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V Morales

Publications and source records attributed to V Morales.

At least 19 recordsLinked to original sources
PubMed1991

Value of follow-up in the management of recurrent colorectal cancer.

The purpose of this article was to study the effectiveness of a prospective follow-up programme in patients after curative surgery for colorectal cancer. Of the initial 151 selected patients, 61 (40%) developed a recurrence in whom only six cases (10%) of potentially curable recurrent lesions were detected. The first clues to recurrence in the 61 patients were history or physical examination in 49%, a rising CEA in 29% and a positive imaging finding in 10%, being difficult to decide which test first signalled a recurrent cancer in an additional 11%. Endoscopy and CEA determinations were the most rewarding investigations. CEA was a sensitive means of identifying disseminated recurrent disease and liver metastases compared with liver function tests or liver ultrasound every 3 months. Endoscopy was useful in the diagnosis of local recurrences. However no follow-up test was capable of detecting recurrent colorectal cancer when it might still have been curable. As a direct result of this follow-up programme 15 patients (23%) underwent re-exploration. No symptomatic patients were candidates for curative re-operation. Of the asymptomatic patients six (four colonic and two rectal cancers) (19.5%) were re-resected for cure. Only three of these were alive and without evidence of disease, 40, 43 and 69 months later so that long term survivors after curative re-resection represent only 5% of all patients with recurrences (7.2% of the recurrent colonic cancer and 3% of the rectal cancer). Our follow-up programme did not permit us to alter the incidence of disseminated recurrent disease, and the effectiveness of the curative re-resection represents an increase of only 1.3% in the global 5-year survival rates for colorectal cancer. Our study does not demonstrate any great value of 'classical' postoperative follow-up programme.

Adult↗
PubMed1989

[Morphologic changes in ileoanal reservoirs 2 years after their construction].

A study was made of the histologic changes in the mucosa of the ileoanal reservoirs of 10 patients who 2 years earlier had undergone ileoanal anastomosis with a J reservoir for ulcerative colitis (CU). In biopsies of the reservoirs were evaluated: 1) basic morphologic changes; 2) morphometric differences with respect to normal ileal mucosa; 3) the immunohistochemical pattern (IHQ) (IgA, IgG, IgM and CEA) of the reservoir mucosa as compared to normal ileum, active ulcerative colitis. Crohn's disease and celiaca; 4) the possible existence of atypias or dysplasias of the reservoir mucosa; and 5) the number of argentaffin cells per field. The basic morphologic alteration consisted of colonic metaplasia. Reservoir biopsies exhibited partial (8 cases) or subtotal atrophy (2 cases) of the mucosa. With respect to the normal ileum there was a decrease in villi height (p less than 0.05), an increase in crypt depth (p less than 0.05) and a higher index of mucosal regeneration, with a larger number of cells and mitoses per crypt (p less than 0.05). Fifty percent of the reservoirs presented a chronic inflammatory pattern with an acute component in 30% of them. The immunohistochemical pattern of the reservoirs not inflamed was similar to that of normal ileum (IgA much greater than IgM greater than IgG) and that of the inflamed reservoirs was similar to that of intestinal inflammatory disease (marked increase in the IgG. CEA (similar to what?) an alteration of local immune homeostasis could have of the genesis of pictures of "pouchitis". No alarming signs of atypia or dysplasia were found, nor changes in the population of argentaffin cells.

Anal Canal↗
PubMed1989

[Intestinal fistula in Crohn disease].

The treatment of patients with Crohn's disease (CD) presenting intestinal fistulas is debated. A retrospective analysis was made of the treatment of 26 patients with Crohn's disease who had a total of 37 fistulas: 28 internal and 9 external. In 19 patients the fistulas were single and in 7 multiple; in most patients the fistula originated on the terminal ileum. Crohn's disease was ileal in 10 patients, ileocolonic in 15 and exclusively colonic in 1, and the evolution of the disease from the onset of symptoms to the appearance of the fistula was a mean of 5.8 years. The diagnosis, except for two patients in whom it was an operative finding, was based on the clinical examination and radiology studies. All the patients, except for four with asymptomatic internal fistulas, underwent medical treatment as needed. Six patients required only medical treatment, and the rest, 16, received medical and surgical treatment. Surgical treatment consisted basically of resection of the intestinal segment affected by the fistula, with or without anastomosis. The operative mortality was 0% and the morbidity was 25%, the most frequent complication being infection of the surgical wound. All the patients with external fistulas required surgical treatment. In every case the fistula was single. The treatment of internal fistulas in conditioned by the symptoms the response to medical treatment and the presence or not of associated pathology. Asymptomatic patients or those who responded to medical treatment had single fistulas.

Adolescent↗
PubMed1988

Colorectal cancer. The bases for a comprehensive follow-up.

The purpose of this article was to review the effectiveness of follow-up in patients with colorectal cancer submitted to curative treatment. A comprehensive follow-up involves rational initial management of the primary tumor, knowledge of prognostic factors, selection of the patient to be followed, determination of the time for follow-up, use of the most appropriate tests for early diagnosis of recurrence, and eventual curative treatment. The updated answers to all these questions are given through an extensive review of the world literature and confronted with the authors' experience of eight years of follow-up in a series of 170 colorectal cancer patients treated for cure. Although the future might be more promising, past world experience suggests only a few patients could be saved. It is concluded that there is no place for incomplete and disperse screening tests, and only comprehensive, intensive, and very well-coordinated follow-up programs should be undertaken if better results are hoped to be achieved.

Colonic Neoplasms↗
PubMed1988

Association of HLA antigens with alcoholic disease.

A sample of 30 alcoholic patients, selected according to a rigorous criterion, was compared with two samples of the general population with respect to the distribution of HLA antigens. The sole inclusion criterion was the presence of signs and symptoms of an alcohol withdrawal syndrome. The alcoholic sample did not differ from the general population sample with respect to ABO blood group distribution, and had minimal evidence of alcoholic liver disease. The alcoholic group showed highly significant differences from the two general population samples with respect to the HLA system, consisting of a much higher frequency of HLA B40 and DR4 antigens and a much lower frequency of DR3. The results are consistent with the view that alcoholism may have a precise genetic determination.

ABO Blood-Group System↗
PubMed1987

Fournier's syndrome of urogenital and anorectal origin. A retrospective, comparative study.

Twenty-eight patients with genital and perianal necrotizing infections are described. The patients were divided into three groups according to the primary site of infection: group 1, anorectal (14 patients); group 2, urologic (ten patients), and group 3, idiopathic (four patients). The overall mortality was 25 percent, 28.5 percent for the anorectal group and 10 percent for the urologic group, although this difference is not statistically significant. Necrotizing infections of anorectal origin were more severe and had a less typical way of presentation, with subsequent delay in diagnosis and a higher rate of myonecrosis. As a consequence, more debridements and more fecal derivations had to be performed. The etiologic agents were the same among the three groups and comprised a number of anaerobes (Bacteroides spp, gram-positive cocci) as well as aerobes (microorganisms belonging to the Enterobacteriaceae and S. faecalis). Necrotizing fasciitis was the pathologic picture of nine of ten patients with Fournier's gangrene of urogenital origin and seven of 14 with an anorectal source. Synergistic necrotizing cellulitis was identified in half of those secondary to anorectal origin and only one of those with a urologic source.

Adult↗
PubMed1987

[Antibodies against smooth muscle in the detection and follow-up of the celiac disease patient].

The presence of smooth muscle antibodies (SMA) as determined by indirect immunofluorescence was investigated in the serum of 40 patients, 36 out of which were children. Group I included patients having celiac disease (diagnosed by three biopsies). 7/7 (Group Ia) showed no SMA on gluten-free diet while antibodies were present after challenge. 4/6 (Group Ib) were positive also after challenge (these had not had previous determination). Group II was composed by patients presumed to have celiac disease for they had only one biopsy showing grade IV villous atrophy. 5 patients were of recent diagnosis (group IIa) and showed SMA. 4/5 (Group IIb) who admitted not to had been able to follow the gluten-free diet were also positive for SMA. 6/6 (Group IIc) patients on strict gluten-free diet and showing good clinical response had no detectable SMA. Group III included relatives of patients having celiac disease. 5/6 with SMA showed pathologic small bowel biopsies; only 1/4 with no SMA had mucosal alterations. It is concluded that the presence of serum SMA can be considered a useful marker in the follow-up of cases of celiac disease already diagnosed and to investigate presumed cases of such disease.

Autoantibodies↗
PubMed1985

Correction of amino-acid imbalance in postoperative portosystemic shunts.

We report on 22 cirrhotic patients suffering from portal hypertension and bleeding esophageal varices. Sixteen of them underwent H mesocaval shunt with internal jugular vein graft and 6 spleno-renal shunts. Mortality was 13.2%. All the patients were treated postoperatively with parenteral and oral nutritional support with solutions containing no aromatic amino-acids, following Fischer's formula. We determined Fischer's index (formula; see text); normal value 2.67 +/- 0.22) on the day of operation (1.6 +/- 0.22), on the 8th postoperative day (2.32 +/- 0.49), and on the 15th postoperative day (1.85 +/- 0.37). Only 1 patient suffered from hepatic encephalopathy in the immediate postoperative period. Three months after operation Fischer's index was 1.20 +/- 0.11 and only 2 patients with an index below 1 suffered from chronic encephalopathy. We conclude that there is a correlation between Fischer's index and the presence of post-shunt hepatic encephalopathy. The proposed policy of parenteral nutrition improves the values of Fischer's index in the immediate postoperative period and we believe that nutritional support should be included routinely as an adjuvant therapy in portosystemic shunts in cirrhotic patients.

Adult↗
PubMed1984

Automatic preoperative classification of carcinoma of the colon and rectum.

The Dukes' and TNM systems for staging carcinoma of the colon and rectum are still the best pathologic classifications, but they do not apply to all patients and do not distinguish between patients who will die and patients who will be cured by the same therapeutic procedure. A new approach to this problem should be to establish a biochemical automatic classification, complementary to the morphologic one, which allow us to classify every patient before and after the first and subsequent treatments. By using several nonspecific tumor markers, such as CEA, AAT, AF, AAG, GGT and transferrine, a discriminant analysis was executed among the groups of patients with LD, RD and DD. Our initial results with only 12.8 per cent of incorrect classifications, that is patients classified in a less advanced group, suggest that this system may be quite useful in order to select those patients with carcinoma of the rectum who should benefit from preoperative radiotherapy as well as those who should receive adjuvant therapy after the first treatment. On the other hand, for patients classified in a more advanced group than the pathologic grading, we may well be able to identify those patients with occult disease for which the frequency of revisions should be shorter.

Adenocarcinoma↗
PubMed1983

Method of assay for 4-aminobutyrate-2-oxoglutarate aminotransferase.

In this paper an analytical colorimetric method is presented where 2,4-dinitrophenyl hydrazine is used to measure small amounts of succinic semialdehyde in the presence of 2-oxoglutarate. This method is applicable to the measurement of 4-aminobutyrate-2-oxoglutarate aminotransferase activity, where succinic semialdehyde formed during the enzymatic reaction has to be measured in the presence of 2-oxoglutarate.

4-Aminobutyrate Transaminase↗
PubMed1979

Antenatal intestinal perforation and meconium peritonitis associated with the neonatal small left colon syndrome.

Although NSLCS has been considered to have a benign course, we have described an infant who had intrauterine intestinal perforation and meconium peritonitis associated with the NSLCS. Infants of diabetic mothers who are stillborn or who develop abdominal distention shortly after delivery should be suspected of having this complication of NSLCS. This disorder must also be considered in the differential diagnosis of infants who present with meconium peritonitis.

Colonic Diseases↗