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Biomedical subjects

R Fernández Lobato

Publications and source records attributed to R Fernández Lobato.

At least 19 recordsLinked to original sources
PubMed2001

Colocutaneous fistula due to polypropylene mesh.

Fistulae due to polypropylene mesh are known to occur if the prosthetic mesh is placed close to a hollow viscus. Some cases of enterocutaneous fistula have been reported but there are few cases of fistula affecting the large bowel. It is important to recognize these cases because they are severe complications of the prosthesis and difficult to manage. We present a case of colocutaneous fistula caused by fragmentation of polypropylene mesh and erosion into the sigmoid colon after recurrent incisional hernia repair.

Aged↗
PubMed2001

Treatment of left colon neoplasic obstruction by placement of self-expandable stents.

INTRODUCTION AND OBJECTIVE: Neoplasic stenoses of the left colon are most frequently caused by primary colon carcinoma, infiltration from an external tumour and great adenomatous polyps. These patients often develop obstruction as their first symptom, leading to emergency surgical procedures in adverse circumstances and without an appropriate intestinal preparation that might prevent primary anastomosis. Therapeutic options for this event, such as Hartmann's resection, subtotal colectomy or anterograde colon lavage are not always possible. In these patients a colostomy is performed that requires future reoperation for reconstruction of the intestinal transit. Transtumoral self-expandable stenting followed by elective surgery might be the best option in these cases, as well as an alternative to surgery in non-operable patients. PATIENTS AND METHODS: Twenty four patients treated with this procedure in the past four years were divided in two groups. In group 1 (14 patients), the stent was placed as a permanent and palliative measure for the management of the disease. In group 2 (10 patients), the stent was placed temporarily for the management of the intestinal obstruction and latter the patients underwent elective surgery with fully preoperative and extension study and an appropriate preparation of the colon in order to allow reliable primary anastomosis. RESULTS: There were no hospital mortality nor stent migrations. There was only one complication (perforation caused by the stent) that required emergency surgery, but with any further complications. Failure to place the stent occurred in one patient. CONCLUSIONS: Self-expandable stents relieve neoplasic colon obstructions and allow to complete the study protocol, followed by elective surgery associated to less morbi-mortality. In patients with advanced or irresectable cancer, they provide a palliative and safe alternative to surgery, with satisfactory results.

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PubMed2000

Liver hematoma following endoscopic retrograde cholangiopancreatography (ERCP).

We report the case of an 81-year-old man who presented with abdominal pain following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. A diagnosis of infected hematoma was made. A CT-guided puncture produced bloody matter that grew Citrobacter freundii. A catheter was left in place for 3 weeks before the patient could be discharged from hospital. We hypothesize that the hepatic parenchyma had been torn by the guide used during the ERCP. This case represents the first report of this type of iatrogenic injury.

Abdominal Pain↗
PubMed1999

Palliative treatment of malignant colorectal strictures with metallic stents.

PURPOSE: To assess the effectiveness and safety of self-expanding metallic stents as a primary palliative treatment for inoperable malignant colorectal strictures. METHODS: Under radiological guidance 20 self-expanding metallic Wallstents were implanted in 16 consecutive patients with colorectal stenoses caused by malignant neoplasms, when surgical treatment of the condition had been ruled out. The patients were followed up clinically for 1-44 months, until death or termination of this study. RESULTS: The stents were successfully implanted in all cases and resolved the clinical obstruction in all the patients except one, who underwent subsequent colostomy. During follow-up of the remaining 15 patients, clinical complications arising from the procedure were pain (two patients), minor rectal bleeding (one patient), and severe rectal bleeding (one patient) (26%). There were three cases of stent migration and three cases of stent occlusion, and reintervention by us was necessary in 20% of cases (3/15). The mean life span following the procedure was 130 days, and none of the patients exhibited clinical symptoms of obstruction at the time of death (12 patients) or termination of the study (3 patients). CONCLUSION: Deployment of metallic stents under radiologic guidance is an effective alternative as a primary palliative measure in malignant colorectal obstruction, though the possible clinical complications and need for repeat intervention during follow-up should be taken into account.

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PubMed1997

[Diagnostic validity of signs and symptoms defining the diagnosis of acute appendicitis].

A prospective study of 810 consecutive cases submitted to emergency appendicectomy was performed to determine the predictive value of abdominal pain, nausea, vomiting, fever, abdominal tenderness and total and differential leucocyte count in the diagnosis of appendicitis. Age, sex, time of evolution and degree of inflammation were considered as conditioning factors. Most of the cases were diagnosed within the first 12 h. Pain demonstrated acceptable sensitivity (85.2%) and a high positive predictive value (95.7%) but with an important proportion of false negatives (14.8%). The predictive value of abdominal exploration was 97.6% with a sensitivity of 96.1%. Leucocytosis increased with the degree of inflammation and values above the cut off point established (12,500 leucocytes/dl and 85% segmented) significantly increased the strength of the association. Pain on palpation and leucocytosis with shift to the left increased the sensitivity to 98.1% with false positives of 1.3%. The percentage of acute perforated appendicitis increased from 5 to 15.3% when diagnosis was delayed more than 12 h. Once the clinical manifestations and analytical alterations were established (6 h after initiation of the clinical picture) these did not modify with the time of evolution. The greater the involvement of the appendix the earlier the presentation although, logically, the later the diagnosis the greater the percentage of perforated appendix. The classical criteria of pain, tenderness and leucocytosis with left deviation does not allow the diagnosis of 1.9% of the cases of appendicitis with 1.3% of false positives. Once the clinical manifestations are established, these do not modify with the time of evolution, but the percentage of perforations does increase with time. To reduce this percentage, diagnosis must be made within the first 24 h.

Acute Disease↗
PubMed1997

[A paratesticular myxoid liposarcoma as a simulator of a hernial process. A case report].

OBJECTIVE: To describe a case of paratesticular liposarcoma in a 69-year-old male. The literature is briefly reviewed and the prognostic and therapeutic aspects are discussed. METHODS/RESULTS: The patient was submitted to surgery. Pathological analysis of the surgical specimen disclosed a myxoid liposarcoma with undifferentiated pleomorphic areas. Patient follow up has shown no recurrence or metastasis. CONCLUSIONS: This tumor type develops in scrotal soft tissue, slowly increasing scrotal size, and should be distinguished from inguinoscrotal hernia. Together with physical examination, ultrasonography is generally useful. Treatment is by radical orchiectomy through an inguinal approach; the role of adjuvant therapy remains unclear. It has a good prognosis, with frequent local relapses; metastatic spread is uncommon.

Aged↗
PubMed1995

[Desmoid tumor: a simple problem with severe sequelae].

Desmoid tumours are rare benign lesions with an important local invasive potential and high risk of recurrence. The reported incidence is low, and the diagnosis is made in young women with an abdominal mass. Estrogen levels, a history of trauma and Gardner's syndrome have been incriminated. The defect of the entire thickness of the abdominal wall was reconstructed with a graft of marlex in three cases. The aggressive behavior of these three cases, and diagnosis of eight extraperitoneal cases in a short period of two years prompted us to review the features of the disease.

Adult↗
PubMed1995

[Pseudomyxoma peritonei].

Pseudomyxoma peritonei is an infrequent clinical entity, characterized by peritoneal implantations organized in cyst of mucine or free peritoneal mucine. Most arise from cystadenoma or cystadenocarcinoma of the ovary and appendix, and fewer from other tumours and locations. It is more common in females, and it is usually diagnosed over the fifth decade. Three cases of pseudomyxoma peritonei are presented, two associated to appendicular carcinoma and one to carcinoma of the ovary, and the data published about this disease are reviewed.

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