Browsing by Author "Quichimbo Sangurima, Fausto Marcelo"

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Caso clínico 1: cirugía de control de daños + gastrectomía en manga por cuadro de vólvulo secundario a hernia diafragmática: reporte de caso clínico; y, Caso clínico 2: tumor de Buschke Lowenstein en paciente embarazada, reporte de caso clínico
(Universidad de Cuenca, 2023-06-12) López Espinoza, Camilo Enrique; Quichimbo Sangurima, Fausto Marcelo
Diaphragmatic hernias occur when abdominal viscera displace into the thoracic cavity. In adults, most hernias are acquired and are treated with elective surgery. However, in cases of gastric volvulus, they become an emergency where aggressive management and resolution of the defect is necessary to avoid organ necrosis. These cases are rare and difficult to diagnose, but are usually performed by radiology and treatment varies according to the extent of gastric necrosis and the skill of the medical team. We describe a 41-year-old woman with no past history who is admitted to the hospital for severe abdominal pain and nausea. Clinical findings include a distended and painful abdomen, with no signs of peritoneal reaction. After progressive hemodynamic deterioration, she is admitted to the operating room, where a grade III diaphragmatic hernia with organoaxialgastric volvulus with extensive necrosis is evidenced. The patient underwent damage control surgery and after initial resuscitation in the intensive care unit, a gastric sleeve and abdominal cavity closure were performed due to 60% gastric necrosis. This case highlights the importance of considering diaphragmatic hernia as a possible diagnosis in patients with severe abdominal pain and the need for an adequate therapeutic approach to prevent serious complications. It also shows the importance of an integral management of the patient for a successful recovery, working hand in hand with the intensive care unit, anesthesiology, physical therapy, nutrition. Abstract case 2 Buschke-Lowenstein tumor (BLT) is a rare, fast-growing, locally invasive type of tumorigenesis in the anogenital region caused by papillomavirus. Immunosuppression, chronic inflammation, poor hygiene and HIV infection have been identified as risk factors for this disease. We present the case of a 38-year-old female patient in her second trimester of pregnancy, who is admitted for the presence of giant condylomatous lesions in the perianal region, which appeared suddenly and presented an accelerated growth, causing multiple discomforts. The patient underwent a surgical resection showing great infiltration to neighboring tissues including the vaginal vertex. Histopathological examination confirms the diagnosis of BLT. The evolution is favorable. The importance of early detection of giant condylomatous lesions in the perianal region and timely treatment to prevent complications in the patient's health and possible complications is emphasized, as well as the rarity of this pathology due to the lack of case reports, as well as insisting on the importance of the fight against sexually transmitted diseases and the increased use of vaccination against HPV in the future.
Caso clínico 1: hernia diafragmática postraumática, Caso clínico 2: hernioplastia insicional lumbar
(Universidad de Cuenca, 2023-06-15) Castro Palaguachi, Verónica Graciela; Quichimbo Sangurima, Fausto Marcelo
Introduction: Diaphragmatic hernias are defined as the passage of abdominal organs into the thoracic cavity through a defect in the diaphragm, sometimes resulting from severe trauma, constituting a surgical challenge. Thoracoabdominal incisions are commonly used for various thoracic and vascular cases, although they are rarely used for diaphragmatic hernias, which are usually repaired by laparotomy, thoracotomy or minimally invasive approaches. Case report: We present the clinical case of a 25-year-old patient with a history of penetrating stab wound trauma 4 years ago, who came to the emergency room with diffuse abdominal pain diagnosed on admission as acute partial subocclusive abdomen treated surgically by exploratory laparotomy with surgical findings of non-diseased appendix and ileus, with torpid evolution 5 days later he presented respiratory difficulty, chest x-ray was performed showing left pleural effusion, treated with pleural drainage obtaining fecaloid liquid of approximately 1500ml volume, so it was decided to perform an urgent thoracotomy finding perforated diaphragmatic hernia + pleural empyema + necrosis of the splenic angle of the colon, diaphragmatic herniorraphy + pleural cavity lavage + decortication + pleural drainage + laparotomy + resection of the splenic angle of the colon + end-to-end anastomosis + peritoneal peritoneal cavity lavage + peritoneal cavity lavage + pleural drainage + peritoneal anastomosis + peritoneal anastomosis terminal anastomosis + peritoneal cavity lavage + Jackson Pratt drain placement Results: Patient remained hospitalized for 43 days, presented as a complication pachyepleuritis left empyema reintervened by left lateral thoracotomy, evolving favorably after receiving treatment with intravenous is discharged home in good condition. Introduction: Lumbar hernia is the rarest of all abdominal wall hernias and represents only 0.2% of all hernias. About 20% are congenital, mainly secondary to embryonic development defects, while 80% are acquired.1,2 The most recent literature recommends the laparotomy approach with the use of prosthetic materials as the most appropriate, so the procedure is fast, easy, and safe.2,3 Clinical case: A 46-year-old patient with a history of left radical nephrectomy by lumbotomy approach in 2021, who presents moderate intensity pain and sensation of mass protrusion in the left lumbar region. The physical examination showed a wall defect of approximately 10 cm diameter throughout abdominal content protruded at repose and before Valsalva maneuvers, but it was also reducible by external compression. Simple and contrast-enhanced computerized axial tomography (CAT) of the abdomen and pelvis reported a hernial defect at the left lumbar level with omental content of approximately 8x7cm without compromise of vascularization. A lumbar insicional hernioplasty was performed with a double mesh technique, “sandwich” type, one of them placed intraperitoneal and the second retromuscular. Conclusion: Surgical repair by open approach of hernial defects at the lateral level, using double mesh (intraperitoneal and inframuscular) “sandwich” type, is a safe technique and with satisfactory results in those patients with a defect greater than 5 cm with a bad quality aponeurosis.
Caso clínico 1: tumor de timo. Caso clínico 2: persistencia de conducto onfalomesentérico en adultos
(Universidad de Cuenca, 2023-05-08) Bautista Vásquez, Ángel Fernando; Quichimbo Sangurima, Fausto Marcelo
Clinical case thymus tumor Introduction: Thymomas are epithelial neoplasms of the thymus gland, it is located behind the sternum and plays an important role in the immune system before birth. Thymus tumors are rare and represent 2% of mediastinal tumors. The gold standard in treatment is the surgical act; Therefore, the objective is to describe the clinical case as a contribution to the scientific community. Case report: A 67-year-old female patient, with a history of type 2 diabetes mellitus and obesity, productive cough of three months of evolution, went to the clinician for control, who requested a CT scan and revealed a mass located in the anterior mediastinum. a biopsy is then performed, confirming the diagnosis of thymoma. Conclusions: Thymus tumors (thymoma) are rare pathologies, most of them are diagnosed as findings, they are generally asymptomatic, difficult to identify, so high diagnostic suspicion is needed. Its treatment is surgical after obtaining a biopsy for planning surgery. Clinical case persistent omphalomesenteric duct in adults. Introduction: When naming umbilical diseases, reference is made to multiple pathologies that can affect the umbilical cord, they can be acquired or congenital. The most representative are the persistence of the urachus and the omphalomesenteric duct, which are common in children but rare in adults. Case report: A 68-year-old male patient, from a rural area, a farmer, with a history of hypertension, osteoarthritis with treatment, conventional prostatectomy more than 20 years ago, and umbilical discharge since childhood. He went to the emergency room after a physician's evaluation, due to the presence of “purulent” discharge at the umbilical level, pain, and erythema. He was admitted to internal medicine with a diagnosis of cellulitis versus abscess. The surgery service was consulted, which decided on surgical resolution with the following finding: entero-umbilical fistula 70 cm from the ileocecal valve due to persistent omphalomesenteric duct. On the eighth day of hospitalization, he was discharged, with a favorable evolution, outpatient treatment and outpatient control. Conclusions: The persistence of the omphalomesenteric duct in adults is a rare entity. In general, patients suffering from this condition are asymptomatic or report small amounts of umbilical secretion that goes unnoticed. Its diagnosis is incidental, usually during imaging tests. and it is more infrequent is that it presents complications in advanced ages. The definitive treatment when diagnosed is surgical.
Complicaciones y factores asociados a apendicectomía abierta y laparoscópica. Hospitales Vicente Corral Moscoso - José Carrasco Arteaga, 2018
(Universidad de Cuenca, 2020-02-20) Castro García, Walter Eduardo; Quichimbo Sangurima, Fausto Marcelo
Background: Appendicitis is one of the most common surgical problems. One in 2,000 people has an appendectomy at some point in their life. Objective: to determine the prevalence and factors associated with postappendectomy laparoscopic and conventional complications in patients treated at the José Carrasco Arteaga and Vicente Corral Moscoso hospitals, during the year 2018. Methodology: this is a cross-sectional analytical study. The sample consisted of 440 patients who met the inclusion criteria. The information was collected using a form prepared by the author. The associated factors were analyzed with the Odds Ratio statisticians with their 95% CI, plus the binary logistic regression. The hypothesis was accepted with a p value <0.05 of Pearson's Chi2. Results: the prevalence of complications was 6.4%. The factors associated with statistical significance were: age 34 years (OR 2, 8; 95% CI 1.30 - 6.42; p 0.007), overweight / obesity (OR 3.9; 1.0 - 16.4; p 0.04), surgical time greater than 60 min (OR 7.3; 95% CI 3.05 - 17.80; p 0.000) and the least surgical experience (OR 8.2; 95% CI 2.8 - 24.3; p 0.000). Male sex was an associated factor, but not with statistical significance (OR 1.9; 95% CI 0.4 - 8.89; p value 0.37). Conclusions: the prevalence of post-appendectomy complications was lower than that reported in the literature and the associated factors were age> 34 years, male sex, overweight / obesity, surgical time greater than 60 min., And the curve of less learning
Localización de la punta del cateter venenoso central mediante control electrocardiográfico, Hospital Vicente Corral Moscoso, Cuenca 2010
(2011) Quichimbo Sangurima, Fausto Marcelo; Figueroa Morales, Francisco Efraín; Merchán Bueno, Miguel Oswaldo
Use of central venous catheter (CVC) has become general, there are several techniques applied for its positioning and depends, to a great extent, of the preference and experience of places who it. Once installed a central line, correct location of the tip of catheter is importance very much. In this point the guide with electrocardiographic control assures a suitable location and greater effectiveness in relation to the methods classically used. Objective: To validate cardioscopía as method for the suitable location of the tip of CVC in the of subclavian vein catheterization in front of the chest radiograph control applied in patients of the Hospital Vicente Corral Moscoso. Methods: A study of validation of diagnostic test for the location of the tip of CVC by subclavian via was realized, 142 were included patients. Results: Central venous catheterization by subclavian vein via was realized to the study population, of them was reached a positive result in the electrocardiographic guide in 90 patients (63.4%). The location of the tip of CVC was verified according to the standard method used in our means, the thorax x-ray and it was observed that the 77.78% of the electrocardiogram-guided central venous catheterization were correctly placed, whit a RP of 3.67 (IC 95% = 2.15 -6.28 p = 0.000), demonstrating the validity of the method in study. Also one determined that the distance skin/tip of the catheter average for the population in study is of 11.5 ±1.27cm Conclusions: Use of Electrocardiogram-guided central venous catheterization technique is most reliable that method done blindly, to ensure an adequate placement of tip of CVC. Key Words: Venous central catheterization, electrocardiographic monitoring.
Prevalencia de hernias incisionales y factores de riesgo asociados, hospitales José Carrasco Arteaga y Vicente Corral Moscoso, período 2018 – 2020
(Universidad de Cuenca, 2021-05-31) Jordán Fiallos, Diana Lorena; Quichimbo Sangurima, Fausto Marcelo
Background: Incisional Hernia is a complication associated with high morbidity in patients undergoing abdominal surgery and is due to various factors. Objective: determine the prevalence of Incisional Hernias and associated risk factors in José Carrasco Arteaga and Vicente Corral Moscoso hospitals. Method and Materials: retrospective-prospective cross-sectional study, with associated factor analysis. The study population consisted of 224 patients from the elective and emergency surgery service of the Vicente Corral Moscoso and José Carrasco Arteaga hospitals. For the collection of information a validated survey was applied, the collected data was entered into SPSS Software v.22. The results are presented through tables and graphs, with analysis of frequencies, percentages, means and standard deviation. The analysis of the relationship of the problem with the associated factors was measured with the OR, Confidence Intervals and the p-value, considering statistically significant differences a p < 0.05. Results: the prevalence of incisional hernia in the José Carrasco Arteaga and Vicente Corral Moscoso hospitals was 39.2%; of which 30.7% corresponds to the José Carrasco Arteaga hospital and 8.4% to Vicente Corral Moscoso. The age group with the highest prevalence was that of adults, living in urban areas. The risk factor was surgical site infection. Conclusion: Incisional hernia is a frequent complication in abdominal surgeries, where surgical site infection is identified as a risk factor for IH
Valores referenciales de conducción nerviosa obtenidos en el laboratorio de electrofisiología de la Facultad de Ciencias Médicas de la Universidad de Cuenca. Noviembre 2002-Marzo 2003
(2003) Quichimbo Sangurima, Fausto Marcelo; Sánchez, Juan Carlos; Sigüenza, Pablo; Vizhñay, Pablo; Díaz Heredia, Favian Eduardo
a table of reference values of the driving speed of the motor nerves is constructed: median, ulnar, peroneal, tibial, and sensory nerves. For this we selected 80 individuals who did not have neuropathy or triggers them, being grouped into age ranges of 20-29 years, and 30-39 years, by sex, in whom we conduct studies of speed, motor and sensory nerve conduction with the following results: For studies of motor nerve conduction velocity, average values are in the median nerve 58.2 m / s, 63.7 ms ulnar, peroneal 54.9 m / s for the tibial 51.2 m / s. For sensory nerve conduction velocity. In midrib 51.8 m / s, in the ulnar 62.4 m / s, and the peroneal 52.6 m / s. Through comparison with studies in another country it was determined that in our population the motor nerve conduction velocity is faster and sensory nerve conduction velocity is lower