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Biomedical subjects

N Landoni

Publications and source records attributed to N Landoni.

18 recordsLinked to original sources
PubMed2005

Endoscopic gastroenteric anastomosis using magnets.

BACKGROUND: Current management of malignant obstruction of the upper digestive tract includes surgical gastrointestinal bypass or endoscopic insertion of self-expandable metal stents. The safety, efficacy, and long-term patency rates of anastomoses created using the novel technique of endoscopic gastroenteric anastomosis using magnets (EGAM) are evaluated in this study. PATIENTS AND METHODS: 15 patients (13 men, 2 women; mean age 64.5 years) with malignant obstruction, who underwent EGAM and had monthly follow-up between December 2001 and May 2003, were included in this study. RESULTS: The procedure was successful in 13 patients (88.66 %). The mean survival was 5.23 months. There were four minor complications (30.76 %) during the follow-up period. CONCLUSION: Our results demonstrate the feasibility, safety. and efficacy of this technique for creating a gastroenteric anastomosis. The success rate was 86.6 %, there were no immediate complications, and there was no mortality related to the procedure.

Aged↗
PubMed2003

[Complications of endoscopic retrograde cholangiopancreatography].

INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) FOLLOW-UP: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8%), strictures (18%), pancreatic cancer (4.3%), ampullary cancer (2.3%) and normal ERCP (24.4%). CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53%) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated.

Adolescent↗
PubMed2000

[Randomized prospective study to compare the efficiency between standard plastic and polyurethane stents in biliary tract malignant obstruction].

UNLABELLED: The aim of this paper is to compare the efficiency between standard plastic stents and polyurethane stents used in biliary tract malignant obstruction. The main problem of the plastic prosthesis is their early occlusion. On the other hand there is the hypothesis that due to the less porousness of the polyurethane surface, there might be lesser adherence and consequently a late occlusion. Thirty-eight patients in two groups of 19 were evaluated prospectively and at random in the Jerusalem Hadassah Hospital and the HIGA San Martín La Plata. They had biliary tract obstruction due to inoperable tumors. Biliary endoprosthesis (plastic standard or polyurethane 10 French diameter) were placed, according to the randomization, after a previous staging with clinical examination, laboratory analysis and images. The follow-up with the same parameters was monthly done. Twelve of the 38 patients were female and 26 male; age average 62.73 (range 81-49). The stents were placed in 17 patients with biliary cancer, 14 pancreatic cancer, 2 papila cancer, 2 gallbladder cancer with bile duct invasion and 3 liver metastasis with biliary tract compression. The clinical and laboratory parameters in 36 patients at 30 days improved. On the contrary, 2 (1 plastic standard and 1 polyurethane stent) did not improve. There were 29 deaths due to the basic illness and not related to the endoscopic method. The mean obstruction occurred at 12.76 weeks (range 32-4) in the standard stents and 12.05 (range 24-2) in the polyurethane ones. CONCLUSION: There were no significant differences in the two groups patients.

Aged↗
PubMed1998

EsophaCoil: long-term results in 81 patients.

BACKGROUND: Cancer of the esophagus and gastric cardia cause progressive dysphagia. Half of patients are not amenable to surgical resection; of those who are, about 20% will suffer either from local recurrence or anastomotic strictures. Self-expandable metallic stents of diverse characteristics have been used in these clinical conditions. However, expandable metallic stents have several drawbacks: low radial force, migration, epithelial trauma, and tumor ingrowth. We herein report our long-term experience with EsophaCoil, a self-expandable esophageal metallic coil, in 81 patients. METHODS: From January 1993 to July 1996, 84 stents were placed in 81 consecutive patients (53 men and 28 women, mean age 69.8 years (range 40 to 90 years). 41 patients had esophageal squamous cell carcinoma, 32 adenocarcinoma of the esophagus and cardia, 5 mediastinal metastasis, 1 sarcoma, and 2 had benign esophageal strictures. Five patients had bronchoesophageal fistulas. Mean dysphagia score before treatment was 3.5, mean stricture length 6 cm. Most patients were hospitalized for at least 24 hours after stent implantation. Patients were followed and early and late complications were recorded. RESULTS: Stents were successfully placed in all patients. Dysphagia improved in 96% of patients (score dropped from 3.5 to 1.2). Mean patient survival after stent insertion was 4 months (range 0.5 to 20 months). Bronchoesophageal fistulas were closed in all 5 cases. Early complications occurred in 11 patients. These were severe in 3 (esophageal perforation) and mild in 8 patients (precordial pain lasting 24 to 48 hours). Late complications occurred in 18 patients and included migration to the stomach (5 patients), stent breakage (5 among the first 20 cases), food impaction (5), tumor overgrowth (2), and bleeding (1). CONCLUSIONS: In a long-term follow-up, EsophaCoil was effective in the palliative treatment of dysphagia caused by malignant esophageal strictures, including cases of fistulas, having low malfunction and migration rates. No tumor ingrowth was seen.

Adenocarcinoma↗
PubMed1996

[Endoscopic treatment of pancreas divisum].

The pancreas divisum is the most frequent congenital anomaly of the pancreas. It is caused by the absence of fusion in the dorsal and ventral pancreatic buds, so that most of the gland drains through the Santorini duct in the minor papilla. It has been suggested that the relative obstruction of the pancreatic pain and pancreatitis in these patients. According to this the treatment consists in facilitating the minor papilla drainage via surgery or endoscopy. Two endoscopic treatment cases are presented. In both pancreatic duct stent and further sphinterotomy were performed. This treatment and their follow-up are evaluated, coming to the conclusion that this method should be taken into account in the future, due to its viability and low morbimortality.

Adult↗
PubMed1994

[Expandable prosthesis of the biliary tract in malignant stenosis: initial experience].

The endoscopic or percutaneous placement of a stent in the palliative treatment of the malignant obstructions of the biliary tract is a very well established and accepted method in our country. In the last few years the placement of metallic stents has been preconized because they offer advantage over the standard ones. The first three cases where this type of material was used by our team are presented. Effectivity and facility of the method is demonstrated and no early complications were related to it. We make a critical analysis of the presentation world it be advisable to write about this analysis?

Aged↗
PubMed1993

[Endoscopic sphincterotomy. Complications and follow-up].

Between April 1981 and April 1991, there were 547 EPT performed, seventy-five of which had in situ gall bladder. They were performed in two groups, who were similar from the technical-anatomical point of view, and sociocultural background. The early morbidity showed 31 complications (5.6%). The most frequent ones were: perforation in 8 cases and haemorrhage in 5. Medical treatment, which included the endoscopic technique in 20 cases (3.7%) and surgical procedures in 11 cases (2.0%) was used. The mortality rate was 1.8% (10 cases), perforation (4) and cholecystitis (3) being the main causes. There were three deaths (0.5%) not related to the method. The morbi-mortality was not significantly increased by the complementary methods. After analysing the complications related to the cause of EPT performance, it was observed that they were more frequently produced in choledochal stones: 20 (3.6%), followed by choledochal and gall bladder stones: 7 (1.3%). However the mortality was 0.7% in the former and 0.5% in the latter. The morbi-mortality of the last two years is compared to that of the preceding ones. The follow-up was done in 114 (20.8%) of the cases with a marked difference between the high sociocultural group (76 cases) and the low one (36). Eighteen pathological cases were found (3.3%). The treatment of each complication in long term is shown.

Follow-Up Studies↗
PubMed1992

Pre-cancerous lesions of the oesophagus in Argentina: prevalence and association with tobacco and alcohol.

The prevalence of pre-cancerous lesions of the oesophagus and their association with alcohol and tobacco were examined in an endoscopic survey carried out in La Plata, Argentina. The study included 406 subjects over 15 years of age attending several gastroenterology clinics because of various gastrointestinal symptoms. Among males, the prevalence rates of chronic oesophagitis, epithelial atrophy and dysplasia were 42%, 3.8% and 2.4% respectively, and in females these prevalences were 36%, 2.5% and 0.0%. The presence of these pre-cancerous lesions was significantly associated with alcohol drinking and tobacco smoking.

Adolescent↗
PubMed1992

[Endoscopic sphincterotomy. Its complications and their follow-up].

Between April 1981 and April 1991, there were 547 EPT performed, seventy-five of which had in situ gall bladder. They were performed in two groups, who were similar from the technical-anatomical point of view, and sociocultural background. The early morbidity showed 31 complications (5.6%). The most frequent ones were:perforation in 8 cases and haemorrhage in 5. Medical treatment, which included the endoscopic technique in 20 cases (3.7%) and surgical procedures in 11 cases (2.0%) was used. The mortality rate was 1.8% (10 cases), perforation (4) and cholecystitis (3) being the main causes. There were three deaths (0.5%) not related to the method. The morbimortality was not significantly increased by the complementary methods. After analysing the complications related to the cause of EPT performance, it was observed that they were more frequently produced in choledochal stones: 20 (3.6%), followed by choledochal and gall bladder stones: 7 (1.3%). However the mortality was 0.7% in the former and 0.5% in the latter. The morbimortality of the last two years is compared to that of the preceding ones. The follow-up was done in 114 (20.8%) of the cases with a marked difference between the high sociocultural group (76 cases) and the low one (36). Eighteen pathological cases were found (3.3%). The treatment of each complication in long term is shown.

Argentina↗
PubMed1991

[Primary risk of hemorrhage due to esophageal varices in cirrhotic patients: significance of the associated endoscopic signs and hepatic functional reserve].

Significance of endoscopic findings associated to esophageal varices (Japanese Research Society for Portal Hypertension) and hepatic dysfunction (Child-Pough classification) as predictive factors of variceal bleeding in cirrhotic patients is analyzed. In a cooperative prospective experience 137 cirrhotic patients with esophageal varices were examined in the period May 1987/89: 83 out of them had never bled from their varices (VENS group) while 54 recently had (VES group). A highly significative association was found between variceal size over 3 mm (grade II-III) and bleeding: 96.3% vs. 34.9% in VENS group (p = 0.01); similar association was found with regard to endoscopic detection of "red signs": 92.6% in bleeding group vs. 20.5% in VENS one (p = 0.01). "Red signs" were found on grade II-III varices in 98.5% of cases, and this association were related to variceal bleeding in 75.5%. Hepatic dysfunction was not directly related to bleeding episodes but "red signs" endoscopic detection in VENS group increased with liver function deterioration: 9.1% in Child A class, 27.3% in Child B, and 41.2% in Child C (p = 0.01). The strong association founded between bleeding and both grade II-III variceal size and "red signs" detection, suggest the possibility to identify a high risk group of cirrhotic patients candidate to prophylactic methodologies.

Adult↗
PubMed1991

[Endoscopic prosthesis of the bile ducts].

During the period 30/5/84-30/7/90, 70 endoscopic prosthesis were settled in 47 patients; 18 men and 28 women; age average 73.17 and ranging 33 to 70. The distribution in ethnic groups showed a top between 70 to 79. The main causes for the implantation were bile ducts cancer, ampullary carcinoma and biliary stones; which were not likely to endoscopic gallstone extraction all of them in 13 opportunities (18.57). The more widely diameter used were 7 and 10 French and the more used was the straight line. Two prosthesis were way implanted without previous sphincterotomy and 1 in Billroth II. The early complications were present in 4 cases (5.7) and all of them led to death independently of the treatment used. The most frequent complication was cholangitis (37.14) most of which were treated by endoscopy, only 2 of them were chirurgical, there was no mortality. The evolution is being analyzed so far.

Adult↗
PubMed1990

[Evaluation of esophageal endoprosthesis].

In 60 patients with either non operable esophageal pathology on neighbouring organs pathology with esophageal involvement, esophageal endoprosthesis therapy was assessed. The various implantation techniques are described. Main causes for implantation were epidermoid esophageal carcinoma in 48 instances and gastric adenocarcinoma with esophageal involvement in 9 cases. The causes most frequently associated with early morbimortality were perforation in 4. All cases were medically treated with a 16.9% mortality rate (10 cases), due to broncoaspiration as main cause. Endoscopic reimplantation of the prosthesis was the treatment of choice in perforated cases.

Adult↗
PubMed1988

[Value of the endoscopic sphinctero-papillotomy by surgical radiocholangiodebitometry].

First results of a prospective study about behavior evaluation of endoscopic sphincterotomy of the ampulla of Vater (EPE) through a serial surgical debitometric (RCDM) assessment are analyzed. Five patients submitted to an EPE looking for a biliary tract decompression because of clinical reasons, prior their surgical cholecystectomy, are comparatively evaluated by serial RCDM with regard to 24 patients receiving a broad transduodenal sphincteroplasty (EPTD). Normal debitometric values (N greater than or equal to 13 cc/min.) were obtained from a sample of 673 surgically explored patients. Debitometric behavior of EPE were comparable in all cases and over our standard (mean = 18.6 +/- 2.3 cc/min.); they showed no differences to surgical EPTD patients (x = 18.3 +/- 2.0 cc/min.). Despite uniform results in the EPE group, a more extensive sample is necessary for definitive conclusions; serial surgical RCDM in patients who received EPE, in spite of limited indications, seems to be a valuable method to analyze early functional events after the procedure.

Adult↗
PubMed1982

[Epidemiological significance, clinico-morphological evaluation and behavior of pathogenetic factors, in asymptomatic chronic carriers of the HBsAg in the La Plata area. Study in voluntary blood donors].

Seric positivity for HBsAg (CIED) investigated on 100.000 volunteer blood donors of La Plata city was 0.239%. Humoral findings on 40 cases only revealed TGO-TGP seric levels over twice the normal in 15 and 10% respectively. On 27 biopsied patients, chronic active hepatitis in one case and chronic persistent hepatitis in another one were found. Non-specific chronic inflammatory changes were seen in 18.5%. Correlation between TGO-TGP levels and histologic damage was generally proved. HBeAg seric positivity in 3/29 cases (10.3%) was accompanied of both raised TGO-TGP levels and some kind of chronic inflammatory change. Statistic high risk was determined for both O-Rh negative blood group and HLA-Bw21 individuals. Diminished cutaneous PPD reactivity without significative alteration of linfocite population was established.

Adult↗
PubMed1981

[Endoscopic polypectomy in the diagnosis and treatment of early colorectal cancer].

The rectocolon cancer (RCC) behavior in La Plata is clearly shown to be similar to the one found in high risk countries, both from the epidemiological and the histopathological point of view. The disagreement among different polyps coming from necropsy, endoscopy or surgery is found and discussed in relation to distribution, size and histopathological type. The evidence of de sequence adenoma-carcinoma is once more found in the cases studied. On the other hand, displastics lesions in non-neoplastic flat mucosa are not found. THe malignant potential of the adenomas is found to increase with the increment of their size, villous component and atipía degree. This evidence come from 100 adenomas considered. It is also found that in this sample that the malignant potential is high in small lesions -4,3%of invasive carcinoma on adenomas smaller than 10 mm. In a sample of 1000 colonoscopies, 122 endoscopic polipectomies where performed without evidence of either morbility or mortality. In this material, 4 rectocolonic early cancer were detected in polyps smaller than 10 mm. This fact strongly support the indication of resection in every rectocolonic elevated lesions. 11.4% of total resected polyps were found to be of the early RCC type this figure increases if the incidence of the polipectomy in children is discarded because in this cases adenomatous polyps do not appear in our experience. The clinic-epidemiologic character of 13 early RCC cases followed for periods until 5 years are described.

Argentina↗
PubMed1979

[Presence of antisinusoid antibodies in alcoholic hepatitis. Its probable pathogenic implications].

In nine patients with histological diagnosis of alcoholic hepatitis, in-situ deposition of autologous immunoglobulins (IgG, Iga, IgM) were investigated by inmmuno fluorescent techniques (IF). In three patients a linear fluorescent pattern was seen on the sinusoidal walls. The bound inmunoglobulins could be eluted by treatment with low pH buffers. In the same patients circulating antibodies against liver structures were investigated by indirect IF using normal murine or human liver as targets. In the same patients showing bound immunoglobulins in their liver, curculating antibodies against human sinusoids and not against murine liver could be found. On the basis of these findings the probable pathogenetic role of immune mechanism in alcoholic liver damage is discussed.

Antibodies↗
PubMed1979

[Endoscopic cytological diagnosis of the upper digestive tract].

207 cases of oesopha-gastric endoscopic exfoliative citology was realized during 1976-1977, 126 was malignant and 81 non-malignant. The high general diagnosis posivity in oesophagus (96,9% without erroneous posivity, and a posivity of 88,8% en stomach, with 4,2% erroneous posivity are remarked. The quick diagnosis, the easy technique and the unexpensive process, both the needed of high professional capacity, are realized. The incidence of tumoral localization, macroscopic and histologic characters on diagnosis security are comented.

Biopsy↗