Ascariasis in the hepatobiliary system: laparoscopic management.

BACKGROUND: Ascariasis is an endemic disease in developing countries. The parasite can invade the hepatobiliary tree and cause symptoms. Medical therapy can be ineffective in these patients and intervention techniques required. STUDY DESIGN: A retrospective review of patient charts between February 1992 and February 2007 in the Hospital Latinoamericano, Cuenca, Ecuador, was performed to identify patients having surgical or endoscopic treatment for hepatobiliary ascariasis. Patient demographics, treatment algorithms, and outcomes are described and analyzed. RESULTS: There were 13 cases of hepatobiliary infestation by ascaris treated through endoscopy or operation. All patients presented with colicky abdominal pain in the right upper quadrant. Hepatic and biliary ultrasonography identified parasites in 12 patients. In the other patient, a hepatic abscess containing ascaris was found incidentally during cholecystectomy. There were 11 patients with ascariasis in the common bile duct, 1 in whom the cystic duct was occluded, causing acute cholecystitis. In 12 patients, conservative management was attempted and was unsuccessful. Endoscopic extraction was successful in four of these patients. Six patients underwent laparoscopic cholecystectomy, common bile duct exploration with parasite extraction, and T-tube placement. Parasite extraction through common bile duct exploration followed by primary closure was performed in one patient. Cholecystotomy and parasite extraction followed by cholecystectomy were performed in one patient. The final patient had cholecystectomy and parasite extraction from a liver abscess without earlier medical therapy. CONCLUSIONS: Ascariasis in the hepatobiliary system should be considered in the differential diagnosis of upper abdominal pain for patients in populations at risk. When an operation is indicated, it can be accomplished by endoscopic or laparoscopic approach.

Intoxicación por fosforados inorgánicos: reporte de caso

Las intoxicaciones por fósforo blanco, no han dejado de observarse en la actualidad (2). El fósforo blanco es un compuesto muy tóxico, que en el humano causa intoxicación aguda tras la ingesta por vía oral, que por lo general es en forma suicida, en mujeres jóvenes como son los casos que presentamos. El cuadro clínico es similar a los tres casos, caracterizado por dolor abdominal, vómito, ictericia y con un componente depresivo. Con el propósito de reducir su prevalencia las autoridades de salud deberían prohibir su fabricación y su venta.

Complicaciones frecuentes de diabetes mellitus en el Hospital Provincial de Cotopaxi

El presente es un estudio descriptivo realizado en el Hospital Provincial de Cotopaxi, durante 1987 a 1997, con un universo de 57.856 pacientes atendidos en este hospital, el mismo que cuenta con 202 camas para dar atención a toda la población de la provincia en lo que comprende consulta externa y hospitalización, de los cuales se diagnosticó a 170 pacientes de diabetes mellitus por medio de la clínica y exámenes de laboratorio, determinándose sus complicaciones en relación con diferentes variables clínicas, así tenemos que: la diabetes mellitus no insulino dependiente, representa el 97.6 por ciento del total de casos de diabtes mellitus; el mayor porcentaje de pacientes supera los 50 años de edad (74 por ciento)...