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PubMedDate not supplied

[Percutaneous cholangioscopy. An alternative in the treatment of retained stones].

We report our experience in the use of percutaneous cholangioscopy for extraction of retained stones in the biliary tract, at the Oncology Hospital, Centro Médico Nacional, IMSS, between July 1984 and January 1990. Ninety seven patients were evaluated; the endoscopic manipulation was successful in 82 patients (84.5%). The main causes of failure were: narrow fistula, impacted stone, very small stones and false way. There were minor complications on 13 patients, but in two cases intestinal perforation indicated laparotomy. No death was reported. The main disadvantage of cholangioscopy was the waiting period, necessary to obtain a strong fistula. Nevertheless, the endoscopist can also relay on other techniques, such as sphincterectomy; the choice depends of each particular case.

Cholelithiasis↗
PubMed1976

Gastrointestinal injuries.

Any wound that penetrates the abdomen may involve the gastrointestinal tract whether controlled for a specific operation of diagnostic procedure or uncontrolled when secondary to blunt or penetrating trauma. The first important consideration is the prevention of complications. The choice of incisions, the managment of the contaminated peritoneal cavity, intestinal fistulas and specific bowel injuries and the importan differences in the treatment of injuries to small intestine versus to large intestine and rectum be considered. Bowel viability must also be determined.

Colon↗
PubMedDate not supplied

Therapeutic approaches for chlordecone poisoning in humans.

Due to lack of adequate industrial safety measures, workers in a small factory that manufactured the organochlorine pesticide chlordecone were exposed to large amounts of this toxic material for many months. High concentrations of chlordecone were present in samples of blood, liver, and fat from these workers. Toxic manifestations prominently involved the nervous system, liver and testes. Although a plasmaphoresis experiment indicated that chlordecone is rapidly transferred from tissues to blood, attempts to employ hemoperfusion as a means for removing chlordecone from the body were unsuccessful because chlordecone is avidly bound by plasma proteins and was not extracted by the hemoperfusion sorbents. An alternative approach to therapy was based on the observations that stool contains only a small fraction of the substantial amounts of chlordecone excreted in bile. Oral administration of cholestyramine, a nonabsorbable resin that binds chlordecone in vitro, increased fecal excretion of chlordecone and accelerated its disappearance from the body. This treatment was accompanied by amelioration of the clinical manifestations of toxicity, indicating that the subacute toxic effects of chlordecone are reversible. Studies of chlordecone excretion in one patient with a surgically created bile fistula disclosed the existence of the novel, nonbiliary mechanism for excretion of chlordecone in the stool. Further physiological studies are needed to explore the possible role of the gut in the excretion of many kinds of slowly eliminated lipophilic toxins.

Bile↗
PubMed1996

Prospective randomized trial comparing Billroth I and Billroth II procedures for carcinoma of the gastric antrum.

BACKGROUND: Controversy persists regarding digestive reconnection following subtotal gastrectomy for carcinoma. A randomized prospective trial comparing Billroth I and Billroth II procedures for mortality, digestive comfort, survival, and patterns of recurrence was conducted. STUDY DESIGN: Thirty patients underwent Billroth I and 32 patients underwent Billroth II procedures. Stages I, II, III, and IV of the tumor-node-metastasis (TNM) staging system accounted for 27, 16, 47, and 10 percent of tumors, respectively. Billroth I and II groups were well-matched for clinicopathologic variables. RESULTS: Duration of surgery, volume of blood transfused, and abdominal drainage were similar in the two groups. The duration and volume of gastric drainage were greater in patients following Billroth I procedures. Four fistulas were noted in the Billroth I group and one fistula developed in a patient following Billroth II gastrectomy. Billroth I gastrectomy and low preoperative serum albumin were independent risk factors for fistula development. Fistula development accounted for an increase in the duration of hospital stay following Billroth I procedures. Hospital mortality was similar in the two groups. Five-year actuarial survival rate was 42 and 40 percent for patients undergoing Billroth I and Billroth II procedures, respectively. Long-term survival was similar for patients having each procedure, and this was verified for all TNM stages. There were seven recurrences at the hepatic pedicle in the Billroth I group and one recurrence of this type in the Billroth II group, requiring four reinterventions. CONCLUSIONS: Digestive comfort and long-term survival are similar after Billroth I and Billroth II gastrectomy for carcinoma. Billroth I gastrectomy is associated with an increased risk of fistula development and of recurrence of carcinoma at the hepatic pedicle.

Aged↗
PubMed2007

Increased heritability of certain types of anorectal malformations.

PURPOSE: Various lines of evidence point to genetic causes for the diverse spectrum of anorectal malformations (ARMs); we therefore studied patterns of heritability in a large case series. METHODS: We searched our ARM database for all patients having family members with congenital anomalies. This group was analyzed to determine the type of ARM and the specific anomalies in affected family members. RESULTS: Thirty-nine of 1606 patients (2.4%) had a family member with a congenital anomaly. The associated non-ARM anomalies included sacral masses and gynecologic, hematologic, esophageal, duodenal, renal, and spinal anomalies. Of these, 24 patients (1.4%) had 1 or more family members with an ARM. Among females with a positive family history, 73% of patients had either a vestibular or perineal fistula, compared with only 36% in patients without a family history (P = .0004). Among males, 35% had perineal fistulas compared with only 10% of those without affected family members (P = .0051). CONCLUSIONS: A positive family history in 1.4% is supportive of a strong genetic component to ARM. The risk of having an affected family member is significantly increased in the presence of a vestibular or perineal fistula. These new data allow for more informed counseling of families with an ARM and support the need for further genetic studies.

Anal Canal↗
PubMed2004

Tracheal agenesis: management of the first 10 months of life.

Tracheal agenesis is a potentially lethal congenital anomaly, appearing only at birth. We describe a newborn preterm infant who presented with immediate respiratory distress and no audible cry. There was almost complete tracheal agenesis with a very short segment of distal trachea (only two tracheal rings) arising from the anterior wall of the esophagus, before dividing into the mainstem bronchi. The anomaly was unsuspected prenatally, as the scan showed pyloric atresia and complex congenital cardiac disease. Despite the patient's difficult course, with correction of the rare-associated malformations (cardiac and gastrointestinal tract anomalies), the fact that the child is lively and neurologically normal for her age, requires that we now consider the patency of the airway and the possibility of surgical correction, in accordance with a good quality of life.

Abnormalities, Multiple↗
PubMed2004

[Curative-tactical approaches in patients with pancreatic pseudocyst].

Experience of treatment in the clinic of 162 patients with pancreatic pseudocyst was analyzed. Modern principles of diagnosis and treatment of patients were adduced. Operation before the cyst capsule formation is compulsory, caused by the complications occurrence and the pancreonecrosis progression. External drainage of an acute pancreatic pseudocyst was performed in 61 patients, internal drainage--in 72. After external drainage the cyst recurrence was noted in 17, the pancreatic fistula formation--in 7 patients. The poorest results were noted in patients with infected pancreonecrosis and in pseudocyst formation.

Adult↗
PubMed1991

Non-endocrine applications of somatostatin and octreotide acetate: facts and flights of fancy.

Somatostatin, originally detected by Krulich and ultimately isolated by Brazeau, was initially described as a growth hormone release-inhibiting factor. Subsequent investigation into the use of native somatostatin and the development of long-acting somatostatin analogues, especially octreotide acetate, have fostered increasing uses of these compounds. Though the clinical and investigational uses of somatostatin and its analogues are varied, one central theme remains constant: the ability of these agents to suppress circulating peptide levels. This article, a review of the current non-endocrine applications of somatostatin and its analogues, covers a wide range of potential applications for somatostatin-like compounds. These include use in cirrhosis and variceal bleeding, peptic ulcer disease, pancreatic fistulas, acute and chronic pancreatitis, dumping syndrome, cancer therapy, small bowel fistulas, psoriasis, pain control, and autonomic hypotension. Somatostatin may also play a role in the development and potential treatment of neurologic disease and may have profound found influence on behavior.

Digestive System Diseases↗
PubMedDate not supplied

[Guided digestive fistula. Complementary method in prophylactic and curative postoperative peritonitis].

Guided fistula (or sinus tract) techniques, which are a nowadays a controversial topic, comprise a group of simple surgical methods of postoperative peritonitis treatment. This retrospective study is an attempt to bring further insights into the literature debate on the utility of the aforementioned techniques by presenting Craiova C.F.R. General Surgery Department 7 years (from 1991 through 1998) experience with 26 operated on patients, who underwent digestive guided fistulas too. In 16 of our study patients sinus tracts were created for postoperative peritonitis prophylactis purpose, whereas digestive guided fistulas, which were performed in the other 10 patients, were meant to treat peritonitis secondary to anastomosis breakdown. In 87% of pur series of digestive guided fistula patients the postoperative outcome was satisfactory. Three deaths were recorded only among the nonprophylactic sinus tract patients. Guided fistula method is an useful adjunct of the complex, well-codified management of postoperative peritonitis including its efficient prevention.

Adult↗
PubMed1989

[Diarrhea in intestinal inflammatory diseases].

Diarrhoea is a frequent symptom in ulcerative colitis (UC) and Crohn's disease (CD) which it often reveals. Its clinical features, course, physiopathology and treatment are different in these two diseases. UC is accompanied by an imperative, blood-stained, diurnal and often noctural diarrhoea the intensity of which fluctuates with the course of the disease, usually regressing under medical treatment but capable of becoming severe. This diarrhoea is due to several physiopathological mechanisms such as loss of colonic absorption function, exudative enteropathy and disorders of motility. Contrary to the lesions of UC, those of CD involve the whole digestive tract; they are multisegmental, ileal, colonic, ileocolonic or diffuse. Diarrhoea takes different forms depending on the site and evolutive stage of the lesions: malabsorption of bile salts and/or fatty acids in ileal lesions or after surgical resections, bacterial proliferation above stenoses, intestinal shunts due to internal fistulae, reduced absorbing area, exudative enteropathy and motor disorders in colonic lesions. In UC, treatment of the diarrhoea is that of exacerbations: systemic or topical corticosteroids or 5-aminosalicylic acid. In CD, side by side whit the maintenance treatment of the disease with anti-inflammatory drugs, the symptomatic treatments of diarrhoea play an important role and must be tailored to the responsible physiopathological mechanisms; some patients need artificial feeding.

Anti-Inflammatory Agents↗
PubMed2002

Infliximab decreases resource use among patients with Crohn's disease.

GOALS: Surgery accounts for one half, and hospitalizations for one third, of overall costs for patients with Crohn's disease (CD). Infliximab induces remission and heals fistulas in CD but is more costly than traditional therapies. Its impact upon resource use in CD is unknown. STUDY: The medical records were reviewed for all CD patients managed at our institution for at least 1 full year both before and after initial infliximab infusion. The incidences of hospitalizations, hospitalized days, surgeries, endoscopies, radiologic examinations, outpatient and emergency room (ER) visits were studied (weighted according to time period). RESULTS: There were 79 patients (59% female, mean age 38.6 years). A decrease was seen in the annual incidence of all surgeries (38%, p < 0.01), gastrointestinal (GI) surgeries (18%, p < 0.05), endoscopies (43%, p < 0.01), ER visits (66%, p < 0.05), all outpatient visits (16%, p < 0.05), outpatient GI visits (20%, p < 0.01), all radiologic examinations (12%, p < 0.01), and non-plain films (13%, p < 0.01). Fistula patients (n = 37) had decreases in hospitalizations (59%, p < 0.05); GI surgeries (59%, p < 0.01); all surgeries (66%, p < 0.01); all, GI, and surgical outpatient visits (27%, 26%, and 70%, respectively, p < 0.05 for all); ER visits (64%, p < 0.05); all radiologic examinations (40%, p < 0.05); and non-plain films (61%, p < 0.05). Patients with luminal disease(n = 42) had decreases in endoscopies (52%, p < 0.05), and ER visits (69%, p < 0.05). Patients of both genders and all ages experienced decreases in resource use. CONCLUSION: Patients with CD decreased their use of some services, with a decreased number of hospitalizations and a decrease in the use of surgical services seen primarily in the patients infused for fistulas. This decrease in use of healthcare resources raises the potential of overall cost savings in CD patients receiving this drug.

Adult↗
PubMed2000

Assessment of sphincterotomy results in patients treated for anal fissure.

OBJECTIVE: This paper summarizes results of a study of 90 patients operated on for chronic anal fissure with lateral sphincterotomy (LS) between 1985 and 1997. METHODS: Preoperative and postoperative complaints, anal examination and continence were evaluated. All patients were asked to rate the results of LS as very good, good, satisfactory or unsatisfactory. RESULTS: Sixty-six patients (73.3%) judged the results of LS to be very good. Only 4 (4.4%) judged the results unsatisfactory and 1 patient (1.1%) considered the results satisfactory. Recurrent anal fissure was found in 4 cases (4.4%). Two patients developed a fistula in connection with the procedure. CONCLUSIONS: Lateral sphincterotomy is a safe and simple operation that yields good results. However, LS should be diagnosed and performed by a surgeon skilled in proctologic surgery.

Chronic Disease↗
PubMed2000

[Diverticulectomy for hypopharyngeal diverticula].

In the Otolaryngology Department of Pomeranian Medical Academy in Szczecin since 1980-1999 14 patients with pharyngo-oesophageal diverticulum were diagnosed and treated. Diverticulectomy was performed in 13 cases. Not dangerous complications during the postoperative period were observed in four cases. In one case it was abscess in postoperative wound, in two cases fistula to soft tissue in prevertebral region and in one case paresis of vocal cord. In all these cases complications retreated spontaneous. We had not observed any recurrence of pharyngo-oesophageal diverticulum. In 6 cases control radiological examination was performed (from 2 months to 7 years after surgical treatment). In all cases we hadn't observed any recurrence of diverticulum. In one case radiological examination revealed diverticulosis in all digestive system. But even in this case we hadn't found recurrence of Zenker's diverticulum. In this paper we discuss other methods of treatment of pharyngoesophageal diverticulum.

Aged↗
PubMed1992

Protection of pancreatic and biliary anastomosis after partial duodenopancreatectomy by external drainage.

The pancreaticojejunostomy after duodenopancreatectomy is the "Achilles' heel" of the procedure. Herein we describe a technique for percutaneous drainage of the efferent limb of the Roux-en-Y loop relieving tension from the anastomosis. Seventy-six Whipple procedures, using this technique, have been done. The operative mortality rate was 1.3 per cent and anastomosis leakage occurred in two instances. In addition, one patient had to be reoperated upon for biliary fistula. Our technique for external Roux-en-Y loop drainage after partial duodenopancreatectomy is safe and efficient and permits rapid diagnosis of anastomotic complications.

Adult↗
PubMed2006

[Laparoscopic colon-sigmoid resection with mesenteric artery preservation for diverticular disease].

AIM: About 2/3 of the Western population over the age of 80 years are affected by colic diverticulosis; 25% will develop diverticular disease with or without complications: fistula, obstruction, pericolic abscess, free perforation or hemorrhage. Laparoscopic approach for benign diseases of the colon such as diverticulosis, Chrohn's disease, etc. is unanimously considered as a very effective procedure. We have performed a retrospective analysis of 9 years with laparoscopic approach of the diverticular disease. The purpose of this study was to determine the feasibility, safety and benefits of laparoscopic approach. METHODS: From May 1994 to November 2002, 69 patients affected by non-complicated diverticular disease, were treated laparoscopically, at the Mininvasive Surgery Department of Spoleto. In the same period other 213 patients suffering from cancer of the colon-rectum were operated through laparoscopic surgery. A colosigmoid resection with mesenteric inferior artery preservation was performed in 46 cases (67%). RESULTS: We have performed only a laparoscopic colectomy technique (no hand-assisted procedures); the convertion rate was of 7.2%, the mean operative time was 145 min, no intraoperative complications were observed and finally the mean hospital stay was of 7.4 days (6-9). The postoperative complications were 1 case of infection of the umbilical scar and 1 case of pleural effusion with bronchopneumonia. CONCLUSIONS: Elective laparoscopic colectomy for diverticular disease is feasible, safe and gives very good results: minimum postoperative discomfort, rapid recovery, low mobility and postoperative stay, rapid return to normal activities. However, in some cases, this procedure can be extremely difficult because of previous inflammatory complications (adhesions, fistulas or stenosis), therefore, high surgical skills in laparoscopic-colic surgery are required.

Aged↗
PubMed1996

Factors influencing outcome in patients with gastrointestinal fistula.

The analysis of the prognostic factors in patients with gastrointestinal fistula requires an assessment of the quantitative and qualitative characteristics of the study population. General patient characteristics such as age, presence and degree of malnutrition, levels of plasma proteins, diagnosis of cancer or inflammatory bowel disease, or systemic sepsis must be considered, as well as local fistula characteristics. Besides the local anatomic characteristics of the fistulous tract, other factors such as fistula output, organ of origin, cause, and duration of the fistula must be considered in the assessment of a fistula patient. It is recognized, however, that it is very difficult to conclude that the presence of a single prognostic factor increases the risk in patients as complex and heterogeneous as those with digestive fistulas. It remains to be shown whether the combination of several predictive factors may enhance the chances of accurately predicting fistula closure and mortality in digestive fistulas.

Fistula↗