Quiste congénito del conducto nasolacrimal/dacrio-cistocele: causa de dacriocistitis no diagnosticada / Congenital cyst of nasolacrimal duct/dacriocistocele: cause of non-diagnosed dacriocistitis

RESUMEN Se presenta dos casos de pacientes menores de 5 meses los cuales durante las primeras semanas de vida presentan descarga ocular muco-purulenta de manera recurrente. Posteriormente en la endoscopia se encuentra en los dos casos masas quísticas intranasales dando un diagnóstico de dacriocistocele más quiste congénito del conducto nasolagrimal. El dacriocistocele es una causa muy rara de obstrucción del conducto nasal y más raro cuando viene acompañado de un quiste congénito del conducto nasolagrimal. Debido a su rareza y a su sintomatología muchas veces atípica resulta en un diagnóstico complicado para el otorrinolaringólogo y para el oftalmólogo.

ABSTRACT Two cases of patients younger than 5 months are presented, who during the first weeks of life have recurrent muco-purulent ocular dis-charge. Subsequently, in endoscopy, in both cases, intranasal cystic masses were found, resulting in a diagnosis of dacryocystocele plus congenital cyst of the lacrimal duct. Dacryocystocele is an uncommon cause of nasal duct obstruction, but it becomes less common when accompanied by a congenital tear duct cyst. Due to its uncommonness and its often-atypical symptoms, it results in a complicated diagnosis for the ENT and the ophthalmologist.

A Facial Plastic and Reconstructive Surgery Training Module Using Surgical Simulation for Capacity Building.

OBJECTIVE: To introduce 3 novel intensive facial plastic and reconstructive surgery teaching modules for surgical capacity building using simulation in a low-middle income country. DESIGN: Prospective cohort study. SETTING: University-based medical center in Quito, Ecuador. PARTICIPANTS: First- and second-year otolaryngology residents in Quito, Ecuador. RESULTS: Residents participated in an intensive 3-day teaching program focused on microtia, nasoseptal abnormalities, and facial paralysis that included didactic lectures, simulation workshops, and live surgery. Residents underwent rigorous pre- and postmodule testing including written, oral, and practical examinations in each subject area. All participants completed anonymous feedback surveys with ratings on a Likert scale from 0 (very poor) to 10 (excellent). Nineteen residents completed both pre- and postmodule testing. The training module was successfully implemented and testing performance across all 3 subject areas significantly improved. Resident feedback was exceedingly positive, with average scores for each component ranging from 8.9 to 9.8, with highest scores given to the simulation workshops. The postmodule survey indicated that all residents found the course helpful and they desired additional courses covering more subject areas. CONCLUSIONS: Implementation of an intensive surgical training module combining didactics, surgical simulation, and live surgery resulted in the successful transfer of both skills and knowledge. While the long-term benefit of this program is yet to be determined, this model of training may prove to be a useful tool to help address surgical capacity building in the developing world.

Evaluation of subjectivity in the interpretation of videonystagmography.

CONCLUSION: Subjectivity seems to play a definite role in the interpretation of the pendular test, but somewhat less for caloric testing, where pure visual analysis seems to be more reliable. Automated values provided by proof-tested software may be useful. OBJECTIVES: In some centers, the interpretation of videonystagmography is still based on direct visual analysis of recorded tracings. Our study addresses the importance of subjectivity in the interpretation of videonystagmographic readings. PATIENTS AND METHODS: Two experts (one junior and the other senior) were asked to interpret the same caloric and pendular tests on two different occasions, 3 months apart. Initial reading was performed without knowledge of the patient's history or the results of other neuro-otological tests. Three months later, interpretations were done with complete access to the patient's charts. The experts' answers were compared to the values provided by the computer software. RESULTS: For the pendular test, inter-expert agreement was poor. With knowledge of the patient's history, the expert's interpretations tended to coincide with the software's calculations. For the caloric test, interpretation was less variable.

Anatomic and functional long-term results of canal wall-down mastoidectomy.

The objective of this study was to evaluate, over the long-term, the anatomic and functional outcome of canal wall-down mastoidectomy performed for chronic otitis media with cholesteatoma and chronic otomastoiditis resistant to all conservative treatment. The study was made through a retrospective review of 338 cases of consecutive primary canal wall-down mastoidectomies performed between 1974 and 1998. Included were 259 cases with sufficient data. In all cases, functional reconstruction was performed at the same time as the mastoidectomy. Demographic and clinical data were collected from each file. From the clinical data, the surgical techniques, complications, the number of follow-up visits necessary to ensure cavity cleanliness, details of care provided over the period 1 to 24 years (mean, 7 years) after the operation, and audiometric data from admission and from the latest postoperative follow-up were retained. Canal wall-down mastoidectomies were followed up an average of 10 times during the first 6 months after operation, twice a year over the 6-year period following surgery, and less than twice a year beyond the 6-year period. Care was dispensed for meatal stenosis, scars, infections, polyps, and beads of cholesteatoma. Surgical revisions were performed because of residual or recurrent cholesteatoma in 6.1% of the cases, because of perforation of the tympanic membrane in 7.3% of the cases, and to improve hearing in 12.2% of the cases. At the last consultation, 1 to 24 years after surgery, cavities were found to be dry and self-cleaning in 95% of the cases, and still humid, with otorrhea, in 5% of the cases. Over the long-term, the hearing threshold remained unchanged in 41.3% of the cases. It was improved after surgery by 10 to 19 dB in 15.4% of the cases, by 20 to 29 dB in 11.5% of the cases, and by more than 29 dB in 3.8% of the cases. The hearing threshold was thus improved or at least remained unchanged in 72.0% of cases. Hearing losses occurred in 28% of the cases: by 10 to 19 dB in 11.9%, by 20 to 29 dB in 6.5%, and by more than 29 dB in 9.2% of the cases. A sensorineural hearing loss of more than 60 dB at all frequencies occurred immediately after the operation in 2 cases (0.7%). There was 1 case of facial paralysis (0.3%). Four patients (1.5%) complained of persistent vertigo. Canal wall-down mastoidectomy is an adequate treatment for chronic otitis with cholesteatoma or chronic otomastoiditis. The anatomic and functional results are satisfactory, and the rate of complications is acceptably low. A tympanoplasty can be performed simultaneously. Thus, for the large majority of patients, only a single intervention is required; however, a small minority can benefit from a revision tympanoplasty. In order to obtain these results, both the patient and the surgeon should engage in a long-term follow-up.

Estudio clínico comparativo de los efectos indeseables de los anticonceptivos orales / Comparative clinical study of the undesirable effects of the oral contraceptives

Se estudiaron 31 pacientes seleccionadas de entre 45 mujeres usuarias de anticonceptivos orales de las comunidades de San Simón y San Juan (provincia de Bolívar), que fueron divididas en dos grupos homogéneos y comparables, según si usaron un preparado monofásico (16 pacientes) o trifásicos (15 pacientes), se registro la frecuencia de efectos indeseables en cada uno de los grupos. En el grupo monofásico se presentaron efectos indeseables en cada uno de los grupos. En el grupo monofásico se presentaron efectos indeseables en el 87.5xciento, en el trifásico 40xciento, diferencia estadísticamente significativa (alfa=0.05). El incremento de peso se registro, para el grupo monofásico, en 4 pacientes (25xciento) con una media de 14.75xciento, y en el trifásico 3 (20xciento) con una media de 8.66xciento, el incremento de presión arterial media se registro para el grupo monofásico en 5 pacientes (31,25xciento) con un promedio de 13.5mm de Hg. Solo hubo diferencia significativa de efectos indeseables monofásico vs. trifásico en la presencia de cloasma y várices. Se concluye que el preparado monofásico presenta mayor índice de efectos indeseables que el trifásico, esa diferencia es muy acentuada al comparar la presencia de cloasma y várices, por tanto consideramos que la indicación de uno u otro preparado debe ser hecha tomando en cuenta, sobre todo, estos aspectos.

Estudio clínico comparativo de efectos indeseables de los anticonceptivos orales / Comparative clinical study of undesirable effects of the oral contraceptives

Se analizó a 31 pacientes, seleccionadas de entre 45 mujeres usuarias de anticonceptivos orales de las comunidades de San Simón y San Juan (provincia de Bolívar), divididas en 2 grupos homogéneos y comparables, según si usaron un preparado monofásico (16 pacientes) o trifásico (15 pacientes), se registro la frecuencia de efectos indeseables en cada uno de los grupos. Resultados: en el grupo monofásico se presentaron efectos indeseables en el 87.5xcto, en el trifásico 40xcto, fue significativo. (alfa=0.05). Incremento de peso se registró, para el grupo monofásico en 4 pacientes (25xcto) y en el trifásico 3 (20xcto), Incremento de presión arterial media, se registró para el grupo monofásico en 5 pacientes (31,25xcto) y en el trifásico de 13,5mm de Hg. Solo hubo diferencia significativa de efectos indeseables monofásico presenta la presencia de cloasma y várices, por tanto consideramos que la indicación de uno u otro preparado debe ser hecha tomando en cuenta, sobre todo, estos aspectos.

Detección oportuna del cáncer cervical en la amazonía / Opportune detection of the cervical cancer in amazonía

Se realizaron por primera vez a orillas del Río Napo, específicamente en las poblaciones de Tiputini y Nuevo Rocafuerte, se toma una muestra de 30 Pap-test, con la intención de realizar un diagnóstico de Salud. Las ciudades mencionadas se encuentran a 360 km, aproximadamente de la ciudad de Orellana. Determinamos que el 100xcto de las mujeres nativas icluídas en el estudio jamás habían sido sometidas a un exámen similar en tanto que el 100xcto de las colonas. El 100xcto de las mujeres tenían sintomatología, presentando el 26.6xcto sangrado. El 96.6xcto presentaron un informe citológico inflamatorio, y tan solo un 3.4xcto un informe de Displasia leve.

Detección oportuna del cáncer cervical en la amazonía / opportune Detection of the cervical cancer in amazonia

Se realizaron por primera vez a orillas del Río Napo, específicamente en las poblaciones de Tiputini y Nuevo Rocafuerte, se toma una muestra de 30 Pap-test, con la intención de realizar un diagnóstico de salud. Las ciudades mencionadas se encuentran a 360 km, aproximadamente de la ciudad de Orellana. Determinamos que el 100 por ciento de las mujeres nativas incluídas en el estudio jamás habían sido sometidas a un exámen similar en tanto que el 100 por ciento de las colonas sí. La edad de las mujeres iba en un rango de 15 a 70 años, con una desviación estandar de 11.73 entre nativas y colonas. El 100 por ciento de las mujeres tenían sintomatología, presentando el 26.6 por ciento sangrado...

Estudio clínico comparativo de efectos indeseables de los anticonceptivos orales / comaprative clinical Study of undesirable effects of the oral cantraceptives

Se analizó a 31 pacientes, seleccionadas de entre 45 mujeres usuarias de anticonceptivos orales de las comunidades de san Simón y San Juan (provincia de Bolívar), divididas en 2 grupos homogénicos y comparables, según si usaron un preparado monofásico (16 pacientes) o trifásico (15 pacientes), se registró la frecuencia de efectos indeseables en cada uno de los grupos. Resultados: En el grupo monofásico se presentaron efectos indeseables en el 87.5 por ciento, en el trifásico 40 por ciento fue significativo (alfa=0.05)Incremento de peso se registró, para el grupo monofásico en 4 pacientes (25 por ciento) y en el trifásico 3 (20 por ciento),Incremento de presión arterial media, se registró para el grupo monofásico...