-2004) we performed 620 explorations with TEMPs, with a current average of 11 examinations/month. TEMP durability is around 100 gut explorations. The esophagus and stomach were examined in 60% of cases. Primary indications included gut cancer staging and submucosal lesions (65%). Perforation and mortality rates amounted to 0%.

Endosonography↗
PubMed1999

[Echo-endoscopy: the clinical implications after a period of more than 16 years of its existence].

Endosonography is an imaging diagnostic technique recently introduced in our country. It allows us to perform an ultrasound from within the digestive tube. Because of the transducer proximity to the gut wall and the high frequency of emission we are able to visualize with great resolution small lesions as well as differentiate the five layers of the gastric wall and examine structures close to the digestive lumen with a 7 to 8 cm penetration. This is a brief introduction to the basic pillars of endosonography and its main indications, well defined after sixteen years of clinical practice.

Digestive System Diseases↗
PubMed1995

Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia. Role of cholecystectomy.

To establish the pathogenic role of duodenogastric reflux in dyspeptic symptoms we have compared the clinical features, gastrointestinal motility, and rates of duodenogastric bile reflux in 12 cholecistectomized dyspeptic patients, 12 dyspeptic patients with intact gallbladder, and 12 healthy controls. Specific symptoms were scored for severity and frequency. Gastrointestinal manometry was performed during 3 hr of fasting and 2 hr postprandially. Simultaneously, samples of duodenal and gastric contents were obtained sequentially for quantification of bile acids. Results show that symptom global severity (9.6 +/- 0.4 vs 8.8 +/- 0.7) and frequency (9.9 +/- 0.8 vs 9.0 +/- 0.5) were similar in both dyspeptic groups; only abdominal pain was milder in cholecystectomized patients (1.9 +/- 0.1 vs 2.6 +/- 0.2; P < 0.05). Fasting gastric bile acid concentrations were higher in cholecystectomized patients (P < 0.05) and antral postcibal motility lower (P < 0.05) than in the groups. No relation among gastric hypomotility, duodenogastric bile reflux, and symptom scores was detected. We concluded that patients with functional dyspepsia and a prior cholecystectomy have clinical features similar to those with gallbladders, but some physiological features are dissimilar: antral motility is decreased and duodenogastric bile reflux is increased. Thus, a uniform clinical expression of various pathophysiological disturbances constitutes the basis of functional dyspepsia.

Adult↗
PubMed1995

Does Helicobacter pylori infection increase gastric sensitivity in functional dyspepsia?

The role of Helicobacter pylori infection in the pathogenesis of functional dyspepsia is debated. It is known that a substantial fraction of dyspeptic patients manifest a low discomfort threshold to gastric distension. This study investigated the symptomatic pattern in 27 H pylori positive and 23 H pylori negative patients with chronic functional dyspepsia, and potential relations between infection and gastric hyperalgesia. Specific symptoms (pain, nausea, vomiting, bloating/fullness, early satiety) were scored from 0 to 3 for severity and frequency (global symptom scores: 0-15). The mechanical and perceptive responses to gastric accommodation were evaluated with an electronic barostat that produced graded isobaric distensions from 0 to 20 mm Hg in 2 mm Hg steps up to 600 ml. Gastric compliance (volume/pressure relation) and perception (rating scale: 0-10) were quantified. Standard gastrointestinal manometry and recorded phasic pressure activity at eight separate sites during fasting and postprandially were also assessed. H pylori positive and H pylori negative patients manifested similar severity and frequency of specific symptoms and global symptom scores (mean (SEM)) (severity: 9.5 (2.0) v 9.0 (2.1); frequency: 10.8 (2.0) v 9.7 (2.2)). No differences were seen either in gastric compliance (53 (4) ml/mm Hg v 43 (3) ml/mm Hg) or in gastric perception of distension (slope: 0.50 (0.05) v 0.53 (0.06)). Postprandial antral motility was significantly decreased in H pylori positive patients (two hours motility index: 10.4 (0.6) v 12.6 (0.5); p < 0.05). It is concluded that H pylori infected patients with functional dyspepsia present no distinctive symptoms by comparison with H pylori negative counterparts and H pylori infection is associated with diminished postprandial antral motility but it does not increase perception of gastric distension.

Adolescent↗
PubMed1994

[Value of endoscopic ultrasonography in the diagnosis of pancreatic and gastroduodenal endocrine tumors].

OBJECTIVE: To present our experience in the localization of endocrine-gastroenteropancreatic tumors (EGPT) by endoscopic ultrasonography. METHODS: Endoscopic ultrasonography was performed in 10 patients with 13 pancreatic tumors and four in the digestive tract. RESULTS: Sensitivity and diagnostic efficacy were 69% and 70%, respectively. These values were greater than those observed by other image techniques. Also, additional diagnoses and other three tumors of less than 1 cm undiagnosed by ultrasonography (US), Computer Tomography (CT) and Magnetic Resonance (MR), were detected. Specificity was 80% because among five case-controls a false positive was found. With more experience and the possibility to find small tumors, USE should improve other image techniques in the diagnosis and localization of endocrine digestive tumors.

Adenoma, Islet Cell↗
PubMed1990

[Steatorrhea and its treatment with pancreatic enzymes in endocrine tumors of the pancreas (pancreatic adenomas)].

We report the treatment of steatorrhea with pancreatic enzymes in four pancreatic endocrine tumors treated in our hospital. All four patients were males, with a mean age of 50 +/- 4.6, a basal steatorrhea of 10.8 +/- 3.7 g/24 h (N: less than 5 g/24 h), and a defecation rate of 1.8 +/- 0.8 (mean +/- SD). They were treated for one week with Pankreon 700 in the form of pills of 700 mg pancreatin (28,000 U lipase PIF, 22,000 U amylase PIF and 1,500 U protease PIF). They were given 15 pills/day divided into three doses. The mean steatorrhea dropped to 7.1 +/- 1.5 g/24 h. Then the patients were given Creon capsules with 300 mg pancreatin in pellets (8,000 U lipase PIF, 9,000 U amylase PIF and 450 U protease PIF). They were given six capsules/day divided into three doses, and the steatorrhea dropped to 7.2 +/- 4.1 g/24 h, while the rate of defecation dropped to 1/day. On comparison of the two products (Pankreon-- a classic form of pancreatin, and Creon-- a modern galenical in pellets), it was found that Creon achieved the same results as Pankreon 700 in a doses 2.5 times lower. This pilot study demonstrates that exocrine pancreatic insufficiency can be frequent in endocrine tumors of the pancreas, and although underestimated, it can be partially corrected with pancreatic enzymes.

Amylases↗
PubMed1989

[Ranitidine and cimetidine in long-term (2 years) maintenance therapy of chronic gastric ulcer].

Sixty patients with chronic gastric ulcer (UGC) received randomly cimetidine (CMT) or ranitidine (RNT) for 2 years, at a dose of 400 mg/night CMT or 150 mg/night RNT, in a prospective, controlled, simple blind clinical trial of these medications and endoscopy findings. The objective was to evaluate the brute rate of symptomatic recurrences during maintenance therapy and the rate of asymptomatic ulcers up to the end of this period of treatment. Of the 60 patients with healed chronic gastric ulcer who began the trial, 12 abandoned treatment (20%), six in each group. In the group treated with CMT (n = 24) there were 10 symptomatic recurrences (41.6%), and in the group treated with RNT (n = 24), four symptomatic recurrences (16.6%). Differences, although near statistical significance, were not mathematically significant. The rate of endoscopic ulcers at the end two 2 years of maintenance treatment was 45.4% and 42.8%, respectively. There were no important secondary effects that obliged suspension of the medication. The conclusion that can be drawn from this study are that maintenance treatment with CMT and RNT reduce recurrences and complications, with a favorable therapeutic tendency for RNT; the majority of symptomatic recurrences appeared in the first year of therapy; the percentage of asymptomatic ulcers at the end of this therapy was reduced by almost 20%; and there were no statistically significant differences between CMT and RNT.

Adult↗