[Surgery for choledocholithiasis following extracorporeal lithotripsy in 3 patients]. / Cirugía por litiasis coledociana después de litotripsia extracorpórea en tres pacientes.

Extracorporeal lithotripsy has been used as a therapeutic modality for gallbladder and common duct stones. When duct stones are fragmented and do not pass to the duodenum or endoscopic extraction is not possible, a surgical intervention seems justified. At operation under these circumstances we have appreciated an unusual increment of vascularity and inflammation that makes the operation somewhat difficult. In the last year we have operated three patients that had common duct stones and received lithotripsy. In two cases the procedure failed. Even when postlithotripsy cholangiogram showed fragmentation of stone, in one patient those fragments could not be evacuated transendoscopically and patient was operated few days later. During operation small fragments were found and probably they could have been eliminated through the sphincterotomy. Thus, we suggest to obtain a new cholangiogram before operating such cases.

[Amebiasis. Surgical treatment in 1989]. / Amibiasis. Tratamiento quirúrgico en 1989.

Even when the number of patients with invasive amebiasis has decreased, the internist and surgeon must be alert in case that the patient requires an operation. Amebic liver abscess is treated medically; percutaneous evacuation is rarely used and surgical drainage is made when there is not response to medical treatment or there is high risk of abscess rupture. Operation is mandatory when the abscess has ruptured to the abdominal cavity or through the pericardial sac. In fulminant colitis it is necessary to resect the diseased portion of the colon without primary anastomoses. Amebic apendicitis is difficult to diagnosis before an operation. It may be suspected in cases of apendicitis if the cecal wall is inflammed. Colon ameboma requires medical treatment except if it is associated with necrosis or perforation. In a four year period (1985-1988) 294 patients with diagnosis of invasive amebiasis were admitted to three hospitals of the Instituto Mexicano del Seguro Social in Mexico City. 218 had hepatic abscess, 45 required surgical drainage with four deaths (9%) and four not operated patients died. In this series only four patients had their abscess drained percutaneously. 31 patients with amebic colitis were treated; three required colonic resection with one death. Ameboma was seen in five patients and there were 11 cases of amebic apendicitis. No deaths occurred in these last two groups.

[Amebiasis. Has its clinical expression changed?]. / Amibiasis. Ha variado su expresión clínica?

In Mexico, like in other countries, there is an special interest for amebiasis because it represents a Public health problem; there are about 5 million people that in some time of their lives had tissue invasion by this parasite. 1-2% of mexicanas have intestinal amebiasis and probably there are 850,000 to 1,700,000 carriers of entamoeba cysts. 6% of the general population have circulating antiameba antibodies. In 1988 we studied the amebic hepatic abscess seen in the hospitals of the Instituto Mexicano del Seguro Social in the Valley of Mexico. During that year there were 396 patients with such illness (0.19% of hospital admissions) with a 1.01% mortality. Comparing this data with reports of 1969 there was a reduction in the number of patients and deaths. Also amebiasis has decreased in autopsy studies. However, we have not found recent variations in the clinical behavior of amebiasis. Advances in diagnostic methods and more liberal use of metronidazole have reduced the number of severely ill patients.

[Evaluation of undesirable effects of low-molecular-weight heparin during prevention of thromboembolic disease in abdominal surgery patients]. / Valoración de los efectos indeseables de una heparina de bajo peso molecular, durante la profilaxia de enfermedad tromboembólica en pacientes de cirugía abdominal.

The objective of the present study was to determine the type, frequency and severity of the side effects of a low-molecular-weight heparin (LMWH) during the prophylaxis of thromboembolic disease (TED) after abdominal surgery. The study was prospective, comparative, longitudinal, and open. The setting was at the surgical and hematology services of a teaching hospital. There were 57 patients (27 males, 30 females) with risk factors for TED, including gastrointestinal malignancies. Seventeen patients (Group A) received LMWH, 20 mg/day; 20 (Group B) standard heparin (SH), 5,000 U/12 h, and 20 (Group C) formed the control group. LMWH or SH were administered 2 h before surgery and then, when patients assumed complete ambulatory status, at the end of their hospital stay or for a maximum of ten days. There were no significant differences among the groups in relation with age, anthropometric variables, type and duration of surgery, nor in the extent of the surgical bleeding, days to full ambulatory status nor length of postoperative hospital stay. A similar number of erythrocyte transfusions were used on the three groups. Eighty-three percent of the patients were 50 years of age or older. None developed TED. Postoperatively in group "A" a significant increase in platelets (p = 0.01) was found, as was the shortening of the activated partial thromboplastin time (P = 0.007); other adverse effects did not occur during the administration of LMWH. These findings allowed us to conclude that LMWH constitutes a safe, reliable and comfortable alternative for prophylaxis of TED in this type of surgical patients.

[Surgical treatment of amebic liver abscess]. / Tratamiento quirúrgico del absceso hepático amibiano.

Results of surgical treatment of hepatic amebic abscess in three hospitals during last three years are presented. Seventy four percent of patients admitted with complications of amebiasis have liver abscess. Of them 22% require surgical treatment and mortality is 8%. Nineteen years ago the amount of patients admitted with amebic complications was greater and a larger number of patients were operated; however mortality has not changed.

Rectopexia presacra para el prolapso rectal masivo del adulto. / Presacral rectopexy for the massive rectal prolapse in adult

Cuando ocurre un prolapso rectal masivo el cirujano cuenta con multiples tecnicas para su tratamiento y debe elegir la mejor.Se presentan los resultados de ocho enfermas a las que se les trato con rectopexia presacra empleando una banda de mersilene o silastic, con tecnica similar a la descrita por Ripstein, que corrige la curvatura del recto al fijarlo a la fascia presacra. Desde el postoperatorio inmediato observamos reduccion del prolapso. Una paciente anciana fallecio por problemas cardiopulmonares una semana despues de la intervencion; las otras siete tienen continencia anal y no han requerido de otras intervenciones en un periodo de 3 a 6 ano

Manejo anestésico para el trasplante de páncreas: experiencia de cinco casos / Anesthetic management for pancreatic transplantation: the initial experience

El trasplante de páncreas, es la única forma terapéutica que consigue la normalización de la glucos y que libera al enfermo diabético tipo I del tratamiento insulínico. En un periodo de cuatro años se hace una revisión retrospectiva de la expereincia de trasplantes de páncreas en sus diferentes modalidades. En el presente artículo se describen cinco casos y se discuten los aspectos fundamentales del manejo perioperatorio y transanestésico que representa en la actualidad un verdadero desafío para el anestesiólogo