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2.
Article in Portuguese | MEDLINE | ID: mdl-9659740

ABSTRACT

The authors discuss an uncommon case in the literature of a carcinoid tumor of in the bifurcation of common hepatic duct. The tumor was surgically resected and the duct was reconstructed by Y of Roux's technic. The patient had a good evolution and no tumoral lesion was found in post operative exams during the last six months. The authors present a literature review and discuss diagnosis, treatment and prognosis.


Subject(s)
Carcinoid Tumor/diagnosis , Common Bile Duct Neoplasms/diagnosis , Anastomosis, Roux-en-Y , Carcinoid Tumor/surgery , Common Bile Duct Neoplasms/surgery , Female , Humans , Middle Aged
3.
Rev Hosp Clin Fac Med Sao Paulo ; 50(4): 236-9, 1995.
Article in Portuguese | MEDLINE | ID: mdl-8560156

ABSTRACT

Clinical manifestation of carcinoide syndrome are often difficult to control with medical treatment and so present a large problem for doctors. In the majority of cases, such manifestations are seen in patients with hepatic metastases. In such cases the control of the problem can be achieved by local hepatic treatment. A 57 year old patient with carcinoide syndrome for a year, with extensive hepatic tumor from a carcinoide tumor, whose origins were not lokted, had a urinary excretion 5-hidroxi-indolacetic = 73 mg in 24 hours, he used cyproheptadin, loperamida and metisergida without showing improvement. In light of the failure of medical treatment and the impossibility of surgery he was given into hepatic chemoembolization (QEH) with lipiodol, doxorrubicin (1.0 mg/Kg) and mitomicin (10.0 mg) twice. Clinical control with absolute recovery of "flushing" and diarrhea were achieved, a dose of 5-HIAA U (5.5 mg) after the first application. Transitory alterations of the aminotransferasis alkaline phosphates and leucocytosis. Besides the post embolization syndrome that regressed in 20 days, there were no complications recurring after treatment. The period of recovery was more than 9 months. We can then conclude that hepatic chemoembolization is an efficient treatment to control carcinoid syndrome.


Subject(s)
Carcinoid Tumor/therapy , Chemoembolization, Therapeutic , Liver Neoplasms/therapy , Antibiotics, Antineoplastic/administration & dosage , Doxorubicin/administration & dosage , Hepatic Artery , Humans , Male , Middle Aged , Mitomycins/administration & dosage
4.
Article in Portuguese | MEDLINE | ID: mdl-8235275

ABSTRACT

In Brazil, the incidence of IPF due to alcohol-induced CP seems to be higher than in other countries. The authors analysed some general, epidemiologic, laboratory and radiologic features in 98 patients with CP, all of them alcoholics, divided in two groups: 49 patients without IPF (I) and 49 patients with IPF (II). The authors first analysed the following parameters in each group and then comparatively in both groups: age, sex, race, smokers and daily consumption of cigarettes, daily consumption of alcoholic beverages, years of alcohol consumption, and mortality. The authors concluded that pancreatic fistula plays in effusions the main role, secondary to cysts disruption or necrosis of the main pancreatic duct.


Subject(s)
Pancreatic Cyst/complications , Pancreatic Fistula/complications , Pancreatitis/complications , Adult , Age Factors , Alcoholism/complications , Chronic Disease , Female , Humans , Male , Middle Aged , Necrosis , Pancreatic Cyst/epidemiology , Pancreatic Ducts/pathology , Pancreatic Fistula/epidemiology , Pancreatitis/epidemiology , Sex Factors , Time Factors
5.
Rev Hosp Clin Fac Med Sao Paulo ; 44(5): 237-43, 1989.
Article in Portuguese | MEDLINE | ID: mdl-2484020

ABSTRACT

Pleural effusion and ascites are now recognized as possible complications of chronic pancreatitis. Diagnosis of these conditions can be made by the finding of high amylase levels in the pleural or ascite fluid. Out of 31 of our patients with this complications 19 had ascites, 10 pleural effusions and two both pleural effusion and ascites. In 19 patients, presenting poor clinical conditions, the treatment was external drainage. Remaining patients were treated by internal drainage or resection. Eight out of the 19 patients treated by external drainage and one of the 13 patients with internal drainage had to be reoperated. There was no mortality. Though external drainage is followed by high incidence of reoperations this technique should be used in patients with poor conditions.


Subject(s)
Ascites/surgery , Pancreatitis/complications , Pleural Effusion/surgery , Adult , Amylases/blood , Ascites/diagnosis , Ascites/etiology , Cholangiopancreatography, Endoscopic Retrograde , Drainage , Humans , Male , Middle Aged , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Preoperative Care , Reoperation
6.
Rev Hosp Clin Fac Med Sao Paulo ; 44(5): 214-20, 1989.
Article in Portuguese | MEDLINE | ID: mdl-2636996

ABSTRACT

The etiology of chronic pancreatitis was investigated in 407 patients: 381 (93.6%) had a history of heavy alcoholic ingestion (average = 295.3 +/- 171.3 g of ethanol) during a time of 19.2 +/- 8.0 years: five patients (1.0%) had familial background of pancreatitis, two (0.5%) had the obstructive form, and two (0.5%) presented history of malnutrition. In 18 patients (4.4%) it was not possible to determine the etiology. Patients with the alcoholic form started the alcohol abuse at the age of 19.4 +/- 6.0 years. A careful dietetic inquiry showed that patients with chronic pancreatitis lived on a diet which was significantly richer in protein than that of patients of the control group (p less than 0.01). Attention is called to the high incidence of chronic alcohol abuse in patients with chronic pancreatitis.


Subject(s)
Alcoholism/complications , Pancreatitis/etiology , Adolescent , Adult , Aged , Brazil , Cholelithiasis/complications , Chronic Disease , Feeding Behavior , Female , Humans , Male , Middle Aged , Prospective Studies
7.
Rev Hosp Clin Fac Med Sao Paulo ; 44(5): 221-6, 1989.
Article in Portuguese | MEDLINE | ID: mdl-2700104

ABSTRACT

The clinical aspects, complications and association with other diseases were investigated in 407 patients with chronic pancreatitis. The most frequent symptoms were abdominal pain (93.6%), weight loss (91.6%), diabetes (37.8%) and malabsorption (31.7%). Pancreatic cysts (32.6%), ascites and/or pleural effusion (12.5%), pancreatic necrosis (11.2%), gastrointestinal bleeding (12.8%) and pancreatic abscess (7.3%) were the most frequent complications. The symptoms and complications observed are discussed and their incidences compared to those reported from other countries.


Subject(s)
Pancreatitis/complications , Chronic Disease , Female , Humans , Male
8.
Rev Hosp Clin Fac Med Sao Paulo ; 44(5): 227-31, 1989.
Article in Portuguese | MEDLINE | ID: mdl-2700105

ABSTRACT

Thirty one alcoholic patients with pancreatic cysts were studied by ultrasonographic scanning with the purpose to observe the evolution of the cysts. The mean time of the follow-up was 15.6 +/- 9.2 months; the patients were aged 40.2 +/- 9.3 years (male = 93.5%; female = 6.4%) the average pure ethanol intake was 288.3 +/- 185.9 ml for a period of 20.8 +/- 9.3 years. In 21 of the 31 patients (67.7%) the ultrasonographic examination showed total spontaneous resolution of the cysts within a time span of less than 18 months. The majority of the parameters studied (age, time and volume of ethanol intake, pain, diabetes, calcifications and previous cyst drainage) had no relation with the evolution of the cysts. In 11 patients (52.3%) the cysts showed an initial enlargement before decreasing in size. The cysts located in the pancreatic head showed less tendency to spontaneous resolution. Complications were observed in two patients: intra-cystic haemorrhage in one and rupture into the peritoneal cavity in the other. Our observations suggest that patients with pancreatic cysts secondary to chronic alcoholic pancreatitis should be controlled with periodical ultrasonography. Surgical approach should be reserved for patients with complications.


Subject(s)
Pancreatic Cyst/physiopathology , Pancreatitis/complications , Adult , Chronic Disease , Female , Humans , Male , Middle Aged , Pancreatic Cyst/complications , Pancreatic Cyst/pathology , Remission, Spontaneous , Ultrasonography
9.
Rev Hosp Clin Fac Med Sao Paulo ; 44(2): 63-72, 1989.
Article in Portuguese | MEDLINE | ID: mdl-2515572

ABSTRACT

The seric levels of gastrin, pancreatic glucagon, pancreatic polypeptide, enteroglucagon, motilin and cholecistokinin were evaluated in ten patients with chronic Chagas' disease and compared with those observed in nine normal control subjects. The seric values of all the hormones were determined on basal stimulation, after continuous intravenous secretin infusion and infusion of stepwise increased concentrations of caerulein (direct stimulation), and after intravenous secretin administration followed by intraduodenal instilation of increased concentrations of phenylalanina (combined stimulation). All the hormones, basal and after direct stimulation, showed similar values, except gastrin that in the chagasic group presented higher levels than in control subjects. Phenylalanine and pancreatic polypeptide showed significantly higher values in the control group than in the one of patients with Chagas' disease. The hormonal response in patients with chronic Chagas' disease suggested a neural impairment of the enteropancreatic axis.


Subject(s)
Chagas Disease/blood , Gastrointestinal Hormones/blood , Pancreatic Hormones/blood , Adolescent , Adult , Ceruletide/pharmacology , Esophageal Achalasia/blood , Female , Humans , Male , Middle Aged , Phenylalanine/pharmacology , Secretin/pharmacology , Stimulation, Chemical
10.
Rev Hosp Clin Fac Med Sao Paulo ; 44(1): 47-51, 1989.
Article in Portuguese | MEDLINE | ID: mdl-2814189

ABSTRACT

The clinical evolution and treatment of two patients with alcoholic chronic pancreatitis complicated with digestive hemorrhage localized in the gastric corpus and fundus are discussed. The clinical picture and the endoscopic features suggested that the hemorrhage was due to hemorrhagic gastritis and not to rupture of varicose veins. Hemorrhagic gastritis as a consequence of segmentary portal hypertension may be responsible for the difficulty in establishing the etiology of digestive hemorrhage in such cases.


Subject(s)
Esophageal and Gastric Varices/complications , Gastritis/complications , Gastrointestinal Hemorrhage/etiology , Splenic Vein , Thrombosis/complications , Adult , Endoscopy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/surgery , Humans , Male , Splenic Vein/surgery
13.
Int Surg ; 70(1): 53-6, 1985.
Article in English | MEDLINE | ID: mdl-4019085

ABSTRACT

Twenty-one patients with pancreatic pseudocysts secondary to alcoholic pancreatitis were treated by cystojejunostomy (16), cystoduodenostomy (4) and external drainage (1). In all patients, the duct of Wirsung was drained into a defunctionalized loop of the jejunum at the same operation. There was no early or late mortality. Pseudocyst recurrence did not occur, and only one patient (4.7%) had light pain recurrence in the follow-up period. The importance of providing an outflow route for the obstructed pancreatic duct, and not just for the pseudocyst, is stressed due to this experience with patients affected by underlying chronic pancreatitis.


Subject(s)
Alcoholism/complications , Pancreatic Cyst/surgery , Pancreatic Ducts/surgery , Pancreatic Pseudocyst/surgery , Pancreatitis/etiology , Chronic Disease , Dilatation , Drainage , Duodenum/surgery , Humans , Jejunum/surgery , Pancreatic Pseudocyst/etiology , Pancreatitis/surgery , Postoperative Complications , Time Factors
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