Revista Médica del Hospital José Carrasco Arteaga最新文献

{"title":"Factores asociados con infecciones por bacterias multirresistentes en el Hospital “Vicente Corral Moscoso” de Cuenca, 2018-2019","authors":"Thalía Aracely Mogrovejo Loyola, Adrián Marcelo Sacoto Molina, Marlene Elizabeth Álvarez Serrano","doi":"10.14410/2023.15.1.ao.04","DOIUrl":"https://doi.org/10.14410/2023.15.1.ao.04","url":null,"abstract":"BACKGROUND: Bacterial resistance constitutes a set of processes that allow microorganisms to adapt to a hostile environment, paradoxically driven by antimicrobials, through the process of selective pressure, which results in the ineffectiveness of therapeutic measures, triggering an increase in morbidity and mortality rates and greater expenditure of medical resources; therefore, the aim of this study is to determine the factors associated with infections caused by multidrug-resistant bacteria at Hospital \"Vicente Corral Moscoso\" in the city of Cuenca-Ecuador. METHODS: retrospective case-control study, with a sample of 147 cases of hospitalized patients with infections by multiresistant bacterial agents randomly chosen, and 147 control patients with infections by multisensitive bacterial agents matched by age and sex. The studied variables were: age, sex, hospital service, origin of the biological sample, infectious bacterial agent, mechanism of resistance and risk factors. The probability of association between the variables was calculated by means of the Odds Ratio, with a confidence interval (CI) of 95% and significance level of p< 0.05, calculated by McNemar's test. RESULTS: there was a slight predominance of male sex and age of 60 years or more in this sample of 294 patients. Most cultures (32%) were from sputum samples. The most frequently isolated bacterial agent was E. coli. The most common mechanism of resistance was the production of extended-spectrum beta-lactamases (54%). The statistically significant associated factors with infections by multidrug-resistant bacteria were: the presence of central venous catheter (OR: 3.35, CI: 1.71-6.75, p˂0. 001), previous hospitalization (OR: 2.43, CI: 1.33-4.5, p=0.0003), mechanical ventilation (OR: 3.16 CI: 1.21-9.68, p=0.014) and previous antibiotic therapy (OR: 5.58, CI: 2.60-12.61, p˂0.001). CONCLUSION: The most frequently isolated bacteria were E. coli. The most common mechanism of resistance was the production of extended-spectrum beta-lactamases. This study determined the statistically significant association between infections by multidrug-resistant bacteria and the following factors: the presence of central venous catheter, previous hospitalization, history of mechanical ventilation and previous antibiotic therapy.< jats:p> </jats:abstract> <publication_date media_type='print'> <month>08</month> <day>22</day> <year>2023</year> </publication_date> <publication_date media_type='online'> <month>08</month> <day>07</day> <year>2023</year> </publication_date> <pages> <first_page>11</first_page> <last_page>16</last_page> </pages> <doi_data> <doi>10.14410/2023.15.1.ao.0</doi> <resource>https://revistamedicahjca.iess.gob.ec/ojs2/index.php/HJCA2/article/view/36</resource> </doi_data> </journal_article> <!-- ============== --> <journal_article publication_type='full_text'> <titles> <title>Colostomía Trephine vs Convencional en pacientes con obstrucción intestinal de etiología tumoral en el Instituto ","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117307102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hernia Diafragmática Congénita Tardía, a propósito de un caso","authors":"Pedro Luis Maldonado Muñoz, Juan José Aguilar Astudillo, María Belén Maldonado Muñoz","doi":"10.14410/2023.15.1.cc.07","DOIUrl":"https://doi.org/10.14410/2023.15.1.cc.07","url":null,"abstract":"BACKGROUND: Congenital diaphragmatic hernia (CDH) is the result of incomplete closure of the pleuroperitoneal canal during the period of fetal development; this diaphragmatic defect allows organs and abdominal content to protrude into the thoracic cavity. Ninety percent of cases are diagnosed prenatally or immediately in newborns. Late presentation hernia is defined as CDH diagnosed after the neonatal period and is relatively rare, with an incidence between 5-30% of cases. Clinical manifestations outside the neonatal period are usually more subtle and nonspecific and present as a diagnostic challenge. CASE REPORT: We present the case of a 3-month-old, eutrophic infant who was brought to the emergency department with 72 hours of evolution alimentary vomiting, irritability and hyporexia. On physical examination he presented abolition of vesicular murmur in the left pulmonary field, so a chest X-ray was performed, which incidentally showed images compatible with intestinal contents in the left thoracic cavity, making the diagnosis of CDH. EVOLUTION: The patient was admitted and corrective surgery of the defect was performed with open technique. The procedure was performed without complications with favorable postoperative evolution. The patient was discharged in good condition 10 days postoperatively. Two subsequent controls were performed, one 15 days and the other one month after hospital discharge; the patient was clinically asymptomatic and without sequelae. CONCLUSION: Late congenital diaphragmatic hernia shows a wide spectrum of clinical presentations, from being asymptomatic to respiratory or digestive symptoms; for this reason it is a diagnostic challenge and it is essential to maintain clinical suspicion in patients with non-specific symptoms. Early surgical intervention is necessary to avoid complications and to favor a good prognosis. The technique used for the resolution of this pathology will depend on each case.","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128917591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporte de Caso Clínico: Oclusión intestinal producto de compresoma fistulizado desde cavidad peritoneal hacia colon","authors":"Juan Pablo Jaramillo Álvarez, Fausto Marcelo Quichimbo Sangurima","doi":"10.14410/2023.15.1.cc.06","DOIUrl":"https://doi.org/10.14410/2023.15.1.cc.06","url":null,"abstract":"BACKGROUND: a retained surgical item is a foreign body that becomes lodged within a body cavity or surgical site unintentionally following surgery. The incidence rate of textilomas varies between 1 in 1 000 to 1 in 1 500 intra-abdominal operations. Up to 30% of patients with retained surgical items may be asymptomatic. Retained surgical items, when lodged in some free space of the abdominal cavity, can migrate as a response of the organism to try to get rid of it. The diagnosis of this entity represents a challenge due to the nonspecific nature of its clinical manifestations and the infrequent occurrence of this diagnostic possibility, which is frequently made incidentally. CASE REPORT: A 24-year-old male patient with a history of laparoscopic cholecystectomy converted to open surgery 3 years ago for acute calculous cholecystitis; he presented a 4-month history of colicky abdominal pain located in the right hypochondrium, in addition to semi-liquid diarrheal stools. He was prescribed different medical treatments for two occasions without improvement and exacerbation of the condition with weight loss, abdominal distension, constipation and irradiation of the pain to the left hemiabdomen. Complementary tests showed leukocytosis and neutrophilia. An abdominal CT scan, performed on suspicion of ureteral lithiasis, showed a mass that appeared to be a fecaloma. EVOLUTION: Rectosigmoidoscopy was performed, with the finding of a mass that totally occluded the intestinal lumen at the level of the sigmoid colon. The mass was removed, and turned out to be a surgical compress. Immediately after the rectosigmoidoscopy, the patient reported improvement and was discharged 12 hours after the procedure without complications and with complete resolution of the symptoms. CONCLUSION: retained surgical materials constitute a health problem that affects the safety of the surgical patient, causing serious consequences to the patient's health and increasing the risk of morbidity and mortality. Intra-abdominal retention of compresses and other types of surgical material may not be considered as a clinical suspicion in the first instance, due to the non-specific nature of the clinical picture; however, whenever there is a surgical history and confusing symptomatology, this diagnostic possibility should be taken into account, and can be confirmed by imaging studies.","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114370103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artículo de Revisión: Efectos metabólicos de la terapia nutricional en pacientes con Diabetes Mellitus tipo 2 y/u obesidad o sobrepeso","authors":"Yolanda Beatriz Benalcázar Rodríguez, Jorge Andrés Torres Jerves","doi":"10.14410/2022.14.3.rb.27","DOIUrl":"https://doi.org/10.14410/2022.14.3.rb.27","url":null,"abstract":"Obesity is a chronic metabolic disease with multiple associated factors that has generated a high health impact worldwide; at the same time, rates of type 2 diabetes mellitus also increase with increasing body mass index. Medical nutrition therapy and a focus on lifestyle changes remain key components in the management of overweight and type 2 diabetes mellitus. However, there is little evidence on the different types of nutritional interventions used as a therapeutic strategy in these patients; therefore, the aim of the present review article is to evidence the metabolic effects of nutritional therapy in patients with type 2 diabetes mellitus and/or obesity or overweight. A literature search was conducted for Randomized Controlled Trials published between 2015 and 2021, in English and Spanish languages, conducted with patients aged 18 years or older, with a diagnosis of type 2 diabetes mellitus and/or overweight or obesity, who were intervened with medical nutritional therapy in order to know the metabolic effects of the diet. The search terms (keywords) included: \"obesity\", \"overweight\", \"type 2 diabetes mellitus\", in combination with \"very low calorie ketogenic diet\", \"Mediterranean diet\" and \"low carbohydrate diet\", using the Boolean operator \"and\". We found 11 published Randomized Controlled Trials that met the eligibility criteria","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115778927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Características clínico-epidemiológicas de las pacientes con diagnóstico de Cáncer de Mama en el Hospital de Especialidades José Carrasco Arteaga, 2014-2018.","authors":"Andrés Sebastián Rodríguez Balarezo, Christian Alexander Lema Guaraca, Luis Xavier Illares Guncay","doi":"10.14410/2022.14.3.ao.24","DOIUrl":"https://doi.org/10.14410/2022.14.3.ao.24","url":null,"abstract":"BACKGROUND: Past and ongoing research on breast cancer has enormous implications for improving clinical outcomes. Considering that breast cancer is a pathology that ranks first among neoplasms, both worldwide and in our environment, we conducted this study to learn about the clinical and epidemiological characteristics of patients diagnosed with breast cancer treated at the Oncology Unit of Hospital de Especialidades José Carrasco Arteaga Specialties (HEJCA). METHODS: Observational, descriptive and cross-sectional study. We included 308 clinical records of patients diagnosed by histology and treated for breast carcinoma at the Oncology Unit of Hospital de Especialidades José Carrasco Arteaga from 2014 to 2018. The variables included in the study were: year of diagnosis, age, origin, residence, BMI, contraceptive use, histological subtype, immunohistochemical subtype, clinical stage, surgical treatment and mortality (with a 3-year follow-up). The results are presented in tables and graphs with frequencies and percentages. RESULTS: The study population included 308 patients with an age range from 25 to 93 years. The mean age at diagnosis was 55.79±12.61; 42.2% of the population was overweight; the most frequent histological diagnosis was infiltrating ductal carcinoma, in 82.1% of the population; the most common molecular subtype was luminal B subtype (49.4%); clinical stage IIA was the most frequent at diagnosis with 36%; radical mastectomy was the most frequent surgical approach (53.2% of the cases). CONCLUSION: Breast cancer occurred most frequently in the fifth decade of life, the average age at diagnosis was 55.79 ± 12.61 years. The most frequently diagnosed histological subtype was infiltrating ductal carcinoma and the Luminal B molecular subtype was the most common. Most patients were diagnosed at clinical stage IIA. Radical mastectomy was the most frequently performed surgical approach (53.2% of patients).","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130105177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporte de caso clínico: Insuficiencia cardiaca en el puerperio","authors":"Carlos Joaquín Córdova Serrano, David Alejandro Puga Bermúdez, Nathaly del Cisne Jimbo Paladines, Oliver Gustavo Brasales Jiménez, Martín Sebastián Serrano Piedra","doi":"10.14410/2022.14.3.cc.28","DOIUrl":"https://doi.org/10.14410/2022.14.3.cc.28","url":null,"abstract":"BACKGROUND: Cardiomyopathies that occur de novo in relation to pregnancy or childbirth have diverse etiologies, although they are uncommon, they contribute substantially to maternal morbidity and mortality. In addition, during gestation there are hemodynamic changes that could make hidden heart disease manifest and produce ventricular remodeling with the consequent appearance of persistent or transient structural heart disease. Currently, there is little data on the prevalence of heart disease that occurs during or after pregnancy; for this reason it is of utmost importance to know the cardiovascular diseases related to this period. CASE REPORT: A 26-year-old female patient, who during her late puerperium, after her first pregnancy, terminated by cesarean section due to preeclampsia with severity criteria, presented signs and symptoms of heart failure. After evaluation, ischemic causes were ruled out, maintaining a high diagnostic suspicion of peripartum cardiomyopathy, based on the absence of a history of heart disease prior to pregnancy, the presence of preeclampsia during gestation and the clinical presentation associated with the puerperium; however, after searching for the etiology by cardiac imaging studies, suggestive data of left ventricular non-compaction cardiomyopathy was reported. EVOLUTION: After definitive diagnosis was made, optimal medical therapy for heart failure with reduced ejection fraction was established. The patient presented a favorable evolution, with symptomatic improvement and decrease of clinical and radiological signs of pulmonary congestion and was discharged with the same pharmacotherapy and indications for outpatient monitoring. CONCLUSION: In this case we are dealing with a patient with no cardiac pathology prior to pregnancy, who debuted with symptoms of heart failure in the late puerperium. Although imaging studies confirmed the diagnosis of left ventricular non-compaction cardiomyopathy, the case should be closely followed up due to the probability of reversible ventricular trabeculations associated with pregnancy and not a noncompacted left ventricular cardiomyopathy per se. Given the difficulty for diagnosis and identification of the etiology, the pathology should be studied exhaustively, especially in patients with a high probability of presenting trabeculations as part of adaptive remodeling.","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"3 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116872330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluación de los índices biométricos fetales para el diagnóstico del Retardo del Crecimiento Fetal","authors":"José Gonzalo Carrión Ordoñez, María Elisa Carrión Barreto, Gleici DaSilva Castro Perdoná, Natielle Gonçalves de Sá","doi":"10.14410/2022.14.3.ao.25","DOIUrl":"https://doi.org/10.14410/2022.14.3.ao.25","url":null,"abstract":"BACKGROUND: Fetal Growth Restriction occurs when a fetus does not reach its intrauterine growth potential due to genetic and/or environmental factors; it is associated with increased perinatal mortality and morbidity and also predisposes to the development of chronic disorders in adulthood. The aim of this study was to evaluate the accuracy of the Biometric Indices: Femur Length/Abdominal Circumference (FL/AC); Transverse Cerebellar Diameter/Abdominal Circumference (TCD/AC) and Humerus, Cerebellum, Femur/Abdominal Circumference Equation (HCF/AC); in predicting fetal growth retardation. METHODS: Diagnostic tests validation study, with a universe of pregnant patients who attended the outpatient clinic of Hospital General Machala, El Oro-Ecuador, for prenatal control, between 32 and 38 weeks of gestation. The following variables were obtained: gestational dating; ultrasound fetal biometry of all the necessary parameters for the described indices calculation; fetal weight estimated by ultrasound, with cut-off point ≤ P° 10. The LH/CA and TCD/CA Indices were calculated, with cut-off points for fetal growth retardation diagnosis of ≥ 23.5 and ≥16.1 respectively. The index proposed by the authors HCF/CA was also applied, taking as cut-off point the 90th percentile: ≥ 1.063. RESULTS: The prevalence of fetal weight less P° 10 in the present study was 12.22%. The biometric index with the highest sensitivity was the HCF CA index with 70.3%; however, the highest specificity was obtained for the LF CA index with 84%. The positive predictive value of the DTC CA index was 24.7%, of the LF CA index: 27.9%, and of the HCF CA index: 31.1%. The negative predictive values found were, DTC CA: 93.9%; LF CA: 91.6% and HCF CA: 95.0%. The positive likelihood ratios obtained were: DTC CA: 2.352; LF CA: 2.781 and HCF CA: 3.25. The negative likelihood ratios were, HCF CA: 0.378, DTC CA: 0.465, LF CA: 0.661. CONCLUSION:The biometric indices for prediction of fetal growth retardation have limited positive predictive accuracy. All indices have high negative predictive accuracy. To confirm the presence of condition disease the HCF CA index has better results, as well as to confirm the absence of the condition disease; the addition of the HCF CA Index increases the predictive results; the Odds Rate obtained indicates that there is 8.595 times higher probability of a positive response, when the condition\"fetus in percentile ≤ 10\" is present.","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116760770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Índice de Nottingham en cáncer de mama como factor pronóstico y de supervivencia en el Instituto De Cancerología y Hospital Dr. Bernardo Del Valle S. Guatemala","authors":"Juan Bernardo Pazmiño Palacios, Juan Carlos Mérida Molina, Elsa Rubidia Dubón García","doi":"10.14410/2022.14.3.ao.26","DOIUrl":"https://doi.org/10.14410/2022.14.3.ao.26","url":null,"abstract":"BACKGROUND: Breast cancer is the most frequent type of cancer in women. The Nottingham Prognostic Index allows the use of a clinicopathological score, resulting in 3 prognostic groups. The aim of the present study was to determine the survival time and disease-free period and its association with the results of the application of the Nottingham Prognostic Index in patients with early stage breast cancer treated at Instituto De Cancerología y Hospital Dr. Bernardo Del Valle S, Guatemala. METHODS: An observational, descriptive, retrospective study was performed, which included 268 patients who underwent surgery after confirmed diagnosis of breast cancer, stages Ia, Ib, IIa or IIb according to TNM classification, between 2011 and 2014, at Instituto De Cancerología y Hospital Dr. Bernardo Del Valle S, of Guatemala. The study variables were: age, clinical stage, Nottingham index, molecular subtypes, survival and disease-free period, with a minimum follow-up of 5 years, until the last registered control. Chi-square calculation was used to look for correlation between the studied variables, statistical significance was considered with a p ≤ 0.05. RESULTS: The mean age of the patients was 56 years. The most common clinical stage was IIa (50%), among these patients 63% had a moderate prognosis (p ≤0.0001). The most frequent molecular subtype was luminal A (49%), of the patients with this subtype the majority (53% n=70) had a moderate prognosis (p=0.008). Among patients with a poor prognosis according to the Nottingham index, the majority (52.7%) had a disease-free period between 0 and 3 years and only 11% had a disease-free period of 7 or more years (p=0.043). Among those with a poor prognosis, the majority (47%) had a survival time between 0 and 3 years and 40.27% between 4 and 6 years (p=0.027). CONCLUSION: The results of the application of the Nottingham Prognostic Index have statistically significant association with clinical stage (p≤0.0001),molecularsubtype (p=0.008), disease-free period (p=0.043) and survival time (p=0.027); therefore it is a good predictor of survival time and disease-free period for breast cancer, and also allows us to correlate the different molecular subtypes and their prognosis.","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"83 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132970577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caso Clínico: Retiro de dispositivo de oclusión y cierre de Comunicación Interauricular con redirección de flujo de venas pulmonares","authors":"Javier Arturo López Rodríguez, Juan Bernardo Flores Siguenza, Luis Felipe Haro Moyón, Lady Marín Valencia, Gabriela Elizabeth Arévalo Placencia, Daniela Lisbeth Arévalo Placencia","doi":"10.14410/2022.14.3.cc.29","DOIUrl":"https://doi.org/10.14410/2022.14.3.cc.29","url":null,"abstract":"BACKGROUND: Atrial septal defect represents 10 to 15% of congenital heart disease and is more frequent in women with a 2:1 ratio. Sinus venosus atrial septal defect is usually associated with partial anomalous pulmonary venous drainage from the right superior pulmonary vein to the right atrium directly or indirectly through the superior vena cava. Rarer still, is the inferior sinus venosus, which may be associated with partial anomalous venous drainage from the right inferior pulmonary vein. CASE REPORT: 13-year-old patient with a history of intervention for interatrial defect closure with Amplatzer occluder at the age of six. He was brought to receive medical attention for fatigue and dyspnea that had been progressing for 2 years. Cardiac CT reported partial anomalous connection of pulmonary veins and echocardiogram reported a residual atrial septal defect of 10 mm and mild to moderate pulmonary hypertension. Based on the findings, surgical treatment was decided. EVOLUTION: In correction surgery, we observed Amplatzer occluder incorrectly positioned, the device was removed and flow was redirected from right pulmonary veins to left atrium with bovine pericardium patch. After the surgical intervention, the patient had a favorable evolution without no post-surgical complications. At follow-up, 15 days after medical discharge, the patient was asymptomatic, and a cardiac CT scan showed the corrected interatrial defect. CONCLUSION: The treatment of atrial septal defect should be individualized, since it will depend on the size of the defect, the age at the time of diagnosis, the magnitude of the shunt, the severity of the symptoms and the presence of other conditions. If the defect requires repair, it is important to weigh the benefits of choosing percutaneous closure vs. surgical intervention to avoid the need for reintervention, as in the present case. Closure and redirection of pulmonary vein flow with bovine patch is a safe and effective option.","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124810516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporte de caso clínico: aplicación de corticoide intralesional en estenosis traqueal recidivante.","authors":"Irene Lucía Torres Washima, Miguel Sebastián Nivelo Ávila, Marcos Andrés Aguirre Vintimilla, Jorge Andrés Torres Jerves","doi":"10.14410/2022.14.2.cc.21","DOIUrl":"https://doi.org/10.14410/2022.14.2.cc.21","url":null,"abstract":"BACKGROUND: Benign tracheal stenosis in adults has three etiologies: secondary to prolonged intubation, idiopathic, and rheumatologic. The one associated with prolonged intubation has been described as a lesion due to the persistent pressure of the balloon on the tracheal mucosa, which predisposes to a regional hyperinflammatory response; for that reason, modulating treatments for this response have been proposed as an alternative to classical surgical treatment. To date there is no treatment defined as Gold-Standard; both open and endoscopic treatments are practiced, among the last described, an option is intralesional corticosteroids injection. CASE REPORT: This is a 47-year-old woman with a history of prolonged mechanical ventilation; months later she was diagnosed with tracheal stenosis, initial treated with dilation and stent placement, with subsequent complications (stent migration, reinterventions due to respiratory distress). The patient sought medical attention due to dyspnea, stridor, productive cough, halitosis and general malaise, finding severe tracheal stenosis (98%) by flexible fiberoptic bronchoscopy. EVOLUTION: Using rigid bronchoscopy, the stent was removed, dilation was performed, and we administered intralesional corticosteroid for one time, with a good immediate response; in addition, a course of intramuscular corticosteroids was administered for two days. Six months after the procedure, the patient remained without recurrences, with a stable tracheal stenosis of 30%. CONCLUSION: After the bibliographic review carried out, as well as the successful experience we had with the patient, we agree with the available literature that this new treatment option is adequate for its application, although we recognize that larger studies are required to define the precise indications and an optimal protocol for its establishment.","PeriodicalId":417745,"journal":{"name":"Revista Médica del Hospital José Carrasco Arteaga","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134637872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}