Splenogonadal fusion associated with Moebius and Poland syndromes: first case reported. / Fusión esplenogonadal asociada a síndrome de Moebius y Poland: primer caso reportado.

INTRODUCTION: Splenogonadal fusion is a rare congenital anomaly of unknown etiology caused by an abnormal fusion of the splenic tissue and the gonadal tissue. CASE REPORT: 2-year-old patient with paralysis of the 6th, 7th, and 9th cranial nerves, tent-shaped mouth, cleft palate, right pectoralis major hypoplasia, disruptive defect of the right upper limb, and a mass located at the left inguinal region. At inguinal hernia repair surgery, a processus vaginalis with non-reducible content was observed. When opening the hernia sac, a descending segment of splenic tissue merging with the upper pole of the left testis was found. The patient was diagnosed with splenogonadal fusion. The splenic tissue merging with the testis upper pole was resected, and the remaining splenic tissue was reduced towards the abdominal cavity. DISCUSSION: Splenogonadal fusion is difficult to diagnose. Being familiar with it allows unnecessary orchiectomies to be prevented.

INTRODUCCION: La fusión esplenogonadal es una anomalía congénita rara, de etiología desconocida, causada por la fusión anormal entre el tejido esplénico y gonadal. CASO CLINICO: Paciente de dos años, con parálisis del 6°, 7° y 9° nervio craneal, boca en tienda, paladar hendido, hipoplasia del músculo pectoral mayor derecho y defecto disruptivo de la extremidad superior derecha, masa visible en región inguinal izquierda. Al realizar la herniorrafia inguinal encontramos un conducto peritoneo vaginal con contenido no reductible y a la apertura del saco herniario observamos un segmento de tejido esplénico que desciende y se fusiona con el polo superior del testículo izquierdo. El paciente fue diagnosticado con fusión esplenogonadal. El tejido esplénico fusionado al polo superior del testículo es resecado y el resto del tejido esplénico se reduce hacia la cavidad abdominal. COMENTARIOS: La fusión esplenogonadal es una patología de difícil diagnóstico y su conocimiento puede evitar orquiectomías innecesarias.

Fusión esplenogonadal asociada a síndrome de Moebius y Poland: primer caso reportado / Splenogonadal fusion associated with Moebius and Poland syndromes: first case reported

Introducción: La fusión esplenogonadal es una anomalía congénitarara, de etiología desconocida, causada por la fusión anormal entre eltejido esplénico y gonadal. Caso clínico: Paciente de dos años, con parálisis del 6°, 7° y 9°nervio craneal, boca en tienda, paladar hendido, hipoplasia del músculopectoral mayor derecho y defecto disruptivo de la extremidad superior derecha, masa visible en región inguinal izquierda. Al realizar laherniorrafia inguinal encontramos un conducto peritoneo vaginal concontenido no reductible y a la apertura del saco herniario observamosun segmento de tejido esplénico que desciende y se fusiona con elpolo superior del testículo izquierdo. El paciente fue diagnosticado confusión esplenogonadal. El tejido esplénico fusionado al polo superiordel testículo es resecado y el resto del tejido esplénico se reduce haciala cavidad abdominal. Comentarios: La fusión esplenogonadal es una patología de difícildiagnóstico y su conocimiento puede evitar orquiectomías innecesarias.(AU)

Introduction: Splenogonadal fusion is a rare congenital anomalyof unknown etiology caused by an abnormal fusion of the splenic tissueand the gonadal tissue. Clinical case: 2-year-old patient with paralysis of the 6 th , 7 th , and9th cranial nerves, tent-shaped mouth, cleft palate, right pectoralis majorhypoplasia, disruptive defect of the right upper limb, and a mass locatedat the left inguinal region. At inguinal hernia repair surgery, a processusvaginalis with non-reducible content was observed. When opening thehernia sac, a descending segment of splenic tissue merging with theupper pole of the left testis was found. The patient was diagnosed withsplenogonadal fusion. The splenic tissue merging with the testis uppe pole was resected, and the remaining splenic tissue was reduced towardsthe abdominal cavity. Discussion: Splenogonadal fusion is difficult to diagnose. Beingfamiliar with it allows unnecessary orchiectomies to be prevented.(AU)

Costos hospitalarios del servicio de anestesiología en el Hospital General de las Fuerzas Armadas N§ 1 de Quito / hospitable Costs of the service of anestesiologia in the General Hospital of the Armed Forces N§ 1 of Quito

El objetivo del presente trabajo es el de conocer los costos del Servicio de Anestesiología del Hospital General de las Fuerzas Armadas de Quito. Se realizó un estudio operativo descriptivo, en el que se aplicó el cálculo de costos operativos del servicio en su conjunto y de cada procedimiento realizado. La información se obtuvo a través de información documental y observación directa y fue de tres tipos: contable, de recursos humanos y estadística. Se utilizó la metodología de costeo directo simplificado. Se diseñaron los instrumentos necesarios para la recolección y consolidación de la información de costos del servicio. El costo total del Servicio de Anestesiología fue de S/. 523 159 408 distribuido de la siguiente manera: materiales y suministros S/. 309 186 739; mano de obra S/. 200 943 605 y gastos generales S/. 13 029 064...

Intoxicación alimentaria en el comedor de una fábrica en Ecuador, 1995 / nourishing Poisoning in the dining room of one makes in Ecuador, 1995

En octubre de 1995 en un restaurante (comedor) de fábrica en la costa de Manabí ocurrió un brote de intoxicación alimentaria. Se realizó la identificación epidemiológica de la fuente, agente etiológico y su modo de transmisión. De un total de 240 personas que comieron eses día, solamente a 156 personas se pudo realizar la encuesta. La investigación se realizó en una semana, a través de la investigación de campo y por medio del análisis estadístico mediante el programa de informática EPI-6, que incluyó: tasas de ataque de enfermos y no enfermos y tablas de contingencia entre las variables. Se encontró que las tasas de ataque mas significativas se hallaban entre los enfermos que ingirieron sopa de chancho (96 por ciento) y ensalada de atún (96 por ciento), en ambos grupos los valores de p fuerom 0,00034 y 0,000011 respectivamente. Las conclusiones fueron que por los datos obtenidos mediante el valor de (p) y el tipo de curva epidemiológica realizada, se trató de una fuente común, con características epidémicas, el posible agente causal fue el S. aureus, y el modo de transmisión, la mayonesa (en la ensalada de atún)...

[Ventricular reentry tachycardia within the bundle branches. Report of 3 cases]. / Taquicardia ventricular por reentrada de rama a rama: presentación de tres casos.

Vientricular tachycardia due to reentry within the bundle branches occurs in the presence of left ventricular dilatation and conduction alterations in the His-Purkinje system. A macro-reentry is formed by the His bundle, left and right bundles and ventricular myocardium. The anatomical substrate of this arrhythmia is ventricular dilatation. However, it may appear in healthy hearts. Alterations of intraventricular conduction are reflected by a prolongation of PR interval and bundle branch block in the surface EKG and prolongation of HV interval in the endocavitary registry. During tachycardia, His activation precedes ventricular activation. We report three patients aged 55, 58 and 78 years old with a dilated cardiomyopathy and ventricular tachycardia due to reentry within the bundle branches. All had a left bundle branch block and a prolonged HV internal. The arrhythmia was induced during the study in two patients. All were subjected to radiofrequency fulguration of the right branch of the His bundle. After fulguration, two remained with a pattern of complete right bundle branch block and one with a complete intermittent AV block. All three are free of arrhythmic events.

[Radiofrequency ablation of right accessory pathways]. / Fulguración con radiofrecuencia de haces paraespecíficos derechos.

BACKGROUND: Accessory pathways are muscular connections between auricles and ventricles, present in different points of mitral and tricuspid annuluses. These pathways participate in 50% of paroxysmal supraventricular tachycardias and the definitive cure of the arrhythmia is their ablation. AIM: To report our experience in patients with right accessory pathways. PATIENTS AND METHODS: Fifty consecutive patients treated between 1990 and 1996 are reported. Eight had a history of syncope, two had a diagnosis of Ebstein disease and 36 had a pre-excitation in the surface electrocardiogram. RESULTS: Fifty four accessory pathways were identified, since four patients had two pathways. Twenty four pathways were posteroseptal, 15 were lateral, 9 were medioseptal and 6 were anteroseptal. One patient had also a nodal reentry tachycardia. Fulguration was attempted in 39 patients and it was finally successful in 32. Three patients required more than one session. There were six relapses and all were successfully ablated in a second session. A mean of 28 radiofrequency applications were done (range 1-76), mean laboratory time was 6 hours and mean radioscopy time was 70 min. Four patients had a transient atrioventricular conduction blockade. CONCLUSIONS: Radiofrequency ablation of accessory pathways has a high degree of success and a low rate of complications.

Muerte súbita: a propósito de un caso / Sudden death: with regard to a case

Expone que la muerte súbita es un evento patológico de difícil explicación, porque en ella se establece causas y mecanismos fisiopatológicos, que no coinciden con cuadros clínicos, ni es posible relacionar hallazgos anatomopatológicos con argumentos predictivos ni tratamientos específicos. Se destaca la patología coronaria en los sucesos de muerte súbita porque más bien estarñian relacionados con la calidad del sustrato miocardico y su tendencia arritmiogénica.

[Idiopathic tachycardia originated in left ventricle]. / Taquicardia ventricular idiopática originada en el ventrículo izquierdo.

BACKGROUND: Idiopathic ventricular tachycardia occurs in patients with no structural heart disease and may originate in left of right ventricle. AIM: To report our experience with this condition. PATIENTS AND METHODS: We report six patients (five male), aged 35 years old as a mean, with idiopathic left ventricular tachycardia that were subjected to conventional electrophysiological studies with atrial and ventricular stimulation programs and radiofrequency fulguration, between December 1993 and May 1996. RESULTS: The mean lapse of disease was 24 months and five patients received antiarrhythmic medications previously. All tachycardias had a morphology with an image of right bundle branch block. Radiofrequency fulguration was done after obtaining a satisfactory pace mapping of at least 11 of the 12 superficial EKG derivations. The procedure was successful in five patients and two had a relapse. One of the relapsed patients was successfully fulgurated again. CONCLUSIONS: Radiofrequency fulguration for idiopathic ventricular tachycardias is a safe and effective therapeutic procedure.

[Radiofrequency catheter ablation in patients with common atrial flutter]. / Fulguración con radiofrecuencia en pacientes con flutter auricular típico.

BACKGROUND: Type 1 atrial flutter is produced by a reentry circuit located in the right atrium that can be interrupted applying radiofrequency in the inferior cava-tricuspid valve isthmus. AIM: To report our experience in the treatment of atrial flutter with radiofrequency ablation. PATIENTS AND METHODS: Nine patients (eight male) whose ages ranged from 6 to 72 years old were studied. Two patients had an operated congenital cardiopathy, two had high blood pressure, one was subjected previously to radiofrequency ablation due to a left paraspecific pathway, one developed a cardiac failure secondary to tachycardia and three did not have evidences of cardiopathy. RESULTS: In two patients, atrial flutter was not interrupted. In the other seven patients, radiofrequency ablation was successful. There were three relapses in the first month after the procedure, of these, two patients were successfully treated again. After a mean follow up of 4.5 months, these patients are asymptomatic and without antiarrhythmic drugs. Analysis of obtained signals, showed that radiofrequency that interrupted atrial flutter always occurred in zones of double potentials. CONCLUSIONS: Radiofrequency ablation is an effective treatment for atrial flutter and the zone of successful ablation is associated to the presence of double atrial potentials.

[Effect of the treatment of hyperthyroidism on the course of exophthalmos]. / Influencia del tratamiento del hipertiroidismo en el curso del exoftalmos.

The exophthalmos evolution in hyperthyroid patients was investigated: twenty patients were randomly assigned to treatment with radioiodine (group I followed 2-162 months) and 20 to treatment with thyroidectomy (group II followed 2-158 months). There was no correlation of sex age and follow up with exophthalmos evolution. In group I, exophthalmos improved in one patient (5%), did not change in ten (50%) and worsened in nine (45%). In group II it got better in six (30%), did not change in seven (35%) and got worse in seven (35%). The differences between the two groups were not statistically significant (p greater than 0.05). The postsurgical thyroid gamma-gram with one mCi of I-131 in group II showed absence of thyroid tissue in nine patients (45%) and remainders of the gland in 11 (55%) and apparently this did not influence the post treatment evolution. The length of pretreatment evolution did not influence the evolution post treatment. In summary, there was no correlation between exophthalmos evolution and kind of treatment in Graves' disease.

Oculomotor and oculovestibular functions in a hemispherectomy patient.

Oculomotor and oculovestibular functions in a patient who had undergone a left hemispherectomy were examined under a variety of visual and vestibular stimuli. The main findings were an inability to hold left eccentric gaze, resulting in gaze-evoked nystagmus to that side; inaccurate saccades to the right; defective smooth pursuit to the left; asymmetrical vestibulo-ocular responses (VOR) in the dark due to the interaction of the VOR with the "spasticity of conjugate gaze", decreased gain of the visuo-vestibulo-ocular reflexes to both sides, more marked to the right, when rotated fixating on a stationary wall target or the environment, due to abnormal smooth and optokinetic systems; and failure to inhibit the VOR when rotated to the left with visual fixation.

Acute autonomic neuropathy.

Case report of acute autonomic neuropathy. It is the twelfth case reported in literature and the second case associated to positive serological tests for infectious mononucleosis. We are reporting for the first time plasma renin activity, decrease response to repetitive pacing of the S-A node, insulin curve with radio-immunoassay and cardiac catheterization findings.