Flora bacteriana intestinal en pacientes con hepatopatías crónicas / Intestinal bacterial flora in patients with chronic hepatopathies

El diagnóstico y tratamiento de las enfermedades hepáticas se encuentran entre los objetivos priorizados del Ministerio de Salud Pública cubano; sin embargo, los nuevos descubrimientos respecto a su fisiopatología obliga a los profesionales sanitarios a mantenerse informados y actualizados sobre esa materia, con vista a lo cual se realizó una revisión bibliográfica enfocada fundamentalmente hacia la evolución fisiopatológica de la flora bacteriana intestinal como causante de daño hepático y la anatomía y fisiología del sistema hepatobiliar.

The diagnosis and treatment of the hepatic diseases are among the prioritized objectives of the Cuban Public Health Ministry; however, the new findings regarding their pathophysiologies oblige the sanitary professionals to be informed and updated on that matter, for that purpose a literature review was carried out mainly aimed at the pathophysiological clinical course of the intestinal bacterial flora that accounts for the hepatic damage, anatomy and physiology of the hepatobiliary system.

The effects of cholecystojejunostomy and biliary drainage on biliary motor / 华中科技大学学报（医学）（英德文版）

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.

Estudio preliminar de fibrosis en estenosis biliar experimental / Preliminar study of fibrosis in experimental biliary stenosis

Uno de nuestros enfermos presentó ictericia en el postoperatorio y la ERCP demostró un clip en el colédoco. Esto motivó la búsqueda en la literatura si existía un tiempo, después de producido el accidente, en el cual se podía retirar el clip o ligadura, sin que existiera daño o reacción importante del colédoco. Al no encontrarlo, diseñamos un modelo experimental el cual desarrollamos en nuestro laboratorio de cirugía e investigación experimental. El objetivo de esta investigación fue determinar la cuantía y el momento en que se producen las alteraciones anatómicas (principalmente la fibrosis), que van a llevar, eventualmente, a una estenosis futura (aunque el clip se haya retirado). Se planifica una serie de 10 perros que se operaron bajo anestesia general, en forma consecutiva, a los cuales se les coloca un clip en el colédoco, el que fue retirado en días sucesivos (del 1 al 10). El colédoco fue extirpado y la muestra analizada en anatomía patológica posteriormente. Se observó una fibrosis leve a moderada, con inflamación rica en linfocitos y células plasmáticas. El sitio del clip presentó necrosis focal de tipo isquémica. Estos hallazgos pueden constituir una línea interesante de investigación en el estudio de los mecanismos que llevan a la estenosis de la vía biliar, y definir el momento en que se producen alteraciones probablemente irreversibles en el colédoco

Laparoscopic cholecystectomy with selective pre-operative endoscopic cholangiography and sphincterotomy, a safe combination

One hundred and twenty four patients with symptomatic gall bladder stones underwent elective laparoscopic cholecystectomy over a period of three years. They have been successfully and safely performed without operative cholangiography for one hundred and twenty one patients [97.6%]. Pre-operative endoscopic retrograde cholangiogram was performed for fourteen patients suspected to have choledocholithiasis on clinical grounds. Ten of them were found to have common bile duct stones. Endoscopic sphincterotomy was done for these ten patients and all stones were cleared. For one month follow up after discharge, no complications were seen and none has come back with late complications thereafter. Laparoscopic cholecystectomy with endoscopic retrograde cholangiogram and sphincterotomy was safe and effective with good cosmotic result and fast recovery. There was no need to perform operative chorangiogrom and exploration of common bile duct

importance of stone size on success rate of endoscopic extractions of common bile duct stones

To evaluate the importance of common bile duct stone size on success rate of extraction. A retrospective analysis of medical records of patients with common bile duct stones. Gastroenterology unit at King Khalid University Hospital, Riyadh. Patients were admitted from our clinics or referred from the medical and surgical wards or from other hospitals. All medical records of patients with choledocholithiasis diagnosed by endoscopic retrograde cholangiopancreatography between 1985 and 1992 were reviewed. Patients' age, sex, nationality, number and size of bile duct stones and success rate of extraction were recorded. A total of 211 patients, 86 males and 125 females. Mean age 53.2+17.4 years were included in the study. Endoscopic sphincterotomy was successful in 97.6%. Endoscopic common bile duct clearance was achieved in 75.4% [group one], while 24.6% of stones could not be retrieved [group two]. There was no significant difference between stone number in both groups. However, stone size was significantly larger in group two [p<0.0001]. Ninety five percent of stones <10 mm were extracted compared to 69% of stone size less than 15 and greater than 10 mm and 31% of stones >/= 15 mm in size. Stone size has significant impact on success rate of extraction

Fascioliasis coledociana en México / Cholecochal fascioliasis in Mexico

Objetivo: Recopilar los casos publicados de fascioliasis colediociana en México durante un periodo de 40 años. Diseño: Estudio retrospectivo, longitudinal, observacional Método: Revisión de la literatura nacional que abarcó un periodo de 40 años (1955-1995). Resultados: Durante este lapso se publicaron en México un total de 18 informes de pacientes con fascioliasis coledociana. La edad promedio fue de 45 años, predominó en el sexo femenino con 14 pacientes. En 8/18 se documentó la ingesta de berros. La eosinofilia sólo se presentó en 6 enfermos, se asoció con colecistitis crónica litiásica en 7 pacientes. El diagnóstico se hizo durante el acto quirúrgico en 16/18 pacientes, en los dos restantes se hizo en forma preoperatoria, en uno mediante colangiografía-pancreático-retrógrada-endoscópica(CPRE) y en el otro por ultrasonografía. El Tratamiento fue quirúrgico en todos y consistió en colecistectomía, exploración de vías biliares y administración de dehidroemetina en el postoperatorio. La morbilidad y la mortalidad fueron de cero. Conclusión: En una entidad con una frecuencia baja, se debe sospechar cuando exista colecistitis crónica, con o sin obstrucción de colédoco, asociada a eosinofilia y antecedente de ingesta de berros. El ultrasonido y la CPRE con aspirado duodenal apoyan el diagnóstico. El tratamiento es la colecistectomía, exploración de vía biliar y administración de dehidroemetina o diclofenal

Evolution of experience in laparoscopic cholecystectomy

A prospective study of 100 consecutive laparoscopic cholecystectomies was initiated with the introduction of the procedure. Patients presented with chronic calcular cholecystitis [81], acute cholecystitis [8], gall stone pancreatitis [4], chronic calcular cholecystitis with common bile duct [CBD] stone [4], mucocele of gall bladder [2] and acalculous cholecystitis [1]. Obesity, cirrhosis, previous abdominal surgery and thick wall gall bladder were not considered contraindication for the procedure. No mortality was reported and major morbidity occurred in only 3 cases: one post-operative bleeding, one CBD injury and one subphrenic abscess. Also mild cellulitis around the umbilicus occurred in 4 patients and gall bladder perforations dealt with during the surgery in 9 cases. Operative cholangiogram was done in 38 cases and was technically impossible in 2 cases. Conversion to open cholecystectomy was necessary in 4 cases: one for CBD injury, one for instrument failure, one for technical difficulites and the fourth one for common hepatic duct stone. The mean operative time was 88.4 minutes [range 20-200 minutes] and the mean post operative hospital stay was 2.23 days [range 1-10 days] and median time to return to normal activity and work was 8.7 days. These results confirm previous reports that laparoscopy has actually revolutionized the procedure of cholecystectomy

Immediate effects of the endoscopic sphincterotomy on the motility of the sphincter of Oddi

A técnica de manometria endoscópica foi utilizada para registrar o perfil pressórico da junçäo coledocoduodenal, antes e imediatamente após esfincterotomia endoscópica em 13 pacientes com cálculos coledocianos. Pré-medicaçäo (meperidina, atropina e diazepam) foi adminsitrada a todos os pacientes e colangiopancreatografia endoscópica foi realizada antes da esfincterotomia endoscópica. Nos pacientes com papila intacta, as características da motilidade do esfíncter de Oddi foram semelhantes às descritas em pacientes sem pré-medicaçäo, ou submetidos à colangiografia antes da esfincterotomia endoscópica. A esfincterotomia endoscópica, que teve sucess quanto a remoçäo imediata de cálculo em nove dos 13 pacientes, causou uma reduçäo imediata da motilidade do esfíncter de Oddi em todos os pacientes, mas aboliu-a em apenas dois casos. Os resultados mostram que o sucesso na extraçäo de cálculo coledociano pela esfincterotomia endoscópica, pode ser conseguido sem aboliçäo total da motilidade do esfíncter de Oddi