Longstanding Presence of a Vaginal Foreign Body (Battery): Severe Stenosis in a 13-Year-Old Girl

El presente proyecto tiene como objetivo fundamental, establecer un modelo de negocio rentable que posibilite ofrecer a las medianas empresas servicio de auditorías operacionales, control interno, administración de riesgos y servicios forenses. El desarrollo de estos servicios posibilitará que las empresas puedan mitigar los riesgos de negocio, el fraude interno o externo, los cuales se traducen en pérdidas financieras dentro de las empresas, así como en la reducción de su rentabilidad futura, arriesgando su sostenibilidad en el mercado. Sin embargo, ante los diversos escenarios que ha atravesado el país, surge la necesidad, por parte del sector empresarial, de invertir en la mejora de sus capacidades y procesos para obtener ventajas competitivas y aumentar su cuota en el mercado, dado que la incertidumbre y la falta de información son obstáculos claves para la toma de decisiones en los distintos niveles de una organización. En esta línea, las empresas deben adaptar nuevos estándares de cumplimiento legal dentro de la lucha contra la corrupción plasmada en el Decreto Legislativo N° 1385, la cual motiva a que las empresas adopten medidas de control interno y riesgos y posibiliten el desarrollo de lineamientos y objetivos empresariales enfocados al control del fraude y la corrupción. Ciertamente, se puede inferir que las pequeñas y medianas empresas desatienden el desarrollo del control interno debido a su dimensión, dado que tienen dificultades para crecer a causa de su cultura desordenada de desarrollo, como cuando van creando áreas de acuerdo con la necesidad del momento, el cual puede generar mayores costos y una difícil detección de los procesos, lo que no permitiría un adecuado control y correcta gestión de riesgos. Frente a lo planteado, nuestra propuesta de negocio está orientada la atención de medianas empresas, con el fin de fortalecer las capacidades de estas empresas en los distintos sectores económicos del país y que, a la vez, les posibilite hacer frente a los nuevos riesgos, dentro y fuera, de sus organizaciones. Y si bien surgen en el mercado diversas consultoras que buscan cubrir estos servicios, la mayoría son extranjeras reconocidas, por lo que nuestra firma ingresa al mercado de la consultoría como una proveedora de los más apremiantes servicios, con bajos costos y al alcance de las empresas, con la finalidad de contribuir al desarrollo, crecimiento y generación de valor de dichas organizaciones. Por ello, los servicios propuestos en el Plan de negocio están definidos por paquetes alineados a una estrategia por diferenciación, por lo que ofrecemos servicios con características únicas y con posibilidades de obtener mayores precios en el mercado. En la primera etapa del Proyecto, los años uno y dos del periodo de análisis, la prioridad es consolidar el negocio a través de la formación del equipo de consultores y auditores altamente calificados, la implementación de procesos internos, uso y aplicación de tecnologías, sistemas de control y de dirección. Para ello, es indispensable el desarrollo de alianzas estratégicas con instituciones del ejercicio de la profesión contable, así como con las principales empresas y certificadoras de calidad asociadas para fortalecer los servicios. Con respecto a la expansión, a partir del tercer año del análisis. En esta etapa se consolidará las actividades de la etapa uno y para ello se requerirá incrementar la capacidad instalada, para lo cual se considerará el espacio físico requerido, así como a los consultores especializados y el equipamiento respectivo. Se busca, por tanto, crecer significativamente en facturación y acumulación de clientes. También, en esta etapa, se debe expandir el negocio a las regiones del interior del país, se consolidarán alianzas con asociaciones de empresas y se buscará integrar una red de socios externos de confianza y de organizaciones que impulsen la consultoría. El proyecto presenta niveles aceptables de rentabilidad sustentado en el mercado objetivo, al cual se orienta de acuerdo con el estudio de mercado y al tamaño de la demanda potencial. Por tanto, es un negocio viable porque existen las condiciones necesarias para implementar los servicios y porque se proyecta a un entorno favorable en el segmento empresarial peruano, que es impulsado desde el Gobierno central y respaldado por las proyecciones favorables de crecimiento en la actividad económica. Se puede concluir, que el mercado empresarial peruano es reacio a invertir en contratos de consultoría, por lo cual la tarea principal para la captación de clientes será difundir la importancia de los beneficios que genera la adquisición de los servicios propuestos en el presente Plan de negocio. Finalmente, la firma consultora busca, en el mediano plazo, ser reconocida en los sectores económicos objetivo y en las asociaciones como una consultora experta en potenciar a medianas empresas.The main objective of this project is to establish a profitable business model that makes it possible to offer forensic audit and internal control and risk audit services to medium-sized companies. The development of these services will enable companies to mitigate business risks, internal or external fraud, which translate into financial results of companies, as well as reducing their future profitability, risking their sustainability in the market. However, faced with the different scenarios that the country has gone through, there is a need, on the part of the business sector, to invest in the improvement of its capacities and processes in order to obtain competitive advantages and increase its share in the market, given that the uncertainty and The lack of information are key obstacles to decision making at different levels of an organization. In this line, companies must adapt new standards of legal compliance within the fight against corruption embodied in Legislative Decree No. 1385, which motivates companies to adopt internal control measures and risks and enable the development of guidelines and business objectives focused on the control of fraud and corruption. Certainly, it can be inferred that small and medium enterprises disregard the development of internal control due to their size, given that they have difficulties to grow because of their disorderly culture of development, as when they are creating areas according to the need of the moment, which can generate higher costs and a difficult detection of the processes, which would not allow an adequate control and correct risk management. In light of the above, our business proposal is focused on the attention of medium-sized companies, in order to strengthen the capabilities of these companies in the different economic sectors of the country and, at the same time, make it possible to face the new risks, inside and outside, of their organizations. And while there are several consultants in the market that seek to cover these services, most are foreign recognized, so our firm enters the consulting market as a provider of the most pressing services, with low costs and within the reach of companies, with the purpose of contributing to the development, growth and generation of value of said organizations. Therefore, the services proposed in the Business Plan are defined by packages aligned to a differentiation strategy, which is why we offer services with unique characteristics and with the possibility of obtaining higher prices in the market. In the first stage of the Project, years one and two of the analysis period, the priority is to consolidate the business through the formation of a team of highly qualified consultants and auditors, the implementation of internal processes, use and application of technologies, systems of control and direction. For this, it is essential to develop strategic alliances with institutions in the accounting profession, as well as with the main companies and associated quality certifiers to strengthen the services. With respect to the expansion, from the third year of the analysis. In this stage, the activities of stage one will be consolidated and for that, it will be necessary to increase the installed capacity, for which the physical space required will be considered, as well as the specialized consultants and the respective equipment. Therefore, it seeks to grow significantly in billing and customer accumulation. Also, at this stage, the business should be expanded to the interior regions of the country, alliances with business associations should be consolidated, and a network of trusted external partners and organizations that promote the consultancy should be integrated. The project presents acceptable levels of profitability sustained in the target market, which is oriented according to the market study and the size of the potential demand. Therefore, it is a viable business because the necessary conditions exist to implement the services and because it is projected to a favorable environment in the Peruvian business segment, which is driven by the central government and supported by favorable projections of growth in economic activity. It can be concluded that the Peruvian business market is reluctant to invest in consulting contracts, so the main task for attracting customers will be to disseminate the importance of the benefits generated by the acquisition of the services proposed in this Business Plan. Finally, the consulting firm seeks, in the medium term, to be recognized in the target economic sectors and associations as an expert consultant in empowering medium-sized companies.Trabajo de investigació

Longstanding Presence of a Vaginal Foreign Body (Battery): Severe Stenosis in a 13-Year-Old Girl

Background: In recurrent/unresponsive vaginal discharge a vaginal foreign body should be considered. Case: We present the case of a 13-year-old girl who suffered from a foul-smelling dark brownish and malodorous vaginal discharge since the age of 7 years. When the girl was 11 years old, a foreign body was discovered on ultrasound imaging; removal by colposcopy failed, because of the complete battery inclusion in the posterior vaginal wall. Two years later, at our institution, radiological images yielded the general position of the foreign body; colposcopy showed complete vaginal stenosis. Forced dilatation allowed surgical removal of the battery which was embedded in the vaginal fundal wall. Summary and Conclusion: Early removal of foreign objects prevents ulceration, necrosis, stenosis, perforations, and late serious sequelae such as pelvic inflammation and infertility

Pediatric and Adolescent Gynecology: Treatment Perspectives in Minimally Invasive Surgery

Minimally invasive surgery (MIS) is widely utilized across multiple surgical disciplines, including gynecology. To date, laparoscopy is considered a common surgical modality in children and adolescents to treat gynecological conditions. Robotic surgical devices were developed to circumvent the limitations of laparoscopy and have expanded the surgical armamentarium with better magnification, dexterity enhanced articulating instruments with 5-7 degrees of freedom, and ability to scale motion thus eliminating physiologic tremor. There are well-documented advantages of MIS over laparotomy, including decreased post-operative pain, shorter recovery times, and better cosmetic results. Indications for MIS in pediatric gynecology are reported in this review and technical considerations are described to highlight new treatment perspectives in children and adolescents, which have already been described in the literature regarding adult patients

Bruises around the umbilicus in an infant

The most common causes of umbilical discharge in infancy are infection and umbilical granuloma that may be treated by antibiotics and topical application of silver nitrate subsequently. If the umbilical discharge persists or if there is any abnormal discoloration around the umbilicus, it is important to investigate for underlying congenital abnormality that may be cured by surgical intervention. Unusual presentation of omphalomesenteric duct cyst has been reported in literature. We report, for the first time as far as our search is concerned, a case of a 16-month-old infant who presented initially with persistent umbilical discharge and finally with bruising around the umbilicus in keeping with Cullen’s sign. A diagnosis of omphalomesenteric duct cyst containing pancreatic tissue was made on histopathological examination. This case emphasizes that, a persistent umbilical discharge and or discoloration around the umbilicus should be further investigated and an omphalomesenteric duct cyst can present as Cullen’s sign

Renal leiomyoma in pediatric age: a rare case report with review of the literature

Renal leiomyoma (RL) is a rare benign tumor originating from muscle cells and has been rarely described in the pediatric age-group. A case of a large RL in an 11-year-old girl is reported with a literature review. The girl was admitted for abdominal pain due to mass effect. Contrast-enhanced CT showed a circumscribed low density mass (22 × 19 × 12 cm) arising from the right kidney. A right nephrectomy was performed. The mass was well defined and encapsulated. Only the histopathology and immunohistochemistry confirmed the diagnosis of RL. Even though partial nephrectomy may be possible, radical nephrectomy remains the recommended treatment for large leiomyoma

Unusual gastric submucosal perforation following multiple magnetic bead ingestion in an infant

Introduction: Magnetic beads are hazardous, having potentially lethal consequences if ingested. Case Report: A two-year-old girl, presented to the pediatric emergency department with an history of worsening abdominal pain, nausea and vomiting. The patient appeared in moderate distress. Physical examination revealed abdominal tenderness with guarding and rigidity. On abdominal X-ray examination, nine opaque foreign bodies (magnetic beads) were seen in the left hypochondrium. Explorative gastroscopy was performed and two magnets appeared at the lessure curvature, but not the reaming seven. These were pulled out and another gastroscopic attempt showed appearance of another two of the remaining ones. Removing these, the remaining ve were all attached as seen on the X-ray. The magnets must have caused pressure necrosis on a gastric mucosa fold with subsequent limited submucosal perforation making a pouch was the spheres were logged. Conclusion: The ingestion of multiple magnets may require urgent surgical intervention and early removal because of very high risk of gastrointestinal perforation

Isolated Ileal Perforation in Infancy: A Lethal Initial Presentation of Hirschsprung's Disease

Arare case of ileal perforation, as a fatal initial presentation of total colonic aganglionosis (TCA) in infancy is reported. A 10-week-old boy, was brought to the emergency department with symptoms of complicated intestinal obstruction. He looked ill, was lethargic, markedly dehydrated and had a severely distended abdomen. An abdominal X-ray revealed multiple air fluid levels seen in a distended small intestine. During exploratory laparotomy the ileum was massively dilated with distal segment perforation. Ileal perforation repair was performed. A totally collapsed microcolon was identified. Biopsies were taken from the high rectum, sigmoid and hepatic flexure. Appendectomy and ileostomy were performed. All biopsies, as well as the appendix, showed absence of ganglion cells. Despite this procedure the patient progressively deteriorated and later died due to sepsis. Ileal perforation in infants is a rare, but potentially fatal initial presentation of TCA. Early detection is essential to prevent life-threatening complications

Robotic-assisted surgery approach in a biliary rhabdomyosarcoma misdiagnosed as choledochal cyst

Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC

Intrascrotal lipoblastoma in a ten year old boy: case report and review of literature

Lipoblastoma is a rare benign soft tissue tumor encountered almost exclusively in infancy and early childhood. The location of tumors varies, but most occur in the extremities, trunk, head and neck. Less frequently, lipoblastomas have been reported in the mediastinum, the retroperitoneum and the inguinal region. Only 7 cases of lipoblastoma in the scrotum have been reported so far in the English literature, with none of the patients older than 8. We report an intrascrotal lipoblastoma in a 10 year-old boy. The differential diagnosis is discussed with reference to the literature

Chemotherapy and surgical approach with repeated endovascular embolizations: safe interdisciplinary treatment for kasabach-merritt syndrome in a small baby

Kasabach-Merritt syndrome (KMS) is a life-threatening disease. We describe a combined medical and multistep, endovascular embolization that was successfully performed with surgery