Navegando por Palavras-chave "Fistula"

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    Benign Esophagopulmonary Fistula Through an Epiphrenic Diverticulum and Asymptomatic Achalasia
    (Springer, 2010-04-01) Herbella, Fernando A. M. [UNIFESP]; Del Grande, Jose C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
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    Fístula perilinfática em cobaias: comparação entre evolução natural e correção cirúrgica
    (Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2010-04-01) Onishi, Ektor Tsuneo [UNIFESP]; Fukuda, Yotaka [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Perilymphatic fistulas still represent a major treatment challenge. In some cases, its surgical closure can reduce auditory and vestibular sequelae. AIM: to compare the behavior of cochlear window perilymphatic fistulas in guinea pigs as to their natural evolution and immediate surgical closure. MATERIALS AND METHODS: Experimental study. Forty guinea pigs were submitted to cochlear window membrane lesion and randomly broken down into two groups: open fistula (OF) and surgically closed fistula (SCF). We found the summation potential (SP) and action potential (AP) latencies and amplitudes and the SP/AP ratio at three times: pre-fistula (PRE), immediate post-fistula (IPF) and late post-fistula (LPF). RESULTS: There was a significant drop in amplitudes and raise in SP and AP latencies among the times studied. As to the SP/AP ratios, there was a reduction between PRE and IPF, both were significant. There was no behavior difference between the OF and SCF. CONCLUSIONS: Within the time frame considered, guinea pigs submitted to cochlear window membrane lesions evolved with a worsening in potentials and latencies. Despite the partial improvement in electrophysiological parameters, surgical closure did not prove statistically more effective than natural evolution.
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    Gastrectomy and Lymphadenectomy for Gastric Cancer: is the Pancreas Safe?
    (Springer, 2008-11-01) Herbella, Fernando A. [UNIFESP]; Tineli, Ana C. [UNIFESP]; Wilson, Jorge L. [UNIFESP]; Del Grande, Jose C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction Resection of the capsule of the pancreas is part of the radical operation proposed by oriental authors for the treatment of gastric cancer. It is unclear; however, if resection of the capsule is a safe procedure or even if it is necessary. This study aims to assess in patients treated for gastric cancer the occurrence of: (a) pancreatic fistula and (b) metastasis to the pancreatic capsule.Methods We studied 80 patients (mean age 61 years, 42 males) submitted to gastrectomy with resection of the pancreatic capsule by hydrodissection. Patients with pancreatic disease, tumoral invasion of the pancreas, submitted to concomitant splenectomy, or anastomotic leakage were excluded. the tumor was located in the distal third of the stomach in 60% of the patients, in the middle third in 27%, and proximally in 12%. Total gastrectomy was performed in 27% of the cases and partial gastrectomy in 73%. in all patients, amylase activity in the drainage fluid was measured on day 2. If initial measurement was abnormal, subsequent measurements were performed in alternated days until normalization. Pancreatic fistula was defined as amylase levels greater than 600. in 25 of these patients (mean age 53 years, 16 males), the pancreatic capsule was histologically analyzed for metastasis.Results Pancreatic fistula was diagnosed in eight (10%) patients. the mean amylase level was 5,863. Normalization of amylase levels was achieved within 7 days in all patients. No patient developed clinical signs of fistula besides abnormal amylase levels in the drainage fluid, such as intra-abdominal abscesses. Pancreatic fistula was associated to younger age (p = 0.03) but not to gender (p = 0.1), tumor location (p = 0.6), and type of gastrectomy (p = 0.8). Metastasis to the pancreatic capsule was not identified.Conclusion in conclusion, resection of the pancreatic capsule must be discouraged due to subclinical pancreatic fistula in a significant number of the cases and absence of metastasis.
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    Nova técnica de alimentação enteral em fístulas esôfago-jejunais
    (Colégio Brasileiro de Cirurgiões, 2004-02-01) Marks, Guido; Fagundes, Djalma José [UNIFESP]; Cevalos, Francisco A; Universidade Federal de Mato Grosso do Sul Depto. de Clínica Cirúrgica; Universidade Federal de São Paulo (UNIFESP); Serviço de Endoscopia
    BACKGROUND: A new procedure for the treatment of esophageal fistula, mainly associated to the ebb esophagojejunal in patients submitted to the total gastrectomy and reconstruction with loop jejunal Rouxen-Y anastomosis is present. METHODS: The method is based in the use of probe standard enteral prolongated with drain to laminate adapted in extremity, which results in advanced positioning inside the jejunum, making the administration of enteral nutrition possible and impeding ebb esophagojejunal. RESULTS: The authors discuss the theoretical advantages of the procedure and they suggest that the treatment of esofagic fistula with probe prolonged enteral would be suitable in the treatment of the fistula esophagojejunal by preventing the ebb esophagojejunal, which would result in smaller period of duration of the fistula esophagojejunal and it would prevent the high mortality rate. CONCLUSIONS: Preliminary studies demonstrated that this is a technically easy, low cost procedure through the endoscopic use. A prospective evaluation for morbility and mortality related to the method is needed.