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3.
World J Surg ; 24(7): 870-3, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10833257

ABSTRACT

We present 98 patients operated on by two techniques of 360-degree fundoplication due to gastroesopagheal reflux disease and divided in two groups: Group I comprised those who were given a conventional valve 5 cm in length, and group II underwent a short fundoplication that did not surpass 1.5 cm. All were subjected to preoperative esophageal manometry, with determination of the pressure and length of the lower esophageal sphincter (LES) and the motor behavior of the esophageal body. The postoperative manometric results are analyzed, checking that after fundoplication there was a significant increase in tone and length of the LES (p < 0.00005); there were no differences between the two groups (p = 0.9920 and p = 0.2160, respectively). The motor function of the esophageal body did not change after surgery. We conclude that even the smallest length of the fundic wrap does not cause a reduction in the pressure and length of the manometric LES; that is, the antireflux effectiveness, measured by manometry, did not depend on the anterior length of the valvuloplasty.


Subject(s)
Esophagogastric Junction/pathology , Esophagogastric Junction/physiopathology , Fundoplication , Gastroesophageal Reflux/surgery , Adult , Aged , Esophagogastric Junction/surgery , Female , Gastroesophageal Reflux/pathology , Gastroesophageal Reflux/physiopathology , Humans , Male , Manometry , Middle Aged , Postoperative Period , Pressure , Retrospective Studies , Treatment Outcome
4.
Med Clin (Barc) ; 107(1): 4-13, 1996 Jun 01.
Article in Spanish | MEDLINE | ID: mdl-8709677

ABSTRACT

OBJECTIVE: To describe the epidemiological characteristics of emergency readmissions due to digestive and hepatobiliary diseases within the hospitals of the Valencian Health Service (VHS), Spain, and to examine their relationship with defined variables related to patients or to previous periods of hospitalization. PATIENTS AND METHODS: Out of the 212,947 episodes of patient hospitalization included in the Uniform Hospital Discharge Data Set of the VHS, excluding those persons under 16 years of age, those who had died in hospital or were discharged due to being transferred to another hospital and also excluding the two hospitals whose record were of poor quality, 18,075 patients were chosen whose principal diagnosis on first admission was one of a digestive or hepatobiliary disease. After a descriptive analysis the relationship was explored between risk of readmission and the variables of age, gender, hospital funding, whether the environment is a rural or urban one, the hospital itself, the diagnostic group, comorbidity, type of admission, length of stay, presence of surgical procedure, discharge criteria and service using an independent Cox Proportional Hazards analysis for each variable and a second Cox analysis adjusted for selected variables. RESULTS: 16.9% of those patients discharged for digestive disorders are re-admitted within a year. The risk of readmission is associated with age, comorbidity, male sex and chronic diseases and, with respect to the previous episode of hospitalization, it is associated with emergency admission, longer period of hospitalization, non-surgical discharge and admission to certain hospitals. CONCLUSION: The risk of emergency readmission is associated with defined variables relating to patient or previous episodes of hospitalization connected with a more serious condition. The risk adjustment carried out could be used in order to identify high-risk cases which could then be paid special attention in order to delay or prevent readmission and as an indirect indicator for use in monitoring the quality of hospital care.


Subject(s)
Biliary Tract Diseases/therapy , Digestive System Diseases/therapy , Liver Diseases/therapy , Patient Readmission , Adolescent , Adult , Aged , Aged, 80 and over , Emergencies , Female , Humans , Length of Stay , Male , Middle Aged , Proportional Hazards Models , Quality of Health Care , Risk Factors
5.
Gastroenterol Hepatol ; 18(1): 1-6, 1995 Jan.
Article in Spanish | MEDLINE | ID: mdl-7621263

ABSTRACT

A group of patients with clinical manifestations suggesting biliary origin in whom diagnostic imaging techniques were negative were studied by duodenal biliary drainage with the aim of identifying whether microcalculi were present in the bilis being responsible for the symptomatology. The problem group was made up of 96 patients with the results being compared with those of a control group (without biliary disease) including 45 subjects. Duodenal biliary drainage was analyzed for the detection of microlithiasis in the biliary sediment in all the subjects. The analysis was positive in 46 (47.9%) of the patients with biliary clinical manifestations while analysis was positive in only 5 (11.2%) of the control group with the differences being statistically significant. Seventeen of the 46 positive patients underwent surgery demonstrating biliary disease in all (chronic cholecystitis). All these patients remained asymptomatic except one on follow up with 94.1% cure by cholecystectomy being achieved. The authors conclude that duodenal biliary drainage is a highly profitable, complication-free and easily performed diagnostic technique for the detection of microlithiasis which should be regularly used in patients with symptoms suggestive of biliary origin and complementary negative explorations.


Subject(s)
Bile , Biliary Tract Diseases/diagnosis , Drainage , Duodenum , Adult , Aged , Biliary Tract Diseases/diagnostic imaging , Cholecystectomy , Cholecystitis/diagnosis , Cholecystitis/diagnostic imaging , Cholecystitis/surgery , Cholelithiasis/diagnosis , Cholelithiasis/diagnostic imaging , Cholelithiasis/surgery , Female , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Ultrasonography
6.
Rev Esp Enferm Dig ; 86(5): 813-7, 1994 Nov.
Article in Spanish | MEDLINE | ID: mdl-7848692

ABSTRACT

The identification of a casual agent in the so-called "idiopatic acute pancreatitis" is of great interest in relationship with the prognosis and the election of correct therapy. We have performed a duodenal drainage for the microscopic study of the bile, looking for cholesterol crystals and bilirrubinate's in a group of 19 patients with idiopatic acute pancreatitis. The results have been compared with a control group composed by 45 assymptomatic individuals. In the patients group drainage results were abnormal in 11 cases (57.9%) vs. 11.2% in the control group (difference statistically significant). In 4 of the 11 cases, a cholecystectomy was performed showing biliary pathology. Patients at follow-up were assymptomatic. Duodenal drainage is an easy method without risks that must be used always in idiopatic acute pancreatitis. It allows the diagnosis of microlithiasis and may help in the therapeutic indication of cholecystectomy.


Subject(s)
Bile , Drainage , Pancreatitis/diagnosis , Acute Disease , Adult , Aged , Case-Control Studies , Female , Humans , Male , Middle Aged , Pancreatitis/etiology
7.
Rev Esp Enferm Dig ; 81(4): 280-4, 1992 Apr.
Article in Spanish | MEDLINE | ID: mdl-1599769

ABSTRACT

A new case of a brown bowel syndrome is presented in a 27 year-old man, clinically with severe esteatorrhea of many years of duration, with moderate pancreatic exocrine insufficiency and intestinal motility disorders suggesting a functional change secondary to a deposit of lipofucsin. We comment the pathogenic, diagnostic and therapeutic implications related to this circumstance.


Subject(s)
Celiac Disease , Intestinal Diseases , Intestinal Diseases/therapy , Adult , Celiac Disease/diagnosis , Celiac Disease/pathology , Celiac Disease/therapy , Humans , Intestinal Diseases/diagnosis , Intestinal Diseases/pathology , Male , Syndrome
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