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Biomedical subjects

R Acuña

Publications and source records attributed to R Acuña.

18 recordsLinked to original sources
PubMed2003

Percutaneous endoscopic gastrostomy: the technique of choice?

BACKGROUND/PURPOSE: The percutaneous endoscopic gastrostomy (PEG) is contested on the ground that it could cause gastroesophageal reflux (GER). The authors studied the complications of PEG to ponder the validity of this contraindication. METHODS: The authors followed up with a group of 81 patients subjected to PEG to assess their complications, GER in particular. RESULTS: In half of the patients, PEG was performed under deep sedation in the intensive care unit and the other half under general anesthesia. The procedure lasted about 12 minutes in both subgroups. Early complications were not observed. Late complications relating to the care of the tube were similar to those reported for other techniques. GER appeared in 8%, but surgical treatment was unnecessary, whereas in patients that presented GER before surgery, it subsided in 38%. A colocutaneous fistula observed in one patient was a consequence of previous interventions. CONCLUSIONS: PEG is minimally invasive, general anesthesia may be avoided, the procedure is rapid, major complications are conspicuously absent, and the incidence of GER is smaller than that associated with alternative techniques. In addition, the cost is low. The authors consider PEG the technique of choice because it has important advantages compared with open or laparoscopic techniques.

Cerebral Palsy↗
PubMed2002

Prevalence of serum antibodies to Helicobacter pylori VacA and CagA and gastric diseases in Chile.

The objective of this study was to evaluate the prevalence of antibodies to Helicobacter pylori CagA and VacA proteins and correlate this prevalence with gastric diseases in colonised Chileans. The study was performed in 418 adults colonised with H. pylori: 316 with gastroduodenal pathology (152 duodenal ulcer, 14 gastric cancer and 150 gastritis patients) and 102 asymptomatic subjects. Serum IgG antibodies to H. pylori were determined by enzyme immunoassay (EIA). Antibodies to VacA and CagA proteins were detected by Western blotting. In a subgroup of the patients, the vacuolating activity was determined by HeLa cell assay and the CagA product was confirmed by PCR assay. IgG antibodies to both VacA and CagA proteins of H. pylori were found in 270 (85%) of 316 colonised gastric patients and in 72 (71%) of 102 asymptomatic subjects. Colonisation with virulent strains was significantly higher among duodenal ulcer and gastric cancer patients than in gastritis patients or asymptomatic subjects. Infections with VacA+/ CagA+ H. pylori strains is common in Chile but, in contrast to some Asian countries, this phenotype was more prevalent in isolates from patients with more severe gastric pathologies.

Antibodies, Bacterial↗
PubMed2000

[Application of serology to confirm the eradication of Helicobacter pylori in peptic ulcer patients].

BACKGROUND: Measurement of changes in serum antibodies is an excellent predictor of Helicobacter pylori eradication after antibiotic treatment. AIM: To measure the changes in serum antibody titers to Helicobacter pylori, before and after treatment. MATERIAL AND METHODS: IgG antibodies to H. pylori were prospectively evaluated in 107 duodenal ulcer patients treated either with antibiotics (amoxicillin, metronidazole and bismuth subsalicylate) plus omeprazole or omeprazole alone. IgG antibody levels were determined using an "in house" ELISA in sera from 49 eradicated patients that received quadruple therapy and 58 non-eradicated patients (12 in whom antibiotic therapy failed and 46 that received omeprazole alone). Endoscopy, urease test, microscopy, and culture of gastric biopsies confirmed H. pylori eradication. RESULTS: Patients in whom H. pylori was eradicated, showed a maintained drop in serum antibody titers that ranged from 15%, 62%, 74% to 76% at 28 days, 4, 8 and 12 months respectively. Such reduction was not observed in patients treated with omeprazole. Patients, in whom quadruple therapy failed to eradicate H. pylori, showed a discrete and transient decrease in antibody titers. By the fourth month, patients in whom eradication with quadruple therapy was not achieved, irrespective of whether they received quadruple therapy or omeprazole alone. CONCLUSIONS: A 45% decrease in IgG titer after 4 months is indicative of therapeutic success in H. pylori eradication. Therefore, serology may be useful to monitor the outcome of antibiotic therapy (Rev Méd Chile 2000; 128: 1119-26).

Adult↗
PubMed1997

Helicobacter pylori infection in Chile.

This article summarizes studies designed to evaluate the role of Helicobacter pylori infection in Chile, described in 21 reports from nine centers in various Chilean regions published between 1985 and 1995. According to their data, H. pylori infection is quite frequent among patients with a variety of gastric conditions, including adults (43%-92%) and children (6%-100%). Levels of specific IgG antibodies to H. pylori are also elevated among patients with duodenal ulcers (100%) and gastritis (86%) as well as asymptomatic adults (75%). Combination therapy with three (but not two) drugs has been proved effective, with clinical improvement, ulcer cure, and H. pylori eradication occurring in well-controlled studies. Available evidence suggests that antibiotic resistance is not a major problem in treatment. The H. pylori reinfection rate is low (4.2% per year), suggesting that combination therapy with three drugs constitutes a cost-effective alternative for treating colonized symptomatic patients. Concurrent preliminary studies revealed that antibodies to VacA but not CagA proteins correlate with disease severity in Chilean patients. It can be concluded that local research assists local administrators of health resources to implement adequate policies to prevent, control, and treat H. pylori-related pathologies.

Chile↗
PubMed1996

Low H. pylori reinfection rate after triple therapy in Chilean duodenal ulcer patients.

OBJECTIVES: We studied prospectively in a single-blind controlled manner the efficacy of 4-wk triple-antibiotic therapy, with amoxicillin (500 mg p.o., t.i.d.), metronidazole (250 mg p.o., t.i.d.), and bismuth subsalicylate tablets (524 mg p.o., q.i.d.), plus omeprazole (20 mg p.o., q.d.) and compared it with omeprazole (id) in the treatment of duodenal ulcer (DU) patients colonized with Helicobacter pylori. METHODS: One hundred DU patients were entered prospectively over a 12-month period. Fifty-seven of them received triple therapy plus omeprazole and 43 received omeprazole alone. Clinical, endoscopic, and bacteriological evaluations were performed on admission and at 28 days, 4, 8, and 12 months after treatment. RESULTS: After 4-wk treatment (day 28), the ulcer healing rate was high, but there was no significant difference between rates in the triple therapy and omeprazole groups (99% vs. 91%). In contrast, the long-term DU recurrence rate after 12-month follow-up was significantly lower (p > 0.01) for triple therapy (3/57, 5%), compared with omeprazole (34/43, 79%). The difference (higher relapse rate for omeprazole-treated patients) was significant (p < 0.001) by the second evaluation, 4 months after treatment. The eradication rate of H. pylori was also significantly higher among DU patients treated with triple therapy (p < 0.001) during all prospective evaluations, grand mean, 82% (range 82-87%), compared with the omeprazole-treated group, in which there were no cases in which H. pylori was eradicated. Follow-up revealed that 2/47 H. pylori-eradicated patients became reinfected after 1 yr, giving a reinfection rate of 4.2 patient/yr. CONCLUSIONS: Four-week triple-antibiotic therapy plus omeprazole constitutes an adequate alternative for treatment of Chilean DU patients.

Adolescent↗
PubMed1996

[Prospective study of erradication of Helicobacter pylori in patients with duodenal ulcer: analysis of antral and gastric body biopsies].

Omeprazole may not eradicate Helicobacter pylori from the stomach but rather displace it from the antrum to the stomach body. This fact could interfere with colonization studies in patients receiving the drug. The aim of this study was to assess the presence of Helicobacter pylori, defined as a positive urease test, culture or microscopical examination, in antral and gastric body biopsies in patients receiving treatment with omeprazole. Sixty four paired antral and gastric body biopsies obtained at the end of a 28 day course of omeprazole, 62 obtained four months later, 40 obtained eight months later and 23 obtained 12 months later were analyzed. There was a 92% concordance between antral and gastric body biopsies for the presence of Helicobacter pylori. However, nine of the samples obtained at 28 days (14%) were negative for H pylori in the antrum but positive in the gastric body. It is concluded that for early assessment of Helicobacter pylori eradication after omeprazole treatment, paired biopsies of antrum and gastric body are needed.

Duodenal Ulcer↗
PubMed1994

Transanal internal sphincter myomectomy: indications, operative procedure and results.

From October 1, 1981, until December 31, 1991, we performed clinical, radiological, electromanometrical, histochemical and histological diagnostic procedures in 906 patients under 15 years of age, because of several distinct colonic and anorectal disorders. 739 were clinically constipated and in 272 of them hypertonicity of the internal anal sphincter with or without achalasia could be demonstrated by manometry. 121 of these patients were submitted to a posterior, transanal, partially resective internal sphincteromyomectomy, according to a slightly modified classical procedure. Follow-up of our operated patients ranged from 1 month to 9 years, with a mean of 3 years and 2 months and overall satisfactory results in 87.6% based on clinical evaluation. Additionally, 55.4% of the operated patients had early postoperative manometric controls (n = 67) and 77.6% of these (n = 52) accepted a third manometry, in order to evaluate late results of our procedure. We could demonstrate that early postoperative anorectal electromanometry shows a highly significant decrease of the internal anal sphincter pressure correlating with a clinical improvement in 98.5% of these patients (n = 67). Most late postoperative examinations showed recurrent elevation of the manometric internal sphincter pressure parameters, exceeding the mean values of our own normal controls. Nevertheless, clinically 98.1% of these patients had a persistent satisfactory remission of their symptoms, thus not correlating with the manometric findings in these cases. We conclude, that transanal internal sphincter myomectomy is a safe surgical procedure, which leads to satisfactory results in approximately 90% of chronically constipated children with anal sphincter hypertonicity, if very precise indications for operation are considered.

Adolescent↗
PubMed1993

[Congenital hepatic fibrosis: an uncommon cause of portal hypertension].

Congenital hepatic fibrosis is an autosomic recessive disease, manifested in children or in young adults by hematemesis due to rupture of esophageal varices. Bacterial cholangitis may occur in some patients. Early diagnosis and treatment with portosystemic anastomosis and/or antibiotics may lead to a long survival with a good quality of life. Diagnosis requires histologic confirmation: normal hepatic lobules are surrounded by broad fibrous bands, and an increased number of bile ducts is usually seen in the portal tracts. Liver function remains well preserved. This report consists of 3 patients: a 17-year-old woman, a 10-year-old boy and a 24-year-old woman who developed severe upper GI bleeding due to ruptured esophageal varices. The first two patients were successfully operated on using the Sugiura technique for portal decompression. Their current survival after surgery is 3 and 9 years, respectively, with normal physical examination and liver function tests. The third patient died shortly after admission, due to the concurrence of a severe suppurative cholangitis.

Adolescent↗
PubMed1990

[The IgG antibody response in patients colonized by Helicobacter pylori].

The IgG antibody response specific to Helicobacter pylori was evaluated through ELISA in a group of 92 gastric patients colonized by this bacteria. 74 had gastritis and 19 gastroduodenal ulcer. Three control groups were studied in a similar way: normal adult volunteers (n = 17), adults with E coli or S typhi bacteremia (n = 30) and normal infants (n = 30). IgG antibody response to H pylori was demonstrated in 98% of colonized patients and 0% of infants. Asymptomatic individuals and those with bacteremia had high rates of antibody response (76 and 90% respectively), although this rate and also the titers of antibody response were significantly lower than that of colonized patients (p < 0.05). ELISA reactive sera from colonized patients and asymptomatic individuals evidenced a similar antibody pattern when tested by blotting. This profile was absent in non reactive sera, including those with high antibody titers to C jejuni. The presence of specific IgG antibodies to H pylori in the majority of colonized gastric patients and asymptomatic adults suggests that this infection is very common in our population.

Adolescent↗