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Biomedical subjects

T Sala

Publications and source records attributed to T Sala.

At least 19 recordsLinked to original sources
PubMed2003

[Endoscopic treatment of pancreatitis and its complications].

OBJECTIVES: To study the long- and short-term safety and efficacy of endoscopic treatment of pancreatitis and its complications in our environment. PATIENTS AND METHODS: We performed a retrospective analysis of 43 patients with chronic pancreatitis, acute pancreatitis complicated with pseudocyst, and pancreatic fistula diagnosed by endoscopic retrograde cholangiopancreatography who were suitable for endoscopic treatment. RESULTS: Endoscopic treatment was attempted in 35 patients. The indication for treatment was pain in 17 patients (48.5%), jaundice in 7 (20%), pseudocyst in 10 (28.5%) and suspected external fistula in 1 (3%). The technique was successfully performed in 28 (80%). Of the patients with pain, pancreatic prosthesis was inserted in 13 and extracorporeal lithotripsy was applied in 6. Sixty-five percent of the patients improved. Of the 7 patients with jaundice, all had secondary stenosis of the biliary tract. Treatment was applied in 2, who showed partial improvement. Of the 15 patients with pseudocyst, endoscopic treatment was indicated in 10; the technique was successfully performed in 8 and complete resolution was achieved in 7 (87.5%). The patient with external fistula was treated with transpapillary prosthesis and complete resolution of disruption of Wirsung's duct was achieved. Overall improvement in successfully treated patients was: complete in 19 (68%), partial in 3 (18%), no improvement in 4 (14%) and 2 patients were lost to treatment. There were 4 short-term complications. There were 4 deaths and one was related to the technique. CONCLUSIONS: Endoscopic treatment of chronic pain in chronic pancreatitis, pseudocysts and fistulas was effective in our environment with a low rate of complications.

Acute Disease↗
PubMed2003

Diagnostic value of symptoms in patients with suspected upper digestive tract disease.

OBJECTIVE: to develop a predictive model based on clinical data for patients with suspected upper digestive tract disease. PATIENTS AND METHODS: forty-seven clinical data were obtained before endoscopy from 283 patients with suspected upper digestive disease (153 men; mean age 55 years, limits 17-92 years). A clinical prediction of diagnosis was made before endoscopy. On the basis of the endoscopic findings, the patients were divided into three diagnostic groups: absence of significant disease (group I), significant benign disease (group II) and malignant disease (group III). The probability rate of belonging to each one of the three groups was obtained for each patient by using Bayes' theorem. RESULTS: the endoscopic findings were classified according to their clinical importance: 121 patients (43%) belonged to group I, 137 (48%) were included in group II; and 25 (9%) in group III. The clinical prediction correctly classified 61% of the patients (group I: 56%, group II: 62% and group III: 76%) The coincidence between prediction obtained using Bayes' theorem and the actual diagnosis was 61% (group I: 65%, group II: 51%, group III: 92%). The predictive model was useful to confirm or not the clinical prediction. CONCLUSION: objective analysis of clinical data can be useful to support clinical judgment, mainly in patients with neoplasia. However, the model is not adequate to improve indication of upper endoscopy since many patients are misclassified.

Adolescent↗
PubMed2003

Menière's disease and gentamicin: preliminary results using the minimum effective dose and integrated therapy.

Treatment of Menière's disease is aimed at restoring a normal quality of life and preserving residual hearing, in view of the increasing frequency with which the contralateral ear is affected. Conventional medical treatment (diuretics + vasoactive drugs) leads to cure in a large percentage of patients (75-95%). In intractable cases, transtympanic (intratympanic) aminoglycoside therapy, associated with various techniques, is becoming widespread as an alternative to surgery. Progressive reduction of the dose introduced into the middle ear did not prevent the onset of anacusis in several patients; the variable, unpredictable permeability of the round window membrane, the object of fundamental studies in the past, explains this complication. The Author has used gentamicin transtympanically in Menierians since 1978, and has treated a total of 105 patients. He first prescribed transtympanic gentamicin therapy that did not follow, but was integrated with conventional medical treatment in 22 intractable Menierians, by instilling the minimum effective dose, to reduce the risk of hearing impairment. Preliminary results, related to stage of disease, may be summarised as follows: improvement in the quality of life, as evaluated by the American Academy of Ophthalmology & Otolaryngology Committee on Hearing and Equilibrium questionnaire (14 patients--63.63%--at point 1 and 8-36.36%--at point 2); disappearance of vertigo in 15 patients (68.18%); a minor vertigo attack in 3 and two minor attacks in 3 others not affecting quality of life; persistence of occasional unsteadiness in one patient. Hearing remained unchanged in 15 patients, improved slightly in 3 cases and worsened slightly in 2; decreased sensitivity to high tones was observed in 2 patients at the first insertion of gentamicin. According to the Author, employing integrated therapy and using the minimum effective dose of gentamicin, the risk of damage to the cochlear structures may be reduced, although not excluded, while restoring a good quality of life, even when repeat instillation is necessary.

Administration, Topical↗
PubMed2002

[Endoscopic treatment combined with extracorporeal shock wave lithotripsy of difficult bile duct stones].

OBJECTIVES: The aim of this study was to determine the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) in difficult bile duct stones resistant to endoscopic extraction. PATIENTS AND METHOD: From January 1997 to February 2002, combined treatment with endoscopy and ESWL was used in 19 patients who had undergone unsuccessful endoscopic bile duct stone extraction after sphincterotomy. The procedure was carried out using analgesic and sedative drugs or deep sedation, prophylactic antibiotic therapy, and monitoring of vital signs. Bile duct stone localization was performed by contrast injection through nasobiliary drainage and fluoroscopy. After each ESWL session, lavage was performed through drainage and stone fragments were extracted endoscopically. RESULTS: The 19 patients presented high surgical risk due to advanced aged and/or concomitant diseases. All presented jaundice and pain and nine (47.3%) presented associated cholangitis. Thirty ESWL sessions were performed (1.57 sessions per patient), with a mean of 2,120 shock waves per session. In 16 of the 19 patients (84.2%), combined treatment with ESWL and subsequent instrumental endoscopic extraction achieved complete clearance of the biliary tract. The treatment failed in 3 patients who were referred for surgical treatment. No early or late complications were observed, except in one patient who presented a self-limiting febrile syndrome. CONCLUSIONS: Therapeutic endoscopy combined with ESWL is safe and effective in patients with difficult bile duct stones. It represents a therapeutic alternative in patients at high surgical risk.

Aged↗
PubMed2001

A randomized comparison of low-dose ketamine and lignocaine infiltration with ketamine-diazepam anaesthesia for post partum tubal ligation in Vanuatu.

Ketamine remains one of the most commonly used anaesthetic agents around the world. Despite it being the anaesthetic agent of choice in many developing nations, there is a paucity of literature describing ketamine in the developing world. In what we believe is the first randomized controlled trial to be performed in Vanuatu (formerly the New Hebrides) we compared the use of ketamine 0.9 mg/kg and diazepam 0.07 mg/kg with ketamine 0.3 mg/kg and 2% lignocaine infiltration in 50 Melanesian women undergoing post partum tubal ligation. All women received 0.5 mg/kg intramuscular pethidine. Visual analog pain scores and verbal numeric satisfaction scores were similar between the groups. However the time to obeyed command was significantly faster in the 0.3 mg/kg ketamine group (7.0+/-4.9 vs 13.0+/-9.2 min). The incidence of dreaming was similar and the content rated as pleasant by both groups. In institutions where post-anaesthesia care resources are limited, 0.3 mg/kg ketamine with local anaesthesia provides for earlier self-care of patients after tubal ligation, without compromise of analgesia, emergence or satisfaction. The implications of these findings extend to other procedures that require short general anaesthesia, which can be adequately performed with low-dose ketamine and local anaesthesia. The latter technique allows more rapid awakening.

Adult↗
PubMed2000

[Comparison of the efficacy of cleaning and disinfection of videoscopes: mechanized versus manual].

AIM: a) To analyze the effectiveness of the automated cleaning and disinfection of endoscopies (Olympus miniETD, not previously tested) versus the manual method; b) To evaluate the drying and storage procedures used in our unit. MATERIAL AND METHODS: Prospective 10-day study. The endoscopies were randomized for automated or manual cleaning and disinfection. Endoscopic samples were collected for microbiology studies at three points during the process: a) after endoscopy (after manual cleaning with water), b) after cleaning with enzymatic detergent and disinfection (automated or manual) and c) at the first hour in the morning. RESULTS: Sixty-five samples were collected after endoscopy: 26 from gastroscopy, 26 from colonoscopy and 13 from duodenoscopy (positive cultures were found in 22, 25 and 10, respectively). The 35 samples collected after automated disinfection were negative, as were 29 of the 30 collected after manual disinfection (p = 0.46). Sixty-four of the 65 samples were negative for hepatitis B and hepatitis C. The only sample positive for hepatitis C became negative after manual disinfection. Positive culture was found in 15% of the samples collected before beginning the session. CONCLUSIONS: a) Automated cleaning and disinfection (Olympus miniETD) are as effective as manual cleaning. b) Drying and storage procedures should be improved and/or disinfection should be carried out again before the first endoscopy of each session.

Colonoscopes↗
PubMed1997

Transtympanic gentamicin in the treatment of Meniére's disease.

Aminoglycosides enable a pharmacological approach, before resorting to surgery, to the treatment of Menière's disease (MD) proving unamenable to routine medical treatment. The staging of MD is an essential preliminary step in the implementation of a specific and personalized treatment with transtympanic gentamicin. The ideal condition is the presence of endolymphatic hydrops with little or no damage to the cochlear and vestibular hair cells. The technical aspects of the method are discussed. In 21 patients with unilateral Menière's disease in various stages, this treatment achieved the regression of vertigo in 86% of cases; hearing was better in 19% of cases, preserved in 62% and worse in 19%; tinnitus regressed totally or partially in 62% of cases; aural fullness also regressed totally or partially in 57% of cases.

Adult↗
PubMed1997

[Hepatoporto-appendicostomy. Our experience in 3 cases of biliary cystic disease].

This report details our preliminary experience with hepaticoporto-appendicostomy in three patients with biliary cystic disease. The surgical procedure was total resection of choledochal cyst and vascularized appendix interposition between biliary tree and duodenum. The children have been followed by clinical, ultrasonography and endoscopic (ECPR) during a period between 1-4 years. There was no episodes of ascending colangitis. All the patients remain free of jaundice and the biochemical abnormalities have become normal three months after interposition. Our results suggest that this procedure is more physiologic than the standard bilioenteric derivation Roux-in-Y, because allow bile to enter freely to duodenum and prevent reflux, stasis and ascending cholangitis. This procedure allows postoperative endoscopic valoration, not possible in another kind of bilioenteric derivations.

Appendix↗
PubMed1996

Individual prediction of response to pneumatic dilation in patients with achalasia.

During nine years, 157 consecutive patients with achalasia have been dilated in our unit. First, the long-term effect of dilation on clinical status was evaluated. The probability of being in clinical remission eight years after first dilation was 51%. The pressure of the LES measured after dilation was highly predictive of the long-term clinical evolution. Second, a predictive model of the individual response to pneumatic dilation was developed and simplified. Therapy was effective in 80% of the patients, after one to four dilations. Younger age was the only factor significantly associated with ineffective therapy. Depending on the prognosis of the outcome calculated with the predictive model, patients were classified in groups of risk that showed a different rate of ineffective, therapy. In the simplified model, age < or = 20 years, male gender, esophageal body diameter < or = 3 cm, esophageal body basal pressure > 15 mm Hg, and pressure of the lower esophageal sphincter > 30 mm Hg were predictors of a poor response to dilation. We conclude that pneumatic dilation is an effective therapy for achalasia. A predictive model was useful to classify the patients in groups with a different risk for ineffective dilation. A simplification of this model could be used to predict the response to dilation.

Adolescent↗
PubMed1995

[Candida esophagitis and cytomegalovirus gastritis: optic and immunohistochemical diagnosis in an HIV+ patient].

Esophageal candidiasis, along with gastritis caused by cytomegalovirus--CMV--, is a common opportunistic infection in immunodepressed patients. A clinico-pathological description is made of a human immunodeficiency virus-positive female (group IV-C-2) with a history of odynophagia and dysphagia resistant to treatment. The light microscopy and immunohistochemical study of an endoscopic esophago-gastric biopsy allowed the diagnosis of moniliasic esophagitis associated with CMV-induced gastritis. Emphasis is placed on the efficacy of immunohistochemical techniques over other methods in diagnosing CMV infection.

Adult↗
PubMed1995

Endoscopic sclerotherapy versus oesophageal transection in the prevention of variceal rebleeding.

OBJECTIVE: To compare sclerotherapy with oesophageal transection in the prevention of rebleeding in patients with oesophageal varices. DESIGN: A prospective trial. PATIENTS: Forty-one patients with cirrhosis and variceal bleeding. METHODS: After recovering from an acute episode of oesophageal variceal bleeding patients were randomized into two groups. One patient was excluded. Twenty-two patients were treated with sclerotherapy (group 1) and 18 underwent an oesophageal transection (group 2), with a shorter elapsed time from randomization to treatment in group 1. Both groups were similar with regard to clinical and biochemical features and variceal size. Failure, defined in group 1 as rebleeding or incomplete eradication after four sclerotherapy sessions, occurred in five (22.7%) patients; in group 2, rebleeding occurred in two (11.1%) patients (no statistically significant difference). CONCLUSION: Although the survival rate was similar in both groups, sclerotherapy is preferable to oesophageal transection because it requires a shorter duration of hospitalization and has fewer complications.

Adult↗
PubMed1995

[Primary carcinoma of the thyroglossal duct. 2 case reports].

AA. present two cases of carcinoma arising on thyroglossal duct's cystic. Those carcinomas are a rare event and will be suspected in the patients that present an irregular tumefaction of medial neck's district. Etiology is unknown; is possible that a preceding irradiation on the neck will represent a factor risk. AA. retained that in case of medial neck's district tumefactions is necessary executed a total examination of neck's and head's district, an echography, a thyroid scintigraphy, a thoracic radiography, a panendoscopy and a FNAB. When we found a squamous carcinoma on residual thyroglossal duct the therapy is chirurgical in function of dimension of T and N with following radiotherapy in function of stage (possible lymph node metastasis). When we found a different adenoma is necessary chirurgical removal of tumefactions with hyoid bone's a body resection (Sistrunk's operation) with total thyroidectomy and following Pochin's test for seeking eventual residual with radiometabolic and suppressive therapy.

Aged↗
PubMed1994

[Combined endoscopic treatment with extracorporeal lithotripsy in chronic calcifying pancreatitis].

In the management of severe chronic pancreatitis, a variety of new endoscopic methods have been proposed as an alternative to traditional surgery. The main goal of these procedures is the remission of pain. They include pancreatic endoscopic sphincterotomy with subsequent endoscopic extraction, which can be associated to extracorporeal shock-wave lithotripsy for stone desintegration before removal of large calculi, and to the insertion of a pancreatic stent in case of a pancreatic duct stricture. We present two cases of severe chronic pancreatitis managed successfully with this endoscopic treatment.

Calcinosis↗
PubMed1994

[Results of endoscopic dilatation treatment of benign esophageal stenosis].

The management of benign esophageal stenoses is based on endoscopic dilatation of the tight segment for the remission of dysphagia. Five hundred and twenty sessions of dilatation with Savary-Guilliard bougies have been performed in one hundred and twenty-nine patients with benign esophageal stenoses. Patients with peptic stenoses (n = 59) needed a lesser number of sessions (mean: 2.47) than patients with postsurgical (n = 44; mean: 4.86) or caustic (n = 18; mean: 7.77) stenoses. The treatment failed in 4 patients (3.2%) and severe complications were observed in 3 patients (2.4%). These results support the efficacy and safety of this technique.

Adolescent↗
PubMed1993

[Endoscopic prosthesis insertion in the palliative treatment of malignant esophageal stenosis. (Endoscopic esophageal prosthesis)].

We report our experience with endoscopic esophageal prosthesis in the treatment of 82 patients with advanced malignant oesophageal stenosis. The cause of the stenosis was an esophageal or esophagogastric cancer in 75 cases and a bronchogenic cancer in 7 patients. In 18 cases a tracheobronchial fistula was also present. A silicone tube (Atkinson) was used in 58 patients, a polyvinyl tube (Wilson-Cook) in 22 cases and a self-expanding tube in the remaining 2 patients. There was no technical failure in the insertion of the prosthesis. A normal feeding was possible in 71 of the 82 patients (86%) within 48 after the intubation. Major complications occurred in 8 cases (9.7%), 4 patients with esophageal perforation and 4 cases with aspiration bronchopneumonia. Postoperative mortality rate was 7.3%, one patient with perforation, 3 cases with aspiration bronchopneumonia and 2 patients with sepsis. The prosthesis partially displaced in 9 cases, but could be endoscopically replaced in all of them. The displacement of the prosthesis was complete in 3 patients, one of which needed a surgical procedure to remove the tube. The prosthesis was bunged up by a solid meal bolus in 4 cases, but an endoscopic procedure was successful in removing the bolus. Therapy with laser was necessary in two cases with self-expanding prosthesis obstructed by tumoral growth. We conclude that, in malignant esophageal stenosis, the endoscopic implantation of esophageal endoprosthesis is an effective, cheap and relatively safe palliative therapeutic alternative with a low postoperative mortality rate.

Adult↗
PubMed1993

[Prevalence of gastroesophageal reflux in patients with primary motor disorder of the esophagus treated with endoscopic pneumatic dilatation].

The prevalence of gastroesophageal reflux after successful pneumatic dilatation was investigated in 30 patients with primary esophageal motor disorder. After a median follow-up period of 377 days, three patients presented symptoms of acid reflux and five patients had endoscopic esophagitis (grade I, 3 patients; grade II, one patient; and grade III, one patient). Ambulatory 24 hr. esophageal pH monitoring was positive in 20% and 30% of the patients compared to our normal values and to those from other series from the literature, respectively. The concordance between pH results and symptoms and/or endoscopic esophagitis was very low. It is concluded that 24 hr. esophageal pH monitoring is frequently abnormal after pneumatic dilatation, but its clinical significance is low, because very few patients have symptoms and/or severe esophagitis.

Adolescent↗
PubMed1992

Does endoscopy improve prediction of the prognosis in upper gastrointestinal bleeding?

To evaluate the prognostic value of the endoscopic examination, we included 189 consecutive patients with upper gastrointestinal bleeding, in a prospective study. Rebleeding was more frequent in patients with endoscopic stigmata of hemorrhage. The prognostic prediction given by the physician was slightly, but not significantly, improved after the result of the endoscopy was available. However, when the clinical data were evaluated by computer, using the Bayes' theorem, the endoscopic findings provided no additional prognostic value. We conclude that the endoscopic findings have intrinsic prognostic value, but add little to clinical data obtained on admission.

Adolescent↗