[Intraoperative endoscopic surveillance in laparoscopic surgical treatment of achalasia]

We study the utility of intraoperative endoscopic control, in laparoscopic surgical treatment of the typical Achalasia of Esophagus. 81 patients were intervened surgically in Centro de Cirugia Endoscopica. Hospital Universitario Calixto Garcia in a five year-old period. All patients received intraoperative endoscopic evaluation to guarantee the effectiveness and integrity of the esophago-cardiomyotomy. The average time of surgical procedure was of 144,7 minutes. The transendoscopic complication in relation with endoscopic procedure was seen in one case but it didn't modify the morbi-mortality of the study. According to Vantrappen classification, 79 patients were considered with a evolution between excellent and good. The use of endoscopic intraoperative control is recommended in the surgical interventions of the patients with achalasia.

Anatomical and functional cardiac abnormalities in type I diabetes

To analyse the anatomy and systolic and diastolic cardiac function in a group of type I diabetics with no other abnormality and to correlate it with the duration of the disease, the presence of complications, the control of the diabetes and the abnormalities in the autonomous nervous system, 125 type I diabetics and 50 age- and sex-matched healthy controls were studied. In 112 diabetics, an echocardiographic image which enabled us to calculate the thickness, cavity dimensions and systolic function rates was obtained. A Doppler echocardiograph was done in all patients to measure 9 parameters of diastolic function. The autonomic nervous system was evaluated by the response to 4 cardiovascular reflexes. Two control groups and 4 study groups were established, based on duration and on the presence and number of microangiopathic complications. The results showed a significant increase in the septal and posterior wall thickness, although without differences between the study groups. There were no differences in the analysis of systolic function. The abnormalities in diastolic function were significant in all the groups, but greater in the groups with microangiopathy. Overall, for groups 1-4, respectively, the incidence of anatomical abnormalities was 9.6%, 17%, 28% and 57% (average 22%); systolic 0%, 0%, 4% and 4.7% (average 2.2%); and diastolic 15%, 21%, 60% and 80% (average 44%). Only 13 diabetics from group 4 presented with cardiac autonomic neuropathy. No correlation between these alterations and the glycaemic control or the duration of the disease was found, although there was a correlation between the presence or absence of complications and the anatomic and diastolic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac anatomical and functional changes in a group of young type I diabetics with microangiopathy]

BACKGROUND

There are conflicting data concerning the alteration of cardiac function in diabetics without another type of accompanying pathology. Therefore this study was designed with the aim to analyze the anatomical and functional changes and relate them with the time and control of diabetes.

METHODS

Fifty-four type I diabetics with a mean age of 33.5 years and 25 healthy controls paired by age and sex were studied. The patients were rigourously selected excluding any disease or treatment other than insulin and the presence of demonstrated microangiopathy was required. M-mode and bidimensional echocardiographic studies were carried out in 46 patients to calculate thickness, cavity dimension and systolic function rates. Doppler-echo studies analyzing 9 parameters of diastolic function were performed in all the 54 patients studied.

RESULTS

The results obtained demonstrated significant differences in the thickness of the posterior wall and the septum in the diabetics in comparison with the normal subjects. No differences were observed in the parameters of systolic function with the diastolic parameters being significant. Considered globally 41% of the patients demonstrated structural alterations, 4% systolic and 70% diastolic. The only significant correlation was established between the diastolic alteration and the time of evolution of the diabetes. The autonomic alteration which some patients presented did not vary the results obtained.

CONCLUSIONS

In this group of selected diabetic structural and cardiac diastolic alterations appeared being attributed only to the diabetes itself in relation to the length of time of the same and possibly to the microangiopathy.

[The cardiac anatomical and functional changes in a group of young type-1 diabetics without microangiopathy]

We study 71 type I diabetics and 25 controls, trying to analyze the anatomical and functional changes due to diabetes. The diabetics, with a mean age of 18.4 +/- 8.2 years, were strictly selected excluding any disease and treatment besides insulin. In 66, and echocardiographic M mode and 2D study was done to calculate wall thickness, cavity dimensions and systolic function indexes; in all, Eco-Doppler analyzing 9 diastolic function indexes. The results showed an increase in septal thickness in diabetics (p less than 0.01 in diastole and less than 0.001 in systole). There was no difference in systolic function or posterior wall thickness, having the diabetics a significant increase of the T 1/2 (p less than 0.001), a decrease of the deceleration of E and the ratio E/A (p less than 0.001). As a group, 12.5% of the diabetics had anatomical abnormalities, and 18.3% diastolic abnormalities at least in two indexes. The only significant correlation was established between the evolution time and the T 1/2 (p less than 0.01). We conclude that in this group of selected diabetics, the anatomical and functional abnormalities found were only imputable to the diabetic abnormality.

Lymphocyte response to grass pollen antigens: a correlation with radioallergosorbent test and effect of immunotherapy

The deoxyribonucleic acid (DNA) synthetic response of cultured lymphocytes to grass pollen antigens was significantly higher in 66 untreated atopic patients than in 15 non-atopic subjects (p less than 0.05). There was no correlation between the DNA synthetic response and the specific IgE antibody level as measured by radioallergosorbent test in the 81 subjects (r= 0.13; p greater than 0.2). The effect of immunotherapy on proliferative lymphocyte response and specific IgE antibody response to grass pollen antigens was evaluated prospectively in 22 atopic patients. The DNA synthetic response to grass pollen antigens was significantly reduced after immunotherapy (p less than 0.01) but the specific IgE antibody level did not change significantly.