Unusual finding during laparoscopic cholecystectomy: liver choristoma in the gallbladder wall

Hepatic choristomas or ectopic livers are rare developmental anomalies and are usually located in the abdomen, retroperitoneum and thorax. A 34-year-old male patient underwent a scheduled laparoscopic cholecystectomy, the findings during surgery were a gallbladder with multiple lithiasis inside, with a smooth fragment of reddish-brown tissue attached to the anterolateral surface of the gallbladder. The patient evolved satisfactorily and was discharged 24 hours after surgery. Objective was to describe a clinical case of hepatic choristoma adhered to the anterolateral wall of the gallbladder, as well as its etiology, clinical picture and therapeutic conduct. Hepatic choristoma in the gallbladder is due to an anomaly in the embryologic development of the liver, due to its potential for malignant degeneration, it should be resected as soon as it is detected, being laparoscopic cholecystectomy an adequate approach.

Historias de violencia y desigualdad de género en mujeres del mercado municipal / Violence and gender inequality in women market vendors stories

Introducción: El problema de la violencia no sólo afecta a quien la padece, pues tiene efectos colaterales en los hijos y otros familiares, lo cual deteriora su salud física, mental y emocional. Objetivo: Analizar la situación de desigualdad y la violencia de género en las mujeres. Metodología: El estudio se realizó bajo un enfoque cualitativo de tipo fenomenológico, aplicando la técnica de la entrevista a profundidad con previo consentimiento informado para su grabación, transcripción, análisis e interpretación. Resultados: Se identificaron formas de violencia física, sexual, psicológica, económica y patrimonial debido a las relaciones asimétricas dentro del hogar, producto del machismo y un sistema patriarcal que afectan la calidad de vida y el desarrollo social de las mujeres. Limitaciones: Las mujeres participantes eran vendedoras del mercado municipal y contaban con poco tiempo disponible para las entrevistas, pues el cierre de sus puestos de trabajo podía generar pérdidas económicas. Valor del estudio: La violencia y desigualdad de género son problemáticas en los países latinoamericanos que se deben abordar desde toda perspectiva para su identificación y prevención oportuna. Conclusiones: La situación de violencia y desigualdad de género ha tenido un impacto negativo no sólo en la vida de las mujeres entrevistadas, sino también de su núcleo familiar, sin embargo, cada una de ellas busca mejorar sus condiciones de vida a pesar de estas adversidades.

Introduction: Gender violence does not only affect the women who suffer it, since it causes collateral effects to children and other family members that deteriorates their physical, mental and emotional health. Objective: To analyze gender inequality and gender-based violence against women. Methodology: We carried out qualitative research of phenomenological type, applying in-depth interviews with previously informed consent for its recording, transcription, analysis and interpretation. Results: Physical, sexual, psychological, economic and patrimonial violence were identified in asymmetrical relationships as a result of sexism and the patriarchal system, which affects women's quality of life and social development. Limitations: Female participants were vendors from a local market and had limited time for the interviews, since the closing of their stands could cause economic losses. Value of the study: Gender-based violence and gender inequality constitute a problem in Latin American countries that should be thoroughly studied for its identification and timely prevention. Conclusions: Gender-based violence and gender inequality produces a negative impact not only on the lives of the women interviewed, but also on their families, however, every one of them tries to improve their life conditions and overcome adversities.

Retrospective review of leptospirosis in Guadeloupe, French West Indies 1994-2001 / Revisión retrospectiva de la leptospirosis en Guadalupe, Indias Occidentales Francesas 1994­2001

Demographic, clinical, biological and personal data were obtained from patients hospitalized with symptoms of leptospirosis in the Hospital of Pointe a Pitre, Guadeloupe, French West Indies from 1994 to 2001. Of the 897 screened patients, 212 were acute cases, 607 were non-infected and 78 were undetermined cases. There was no predominant age group. Leptospirosis transmission followed the rainfall cycle and was greater in rural areas. Jaundice and conjunctival suffusion were significantly more frequent in cases than non-cases. Males, professions considered to be at risk and contact with swine or bovine were associated with infection. Serogroups Icterohaemorrhagiae, Cynopteri, Australis, Sejroe, Pomona and Ballum were serovars presumed responsible for acute cases

Se obtuvieron los datos demográficos, clínicos, biológicos y personales de pacientes hospitalizados con síntomas de leptospirosis en el Hospital de Pointe à Pitre, Guadalupe, Indias Orientales Francesas, en el período comprendido de 1994 a 2001. De los 897 pacientes investigados, 212 eran casos graves, 607 eran no infectados y 78 eran casos indeterminados. No hubo grupo etario predominante. La transmisión de la leptospirosis seguía el ciclo hidrológico y era mayor en las áreas rurales. La ictericia y sufusión conjuntival fueron significativamente más frecuentes en los casos que en los no casos. Los varones, las profesiones consideradas en riesgo, y el contacto con cerdos o bovinos estuvieron asociados con la infección. Los serogrupos Icterohemorragia, Cynopteri, Australis, Sejroe, Pomona y Ballum fueron serovares presumiblemente responsables de los casos graves

Malaria in Guadeloupe (French West Indies) 1991-2000

The only islands in the Caribbean that still have endemic malaria are Haiti and the Dominican Republic. Cases of imported malaria occur on the other islands, particularly Martinique and Guadeloupe, due to the movement of people to and from endemic regions that are geographically and/or culturally close. The re-emergence of transmission cannot be ruled out due to the local persistence of the potential vectors, the anopheles mosquitoes. This retrospective study, over a ten year-period (1991-2000), included all of the cases of malaria confirmed by blood tests at Pointe-à-Pitre University Hospital. This hospital is the main healthcare facility in Guadeloupe. Fifty-nine bouts of malaria occurred in 56 patients. The annual incidence was estimated at 2 to 2.5 cases per 100,000 inhabitants. Plasmodium falciparum largely predominated, accounting for over 80 of cases. The only pernicious case observed resulted in the death of the patient. In all cases the patient had recently travelled to an endemic region, except in one case, caused by P ovale which has never been endemic in the Caribbean. African countries accounted for 43 of cases. No Asian or Pacific strains were identified. In all cases, anti-malarial drugs were not taken, taken incorrectly or were inappropriate. All of the cases of malaria reported in Guadeloupe in the last decade were imported and this region cannot be considered to be at risk of malaria infection. However, long-term epidemiological monitoring is necessary, together with specific entomological monitoring

Evaluation of neonatal sepsis screening in a tropical area Part III: Neonatal sepsis in meconium stained deliveries

Of the 6,060 consecutive live births delivered at the University Maternity Unit of Guadeloupe (French West Indies) during a 30-month period, 635 newborns (10.4) presented with meconium stained (MS) amniotic fluid, of which 595 (94) received bacteriological screening at birth (light MS, n = 543; thick MS, n = 52). Thirty (5) of MS newborns had a bacteraemia (n = 13, group B streptococcus, GBS), and 128 (21.5) a bacterial positive gastric aspirate (n = 54, GBS). Sixty-six newborns among MS babies needed tracheal suctioning (11) in the delivery room for meconium inhalation. Among these 595 screened MS newborns, 286 (48) presented clinical signs of postmaturity at birth, having therefore an explanation for their MS condition. For the other MS newborns without the postmaturity explanation, we experienced twofold increased risk of neonatal sepsis (OR 1.88 for bacteraemia and 2.61 for external carriage p < 0.02, Chi square) as compared with their MS postmature counterparts. We conclude that when meconium stained deliveries are associated with postmaturity signs, one may not need to initiate prophylactic antibiotic treatment at birth unless they present with other traditional risk factors for neonatal sepsis such as intrapartum fever and prolonged rupture of membranes.

Evaluation of neonatal sepsis screening in a tropical area. Part II: Evaluation of intrapartum chemoprophylaxis protocol

The authors report on an analysis of a chemoprophylaxis protocol at the University Hospital of Guadeloupe in the Caribbean. This study comprised 6,060 consecutive deliveries and was initiated to assess the application of an intrapartum chemoprophylaxis protocol, evaluate its results, and try to identify possible necessary modifications to the existing protocol. Although more than 90 of women had at least one bacterial screening (vaginal or urinary) during the last trimester of pregnancy, approximately 75 of mothers who were heavily colonized group B streptococcus (GBS) at delivery were not detected by this systematic screening. As is also reported in other tropical areas where a great proportion of neonatal sepsis occurs in term babies, low birthweight was not a specific risk factor in this study when controlling for other major risk factors such as fever and premature rupture of membranes. Intrapartum chemoprophylaxis was associated with an approximate threefold decrease in the risk of GBS neonatal bacteraemia among at risk deliveries. The results suggest that, in our tropical context, prolonged rupture of membranes of at least 12 hours' duration should be considered as a cause for intrapartum chemoprophylaxis as it accounted for the majority of cases of neonatal bacteraemia that escaped the existing protocol.

Evaluation of neonatal sepsis screening in a tropical area. Part I: Major risk factors for bacterial carriage at birth in Guadeloupe

This prospective study reports on screening for neonatal sepsis among 3,372 live births out of 6,060 consecutive deliveries at the University Hospital of Pointe-Ó-Pitre, Guadeloupe, during a 30-month period. Group B Streptococcus (GBS) was the most common pathogen, representing 46 (89/194) of positive blood cultures and 52 (335/637) of positive gastric aspirates. Although only 3,372 (55) of all live births were screened, 637 (10) had gastric bacterial carriage at birth; of those, 335 (5.5) involved GBS. Similarly, there were 194 (3.2) positive blood cultures, of which 89 (1.5) involved GBS. In this report, all newborns who presented with a positive GBS blood culture had at least one of the external tests positive for GBS (gastric, ear canal, rectum and placenta). Thirty-seven per cent (14/38) of positive neonatal blood cultures occurred in newborns with foetid liquor while in deliveries with intrapartum fever 16.5 (32/195) of blood cultures were positive. In our clinical practice, characteristics that were evident in the delivery room (without knowledge of prenatal follow-up) such as foetid liquor, intrapartum fever, prolonged rupture of membranes, foetal tachycardia and meconium staining were associated with the great majority of neonatal sepsis.

Evaluación de ensayos in vivo e in vitro de materiales para implantes ortopédicos: estudio preliminar

Se analizó comparativamente el comportamiento in vivo e in vitro de un vidrio bioactivo de composición similar a productos utilizados como relleno óseo, y geles de sílice con características superficiales comparables a las de los vidrios bioactivos a poco tiempo de ser implantados. La evaluación in vitro se realizó por análisis de las superficies de las muestras luego de sumergidas en soluciones inorgánicas acelulares a pH 7,3 y 37ºC. Dicho análisis reveló la precipitación de carbonatoapatita sobre la superficie de los geles a mayores tiempos de exposición que en los vidrios bioactivos. El estudio in vivo se realizó mediante la técnica de implantación subcutánea ; también se ensayaron hidroxiapatita comercial y hueso bovino desmineralizado. El análisis histológico determinó la ausencia de osteoinducción y la presencia de reacciones inflamatorias no-inmunogénicas de diferente magnitud ante la partículas de hidroxiapatita, vidrio y geles. La respuesta inmunológica provocada por el hueso desmineralizado interferiría con la formación esperable de tejido óseo. Se observaron granulomas inflamatorios provocados por los geles, que pueden estar relacionados con la disolución y liberación de especies potencialmente citotóxicas. Se propone al tiempo de formación de la capa de carbonatoapatita como un parámetro crítico para la biocompatibilidad de materiales con componentes solubles de cierta toxicidad

Temas de ecocardiografía: III. Evaluación ecocardiográfica previa a la cirugía de los enfermos con conexión atrioventricular univentricular / Echocardiography: III. Early echocardiographic evaluation in surgery of patients with univentricular atrioventricular connection

Los pacientes con conexión atrioventricular univentricular pueden beneficiarse hoy día de diversos procedimientos quirúrgicos paliativos. La indicación quirúrgica óptima debe estar basada en un diagnóstico anatómico y funcional exactos. Para valorar hasta qué punto la ecocardiografía, puede contribuir al diagnóstico revisamos 45 pacientes operados con conexión atrioventricular tipo univentricular. Las técnicas quirúrgicas empleadas fueron las siguientes: banding de la arteria pulmonar en 10 pacientes, de los cuales en 8 se asoció la técnica de Blalock-Hanlon; fístula sistémico-pulmonar en 34 casos, de los que en 6 se realizó también atrioseptectomía de Blalock-Hanlong; anastomosis atriopulmonar modificada (técnica de Kreutzer) en 4 enfermos. La ecocardiografía, fue satisfactoria para el diagnóstico de la malformación y el estado del septo interatrial, el foramen interventrículo-cameral y las válvulas atrioventriculares y semilunares. También fue útil para conocer las características funcionales de las cámaras ventriculares. Sin embargo, la información que facilitó la ecocardiografía, en lo referente al arco aórtico y a las ramas de la arteria pulmonar, fue inexacta y no fiable. En conclusión: 1) El tratamiento quirúrgicos de los pacientes con conexión atrioventricular univentricular está justificado, pues con él se consigue mejorar la calidad de vida del enfermo y de su entorno y, a largo plazo, reducir los costos de la asistencia médica. 2) La ecocardiografía, proporciona una parte muy sustancial de la información que necesitamos para realizar un diagnóstico preoperatorio correcto

Eficiencia de las instituciones de salud publica. / Efficiency of public health institutions

La economia de la salud publica permite mediante procedimientos mejorar la eficiencia de las principales instituciones de salud. Se explican las formas de determinar los principales indicadores que miden la utilizacion de las camas, el gasto economico correspondiente y se propone un indicador de sintesis que permiten evaluar en su conjunto, la eficiencia hospitalaria Se plantean los indicadores fundamentales para evaluar la eficiencia de los policlinicos