Resultados radiológicos y funcionales en fracturas de platillo tibial de alta energía / Radiological and functional results in high-energy tibial plate fractures

Resumen: Introducción: Las fracturas de platillo tibial por mecanismos de alta energía son lesiones graves que ocurren sobre una articulación de carga. Son difíciles de abordar, ya que además de afectar la estructura ósea de la pierna suelen tener lesiones de partes blandas asociadas. Objetivo: Evaluar los resultados radiológicos y funcionales de las fracturas de platillo tibial de alta energía con un mínimo seguimiento de un año. Material y métodos: Estudio retrospectivo, observacional y multicéntrico. Análisis de los resultados radiológicos y funcionales en el tratamiento de fracturas de platillo tibial de alta energía tratadas mediante reducción abierta y fijación interna (RAFI) entre 2014 y 2019. Resultados: 54 fracturas tratadas mediante RAFI. Seguimiento un año, 98.1% de consolidación en 13 semanas de promedio, 83.4% sin alteraciones del eje en plano coronal, 74% sin ensanchamiento articular postoperatorio. Escalas funcionales: Lysholm 82.1 puntos promedio y Oxford Knee Score (OKS) 39.5 puntos promedio. Conclusión: El rango de movilidad articular se redujo luego de una fractura de platillos tibiales de alta energía, pero con buenos resultados funcionales. Cuanto menor deseje y menor ensanchamiento radiográfico postoperatorio, se obtienen mejores resultados.

Abstract: Introduction: The tibial plateau fractures due to high-energy mechanisms are serious injuries that occur on a load bearing joint. These are difficult to approach because, also affect the bone structure of the leg, they usually have associated soft tissue injuries. Objective: To evaluate the radiological and functional results of high-energy tibial plateau fractures with a minimum follow-up of one year. Material and methods: Retrospective, observational and multicenter study. Analysis of radiological and functional outcomes in the treatment of high-energy tibial plateau fractures, treated by open reduction and internal fixation (ORIF) between 2014 and 2019. Results: 54 fractures treated by ORIF. Follow-up one year. 98.1% consolidation in 13 weeks on average. 83.4% without alterations of the axis in the coronal plane. 74% without postoperative joint widening. Functional scores: Lysholm 82.1 average points and Oxford Knee Score (OKS) 39.5 average points. Conclusion: The joint range of motion was reduced after a high-energy tibial plateau fracture, but with good functional results. The less off axis and less post-operative radiographic widening, the better results are obtained.

Psychological impact of the SARS-CoV-2 outbreak on the staff of a French hospital.

Background: The outbreak of SARS-CoV-2 has resulted in anxiety, depression and post-traumatic stress disorder (PTSD) among hospital staff. The factors associated with this psychological impact remain to be determined. Methods: A cross-sectional study using an online questionnaire completed by the staff of a French hospital, two months after the SARS-CoV-2 outbreak. Results: Among the 353 participants (of whom 67% were healthcare professionals), 32% had symptoms of anxiety, 16% of depression and 16% of PTSD. Eleven per cent had initiated or increased treatment with sleeping pills, and 6% with anxiolytics. In a multivariate analysis, factors independently associated with anxiety were: change of professional team, having a relative infected by SARS-CoV-2 and a new/increased treatment with sleeping pills or anxiolytics. The only factor associated with depression was the feeling of risk during professional practice. The factors associated with PTSD were: having a relative infected by SARS-CoV-2, the feeling of risk during professional practice, the increase in smoking and treatment with sleeping pills. The observance of transmission preventive measures (TPM) was not associated with the psychological impact of SARS-CoV-2. A personal history of SARS-CoV-2 infection and age < 36 years were associated with insufficient use of protective equipment. Age < 36 years, and being a healthcare professional were associated with the non-observance of social distancing. Conclusion: The hospital staff displayed psychological consequences, resulting in the use of anxiolytics and sleeping pills. Belonging to a group with low-risk of severe disease was associated with lower observance of TPM.

Crecimiento y metabolismo de Fischerella TB22 en medio de cultivo BG11 / Growth and metabolism of Fischerella TB22 in BG110 culture medium

Los microorganismos fijadores de nitrógeno de vida libre, abarcan una gama morfológica que va desde los organismos unicelulares como las bacterias y algunas cianobacterias, hasta multicelulares, filamentosas, por ello es importante conocer cómo se comportan y se puede saber haciendo una curva de crecimiento microbiano. Para este estudio se prepararon 4 fotobioreactores de columna burbujeada con inoculo de Fischerella TB22, se pusieron en aireación constante con 12 horas luz y 12 horas obscuridad durante 40 días con diferentes tratamientos de ajuste de volumen del medio de cultivo y ajuste del pH. El objetivo de este trabajo fue evaluar el crecimiento en biomasa por peso seco, densidad óptica, pH y amonio de Fischerella sp. en medio de cultivo BG110 durante 12 días. Las variables que se midieron de la curva de crecimiento de las cianobacterias, siguieron el patrón de una curva típica de crecimiento microbiano. (AU)

Free-living nitrogen-fixing microorganisms cover a morphological range that goes from unicellular organisms such as bacteria and some cyanobacteria, to multicellular, filamentous, therefore it is important to know how they behave and can be known by makinga microbial growth curve. For this study, 4 bubbled column photobioreactors with Fischerella TB22inoculum were prepared, they were placed in constant aeration with 12 hours of light and 12 hours of darkness for 40 days with different treatments of volumeadjustment of the culture medium and pH adjustment. The objective of this work was to evaluate the biomass growth by dry weight, optical density, pH, and ammonia of Fischerella sp. in the BG110 culture medium for 12 days. The variables that were measured from the growth curve of cyanobacteria followed the pattern of a typical microbial growth curve. (AU)

Traumatismo torácico en el adulto mayor / Thoracic trauma in the elderly

Resumen Introducción: Los traumatismos constituyen la quinta causa de muerte en el adulto mayor (60 años o más), siendo los traumatismos contusos los más frecuentes. Objetivo: Describir características, índices de gravedad de traumatismo (IGT), morbilidad y mortalidad en adultos mayores (AM) hospitalizados con traumatismo torácico (TT). Materiales y Método: Estudio descriptivo transversal. Período desde enero de 1981 a diciembre de 2017. Revisión de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de TT en AM hospitalizados. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 TT, AM 513 (12,3%). Hombres: 350 (68,2%), edad promedio 71,2 ± 8,4 años, mediana 70 (rango: 60-103), TT aislado 350 (68,2%), asociado a lesiones extratorácicas 163 (31,8%) y de estos 96 (18,7%) se consideraron politraumatismos. Traumatismo contuso 456 (88,9%) y penetrante 57 (11,1%). La causa más frecuente fueron las caídas en 252 (49,1%). Lesiones y/o hallazgos torácicos más frecuentes: fracturas costales 409 (79,7%), hemotórax 186 (36,3%) y neumotórax 185 (36,1%). Tratamiento definitivo: médico 287 (55,9%), pleurotomía 193 (37,6%) y cirugía 40 (7,8%). Cirugía extratorácica 33 (6,4%). Hospitalización promedio 9,0 ± 8,8 días. Según IGT: ISS promedio 12,1 ± 9,6, RTS-T promedio 11,6 ± 1,3, TRISS promedio 8,1. Morbilidad 76 (14,8%) y mortalidad 26 (5,1%). Discusión: La mayoría de los TT en AM son contusos, causados por accidentes domésticos. Las lesiones y hallazgos más frecuentes fueron fracturas costales y hemotórax. La mortalidad fue menor a la esperada según IGT.

Introduction: Trauma is the fifth leading cause of death in the elderly (60 or older), with blunt trauma being the most frequent. Objective: To describe characteristics, Trauma Severity Indices (TSI) and morbidity and mortality in hospitalized elderly for Thoracic Trauma (TT). Materials and Method: Crosssectional descriptive study was carried out. Term: from January 1981 to December 2017. Database review, surgical protocols and medical records were performed. TT description of characteristics was conducted in hospitalized elderly. TSI was calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total 4.163 TT, 513 elderly (12.3%). Men: 350 (68.2%), average age 71.2 ± 8.4 years, 70 median (range 60-103). Isolated TT: 350 (68.2%), 163 associated with extrathoracic trauma (31.8%) and of these 96 (18.7%) were considered polytraumatism. Blunt trauma 456 (88.9%) and penetrating 57 (11.1%). Most frequent domestic accident mechanism was 196 (38.2%) and 158 traffic accidents (30.8%). Frequently thoracic injuries or findings: 409 rib fractures (79.7%), 186 hemothorax (36.3%), and 185 pneumothorax (36.1%). Final treatment: 287 Medical treatment (55.9%), 193 pleurotomy (37.6%), and 40 thoracic surgery (7.8%). Extrathoracic surgery 33 (6.4%). Average hospitalization: 9.0 ± 8.8 days. According IGT: ISS 12.1 ± 9.6, RTS-T 11.6 ± 1.3, TRISS 8.1. Morbidity: 76 (14.8%) and mortality: 26 (5.1%). Discussion: Most TT in elderly are blunt, caused by domestic accidents. Injuries and most frequent findings were rib fractures and hemothorax. Mortality was lower than expected according to TSI.

Traumatismo penetrante cardiaco: caracterización, resultados inmediatos y variables asociadas a morbilidad y mortalidad en pacientes operados / Penetrating cardiac trauma: findings, outcomes and prognostic factors in operated patients

INTRODUCCIÓN: El traumatismo penetrante cardiaco (TPC) por sus características y en particular por su alta mortalidad, constituye un desafío quirúrgico permanente. OBJETIVOS: Describir las características, resultados inmediatos y factores pronósticos en TPC. MATERIALES Y MÉTODO: Estudio descriptivo transversal, revisión de protocolos prospectivos de traumatismo torácico, registros de pabellón y fichas clínicas. Período enero de 1990-diciembre de 2017. Se incluyeron todos los pacientes con TPC operados. Se describen y analizan diversas variables. Se realizó regresión logística con análisis univariado y multivariado para identificar variables asociadas a morbilidad, deterioro neurológico y mortalidad. RESULTADOS: 220 pacientes operados por TPC, 209 (95,0%) hombres, edad promedio 30,4 ± 13,3, mediana 27 años. Mecanismo: agresión en 202 (91,8%). El agente traumático fue en 186 (84,5%) arma blanca, en 21 (9,5%) arma de fuego. Presentaban taponamiento 169 (76,8%) pacientes, ingresaron en shock 103 (46,8%) y en paro cardiorrespiratorio 20 (9,1%). Vía de abordaje fue esternotomía en 157 (71,4%), toracotomía izquierda en 58 (26,4%). Las cavidades cardiacas lesionadas más frecuentes fueron ventrículo derecho en 110 (50,0%), ventrículo izquierdo en 72 (32,7%). Se hospitalizaron en UCI en el postoperatorio 135 (61,4%), se transfundieron 74 (33,6%), presentaron complicaciones 60 (27,3%) y se reoperaron 21 (9,5%). Mortalidad 28 (12,7%). La estadía postoperatoria tuvo una mediana de 6 días (rango 1-150). Se identificaron factores pronósticos. DISCUSIÓN: Los TPC operados son más frecuentes en hombres agredidos con arma blanca, la cavidad lesionada más frecuente es el ventrículo derecho. Nuestra morbimortalidad es comparable con series internacionales.

INTRODUCTION: Penetrating cardiac trauma (PCT) constitute a permanent surgical challenge due to it characteristics and high mortality. AIM: To describe the findings, outcomes and prognostic factors in PCT. MATERIAL AND METHOD: Cross-sectional descriptive study, review of prospective thoracic trauma protocols and surgical registries. Period January 1990-December 2017. All patients with PCT were included. Various variables are described and analyzed. Univariate and multivariate analysis were performed to identify factors associated with morbidity, neurologic dysfunction and mortality. RESULTS: 220 patients PCT, 209 (95.0%) men, mean age 30.4 ± 13.3, median 27 years. Mechanism: Aggression in 202 (91.8%). The traumatic agent was cold steel in 186 (84.4%) and fire arm in 21 (9.5%). 169 (76.8%) patients presented with tamponade, 103 (46.8%) shock and 20 (9.1%) cardiopulmonary arrest. Approach was sternotomy in 157 (71.4%), left thoracotomy in 58 (26.4%). The most common injured areas were right ventricle in 110 (50.0%), left ventricle in 72 (32.7%). 135 (61.4%) patients needed postoperative ICU and 74 (33.6%) were transfused. Complications occurred in 60 (27.3%). Twenty-one (9.5%) were reoperated. Mortality 28 (12.7%). The postoperative median stay was 6 days (Range 1-150). Prognostic factors were identified. DISCUSSION: Operated PCT are more frequent in men with stab wound, the most common injured area is the right ventricle. The morbidity and mortality is comparable with international series.

Resultados funcionales de pacientes tratados con faringolaringectomía y reconstrucción faríngea con colgajo pediculado / Functional Outcomes using pedicle flap reconstruction approach after pharyngolaryngectomy in laryngeal carcinoma patients

INTRODUCCIÓN: La laringectomía total es el tratamiento de elección del cáncer de laringe avanzado, requiriendo en ocasiones asociar una resección parcial o total de la faringe para su manejo. El defecto faríngeo, puede repararse con colgajos libres o pediculados, teniendo estos últimos la ventaja de ser simples, confiables y resistentes a la radioterapia. OBJETIVO: Presentar los resultados funcionales de una serie de pacientes tratados con faringolaringectomía y reconstrucción faríngea con colgajo pediculado. MATERIAL Y MÉTODO: Se revisaron registros de pacientes con laringectomía total más faringectomía parcial y reconstrucción con colgajo pediculado en el Hospital Regional de Talca entre 2009 y 2017, encontrando 6 casos de los cuales 4 se encontraron vivos al momento de iniciar el estudio. Se realizó videofluoroscopía para evaluar deglución, presencia de estenosis y/o fístulas, además, de evaluación nutricional y encuesta de calidad de vida. RESULTADOS: En el estudio de la deglución por fluoroscopía, todos los pacientes presentaron escasa retención del material de contraste en la hipofaringe y esófago cervical, lo cual está en relación con cambios morfológicos posquirúrgicos, sin afectar significativamente el mecanismo deglutorio. Todos los pacientes se encontraron eutróficos en su evaluación nutricional y sin evidencias de alteración de su calidad de vida secundaria a la deglución. CONCLUSIONES: La reconstrucción faríngea parcial con colgajo pediculado en pacientes con laringectomías totales asociadas a faringectomía parcial permite una deglución adecuada y sin disfagia, con un estado nutricional eutrófico.

INTRODUCTION: Total laryngectomy is the treatment of choice for advanced laryngeal cancer and after radiotherapy failure. In patients with pharyngeal invasion, it is associated with total or partial pharyngectomy, wich defect can be repaired with free or pedicle flaps. AIM: To present a brief series of pedicle flap reconstruction approach after pharyngolaryngectomy in laryngeal carcinoma patients and functional outcomes MATERIALS AND METHOD: We looked at laryngeal cancer patient records who were treated with total laryngectomy with partial pharyngectomy and pharyngeal reconstruction with pedicle flap at "Hospital Regional de Talca" between the years 2009 and 2017, finding 6 cases, 4 of which were alive at the beginning of the study. We analized videoflourocopy swallow studies to assess mechanisms of deglutition, and presence of stenosis or fistulas. We also performed a nutritional state assessment and a quality of life questionnaire. RESULTS: During videodeglutition study, the 4 patients showed minimal contrast swallow delay at hypopharynx and cervical esophagus. All the patients were found eutrophic in their nutritional assessment and with no significant evidence of quality of life disturbances secondary to deglutition state. CONCLUSIONS: Partial pharyngeal reconstruction using pedicle flaps in patients who underwent total laryngectomy with partial pharyngectomy allows to maintain an adequate deglutition without dysphagia, as well as a good nutritional state.

The cAMP/PKA Pathway Inhibits Beta-amyloid Peptide Release from Human Platelets.

The main component of Alzheimer's disease (AD) is the amyloid-beta peptide (Aß), the brain of these patients is characterized by deposits in the parenchyma and cerebral blood vessels known as cerebral amyloid angiopathy (CAA). On the other hand, the platelets are the major source of the Aß peptide in circulation and once secreted can activate the platelets and endothelial cells producing the secretion of several inflammatory mediators that finally end up unchaining the CAA and later AD. In the present study we demonstrate that cAMP/PKA pathway plays key roles in the regulation of calpain activation and secretion of Aß in human platelets. We confirmed that inhibition of platelet functionality occurred when platelets were incubated with forskolin (molecule that rapidly increased cAMP levels). In this sense we found that platelets pre-incubated with forskolin (20 µM) present a complete inhibition of calpain activity and this effect is reversed using an inhibitor of protein kinase A. Consequentially, when platelets were inhibited by forskolin a reduction in the processing of the APP with the consequent decrease in the Aß peptide secretion was observed. Therefore our study provides novel insight in relation to the mechanism of processing and release of the Aß peptide from human platelets.

Anti-aggregation effect on platelets of Indiplon a hypnotic sedative non-benzodiazepine drug.

Cardiovascular diseases are one of the main public health problems, and many of them, their pathophysiology involves alterations in platelet activity. Platelet activation is an essential event that is regulated by the intracellular concentrations of Ca2+ and cAMP. Interestingly, it has been shown that the activation of adenosine A2A receptors increases cAMP levels and produces the inhibition of platelet aggregation, which appears as a potential target for regulation of platelet activity. Therefore, we tried to activate A2A receptors using Indiplon, a drug developed for the treatment of insomnia, and analyze its effect on platelet activity in vitro. Our results indicate that Indiplon is able to interact in silico with the adenosine A2A receptor (ΔGbind of -73.321 kcal/mol, similar to that obtained with adenosine), which is involved in the regulation of platelet cAMP levels. In functional studies using PRP, a reduction in platelet aggregation induced by ADP was observed in the presence of Indiplon at 500 µM with a percentage of inhibition 70%, where the use of specific inhibitors (ZM241385 and MSX-2) of the A2A receptor also blocked these effects reducing the percentage of inhibition to 41% and 34.1%, respectively. Also, the use of Indiplon produced a decrease in the expression in the membrane of P-selectin. Thus, Indiplon acts as an A2A receptor agonist and whose activation results in inhibition of platelet aggregation and activation, showing a possible cardiovascular protective role.

[Results of extended transsternal thymectomy for Myasthenia gravis. Experience with 58 patients]. / Miastenia gravis: resultados inmediatos y alejados de la timectomía transesternal extendida.

BACKGROUND: Thymectomy improves clinical outcomes and decreases the need for medical treatment in patients with myasthenia gravis (MG). AIM: To describe the immediate and long-term results of extended transsternal thymectomy (ETT) in patients with MG. MATERIAL AND METHODS: A review of databases, surgical protocols, clinical records and interviews of patients subjected to extended transsternal thymectomy for MG between 1990 and 2016. Perioperative clinical characteristics, anticholinesterase treatment, immediate and remote surgical results were analyzed and patients were followed from one to 10years. RESULTS: We studied 58 patients aged 35 ± 14years (72%) women. In the preoperative period, according to Osserman classification, nine patients (15,5%) were in grade I, eight (13,8%) in grade IIA 8 and 40 (69%) in grade IIB. The pathological study of the surgical piece showed thymic hyperplasia in 39 cases (67,2%). Four patients had postoperative complications but none died. In the Follow-up at 1, 3, 5, 8 and 10years the Masaoka palliation rate was 71.7, 77.5, 67.7, 70.0 and 70,6% respectively. The figures for remission rate were 13.0, 15.0,19.4, 35.0 and 35,3% respectively. The figures for Zielinski positive results were 79.6, 87.5, 87.1, 90.0 and 82,4% respectively. The DeFilippi score improved by 80.4, 87.5, 87.1, 90.0 and 82.4% respectively. The Myasthenia Gravis Foundation of America Post-Intervention State improved by 67.4, 77.5, 77.5, 75.0 and 70,6% respectively. Mean Myasthenia Gravis Activities of daily living (MGADL) and Myasthenia Gravis Quality of life scale 15 (MGQOL 15) were 1.65 and 6.31 respectively. CONCLUSIONS: In selected patients with MG, extended transsternal thymectomy in MG has good immediate and long-term results.

Miastenia gravis: resultados inmediatos y alejados de la timectomía transesternal extendida / Results of extended transsternal thymectomy for Myasthenia gravis: experience with 58 patients

Background: Thymectomy improves clinical outcomes and decreases the need for medical treatment in patients with myasthenia gravis (MG). Aim: To describe the immediate and long-term results of extended transsternal thymectomy (ETT) in patients with MG. Material and Methods: A review of databases, surgical protocols, clinical records and interviews of patients subjected to extended transsternal thymectomy for MG between 1990 and 2016. Perioperative clinical characteristics, anticholinesterase treatment, immediate and remote surgical results were analyzed and patients were followed from one to 10years. Results: We studied 58 patients aged 35 ± 14years (72%) women. In the preoperative period, according to Osserman classification, nine patients (15,5%) were in grade I, eight (13,8%) in grade IIA 8 and 40 (69%) in grade IIB. The pathological study of the surgical piece showed thymic hyperplasia in 39 cases (67,2%). Four patients had postoperative complications but none died. In the Follow-up at 1, 3, 5, 8 and 10years the Masaoka palliation rate was 71.7, 77.5, 67.7, 70.0 and 70,6% respectively. The figures for remission rate were 13.0, 15.0,19.4, 35.0 and 35,3% respectively. The figures for Zielinski positive results were 79.6, 87.5, 87.1, 90.0 and 82,4% respectively. The DeFilippi score improved by 80.4, 87.5, 87.1, 90.0 and 82.4% respectively. The Myasthenia Gravis Foundation of America Post-Intervention State improved by 67.4, 77.5, 77.5, 75.0 and 70,6% respectively. Mean Myasthenia Gravis Activities of daily living (MGADL) and Myasthenia Gravis Quality of life scale 15 (MGQOL 15) were 1.65 and 6.31 respectively. Conclusions: In selected patients with MG, extended transsternal thymectomy in MG has good immediate and long-term results.

Traumatismo torácico: caracterización de hospitalizaciones durante tres décadas / Thoracic trauma: experience of three decades

Background: Trauma is the leading cause of death in young patients and thoracic trauma (TT) is responsible for 25-35% of trauma deaths. Aim: To describe and compare features, trauma severity indexes and morbidity of patients admitted for TT in the past three decades. Material and Methods: Review of a TT database, operative notes and medical records of patients. These were separated by decade of admission (1981-1990, 1991-2000, 2001-2010). TT characteristics were compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results: A total of 3,068 TT were reviewed. In the 1981-1990 period, 604 cases of TT were registered (19.7%), in the 1991-2000 period, 1,070 cases (34.9%) and in the 2001-2010 period, 1,394 cases (45.4%) (p < 0.05). The ages of patients in each of these periods were 34.9 ± 15.5, 33.9 ± 16.2 and 35.7 ± 18.2 years respectively (p < 0.05). The proportion of patients aged 65 years or more were 6.6, 7.7 and 10.1% respectively, the proportion of females was 6.1, 9.4 and 12.0%, respectively. The causing agents per decade were knife wounds in 51.5, 61.1 and 60.0% of cases respectively, firearms in 2.5, 3.3 and 5.0% of cases respectively, multiple trauma in 13.9, 14.5 and 9.0% respectively and morbidity in 18.7, 19.7 and 11.7%, respectively. The ISS per decade was 11.9 ± 6.5, 12.9 ± 6.9 and 10.4 ± 6.8 respectively. No significant difference were found in mortality (1.5, 3.0, 2.0% respectively) or TRISS score (2.7, 3.2 and 3.8% respectively). Conclusions: An increase in the number of hospital admission for TT has occurred in the last three decades, with an increase in the proportion of admissions of subjects aged 65 years or more, females and with firearm injuries.

Tratamiento quirúrgico de la úlcera penetrante de aorta ascendente: casos clínicos / Penetrating ulcer of the ascending aorta treated surgically: report of two cases

Penetrating aortic ulcer (PAU) is an ulceration of an atherosclerotic plaque which disrupts the aortic internal elastic lamina and that can evolve to an intramural hematoma (IH), aortic dissection or aortic rupture. We report two cases with PAU. A 73 year-old woman with a history of hypertension, presented with acute chest pain of three days of evolution and a hypertensive emergency. An electrocardiogram showed ST-segment elevation and elevated cardiac enzymes. Computed tomography (CT) scans showed an acute ascending aortic mural hematoma secondary to PAU and hemopericardium. Replacement of ascending aorta was performed with a vascular prosthesis with extracorporeal circulation (ECC). PAU and IH were confirmed by histopathology. A 62-year old woman with a history of hypertension, diabetes and chronic obstructive pulmonary disease, consulted for abdominal pain of two days of evolution. A thoracic-abdominal CT scan visualized an uncomplicated PAU and an abdominal aortic aneurysm. Because of abdominal pain and signs of peritoneal irritation, an exploratory laparotomy was performed finding a typhlitis. Resection and ileo-ascendo-anastomosis were performed. A new CT scan showed PAU with high risk of rupture without a clinical acute aortic syndrome. The patient was operated replacing the ascending aorta with a vascular prosthesis using ECC. Three PAU were found. Histopathology confirmed the diagnosis. Both patients evolved without postoperative complications.

No effect of different bariatric surgery procedures on LINE-1 DNA methylation in diabetic and nondiabetic morbidly obese patients.

BACKGROUND: Bariatric surgery (BS) is proposed as a highly effective therapy for reducing weight and improving obesity-related co-morbidities. The molecular mechanisms involved in the metabolic improvement after BS are not completely resolved. Epigenetic modifications could have an important role. OBJECTIVE: The aim of this study was to evaluate the effect of different BS procedures (Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy) on global DNA methylation (long interspersed nucleotide element 1 [LINE-1]) in a group of nondiabetic and diabetic severely obese patients. SETTING: University hospital, Spain. METHODS: This study included 60 patients (30 nondiabetic and 30 diabetic severely obese patients) undergoing BS: 31 patients underwent Roux-en-Y gastric bypass and 29 underwent laparoscopic sleeve gastrectomy. Before and 6 months post-BS, anthropometric data, blood pressure, and metabolic parameters were determined. LINE-1 DNA methylation was quantified by pyrosequencing. We used the methylation levels of tumor necrosis factor-α as a control gene promoter. RESULTS: There were no differences between LINE-1 methylation levels at baseline and at 6 months after surgery (66.3±1.6 versus 66.2±2.06). Likewise, there was no statistically significant difference on LINE-1 methylation levels when we stratified according to metabolic status (diabetic versus nondiabetic), nor was there regarding the BS procedure. A strong correlation was shown between LINE-1 methylation levels and weight at baseline both in diabetic and nondiabetic obese patients (r = .486; P<.001). Tumor necrosis factor-α methylation levels increased significantly after BS in the group of diabetic obese patients. CONCLUSION: After BS, global LINE-1 methylation is not modified in the short term. More studies are required to determine if LINE-1 is a stable epigenetic marker, or, on the contrary, if it is susceptible to modification by external factors such as changes in lifestyle or a surgical intervention.

Endocarditis fúngica, una causa infrecuente de lesión en válvula cardiaca nativa / Fungal endocarditis, an uncommon cause of native cardiac valve disease

Introducción: La endocarditis fúngica (EF) es una forma grave de endocarditis infecciosa (EI), asociada a una alta morbimortalidad. Su incidencia es baja y se puede presentar después de una cirugía cardiaca, uso de válvula cardiaca protésica, catéteres endovenosos centrales (CVC), etc. Presentación del caso: Hombre de 17 años con antecedente de enfermedad renal crónica en hemodiálisis y múltiples hospitalizaciones por septicemia asociada a CVC, presentó cuadro febril el cual fue tratado con antibióticos y cambio de CVC. Estudio con hemocultivos resultó positivo para Candida parapsilosis. Se decidió hospitalización domiciliaria y tratamiento con Fluconazol. Persistió febril por lo que se decidió hospitalización por sepsis fúngica persistente y continuar tratamiento antimicótico. Estudio con ecocardiograma mostró endocarditis mitral con vegetación móvil en velo anterior e insuficiencia moderada. Se decidió tratamiento quirúrgico, realizándose reemplazo de válvula mitral con prótesis cardiaca biológica. En el intraoperatorio se observó vegetación verrugosa y móvil. Cultivos y estudio histopatológico confirmó EF. Evolucionó con candidemia persistente, pero sin hallazgos ecográficos de endocarditis. Control con tomografía computada demostró hallazgos sugerentes de candidiasis crónica diseminada (CCD), modificándose el tratamiento con Caspofungina y Voriconazol. Al cuarto mes postoperatorio fue dado de alta con tratamiento antifúngico crónico. Discusión: La EF es un tipo infrecuente de endocarditis infecciosa constituyendo un 6% de los casos. Se asocia a una alta mortalidad a pesar de tratamiento médico y quirúrgico combinado. La CCD es una forma infrecuente de candidemia, casi exclusiva de pacientes oncohematológicos. El antecedente de factores de riesgo obliga a sospecharlo.

Introduction: Fungal endocarditis (EF) is a severe form of infectious endocarditis (IE) associated with high morbidity and mortality. Its incidence is low and may be related to heart surgery using prosthetic heart valve, central intravenous catheters (CVC), etc. Case report: Man aged 17 with a history of chronic kidney disease on hemodialysis, and multiple hospitalizations for sepsis associated to CVC, presented febrile illness, which was treated with antibiotics and CVC change. Blood culture study was positive for Candida parapsilosis. Home hospitalization and treatment with Fluconazole was decided. He persisted febrile so hospitalization it was decided by persistent fungal sepsis and to continue antifungal therapy. Echocardiogram study showed mitral endocarditis with mobile vegetation anterior leaflet and mitral insufficiency. Surgical treatment was decided. Mitral valve replacement surgery with biological cardiac prosthesis is performed. A warty and mobile vegetation was observed in the surgery. Cultures and histopathology confirmed EF. He evolved with persistent candidemia, but without sonographic findings of endocarditis. Control with computed tomography showed suggestive findings of chronic disseminated candidiasis (CCD), modifying treatment with Caspofungin and Voriconazole. The fourth postoperative month was discharged with chronic antifungal treatment. Discussion: EF is a rare type of EI constitutes 6% of cases. It is associated with high mortality despite combined medical and surgical treatment. The CCD is an almost exclusive rare form of candidemia in oncohematological patients. The history of risk factors forcing suspect.

Integrated genomic analysis of colorectal cancer progression reveals activation of EGFR through demethylation of the EREG promoter.

Key molecular drivers that underlie transformation of colonic epithelium into colorectal adenocarcinoma (CRC) are well described. However, the mechanisms through which clinically targeted pathways are activated during CRC progression have yet to be elucidated. Here, we used an integrative genomics approach to examine CRC progression. We used laser capture microdissection to isolate colonic crypt cells, differentiated surface epithelium, adenomas, carcinomas and metastases, and used gene expression profiling to identify pathways that were differentially expressed between the different cell types. We identified a number of potentially important transcriptional changes in developmental and oncogenic pathways, and noted a marked upregulation of EREG in primary and metastatic cancer cells. We confirmed this pattern of gene expression by in situ hybridization and observed staining consistent with autocrine expression in the tumor cells. Upregulation of EREG during the adenoma-carcinoma transition was associated with demethylation of two key sites within its promoter, and this was accompanied by an increase in the levels of epidermal growth factor receptor (EGFR) phosphorylation, as assessed by reverse-phase protein analysis. In CRC cell lines, we demonstrated that EREG demethylation led to its transcriptional upregulation, higher levels of EGFR phosphorylation, and sensitization to EGFR inhibitors. Low levels of EREG methylation in patients who received cetuximab as part of a phase II study were associated with high expression of the ligand and a favorable response to therapy. Conversely, high levels of promoter methylation and low levels of EREG expression were observed in tumors that progressed after treatment. We also noted an inverse correlation between EREG methylation and expression levels in several other cancers, including those of the head and neck, lung and bladder. Therefore, we propose that upregulation of EREG expression through promoter demethylation might be an important means of activating the EGFR pathway during the genesis of CRC and potentially other cancers.

Pleurodesis con sangre autóloga en neumotórax espontaneo secundario con fuga aérea persistente / Autologous blood pleurodesis in secondary spontaneous pneumothorax with persistent air leak

Introducción: El neumotórax espontáneo secundario (NES) es la presencia de aire en la cavidad pleural con ausencia de traumatismo, asociado a alguna enfermedad pulmonar subyacente. La pleurodesis es considerada una alternativa al tratamiento de esta patología. La fuga aérea persistente o masiva es una complicación importante del NES, donde la utilización de pleurodesis con sangre autóloga constituye una opción conveniente en pacientes con alto riesgo quirúrgico. Objetivos: Se propuso describir las características de pacientes con NES tratados con pleurodesis con sangre autóloga en Hospital Regional de Concepción. Pacientes y método: Estudio descriptivo transversal, período enero 2012 - enero 2015. Se realizó una revisión de base de datos, protocolos quirúrgicos y fichas clínicas, seguimiento clínico a 36 meses, donde se describieron características clínicas, morbimortalidad, resultados inmediatos y tardíos. Resultados: Del total de pacientes (n=7), 5 (71,4 %) fueron hombres, con edad promedio de 60,7±8,2 años. La causa del NES fue mayoritariamente enfermedad pulmonar difusa en seis pacientes (85,7 %). Se realizaron siete pleurodesis con sangre autóloga sin necesidad de repetir el procedimiento. Se observó cierre de fístula en el 100 % de los pacientes. Al seguimiento no se observó necesidad de nuevos procedimientos. Discusión: La pleurodesis con sangre autóloga es un tratamiento efectivo y seguro en el manejo de la fuga aérea persistente o masiva, con adecuados resultados inmediatos y tardíos en casos seleccionados.

Introduction: Secondary spontaneous pneumothorax (NES) is pleural air occupation without trauma associated with the presence of some underlying lung disease. Pleurodesis is considered an alternative to the treatment of this disease. Persistent or massive air leak is a major complication of NES, where the use of pleurodesis with autologous blood is an accepted option in patients with high surgical risk and air leak. Objetive: Describe characteristics of patients with NES treated with pleurodesis with autologous blood in Hospital Regional of Concepción. Patients and methods: Cross-sectional descriptive study period January 2012- January 2015. It`s made a review of Database, surgical protocols and review medical records, 36 months' clinical follow-up. Description of clinical features, morbidity and mortality, immediate and remote results. Results: Of all patients (n=7), 5 (71.4 %) were males, mean age 60.7 ± 8.2 years. The cause of NES was predominantly diffuse lung disease in 6 (85.7%) patients. Seven pleurodesis with autologous blood were performed without repeating the procedure. Fistula closure was observed in 100% of patients. In follow the need for new procedures wasn't observed. Discussion: Pleurodesis with autologous blood is an effective and safe treatment in the management of persistent or massive air leak, with immediate and remote adequate results.

Quilopericardio secundario a cirugía cardíaca / Chylopericardium after cardiac surgery

Introducción: El quilopericardio post cirugía cardíaca en el adulto es extremadamente infrecuente. Su aspecto lechoso característico y análisis bioquímico permiten el diagnóstico. El objetivo es presentar una complicación excepcional de la cirugía cardíaca, su fisiopatología y tratamiento médico. Presentación del caso: Mujer de 61 años, con historia de disnea progresiva, ortopnea y disnea paroxística nocturna de 12 años de evolución. Se pesquisó en ecocardiograma comunicación interauricular (CIA) tipo ostium secundum con shunt izquierda-derecha, disfunción ventricular, dilatación de cavidades derechas, insuficiencia tricuspídea masiva e hipertensión pulmonar grave. Se discutió caso y se decidió resolución quirúrgica. Se abordó por esternotomía media, y en circulación extracorpórea, se realizó, cierre de CIA con parche de poliéster y plastía tricuspídea. Al tercer día postoperatorio presentó aumento de débito pericárdico con líquido de aspecto lechoso. Análisis bioquímico permitió realizar el diagnóstico de quilopericardio. Se indicó tratamiento conservador con nutrición parenteral total y posterior uso de octreotide a lo largo de aproximadamente un mes. La paciente respondió a la terapia y fue dada de alta, no requiriendo de reintervención. Ecocardiograma de control mostró ausencia de derrame pericárdico. Al mes de seguimiento la paciente se encontró asintomática en capacidad funcional I. Discusión: La cirugía cardíaca es la causa del 9% de los casos de quilopericardio en adultos. Se han descrito diversas etiologías que van desde la lesión directa del conducto torácico hasta la asociación con la hipertensión pulmonar. En el caso presentado, el tratamiento con medidas nutricionales y octreotide fue efectivo evitando una nueva exploración quirúrgica.

Introduction: Adult post cardiac surgery chylopericardium is extremely rare. Its characteris- tic milky look and biochemical analysis allow diagnosis. The objective is to present a rare complication of cardiac surgery, its pathophysiology and treatment. Case report: A 61 years old woman, with a history of progressive dyspnea, orthopnea and paroxysmal nocturnal dyspnea of 12 years of evolution. Echocardiography found an ostium secundum atrial septal defect (ASD) with left-right shunt, ventricular dysfunction, dilated right chambers, massive tricuspid regurgitation and severe pulmonary hypertension. The case was discussed and surgical resolution was decided. A median sternotomy, ASD closure polyester patch and tricuspid plasty was performed. On the third postoperative day presented increased pericardial debit with milky liquid. Biochemical analysis allowed the diagnosis of chylopericardium. Conservative treatment was decided with total parenteral nutrition and subsequent use of octreotide over about one month. The patient responded well to treatment and was discharged, not requiring reoperation. Control echocardiogram showed no pericardial effusion. One-month follow-up the patient was asymptomatic and in functional capacity I. Discussion: Cardiac surgery is the cause of 9% of cases chylopericardium in adults. Various etiologies are described ranging from direct injury to the thoracic duct to the association with pulmonary hypertension. In the case presented, nutritional therapy and octreotide were effective, avoiding a new surgical exploration.

Fístula aortobronquial como causa de hemoptisis masiva / Aortobronchial fistula as a cause of massive hemoptysis

INTRODUCCIÓN: Las fístulas aortobronquiales son una causa muy infrecuente de hemoptisis masiva. Se asocia a la presencia de un aneurisma aórtico, y su evolución es siempre letal sin un tratamiento oportuno. El objetivo es presentar un caso de fístula aortobronquial y la revisión de bibliografía respectiva. Presentación del caso: Paciente de género femenino, de 76 años, hipertensa y diabética, sin otros antecedentes mórbidos. Ingresó al Servicio de Urgencia por hemoptisis posterior a caída a nivel. La radiografía de tórax mostró imagen hiperdensa en vértice pulmonar izquierdo, asociada a desviación mediastínica contralateral. Evolucionó con episodio de hemoptisis masiva el cual fue tratado satisfactoriamente con reposición de volumen y transfusión de hemoderivados. La tomografía computada de tórax con contraste mostró aneurisma de aorta torácica, de diámetro máximo de 10,8 cm...

INTRODUCTION: Aortobronchial fistula is a very rare cause of massive hemoptysis. It is associated with the presence of an aortic aneurysm and its evolution is always fatal without prompt treatment. The objective is to present a case of aortobronchial fistula and to review the respective literature. Case Report: A 76 years old woman, hypertensive and diabetic, no other known morbid history. She was admitted to emergency room with mild hemoptysis after a fall. Chest X-ray showed hyperdense image in the left lung apex, associated with contralateral mediastinal shift. She was treated with antibiotics and antitussives. She evolved with an episode of massive hemoptysis which was successfully treated with fluid resuscitation and blood transfusion. Chest computed tomography showed large thoracic aortic aneurysm with a maximum diameter of 10.8 cm…

Angiosarcoma cardíaco: una neoplasia infrecuente / Cardiac angiosarcoma: an infrequent neoplasia

Los tumores cardíacos son infrecuentes, siendo los más comunes los metastásicos. De los primarios, sólo el 25 por ciento son malignos, donde el angiosarcoma es el más frecuente. Este corresponde a un tumor de alto grado de malignidad, caracterizado por un rápido crecimiento, obstrucción de válvulas y metástasis principalmente pulmonares. Es más frecuente entre los 30 y 50años, especialmente en el género masculino, con una relación de2:1. Su clínica es de naturaleza cardiovascular inespecífica y su pronóstico es malo, con una supervivencia de entre nueve a doce meses a partir del diagnóstico. Presentación del caso: Paciente de género femenino, de 50 años de edad, con antecedentes de hipertensión arterial y artritis reumatoide. Consultó por disnea y deterioro de capacidad funcional. Ecocardiograma transtorácico mostró masa de seis centímetros de diámetro, que ocupa toda la aurícula derecha y que generaba obstrucción al flujo tricuspídeo, asociado a derrame pericárdico masivo con taponamiento cardíaco. Tomografía computada (TC) de cerebro, tórax, abdomen y pelvis descartan lesiones metastásicas. Se decidió conducta quirúrgica. Se resecó el tumor y el 70 por ciento de la pared libre de la aurícula y se instaló prótesis valvular biológica; con pericardio autólogo se reconstruyó la aurícula derecha. Evolucionó favorablemente, sin incidentes. Estudio histopatológico concluyó angiosarcoma cardíaco. Discusión: Los tumores cardíacos son infrecuentes. Se deben sospechar en pacientes con clínica cardiovascular, asociada a masa intracavitaria, derrame pericárdicono explicable por otra causa, así como la presencia de metástasis torácicas de un tumor primario desconocido...

Introduction: Cardiac tumors are rare; of them, the metastatic tumors are the most frequent. Of the primary tumors, only 25 percent are malignant, being the angiosarcoma the most common. It is a tumor of high malignancy, characterized by rapid growth, obstruction of cardiac valves and lung metastases. It is most common between 30 and 50 years, especially in men, with a ratio of 2:1. Its symptoms are nonspecific cardiovascular and its prognosis is poor, with a survival of nine to twelve months from diagnosis. Case report: A 50 years old woman with a history of hypertension and rheumatoid arthritis. She presented with dyspnea and impaired functional capacity. Transthoracic echocardiogram showed a mass of 6 cm in diameter, occupying the entire right atrium with tricuspid flow obstruction, associated with massive pericardial effusion with cardiac tamponade. Computed tomography (CT) of the brain, thorax, abdomen and pelvis discarded metastatic lesions. Surgical treatment was decided. The tumor and 70 percent of the free wall of the atrium were resected and biological prosthetic valve was installed, and the righ tatrium was reconstructed with autologous pericardium. She evolved favorably, without incident. Histopathological reports confirmed cardiac angiosarcoma. Discussion: Cardiac tumors are rare. They should be suspected in patients with cardiovascular symptoms, associated with intracavitary mass, pericardial effusion not explained by other causes, as well as the presence of thoracic metastases from an unknown primary tumor...

Lesión transfixiante de tronco arterial braquiocefálico por traumatismo torácico penetrante / Brachiocephalic trunk perforating injury by penetrating thoracic trauma

Las lesiones del tronco arterial braquiocefálico (TABC) son infrecuentes y se han descrito en el contexto de traumatismos penetrantes o contusos de la región torácica y cervical. Son características su elevada morbimortalidad y dificultad diagnóstica. PRESENTACIÓN DEL CASO: Paciente de género masculino, de 19 años, consultó en Servicio de Urgencia por heridas torácicas tras ser agredido por terceros con arma blanca. Ingresó sin deterioro hemodinámico encontrándose en examen físico una herida en la región esterno clavicular derecha y una herida en hemitórax izquierdo dorsal. Se realizó radiografía de tórax que mostró ensanchamiento mediastínico y hemotórax izquierdo mínimo. Por sospecha de lesión vascular se complementó estudio con angiotomografía computada de tórax que mostró doble extravasación del medio de contraste a nivel del TABC, compatible con lesión transfixiante, además de hemomediastino y hemotórax izquierdo mínimo, sin evidencias de lesión de vía aérea o esofágica. Se realizó pleurotomía para tratamiento del hemotórax. Evolucionó en buenas condiciones generales, sin deterioro hemodinámico, porlo que se decidió resolución endovascular por el equipo de Cirugía Vascular Periférica, realizándose instalación de endoprótesis recubierta en TABC, sin incidentes. No presentó complicaciones postoperatorias. Se realizó Angiotomografía de control con endoprótesis in situ. A 9 meses de seguimiento, el paciente está asintomático. DISCUSIÓN: Las lesiones del TABC son graves. El ensanchamiento mediastínico en la radiografía de tórax debe hacer sospechar lesión de grandes vasos y/o troncos supraaórticos, la que se confirma mediante estudio angiográfico en un paciente estable o en la exploración quirúrgica de urgencia, si presenta deterioro hemodinámico...

Brachiocephalic trunk lesions are rare and have been described in the context of penetrating or blunt thoracic and cervical trauma. They have a high morbidity and its diagnostic is difficult. CASE PRESENTATION: A 19 years oldman, presented in emergency room with chest injuries after being attacked with a knife. He entered without hemodynamic deterioration. In physical examination a wound in the right sternoclavicular region and a dorsal wound in the left hemithorax were found. Chest x-ray showed widened mediastinum and minimum left hemothorax. For suspected vascular injury, a chest computed angiotomography was performed, that revealed double extravasation of contrast medium at brachiocephalic trunk, consistent with a perforating injury, hemomediastinum and minimum left hemothorax. It showed no evidence of airway oresophageal injuries. Pleurotomy was performed for hemothorax treatment. He evolved in good general condition, without hemodynamic deterioration. Endovascular resolution was decided by Vascular Surgery team. A coated stent in the brachiocephalic trunk was installed without incidents. No postoperative complications were presented. The control angiotomography showed stent in situ. At 9 -month follow-up, the patient is asymptomatic. DISCUSSION: Brachiocephalic trunk injuries are serious. A injury of great vessels and/or supraaortic trunks should be suspected with a image of widened mediastinum on chest x ray, and it is confirmed by angiography in a stable patient or by emergency surgical exploration, if hemodynamic deterioration is present...