A modified method of local infiltration for endoscopic stapes surgery: how I do it.

PURPOSE: To present a modified method of local infiltration (MMLI) for endoscopic stapes surgery to reduce surgical time, bleeding and complications. MATERIALS AND METHODS: This study involved 70 patients who underwent stapes surgery for otosclerosis by endoscopic and microscopic approaches. The MMLI was applied as follows: local infiltration was performed with one hand while the other hand inserted the endoscope into the ear canal to observe vasoconstriction signs on the monitor; the single site of infiltration was located at the center of the anterior conchal cartilage. Operative time, intraoperative blood loss, preservation of anatomical structures, postoperative hearing and complications were evaluated. RESULTS: The MMLI allowed for quick bleeding control and a clear and dry operative field. Operative time, intraoperative blood loss and preservation of anatomical structures were significantly reduced in the endoscopic group (P < 0.00) versus the microscopic group. The scutum was removed less frequent in the endoscopic group 7.1% versus 53.6% of the microscopic group (P < 0.00). The chorda tympani was preserved in all cases but it was more manipulated in the microscopic group 39.3% versus 9.5% of the endoscopic group (P < 0.00). No complications were observed and the hearing outcomes were significantly better than the preoperative thresholds. CONCLUSIONS: This is the first report on the use of a MMLI for endoscopic stapes surgery. Using this method, the surgeon performs the infiltration at one site and concurrently observes the vasoconstriction signs without the use of a microscope, frontal lamp or speculum. This method provides benefits in terms of operative time and complications.

[Diagnosis and treatment of the complications of otitis media in adults. Case series and literature review]. / Abordaje diagnóstico y terapéutico de las complicaciones de la otitis media en el adulto. Serie de casos y revisión de la literatura.

BACKGROUND: The complications of otitis media (intra-cranial and extra-cranial) used to have a high morbidity and mortality in the pre-antibiotic era, but these are now relatively rare, mainly due to the use of antibiotics and the use of ventilation tubes, reducing the incidence of such complications significantly. Currently, an early suspicion of these complications is a major challenge for diagnosis and management. CLINICAL CASES: The cases of 5 patients (all male) are presented, who were diagnosed with complicated otitis media, 80% (4) with a mean age of 34.6 years (17-52). There was major comorbidity in 60% (3), with one patient with diabetes mellitus type 2, and two with chronic renal failure. There were 3 (60%) intra-cranial complications: one patient with thrombosis of the sigmoid sinus and a cerebellar abscess; another with a retroauricular and brain abscess, and a third with meningitis. Of the 2 (40%) extra-cranial complications: one patient had a Bezold abscess, and the other with a soft tissue abscess and petrositis. All patients were managed with surgery and antibiotic therapy, with 100% survival (5), and with no neurological sequelae. The clinical course of otitis media is usually short, limiting the infection process in the majority of patients due to the immune response and sensitivity of the microbe to the antibiotic used. However, a small number of patients (1-5%) may develop complications. CONCLUSION: Otitis media is a common disease in our country, complications are rare, but should be suspected when the picture is of torpid evolution with clinical worsening and manifestation of neurological signs.

Enfermedad litiásica biliar en pacientes embarazadas. Estudio Ecográfico / Biliary lithiasic disease in pregnant patients. Echographic study

Se realizó una pesquisa de la vesícula biliar a las pacientes embarazadas que acudieron a la Consulta de Ultrasonido del Hospital General Docente de Baracoa para determinar la frecuencia de la enfermedad litiásica en ellas, aconsejar medidas preventivas y evitar así las complicaciones de dicha enfermedad durante el embarazo. Se analizaron las variables siguientes: frecuencia de litiasis en el embarazo, número de embarazadas al diagnóstico, edad de las pacientes, números de cálculos y su tamaño, tiempo de gestación al diagnóstico y principales síntomas que presentaban las pacientes con litiasis. Se observó que de 100 pacientes embarazadas a las cuales se les realizó el ultrasonido, 4 presentaban litiasis, con más frecuencia las multíparas, con predominio de cálculos múltiples y los mayores de 5 mm

Comportamiento de las enfermedades cardiovasculares asociadas al embarazo / Behavior of cardiovascular disease associated with pregnancy

Se realizó una investigación prospectiva en 150 embarazadas con enfermedades cardiovasculares asociadas, de un total de 1 665 pacientes que tuvieron su parto en el período comprendido entre enero a diciembre de 1997, en el hospital general docente de Baracoa, lo que representó el 9,0 porciento del total de los ingresos. Indicadores como la edad mostraron una moda de 24/27 años y como media 26 años. La mujer primípara tuvo mayor incidencia que las de otro tipo de paridad. En estas gestantes la hipertensión arterial crónica, estenosis mitral y comunicación interauricular fueron las afecciones cardiovasculares que prevalecieron. Predominaron los neonatos a término, y los normopesos en las cardiopatías estudiadas. No hubo mortalidad perinatal ni materna en el período analizado