RESUMEN
Diagnostic laparoscopy continues to play an important role in the accurate evaluation of patients with abdominal disorders. Combined with laparoscopic ultrasound, it is highly accurate in the staging of intra-abdominal malignancies, and it is superior to transcutaneous ultrasonography and computed tomography. Other important applications include the evaluation of patients with acute and chronic abdominal pain, acute abdomen, peritonitis, and blunt and penetrating abdominal trauma. Laparoscopy now rests firmly in the hands of surgeons. The majority of last year's papers originated from departments of surgery; papers on laparoscopy in hepatic disorders are sorely missing in this year's review.
Asunto(s)
Abdomen Agudo/etiología , Traumatismos Abdominales/diagnóstico , Neoplasias Abdominales/diagnóstico , Laparoscopía , Abdomen Agudo/cirugía , Traumatismos Abdominales/cirugía , Neoplasias Abdominales/cirugía , Diagnóstico Diferencial , HumanosAsunto(s)
Neoplasias Abdominales/diagnóstico , Neoplasias Gastrointestinales/diagnóstico , Laparoscopía , Hepatopatías/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Abdominales/patología , Neoplasias Abdominales/secundario , Biopsia/instrumentación , Neoplasias Gastrointestinales/patología , Humanos , Laparoscopios , Hepatopatías/patología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundarioRESUMEN
Dieulafoy's lesion or cirsoid aneurysm is a rare cause of massive upper gastrointestinal hemorrhage. Historically cirsoid aneurysm most often occurs in the stomach, but has been reported to occur in the jejunum. In this paper, four cases are presented that are felt to represent the first documented cases of cirsoid aneurysm involving the duodenum. At endoscopy, the appearance of Dieulafoy's lesion may range from a pinpoint dot, clot, or tortuous vessel, to blood oozing or spurting from normal mucosa. A shallow defect may be present that can give the appearance of a partially healed peptic ulcer. Previous histologic studies have shown a wide-caliber-persistent artery with intimal thickening, sclerosis, and medial muscular hypertrophy. Once the diagnosis is made, surgical intervention utilizing simple ligation of the involved vessel results in cessation of recurrent hemorrhage. Dieulafoy's lesion is probably more common than the previous literature would suggest. The lesion needs to be considered in the clinical setting of the patient with massive upper gastrointestinal hemorrhage, a paucity of symptoms, and negative findings on barium studies, endoscopy, and exploratory laparotomy.
Asunto(s)
Aneurisma/complicaciones , Duodeno/irrigación sanguínea , Hemorragia Gastrointestinal/etiología , Adolescente , Adulto , Aneurisma/congénito , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This prospective study was designed to determine the most accurate method of obtaining a tissue diagnosis in patients with suspected focal liver disease. Computed tomography (CT) was performed initially in all patients. Patients with extensive right lobe disease on CT had a blind, percutaneous liver biopsy. Those with focal lesions on CT were randomized to either a CT or laparoscopic directed biopsy. Patients with no lesions on CT had laparoscopy for further evaluation. The results indicate that blind percutaneous biopsy is sufficient if extensive right lobe disease is present. There is no significant difference in the sensitivity of laparoscopy and CT directed biopsy if focal lesions are detected by CT. However, a negative CT directed biopsy does not exclude malignancy. Laparoscopy has a significant yield in patients with a negative CT and is the procedure of choice in evaluating these patients.
Asunto(s)
Biopsia/métodos , Hepatopatías/patología , Neoplasias Hepáticas/patología , Hígado/patología , Humanos , Laparoscopía , Estudios Prospectivos , Distribución Aleatoria , Tomografía Computarizada por Rayos XRESUMEN
Biomphalaria glabrata, an intermediate host for Schistosoma mansoni, was first reported in Haiti in 1891 at one location in the Départment du Nord and in 1977 it was reported at several sites in one additional watershed. Our study identifies two additional locations each on a different watershed plus a third possible site. A wide but discontinuous distribution of the snail on the north coast of Haiti is confirmed (no autochthonous infections with S. mansoni have been reported). While there are many possible explanations for this discontinuous distribution, a role for the competitor Thiara granifera in shaping the current distribution of B. glabrata is suggested. The incursion of B. glabrata into Haiti is not recent but at the same time is not expanding.
Asunto(s)
Biomphalaria , Animales , Biomphalaria/parasitología , Reservorios de Enfermedades , Ecología , Haití , Schistosoma mansoni , CaracolesRESUMEN
In the past decade, there has been a dramatic increase in the number of reported cases of clinical illness from noncholera (marine) vibrio infections, leading to a greater recognition of this potentially lethal disease. The wide spectrum of pathogenicity of this organism is reflected in the six cases in this report, varying from simple gastroenteritis to focal necrotizing cellulitis to fatal septicemia. We have reviewed the fundamental clinical differences between Vibrio vulnificus and other noncholera vibrio infections. Physicians treating patients with a history of exposure to coastal waters and/or seafood should be aware of the clinical features and the potential for significant morbidity and mortality of associated Vibrio vulnificus infections.
Asunto(s)
Vibriosis/epidemiología , Microbiología del Agua , Adulto , Anciano , Antibacterianos/uso terapéutico , Femenino , Florida , Contaminación de Alimentos , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/complicaciones , Ostreidae/microbiología , Embarazo , Recreación , Vibrio/aislamiento & purificación , Vibrio/ultraestructura , Vibriosis/diagnóstico , Vibriosis/tratamiento farmacológicoAsunto(s)
Colestasis Intrahepática/inducido químicamente , Eritromicina/análogos & derivados , Abdomen , Eritromicina/efectos adversos , Etilsuccinato de Eritromicina , Femenino , Humanos , Hígado/efectos de los fármacos , Hígado/fisiopatología , Pruebas de Función Hepática , Persona de Mediana Edad , Dolor/inducido químicamenteAsunto(s)
Enfermedades Gastrointestinales/complicaciones , Síndromes de Inmunodeficiencia/complicaciones , Infecciones/complicaciones , Agammaglobulinemia/complicaciones , Linfocitos B/inmunología , Infecciones Bacterianas/complicaciones , Candidiasis Mucocutánea Crónica/complicaciones , Infecciones por Citomegalovirus/complicaciones , Síndrome de DiGeorge/complicaciones , Sistema Digestivo/inmunología , Disgammaglobulinemia/complicaciones , Giardiasis/complicaciones , Herpes Simple/complicaciones , Humanos , Deficiencia de IgA , Inmunoglobulina A Secretora/inmunología , Parasitosis Intestinales/complicaciones , Micosis/complicaciones , Estrongiloidiasis/complicaciones , Linfocitos T/inmunologíaRESUMEN
A case of severe Strongyloides stercoralis infection is described in a patient with renal failure due to bilateral cortical necrosis. Because thiabendazole, the drug of choice in strongyloidiasis, is primarily excreted by the kidneys, alternative therapy with a mebendazole was instituted. Although the patient eventually died as a result of the renal failure, successful therapy with mebendazole was well demonstrated.