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Biomedical subjects

M Pera

Publications and source records attributed to M Pera.

At least 55 records · Page 3Linked to original sources
PubMed1995

Uncut Collis-Nissen gastroplasty: early functional results.

BACKGROUND: This study reviewed the short-term results of the uncut Collis-Nissen gastroplasty. METHODS: From 1990 through 1993, 27 consecutive patients (16 men, 11 women) underwent an uncut Collis-Nissen gastroplasty. Mean age was 59 years (range, 30 to 75 years). Three patients had a previous failed antireflux procedure. Indications for operation were gastroesophageal reflux disease resistant to medical treatment in 18 patients and symptomatic hiatal hernia in 9 patients. Fourteen patients had Barrett's esophagus and 4 had a peptic stricture. Complete esophageal function testing including barium swallow, endoscopy, manometry, and 24-hour pH recording was performed in 26 of 27 patients preoperatively and postoperatively. RESULTS: Five patients (19%) had complications, which included atelectasis in 2, cardiac dysrhythmia in 2, and prolonged ileus in 1. There were no operative deaths. Follow-up was complete in all patients and ranged from 8 to 45 months (mean, 22 months). Subjectively, symptoms of reflux were resolved in all patients. Six patients complain of slow esophageal emptying and 3 have occasional episodes of dysphagia. None required postoperative dilation. Ulcers and erosions healed in all 26 patients who underwent endoscopy but recurred in 2 at 21 and 36 months postoperatively. Mean lower esophageal sphincter gradient increased from 8.3 mm Hg preoperatively to 14.6 mm Hg (p = 0.0001). Total percent of acid exposure decreased from 8.0% preoperatively to 1.7% (p = 0.003). CONCLUSIONS: We conclude that the uncut Collis-Nissen procedure provides acceptable short-term control of gastroesophageal reflux disease.

Adult↗
PubMed1995

Adenocarcinoma of the esophagogastric junction and Barrett's esophagus.

BACKGROUND & AIMS: Barrett's esophagus is associated with adenocarcinoma of the esophagus. The aim of this study was to find the prevalence of Barrett's esophagus in patients with adenocarcinoma of the esophagogastric junction. METHODS: Consecutive, freshly resected surgical esophagogastrectomy specimens were examined, and multiple histological sections were made around the tumor periphery. Barrett's esophagus was defined as specialized columnar epithelium above the esophagogastric junction. Tumors centered < or = 2 cm from the junction were defined as junction cancers. RESULTS: Barrett's esophagus was found in 9 of 9 (100%) esophageal adenocarcinomas compared with 0 of 8 (0%) squamous carcinoma controls (P < 0.001). Ten of 24 (42%) junction adenocarcinomas had a Barrett's esophagus. A Barrett's esophagus was found in 8 of 12 (67%) junction cancers < or = 6 cm in length but only 2 of 12 (17%) larger tumors (P < 0.05). Barrett's esophagus was significantly associated with junction tumors < 6 cm compared with squamous carcinoma controls (P < 0.02). In 5 specimens with junction cancer, the length of Barrett's esophagus was < 3 cm, and in 5 specimens it was > or = 3 cm. Specialized epithelium was often found below the esophagogastric junction in controls. CONCLUSIONS: Adenocarcinomas of the esophagogastric junction are associated with short and long segments of Barrett's esophagus. Larger cancers probably overgrow and conceal the underlying specialized columnar epithelium from which they arise.

Adenocarcinoma↗
PubMed1994

Deficient repair of cisplatin-DNA adducts identified in human testicular teratoma cell lines established from tumours from untreated patients.

Germ cell tumour lines appear generally more sensitive in vitro to cisplatin than other cultured cell lines, reflecting their clinical responsiveness. We proposed (Cancer Res 1988, 48, 3019-3024) that cisplatin hypersensitivity, expressed by a testicular teratoma line (SuSa), might be explained by an inability to repair platinated DNA. We have now quantitated cisplatin cytotoxicity by clonogenic assay, and platinum (Pt)-DNA adduct formation and removal immunochemically in four other testicular teratoma continuous cell lines (GCT46, GCT27 clone 4, H32 and H12.1), all established from tissue from non-drug-treated patients. For 1-h in vitro drug exposures, the cisplatin concentration required to reduce survival by 50% (IC50) ranged from 0.09 to 0.42 micrograms/ml (0.3-1.4 microM). Immediately following a 1-h exposure to 5 mu/ml cisplatin, total cellular platination levels ranged from 4.5 to 36.8 fmol Pt per microgram DNA, with lower platination occurring in the most sensitive lines. Following an 18-h post-treatment incubation period, the levels of the major cis-Pt-(NH3)2d(pGpG) (Pt-GG) adducts were not significantly reduced in any of the four lines, indicating a general deficiency in either the rate or extent of removal of these lesions. Deficient removal of the cis-Pt-(NH3)2d(pApG) adducts was also noted in two of the lines. DNA polymerase beta gene expression was comparable in all the tested testicular lines established from previously untreated patients, but markedly lower than that identified in the 833K testicular line, established from a drug-treated patient and identified earlier as proficient in Pt-GG adduct removal (Cancer Res 1988, 48, 3019-3024). Expression of the DNA excision repair genes ERCC-1 and XPBC/ERCC-3 was not significantly different in any of the five lines tested, including the 833K cell line. These data provide evidence of the apparent inability of testicular cell lines, derived from untreated tumours, to repair the major platinum-DNA intrastrand crosslinks, and so provide a biological basis for their hypersensitivity to cisplatin.

Cell Survival↗
PubMed1994

Spectrum of glandular differentiation in experimental carcinoma of the esophagus induced by 2,6-dimethylnitrosomorpholine under the influence of esophagojejunostomy.

To investigate the influence of reflux esophagitis (RE) on the glandular differentiation of carcinomas of the esophagus induced by 2,6-dimethylnitrosomorpholine (2,6-DMNM), a study was carried out using 4 experimental groups and 2 control groups of 8-week-old Sprague-Dawley rats, each consisting of 20 males and 20 females. An esophagojejunostomy (EJ) with gastric preservation was performed in two groups of animals. Fifteen days thereafter the potent esophagotropic carcinogen 2,6-DMNM was subcutaneously injected, once a week for life, at doses of 1/100 and 1/10 of the 50% lethal dose in each group respectively. The result was a spectrum of carcinomatous tumors mainly developing in the lower half of the esophagus, which were thoroughly investigated by serial sectioning, staining for mucins, and in selected cases by electron microscopy. They were classified as follows: 16 pure squamous cell carcinomas (SCC), 5 SCC with focal mucous or glandular differentiation (FGD), 11 pure adenocarcinomas (ADC), and 12 ADC with areas of squamous cell differentiation (SCD). By contrast, in 2 similar experimental groups in which the previous EJ was not performed, 15 animals showed SCC of the pure type, without evidence of mucous or glandular differentiation. No tumors were observed in the two control groups without carcinogen treatment. Of these, the group that underwent EJ showed reflux esophagitis. In conclusion, the tumors of the esophagus induced by 2,6 DMNM under the influence of EJ are not only pure ADC and pure SCC, as we have previously reported, but also intermediate tumors showing either SCC with focal mucous or glandular differentiation (SCC + FGD) or ADC with areas of squamous cell differentiation (ADC + SCD).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1994

Barrett's esophagus.

The development of the columnar-lined lower esophagus, or Barrett's disease, is an acquired condition due to reflux of gastric and duodenal contents. The medical treatment of patients with reflux disease and Barrett's esophagus is currently the same as for patients with reflux without Barrett's disease which may indicate more aggressive antireflux control. Constant surveillance of the Barrett's mucosa remains important. The progression of squamous epithelium to Barrett's metaplasia and eventually invasive carcinoma in a subgroup of patients is well described and becoming more frequent. The discovery of this carcinogenic process is becoming extremely important as it may help improve the dismal long-term prognosis of patients with adenocarcinoma of the distal esophagus and gastroesophageal junction.

Barrett Esophagus↗
PubMed1994

[Cardiac surgery in patients over 70. Its incidence and trends in Spain].

INTRODUCTION AND OBJECTIVES: During the last years elderly population has been growing in all the occidental world. Consequently the number of elderly patients undergoing cardiac surgery has increased. The aim of this work is to know whether this increase has also taken place in Spain. METHODS: A survey among the different Units in the country was performed. The number and percentages of patients older than 70 years with coronary and valvular heart disease operated among 1991 and 1992 was analysed. Twenty-one of the 28 units replied (74%). RESULTS: The percentage of coronary patients older than 70 years operated in 1991 was 15.61% and 19.20% in 1992, a statistically significant increase of 21.84% (p < 0.001). However, there was no significant increase in the number of elderly patients undergoing valvular surgery. CONCLUSIONS: The influence of the elderly population on the activity in cardiac surgery is known to be significant; thus, a careful analysis of the health, social and economic implications seems to be mandatory.

Aged↗
PubMed1994

[Intraportal air secondary to gastric dilatation. A clinical case].

The authors report a case of hepatic portal venous gas (HPVG) secondary to massive gastric dilatation in a diabetic patient following blunt trauma. Both flat plate of the abdomen and ultrasound of the liver were necessary to reach the correct diagnosis. They review the pertinent literature and stress the importance of an accurate nosologic assessment of this uncommon entity in order to avoid undue mishaps.

Abdomen, Acute↗
PubMed1993

Influence of pancreatic and biliary reflux on the development of esophageal carcinoma.

We previously presented an experimental model of Barrett's adenocarcinoma of the esophagus by demonstrating that esophagojejunostomy combined with subcutaneous injection of 2,6-dimethylnitrosomorpholine in Sprague-Dawley rats resulted in development of adenocarcinoma in the distal esophagus. The present study was devised to investigate the influence of pancreatic and biliary duodenal-content reflux on the induction of esophageal carcinoma. Three groups of 8-week-old Sprague-Dawley rats were controls: the first was exposed to pancreatic reflux, the second to biliary reflux, and the third to both. The other three experimental groups were similar except that a 1/100 LD50 dose of 2,6-dimethylnitrosomorpholine was injected subcutaneously weekly, starting on day 15. Carcinoma of the esophagus was induced only in animals receiving the carcinogen after exposure to either pancreatic reflux (3/22, 13%) or pancreatic and biliary reflux (9/27, 33%). Half of the carcinomas were adenocarcinoma and half were squamous cell carcinoma. These findings suggest that under these experimental conditions, in which the carcinogen is used in a low dose, esophageal carcinoma is induced only when pancreatic secretions are present in the duodenal-content reflux. Biliary reflux, however, appears to exert a cocarcinogenic effect when combined with pancreatic secretions. The clinical relevance of these findings needs further evaluation. Conceivably, the elimination of pancreatic and biliary duodenal-content reflux in patients with documented Barrett's mucosa may inhibit the progression from metaplasia to adenocarcinoma.

Adenocarcinoma↗
PubMed1993

Barrett's disease: pathophysiology of metaplasia and adenocarcinoma.

Peptic ulceration arising in the lower esophagus lined by columnar epithelium was described in detail by Tileston in 1906. Although this concept was challenged in 1950 by Barrett, experimental and clinical evidence has now conclusively demonstrated that Barrett's metaplasia is an acquired condition and is a consequence of chronic reflux of gastric or duodenal contents or both. Current concepts suggest that unknown trophic factors present in these secretions stimulate proliferation of multipotential reserve cells located in the esophageal submucosal glands resulting in columnar metaplasia of the normal squamous epithelium with subsequent potential for malignant degeneration. Today, numerous patients are affected by reflux esophagitis, a lesser number by Barrett's metaplasia, and a smaller but ever-enlarging group by adenocarcinoma. Although high-grade dysplasia is considered a precursor to invasive adenocarcinoma, detection of this abnormal mucosa remains controversial and currently requires esophagoscopy with biopsy. Epithelial markers, such as increased activity of mucosal ornithine decarboxylase, sulfomucin production, nuclear DNA aneuploidy, and recently molecular analysis, have also been proposed to identify those paitents at increased risk for malignant degeneration. As more is learned about the pathogenesis of Barrett's disease, perhaps these cancers can ultimately be prevented.

Adenocarcinoma↗
PubMed1993

Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction.

BACKGROUND: The aim of this study was to determine whether the incidence of adenocarcinoma of the esophagus and esophagogastric junction in a well-defined population was higher than previously recognized. METHODS: Clinical records and original histological slides from patients residing in Olmsted County, Minnesota, were reviewed and compared with a previous study in the same population. RESULTS: The incidence of esophageal adenocarcinoma rose from 0.13 for 1935-1971 to 0.74 for 1974-1989, and the incidence of adenocarcinoma of the esophagogastric junction rose from 0.25 to 1.34 per 100,000 person-years. Histological review of preserved surgical specimens showed associated intestinal metaplasia (Barrett's esophagus) in 2 of 2 esophageal and in 5 of 9 esophagogastric adenocarcinomas. CONCLUSIONS: The incidence of adenocarcinoma in each location increased five to sixfold compared with the earlier study. This increase could not be explained by improved diagnostic methods or classification changes. The association with Barrett's esophagus and the parallel increased incidence of cancer in each location is evidence that adenocarcinoma of the esophagus and of the esophagogastric junction are related disorders.

Adenocarcinoma↗
PubMed1992

[A case of retroperitoneal leiomyosarcoma. Considerations].

A case of retroperitoneal leiomyosarcoma is reported. The retroperitoneal localization is quite unusual and early diagnosis is really difficult. Only operation can offer any chance for cure of this neoplasm and radiotherapy and chemotherapy can be very useful. Tumor size and location are the major prognostic factors.

Female↗
PubMed1992

Barrett's esophagus with high-grade dysplasia: an indication for esophagectomy?

Between 1982 and 1991, 19 patients (17 men and 2 women) with Barrett's esophagus, 10 of whom were in a surveillance program, were found to have high-grade dysplasia without evidence of invasive carcinoma. Median age was 66 years (range, 30 to 79 years). Heartburn was the most common presenting symptom. Esophagoscopy at the time of high-grade dysplasia diagnosis demonstrated normal Barrett's mucosa in 10 patients (53%), shallow ulcers in 3, slight mucosal irregularities in 2, small mucosal nodules in 2, stricture in 1, and shallow ulcer with stricture in 1. Eighteen patients underwent esophagectomy. There were no operative deaths. Nine patients (50%) had invasive carcinoma. Postsurgical stage was stage 0 in 9 patients, stage I in 6, stage IIA in 2, and stage IIB in 1. Median follow-up was 34 months (range, 2 to 116 months). Recurrent cancer developed in 2 patients. Overall 5-year survival was 66.7%; 5-year survival for patients with stage 0 disease was 100% and for stage I and II disease, 35.7%. We conclude that high-grade dysplasia in an indication for esophageal resection because of the high rate of associated early invasive carcinoma and that resection can be done safely with the expectation of excellent long-term survival. Because of these findings, we continue to recommend endoscopic surveillance in all patients with Barrett's esophagus.

Adenocarcinoma↗
PubMed1992

Hemosuccus pancreaticus from a pseudoaneurysm of the hepatic artery proper in a patient with a pancreatic pseudocyst.

Pseudoaneurysms of the visceral arteries due to pancreatitis, with subsequent rupture and hemorrhage into the pancreatic duct are unusual. To date, three cases of pseudoaneurysm of the hepatic artery with hemosuccus pancreaticus have been reported in the literature. We describe a case of a pseudoaneurysm of the hepatic artery proper, which ruptured into a pancreatic pseudocyst communicating with the pancreatic duct, and which was the cause of upper gastrointestinal bleeding. This case was successfully managed by resection of both the pseudoaneurysm and the pancreatic pseudocyst.

Aneurysm↗
PubMed1990

AIDS and Salmonella-infected abdominal aortic aneurysm.

The case of a bisexual male patient with acquired immunodeficiency syndrome (AIDS) and an infected abdominal aortic aneurysm requiring surgery is presented. Attention is drawn to the fact that an unpredictable number of operations will be needed in AIDS patients in the next future.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Influence of esophagojejunostomy on the induction of adenocarcinoma of the distal esophagus in Sprague-Dawley rats by subcutaneous injection of 2,6-dimethylnitrosomorpholine.

To study the influence of reflux esophagitis on the carcinogenic response of 2,6-dimethylnitrosomorpholine (2,6-DMNM), an experiment was designed, composed of 6 groups of 8-week-old Sprague-Dawley rats, each consisting of 20 males and 20 females. Group 1 served as untreated controls. All animals of groups 2, 4, and 6 underwent an esophagojejunostomy with gastric preservation to produce a chronic reflux esophagitis. 2,6-DMNM was injected s.c. once weekly for life at doses of 1/100 and 1/10 of the 50% lethal dose to groups 3 and 4 and groups 5 and 6, respectively. Carcinogen exposure began in groups 4 and 6 15 days after the esophagojejunostomy. Squamous cell carcinomas were observed in the esophagus of 36 animals, mainly in those receiving the higher dose. Exophytic squamous cell carcinomas, a variety rarely seen in humans, were mostly seen in the groups receiving 2,6-DMNM alone, whereas endophytic squamous cell carcinomas, the variety most frequently seen in humans, mainly developed in the groups receiving the combined treatment. In addition adenocarcinomas with abundant mucin production were found in the distal esophagus of 23 animals. They were found exclusively in animals of groups 4 and 6 which underwent esophagojejunostomy plus 2,6-DMNM exposure. No adenocarcinomas were encountered in groups without experimental reflux esophagitis. These findings may contribute to further understanding of the association between reflux esophagitis and the various histological types of esophageal carcinoma in humans.

Adenocarcinoma↗
PubMed1988

Management of penetrating abdominal stab wounds.

The authors present the results of a therapeutic trial of the conservative or surgical management of penetrating abdominal stab wounds (PASW) based on clinical criteria. In a prospective series of 100 patients, 70 were treated non-operatively. Thirty patients were operated upon, twenty-one immediately and nine during the 48 h observation period. In five laparotomies no significant injuries were found. Morbidity was similar in both immediate and delayed laparotomy groups (3/21 versus 1/9). Acute alcoholic intoxication identifies a subgroup of patients that are difficult to evaluate and hence are more likely to be managed by laparotomy (chi 2 = 4.056, P less than 0.05). The authors conclude that selective surgical management of PASW based on clinical criteria is an accurate and safe procedure.

Abdominal Injuries↗