Biomedical subjects
R Blanco Benavides
Publications and source records attributed to R Blanco Benavides.
[Morbidity and mortality in surgery for gastric cancer].
BACKGROUND DATA: Surgery stays as the only effective therapy against gastric cancer. Several factors have been postulated to influence morbidity and mortality risk in gastric cancer surgery. OBJECTIVE: Determine morbidity and mortality of gastric cancer surgery and establish risk factors. METHOD: We reviewed the charts of patients who underwent surgery for gastric adenocarcinoma. Morbidity and mortality is reported. Demographic factors, preoperative physical evaluation, biochemical parameters, surgical technique and tumor biology were analyzed as risk factors for morbidity and mortality. RESULTS: During a seven year period, 120 patients were operated for gastric cancer. Median age was 58.07 years. Subtotal gastrectomy was the most common surgical procedure in 51 patients (42.5%). Morbidity was 26.66% (n = 32). Medical most common complication was renal failure (n = 6, 14.63%) and surgical most common complication was wound infection (n = 7, 17.07%). Mortality was 13.33% (n = 16). Statistically significant risk factors for morbidity were age, ECOG status, Goldman Cardiac Risk Index and a total lymphocyte count. Statistically significant risk factors for mortality were Goldman Cardiac Risk Index, albumin, creatinine, and total lymphocyte count. CONCLUSIONS: Morbidity and mortality after gastric cancer surgery is influenced by preoperative conditions of patients.
[Gastrointestinal stroma tumor with gastric involvement. Presentation of a case and review of the literature].
BACKGROUND DATA: Gastrointestinal stromal tumors (GIST) are considered the most common group of non-epithelial neoplasms of stomach and small bowel. OBJECTIVE: To present a case report and literature review. METHOD: Sixty-seven year-old white male with abdominal mass and gastrointestinal bleeding. Laboratory and X-ray test were done resulting in gastric leiomyosarcoma suspect. RESULTS: Patient underwent to exploratory celiotomy with subtotal gastrectomy with splenectomy. Immunohistochemistry results confirms gastrointestinal stromal tumor diagnosis of the stomach.
[Bile duct neuroma. A benign neoplasm resembling Klatskin's tumor. Report of a case].
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[Rectorrhagia as complication of Klippel-Trenaunay syndrome].
OBJECTIVE: To describe the clinical presentation and treatment of two patients with the Klippel-Trenaunay syndrome referred to our hospital because of rectal bleeding and to review the literature concerning the diagnosis and treatment of this complication. CASE 1: Fifteen year old male with the Klippel-Trenaunay syndrome and chronic anemia who presented with severe rectal bleeding. CASE 2: Nineteen year old female with the same syndrome and a two year history of intermittent rectal bleeding, anemia and thrombocytopenia. In both cases the study protocol revealed varicose lesions in the colon as the cause of bleeding and other vascular malformations related to their syndrome. TREATMENT: The first patient was treated with partial colectomy and colorectal anastomosis. Four years after surgery he presented with new episodes of bleeding and was treated with sclerosis of the residual rectal varices using formaldehyde. The second patient was treated with partial colectomy and colostomy. She has received to sessions of sclerosis with absolute alcohol of the residual varices in the rectal stump. Colostomy closure is soon to be performed. CONCLUSION: Klippel-Trenaunay syndrome is a rare clinical entity with vascular alterations at different levels. A small percentage of cases may present rectal bleeding due to colonic varices and can lead to chronic anemia or severe hemorrhage with hemodynamic implications. Treatment of this complication involves resection of the affected colonic segment combined with a secondary procedure to control bleeding of the residual rectal varices.
[Cutaneous metastasis of gastric cancer].
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[Surgery for choledocholithiasis following extracorporeal lithotripsy in 3 patients].
Extracorporeal lithotripsy has been used as a therapeutic modality for gallbladder and common duct stones. When duct stones are fragmented and do not pass to the duodenum or endoscopic extraction is not possible, a surgical intervention seems justified. At operation under these circumstances we have appreciated an unusual increment of vascularity and inflammation that makes the operation somewhat difficult. In the last year we have operated three patients that had common duct stones and received lithotripsy. In two cases the procedure failed. Even when postlithotripsy cholangiogram showed fragmentation of stone, in one patient those fragments could not be evacuated transendoscopically and patient was operated few days later. During operation small fragments were found and probably they could have been eliminated through the sphincterotomy. Thus, we suggest to obtain a new cholangiogram before operating such cases.
[Hepatico-jejunal anastomosis without sutures with permanent access to the anastomosis].
A simple and rapid surgical technique for the treatment of bile duct strictures is described, is a nonsuture technique that permits a safe long term control of the anastomosis, is an hepatico-jejunostomy without sutures, a Roux in Y loop is anchored to the hepatic bilium with a transhepatic Levin F14-16 tube. When the Levin tube is retired a nylon thread is left in place for future use. Has been used with exit in 15 cases two of them presented biliar fistula that was easily treated with sucction at the ends of the catheter.
[Management of pancreatic fistula with terbutaline. Report of a case].
External pancreatic fistulas are secondary to trauma or surgery. Their treatment consists of scrupulous skin care, fluid and electrolyte replacement and nutritional support. Usually they are associated to significant morbidity and mortality as well as long hospital stay. In 1981 Joehl described the inhibitory effect on pancreatic secretion caused by the beta agonist terbutaline, in 1985 he used it successfully in a patient with an external pancreatic fistula following an episode of pancreatitis. We report the case of a 21 year old patient who presented with a 26 day posttraumatic pancreatic fistula that closed five days after the administration of terbutaline. To our knowledge this is the second case reported in the literature. We believe that use of terbutaline, due to its pancreatic inhibitory effect as well as its minimal side effects, might be useful in these patients.
[Amebiasis. Surgical treatment in 1989].
Even when the number of patients with invasive amebiasis has decreased, the internist and surgeon must be alert in case that the patient requires an operation. Amebic liver abscess is treated medically; percutaneous evacuation is rarely used and surgical drainage is made when there is not response to medical treatment or there is high risk of abscess rupture. Operation is mandatory when the abscess has ruptured to the abdominal cavity or through the pericardial sac. In fulminant colitis it is necessary to resect the diseased portion of the colon without primary anastomoses. Amebic apendicitis is difficult to diagnosis before an operation. It may be suspected in cases of apendicitis if the cecal wall is inflammed. Colon ameboma requires medical treatment except if it is associated with necrosis or perforation. In a four year period (1985-1988) 294 patients with diagnosis of invasive amebiasis were admitted to three hospitals of the Instituto Mexicano del Seguro Social in Mexico City. 218 had hepatic abscess, 45 required surgical drainage with four deaths (9%) and four not operated patients died. In this series only four patients had their abscess drained percutaneously. 31 patients with amebic colitis were treated; three required colonic resection with one death. Ameboma was seen in five patients and there were 11 cases of amebic apendicitis. No deaths occurred in these last two groups.
[Primary intestinal anastomosis in the presence of peritonitis (author's transl)].
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