Publications by authors named "Jacqueline Osuna-Rubio"

3 Publications

  • Page 1 of 1

[Histological evaluation of hepatic fibrosis in patients with post surgical bile duct injury].

Rev Med Inst Mex Seguro Soc 2008 Nov-Dec;46(6):663-8

Departamento de Cirugía General, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (CMNO IMSS), Guadalajara, Jalisco, México.

Background: Bile duct injuries after cholecystectomy can produce fibrous and collagen deposit tissue. Our objective was to evaluate the liver fibrosis measured in histological tissue in patients with bile duct injury after cholecystectomy.

Methods: Three normal liver biopsies and 21 from patients with bile duct injuries were studied. Group I: with three normal liver biopsies. Group II: with external abdominal fistula alone in six patients. Group III with complete bile duct obstruction in 15 patients. The surgical biliary enteric reconstructions were performed 8 weeks after bile duct injury in all cases. The fibrosis and collagen deposits were studied by Masson's trichrome and Sirius red stains and they were measured by a digital program.

Results: Group I showed 2 % of fibrosis tissue and 1% of collagen deposit and was considered as normal. Group II showed unexpected 1 fold more liver fibrosis and 9 fold more collagen deposit in extracellular matrix macromolecule (p < 0.05, Anova) against group I. Patients in group III, had fibrous tissue increase 43 folds more and 14 collagen folds more (p < 0.0001, Bonferroni's post hoc) versus group I.

Conclusions: The patients in groups II and III showed liver fibrosis, being this more important in group III.
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April 2009

[Association between wound size after open cholecystectomy with severity of iatrogenic biliary tract lesions].

Gac Med Mex 2008 May-Jun;144(3):213-8

Unidad de Investigación en Epidemiología Clínica, Hospital de Especialidades, Centro Médico Nacional de Occidente-IMSS, Guadalajara, Jal., México.

Background: Transoperative biliary tract injury during open or laparoscopic cholecystectomy is a catastrophic event associated with significant morbidity and mortality. Our objective was to determine if wound size during open cholecystectomy is associated with more complex biliary tract injuries.

Methods: Prospective cohort study performed between March 2006 and February 2007. Sixty-six patients with biliary tract injuries after open cholecystectomy were included. Wound size was analyzed.

Results: Sixty six patients were included, 70% were female with a median age of 44. Seventy four percent were treated for acute cholecystitis. Most participants were overweight or had various degrees of obesity. Biliary tract injuries were not recognized during the primary surgical procedure in 76% of cases. All patients with severe biliary tract injuries (Strasberg E-3 and E-4) had a wound size less than 10 cm in length. Wound size was associated with unrecognized injuries (p=0.000), as well as with injury severity (p=0.000). We were notable to demonstrate a statistically significant association between biliary tract injuries and elective or emergency surgical procedures and midline or subcostal surgical incision for cholecystectomy.

Conclusions: Our findings suggest that minor surgical access during open cholecystectomy may constitute a risk factor since smaller incisions were associated with more severe biliary tract injuries and an inability to observe this damage during the surgical procedure. We suggest to adhere strictly to the guidelines of an adequate surgical exposure during open cholecystectomy to prevent biliary tract injuries.
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October 2008

[Water immersion for adjuvant treatment of refractory ascites in patients with liver cirrhosis].

Cir Cir 2007 Sep-Oct;75(5):337-41

Departamento de Gastroenterología, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco.

Background: Head-out water immersion has been proposed as an adjuvant treatment in refractory ascites and hepatorenal syndrome. We undertook this study to present the results of management of patients with refractory ascites.

Methods: We included 10 patients with diagnosis of hepatic cirrhosis and refractory ascites. Variables were measured in four stages: stage I (basal); II (at the end of water immersion); III (72 h after water immersion); IV (1 week after water immersion concludes). Clinical and laboratory variables were measured and included general exams and renal function tests. Friedman test was used for statistics to establish differences between variables at the end of stage IV. We considered statistical significance when p<0.05.

Results: Median age was 53.8 years, corresponding to seven men and three women with a Child's classification of B or C. Statistically significant variables were weight (p=0.02) and abdominal circumference (p=0.003), as a result of an increased urine output (p=0.03) and glomerular filtration rate (p<0.002). Renal plasma rate increased until stage III, returning to basal level in stage IV. Serum potassium levels decreased but the difference was marginal (p=0.052). During follow-up, two patients died as a consequence of liver insufficiency.

Conclusions: Head-out water immersion showed a decrease in weight and abdominal circumference, which means reduction of ascites. There was a transitory improvement in renal function. No collateral events were reported. Water immersion could be proposed as an adjuvant treatment in patients with refractory ascites and liver cirrhosis.
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October 2008
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