RESUMEN
In the 70years that bariatric surgery has existed, many different surgical procedures have been developed. Four procedures are officially accepted by all learned societies: adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and bilio-pancreatic diversion (BPD). Gastric banding has the lowest short-term surgical risk, but it has the highest re-operation rate. Compared to SG, RYGB presents about twice the risk of early complications. Late complications seem equivalent between the two procedures but studies with follow-up>10years are rarer for SG. SG has become the most commonly performed bariatric procedure worldwide, followed by RYGB, which is still the standard. BPD remains very marginal but the omega gastric bypass, an alternative technique that is still under evaluation, now competes with RYGB. The effectiveness of these different procedures on weight loss remains difficult to compare. SG and RYGB seem to be equivalent for weight loss results and remission of type-2 diabetes (T2DM). Their results are superior to AGB. Procedures that result in greater lengths of intestinal bypass (bilio-pancreatic diversion, omega bypass) seem to have a greater weight-loss effect but are burdened by more side effects. In conclusion, the choice of a procedure is conditioned firstly by the benefit-risk ratio and in relation to patient-related parameters, particularly the body mass index (BMI) and co-morbidities. Long-term results are also linked to factors other than surgery and in particular patient behavioral factors. Obesity is a chronic disease that indicates the need for real long-term medical and surgical management.
Asunto(s)
Cirugía Bariátrica , Derivación Gástrica , Obesidad Mórbida , Humanos , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Resultado del Tratamiento , Derivación Gástrica/métodos , Obesidad/cirugía , Obesidad/complicaciones , Gastrectomía/métodos , Pérdida de Peso , Estudios RetrospectivosRESUMEN
BACKGROUND: Very few studies have been performed on small populations about the links between employment and bariatric surgery. OBJECTIVE: To determine if rates of employment are increased among patients who have undergone bariatric surgery, to assess their post-operative health consequences (post-prandial weakness, diarrhea), and patients' ability to maintain post-operative advice (ie, 30 minutes of daily physical activity, 6 small meals daily) compared to non-employed post-surgical patients. METHODS: This cross-sectional study was performed in the Regional Reference Centre for Obesity, which is a partnership between the University Hospital and a clinic in Angers, France during 2012 using a self-administrated questionnaire completed by patients hospitalized for post-operative follow-ups after bariatric surgery. Issues investigated were their professional situation before and after the surgery, compliancy to post-operative advice, and any postoperative side effects. RESULTS: Employment rates were 64.4% before and 64.7% after the surgery (p=0.94). Of these, 30.6% maintained 30 minutes of daily physical activity vs. 41.0% of non-workers (p=0.02). 50.5% of employed patients and 57.3% of non-workers maintained 6 small meals a day after surgery (p=0.09). 8% of working patients reported post-prandial weaknesses and 8% reported diarrhea that caused problems at work. CONCLUSION: Employment rate remained stable after surgery. Having a job seemed to be an obstacle to managing 30 minutes of daily exercise, especially among women, but not maintaining 6 small meals a day. Therefore, working environment needs to be assessed to improve job quality and retention for patients who have undergone bariatric surgery.
Asunto(s)
Cirugía Bariátrica/psicología , Empleo/estadística & datos numéricos , Obesidad/cirugía , Cooperación del Paciente/estadística & datos numéricos , Adulto , Cirugía Bariátrica/efectos adversos , Estudios Transversales , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
We reviewed two cases of adenocarcinoma of the gastric tube used for reconstruction after esophagectomy for cancer. The first case gastric cancer was detected during follow-up by endoscopic examination. Total resection of the gastric tube and reconstruction by Roux-en-Y was performed each time. The patient was alive and disease-free 1 year after surgery. In the second case the tumor was revealed via thoracic pain. Chemotherapy, using carboplatin-5-fluorouracil, was performed because of lung metastasis but the patient died 1 year later. The incidence of gastric tube cancer after esophagectomy has recently increased in conjunction with the lengthening of survival of esophageal cancer patients. The clinical symptoms related to tumors are associated with short-term survival, whereas the cancers detected by routine endoscopy screening have occasional long-term survival. Gastrectomy is proposed for surgical treatment but the operating procedure is complex with a high morbidity rate. Lesions detected at an early stage could be treated by minimally invasive surgery such as endoscopic mucosal resection.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Neoplasias Primarias Secundarias , Complicaciones Posoperatorias , Neoplasias Gástricas/cirugía , Anciano , Anastomosis en-Y de Roux , Anastomosis Quirúrgica , Carcinoma de Células Escamosas/cirugía , Resultado Fatal , Gastrectomía , Gastroplastia , Humanos , Escisión del Ganglio Linfático , Masculino , Estómago/trasplanteRESUMEN
BACKGROUND: The laparoscopic repair of groin hernias generally involves mesh fixation to avoid displacement and recurrence. Fixation usually uses staples that can lead to nerve injury and chronic postoperative pain. Laparoscopic repairs are associated with a risk of chronic pain of up to 22.5%. The use of fibrin glue (Tisseel) may represent an alternative method of mesh fixation preventing the risk of nerve injury. METHODS: Sixty-six patients had groin hernia repair using a totally extraperitoneal (TEP) laparoscopic procedure. Mesh fixation was achieved using 2 ml of fibrin glue. Comparison was made with an earlier series of 102 patients operated on according to the same procedure in which mesh fixation used tack staples. Complications, length of stay, recurrence, and postoperative chronic pain were assessed. RESULTS: No difference was found between the two series, except there was a significantly higher rate of postoperative chronic pain in the staples series (14.7 vs 4.5%, p = 0.037) and there was one recurrence (1.5%) in the fibrin glue group of patients. CONCLUSIONS: Fibrin glue achieved an adequate mesh fixation with a lower incidence of chronic postoperative pain. Although a prospective randomized study is needed, Tisseel appears to be an alternative to staples for mesh fixation and may help reduce the postoperative pain problems after hernia repair.
Asunto(s)
Adhesivo de Tejido de Fibrina/uso terapéutico , Hernia Inguinal/cirugía , Laparoscopía/métodos , Adhesivos Tisulares/uso terapéutico , Adulto , Anciano , Enfermedad Crónica , Procedimientos Quirúrgicos Electivos , Femenino , Adhesivo de Tejido de Fibrina/efectos adversos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Recurrencia , Estudios Retrospectivos , Seroma/epidemiología , Seroma/etiología , Mallas Quirúrgicas , Suturas/efectos adversos , Adhesivos Tisulares/efectos adversos , Resultado del TratamientoRESUMEN
AIM OF THE STUDY: The aim of this retrospective study was to find a link between vascularization failure and fistula in esophageal surgery. The originality of this study was to be based on hyperselective arteriogaphy of the artery vascularizing the gastric plasty, showing all vascular network of the plasty. PATIENTS AND METHODS: Hyperselective arteriography was carried out in 14 patients operated for esophagus cancer with a gastric plasty replacement. All these patients had a postoperative leakage or a bad vascularization of the gastric plasty during the operation. RESULTS: The vascularization of the gastric plasty was organized from the gastro-epiploic artery by anastomotic transversal network, depending on the left gastro-epiploic artery and left gastric artery. For the 14 patients, a constant link between leakage and vascularization failure could be proved. CONCLUSION: Esophageal surgery is dependent on the vascular status of the patient. The type of gastric plasty with large or narrow tubulization does not interfere with the quality of vascularization at the top of the plasty due to the preservation of a corporeal low branch.
Asunto(s)
Fístula Esofágica/etiología , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Hemorragia Posoperatoria/etiología , Estómago/cirugía , Adulto , Anciano , Anastomosis Quirúrgica , Fístula Esofágica/patología , Esofagectomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/prevención & control , Estudios Retrospectivos , Estómago/irrigación sanguínea , Colgajos QuirúrgicosRESUMEN
Since the end of the nineteenth century, numerous operations were designed to relieve reflux of duodenal content into the stomach and hence the esophagus under certain conditions. The basic surgical principle remains almost invariably the confection of a long Roux-en-Y jejunal limb. The most effective remedial operations are the total duodenal diversion and the supra papillary duodenal diversion. Although the latter technique seems to avoid some of the worst postoperative side effects caused by antrectomy and vagotomy, its feasibility implies the absence of a previous gastrojejunostomy.
Asunto(s)
Reflujo Biliar/cirugía , Anastomosis en-Y de Roux , HumanosRESUMEN
Eighty-eight consecutive patients with antireflux fundoplication had manometry and pH recording pre- and post-operatively at 6 months and 1, 3 and 5 years for a mean follow-up of 30.6 months. Failure occurred in nine patients (11.4%). For the whole group of patients, surgery produced a significant increase in the lower esophageal sphincter (LES) pressure gradient from 9.5 +/- 6.3 to 14.6 +/- 6.7 mmHg and a significant decrease in acid exposure from 20.6% +/- 17.6% to 5.5% +/- 8.8% at 6 months. There was a similar change in pressure (p < 0.0005) and pH (p < 0.002) in the successful but not in the failure group. Over time, the values remained stable in both groups. Post-operative LES pressure was significantly correlated with the outcome at 6 months (p < 0.02), and the pH was inversely correlated at 5 years (p < 0.039). This study confirms the early predictive value of the post-operative LES pressure. Esophageal acid exposure remains a reliable marker of the outcome. However, recurrences remain unexplained by LES pressure measurement and long-term follow-up using manometry and pH recording does not bring additional valuable data.
Asunto(s)
Unión Esofagogástrica/fisiopatología , Fundoplicación , Reflujo Gastroesofágico/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Manometría , Persona de Mediana Edad , Periodo Posoperatorio , PronósticoRESUMEN
Since 1982, Ivor Lewis esophagectomy has been performed on 264 patients with epidermoid esophageal carcinoma in our series. The mean age was 59. There were 243 men and 21 women; 91 patients had respiratory or cardiovascular problems. Two-hundred forty-eight tumors were located in the lower two thirds of the esophagus. Sixty-eight patients had preoperative radiochemotherapy with cisplatinum and 5-flourouracil. One half of the resected specimens showed no residual tumor after radiochemotherapy. Tumor infiltration was T3 or deeper in 162 specimens, and 142 were N0. The main complications were respiratory (16%) and leaks (7%). Respiratory insufficiency was always fatal, but only 16% of the leaks led to death. The overall postoperative mortality was 4.5%, and the overall 5-year survival is 33.3%. Only T1 tumors have a significantly better prognosis (53.2% 5-year survival) as compared to T2 (30.6%) and T3 (27.2%), both at 5-year survival. Negative lymph node patients have a significantly improved 5-year survival rate of 44.8% vs. 15.2% for node-positive patients. For T3 tumors, preoperative radiochemotherapy seems to improve survival. Comparison of Ivor Lewis esophagectomy with other procedures shows no radical differences in complications. The 5-year survival rate seems unaffected by the procedure chosen; radiochemotherapy and extended lymphadenectomy still need further assessment.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidad , Supervivencia sin Enfermedad , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidad , Esofagectomía/efectos adversos , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Tasa de SupervivenciaRESUMEN
From April 1989 to October 1995, 184 patients with squamous cell carcinomas of the esophagus were treated either with surgery alone (112 patients) or with preoperative concomitant radiochemotherapy (72 patients) (2 courses of 18.5 Gy in 5 fractions, days 1-5 with continuous infusion 5-fluorouracil (5-FU) days 1-5 and cisplatinum day 2, separated by a 2-week interval) followed by surgery, and by 4 more courses of chemotherapy alone for good responders. Twenty-seven of these last 72 patients showed histological complete response at surgery (37.5%). There was no statistically significant difference in overall survival between the 2 groups although there were much more T1 patients (small tumors < or = 5 cm in the previous TNM classifications) and less T3 patients (evidence of spread beyond the esophagus) in the surgery alone group, and nevertheless, median survival was better in the combined treatment group (33.6 months versus 21.8 months). However, considering tumor size, there was a statistically significant difference in median survival in favor of the combined treatment group for all T2 patients (> 5 cm without evidence of spread beyond the esophagus in the previous TNM classification) (48.6 months versus 13.8 months), both for T2N0 and T2N1 patients, but also for T1N1 patients (< or = 5 cm with nodal involvement). For the few T3 patients (evidence of spread beyond the esophagus in the previous TNM classification), there was no statistically significant difference between the 2 groups, but the survival curves seemed to show some advantage in favor of the combined treatment group for T3N1 patients. The sex of the patients and the third of the esophagus involved by the tumor did not seem to be of any influence on survival. On the other hand, patients 70-year-old and older showed a poorer survival than other patients. Finally, significantly less patients died with loco-regional recurrences in the preoperatory radiochemotherapy group (32% versus 48%) than in the group treated by surgery alone.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/terapia , Adulto , Factores de Edad , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía/efectos adversos , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Dosificación Radioterapéutica , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Carcinoma de Células Escamosas , Neoplasias Esofágicas , Análisis Actuarial , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Esofagoscopía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , PronósticoAsunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Análisis Actuarial , Anastomosis Quirúrgica/métodos , Carcinoma de Células Escamosas/patología , Terapia Combinada , Neoplasias Esofágicas/patología , Esofagectomía/efectos adversos , Humanos , Masculino , Pronóstico , Estudios Prospectivos , ToracotomíaRESUMEN
75 patients with an epidermoid carcinoma of the esophagus were studied. They all were stage T3 with or without lymph node involvement but without distant metastasis (T3 N0 M0 or T3 N+, M0). All the patients had a curative esophagectomy according to the Ivor Lewis procedure without any adjuvant treatment. In hospital mortality was 4%. There is a 28% 5 year actuarial survival in this group of patients where 60% had lymph node involvement. None of the 13 prognostic factors showed a significant relevance with respect to survival after an univariate analysis. Meanwhile surgical treatment ensured good digestive comfort and good quality of life at home.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Esofagectomía/efectos adversos , Esofagectomía/métodos , Estudios de Seguimiento , Humanos , Estado de Ejecución de Karnofsky , Estadificación de Neoplasias , Pronóstico , Análisis de SupervivenciaAsunto(s)
Adenocarcinoma/cirugía , Esófago de Barrett/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Análisis Actuarial , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Antimetabolitos Antineoplásicos/administración & dosificación , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Esófago de Barrett/patología , Cardias/patología , Cardias/cirugía , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Neoplasias Esofágicas/patología , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dosificación Radioterapéutica , Radioterapia Adyuvante , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
The complications of colostomies may constitute a handicap for patients: their prevalence severity and methods of treatment remain poorly known. 500 colostomy patients, with a mean age of 66 +/- 14 years, were retrospectively reviewed. The mean follow-up of the study was 6 +/- 5 years. Colorectal cancers represented 65% of the initial diseases. 59.5% of colostomies were terminal. They were performed for resection of the colon and or rectum in 56.5% of cases. 30.5% of patients (n = 152) presented complications (n = 235). The early complications (n = 147) observed in 29.5% of patients were mostly benign (20 required emergency operations). The late complications (n = 88), observed in 22.5% of 391 patients with a follow-up of more than one year required another operation in 1/3 of cases (11 cases of stenosis, 9 incisional hernias and 8 prolapses). Complications of colostomies remain frequent (one out of every 4 stomies ends in a complication) and the reoperation rate is situated between 13 and 33%. The therapeutic success rate of late reoperation is between 63 and 74%. When a reoperation is necessary, it should be ideally radical via a midline incision. The transposition technique gives better results than the repositioning technique via a local approach.
Asunto(s)
Absceso/etiología , Colon/patología , Enfermedades del Colon/etiología , Colostomía/efectos adversos , Hernia/etiología , Absceso/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colon/cirugía , Enfermedades del Colon/cirugía , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Herniorrafia , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Complicaciones Posoperatorias , Reoperación , Estudios RetrospectivosRESUMEN
PURPOSE: Today the prognosis for patients with esophageal carcinoma still remains quite poor. In the last few years interesting results have been obtained by associating radio- and chemotherapy with or without surgery with this type of cancer. In this work we report the results of concomitant radio- and chemotherapy in a split-course schedule preceeding surgery for the treatment of squamous cell carcinomas of the esophagus. METHODS AND MATERIALS: Fifty-six patients with squamous cell carcinomas of the esophagus were treated between April 1989 and September 1993 in the Centre Hospitalier Universitaire in Brest, France with two courses of preoperative concomitant radiochemotherapy, separated by a 2-week interval, and followed by surgery (each course 18.5 Gy in five fractions, days 1-5 with continuous infusion 5-fluorouracil (5-FU) 800 mg/m2 days 1-5 and cisplatinum 70 mg/m2 day 2). Patients who had responded well to preoperative treatment (response > 50%) received four more courses of chemotherapy alone. The two patients who were not operated and those with palliative surgery received a third course of radiochemotherapy (radiotherapy 12 Gy in five fractions, days 1-5). RESULTS: Fifty-four patients were operated on. Twenty-one showed histological complete response at surgery (37.5% of the whole group). Actuarial survival for the 56 patients was 55% at 3 years and 30% at 4 years, with a median survival of 37.4 months (40.4 months for complete responders to preoperative treatment). Toxicity of preoperative concomitant radio-chemotherapy was low (5-FU had to be stopped in one patient because of cardiac rythm disturbances and in another patient because of aplasia Grade 4 associated with infection after the first course). Postoperative mortality was 11% (six patients). CONCLUSION: This combination of preoperative radiochemotherapy followed by surgery seems to improve both response rates and survival in patients with esophageal cancer when compared with previous patients treated with surgery alone in our hospital or with results found in literature and it warrants further studies.
Asunto(s)
Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/radioterapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Cisplatino/administración & dosificación , Terapia Combinada , Supervivencia sin Enfermedad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados PreoperatoriosRESUMEN
Improved techniques in esophageal manometry have made this test an attractive option for investigating pharyngeal or esophageal disorders in patients with dysphagia. We studied esophageal as well as upper esophageal sphincter/pharyngeal (UES/P) pressure dynamics in 11 patients with an established diagnosis of oculopharyngeal muscular dystrophy with modern solid-state manometric techniques and then compared manometric and clinical findings. Esophageal manometric abnormalities were found in 10/11 patients, with the most common being simultaneous contractions and incomplete lower esophageal relaxation. 9/11 patients showed abnormal UES/P manometrics, with the most common abnormalities found in the pharynx. The presence of manometric abnormalities closely paralleled clinical assessment of degree of disease severity. Modern manometric techniques offer an opportunity for a quantitative assessment of swallow abnormalities.
Asunto(s)
Unión Esofagogástrica/fisiopatología , Manometría , Distrofias Musculares/fisiopatología , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/fisiopatología , Faringe/fisiopatología , Anciano , Trastornos de Deglución/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distrofias Musculares/complicaciones , Enfermedades Faríngeas/etiología , Índice de Severidad de la EnfermedadRESUMEN
Fourteen patients with scleroderma underwent antireflux operations (10 short Nissen, 2 Collis-Nissen, 1 Collis-Belsey, and 1 vagotomy and antrectomy with Roux-en-Y). Esophageal function was assessed preoperatively and postoperatively with a follow-up range of 8 to 181 months (mean, 65 months). Reflux symptoms were relieved in 10 of the 14 patients (p < 0.01), as shown by a decrease in their 24-hour acid exposure of from 15% to 7.5% (p < 0.05). However, the lower esophageal sphincter pressure gradient created by the operations did not increase significantly (3.7 +/- 3.4 mm Hg to 5.5 +/- 3.5 mm Hg). The esophageal acid exposure decreased sufficiently to promote some alleviation of the esophagitis. Radiologic signs of stenosis regressed in 6 of 7 patients. Postoperative endoscopic assessment revealed complete or partial healing of erosions seen preoperatively in 6 of the 7 patients so studied, and healing of all ulcers in 3 patients. Twelve patients continued to have columnar metaplasia. Manometric studies disclosed no significant changes in propulsion and contractility. Distal esophageal resting pressures rose significantly from 6.2 to 9.4 mm Hg (p < 0.05 mm Hg), suggestive of stasis. Radionuclide transit studies, however, showed no significant decrease in the esophageal emptying capacity after operation. It is concluded that conventional antireflux operations in patients with scleroderma can palliate reflux damage without jeopardizing esophageal function.
Asunto(s)
Síndrome CREST/complicaciones , Esofagitis Péptica/cirugía , Reflujo Gastroesofágico/cirugía , Adulto , Síndrome CREST/epidemiología , Esofagitis Péptica/epidemiología , Esofagitis Péptica/etiología , Unión Esofagogástrica/fisiopatología , Esófago/fisiopatología , Femenino , Estudios de Seguimiento , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/etiología , Humanos , Concentración de Iones de Hidrógeno , Masculino , Manometría , Persona de Mediana Edad , Factores de TiempoRESUMEN
In this paper, the influence of the water content in the acetonitrile/LiClO(4) system on the electrosynthesis and the properties of poly(N-vinylcarbazole), PNVC, films is examined. By using conventional resonant frequency and impedance measurements of an electrochemical quartz crystal microbalance (EQCM), information about the electrochemical, morphological and adhesive properties of the thin conducting films were obtained. By changing the water content of the background electrolyte, the degree of cross-linking (through the vinyl group), the doping level and the morphology of PNVC films vary simultaneously. Two limiting cases of film properties were observed: for less than 10 Vol.% water, a highly doped, porous and cross-linked polymer is synthesized. Above 10 Vol.% water content, a dense and smooth film is deposited. The growth at a constant potential was found to be limited by the diffusion of monomers to the electrode. Films grown from a system containing 20 Vol.% water exhibit better adhesive properties to the substrate than those grown from 2 Vol.% water.
RESUMEN
Fistulas of the anastomosis is the most severe complication after the Lewis-Santy operation. Over the last 10 years, we have performed 227 such operations for cancer of the oesophagus and have observed 16 fistulizations (7%). The aim of this study was to analyze the clinical manifestations and laboratory findings in these cases of fistulization as a function of the site of the plasty, the treatment and the results. We attempted to determine factors which could lead to means of preventing this complication. The fistula occurred at the oeso-gastric anastomosis in 11 cases (4.8%), at the apex of the gastric tube in 2 and on the line of gastric tubulization in 3. A comparison between patients with fistulas (group 1) and those without (group 2) showed that 19% of the patients in group 1 were over 70 years of age versus 9% in group 2 (NS). Three of the 16 patients (19%) with fistula had cirrhosis due to ethylism versus 2 of the 211 patients in group 2 (p < 0.001). Six patients among the 58 with palliative with a fistula (6%) (NS). Thoracic drainage was sufficient in 11 patients and surgical treatment was not required. In 5 reoperation (thoracotomy 4, cervicotomy 1) was necessary due to an intrapleural abscess. After 227 Lewis-Santy operations, 11 patients died during hospitalization (4.8%, 4 of which were complicated with fistula (1.7% of the operated patients and 25% of the patients with fistulas). The frequency of fistulizations after Lewis-Santy operation has decreasing (8%) and the gravity has improved (3 out of 4 were cured).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anastomosis Quirúrgica/efectos adversos , Fístula Esofágica/etiología , Fístula Gástrica/etiología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/cirugía , Drenaje , Fístula Esofágica/diagnóstico , Fístula Esofágica/prevención & control , Fístula Esofágica/cirugía , Neoplasias Esofágicas/cirugía , Fístula Gástrica/diagnóstico , Fístula Gástrica/prevención & control , Fístula Gástrica/cirugía , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , ReoperaciónRESUMEN
From 1978 to 1983, 17 patients had an esophagocardiomyotomy with an added short total fundoplication as an antireflux procedure. Thirteen had achalasia and 4, diffuse esophageal spasm. All patients initially had the usual symptoms of these motor disorders. Early after the operation all became asymptomatic, but over the years of follow-up, symptoms reappeared in 14 of 17 patients, and 5 required reoperation. The distal esophageal transverse diameter showed progressive dilatation from 3.9 cm preoperatively to more than 6 cm after 10 years of evolution. Over the same period, deterioration in the esophageal emptying capacity caused esophageal stasis to increase from 32% to 75%. Manometric changes were significant after the operation: resting pressures in the esophageal body decreased from 10.5 to 4.4 mm Hg (p < 0.001) proximally and from 12.2 to 4.6 mm Hg distally (p < 0.001). Peak contraction pressures became significantly weaker: 38 to 30 mm Hg in the proximal esophagus (p < 0.001) and from 49.2 to 28.1 in the distal esophagus (p < 0.001). Tertiary contractions were unchanged distally, but peristalsis reappeared in more than 30% of all swallows in the proximal half of the esophageal body. The resting pressure gradient in the lower esophageal sphincter area was reduced from 25.5 to 7.4 mm Hg by the operation. This gradient remained stable over 10 years of follow-up. No significant acid exposure was documented in 8 patients undergoing 24-hour pH recordings after their operation. Endoscopy revealed dilatation and retention without evidence of reflux esophagitis damage. Total fundoplication when associated with esophageal myotomy results in improved symptoms in the early postoperative phase.(ABSTRACT TRUNCATED AT 250 WORDS)