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L Sigler Morales

Publications and source records attributed to L Sigler Morales.

6 recordsLinked to original sources
PubMedDate not supplied

[Surgery for choledocholithiasis following extracorporeal lithotripsy in 3 patients].

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.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

[Amebiasis. Has its clinical expression changed?].

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.

Amebiasis↗
PubMedDate not supplied

[Amebiasis. Surgical treatment in 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.

Adolescent↗