Ictericia colestásica neonatal: por quiste de colédoco en hospitaltipo III / Neonatal cholestatic jaundice: choledochal cyst in a type III hospital

La ictericia colestásica neonatal representa un grupo de desórdenes hepatobiliares, constituyendo urgencia médica. Un diagnóstico a descartar es el quiste coledociano. Su tratamiento es quirúrgico por asociación a colangiocarcinoma, existiendo otras complicaciones: daño hepático, pancreatitis aguda. Se presenta el primer caso clínico de quiste coledociano en el hospital de Parral, recinto tipo III. Lactante menor femenino con disminución de 10 por ciento del peso de nacimiento, ictericia leve hasta región inguinal, masa abdominal derecha. lmageneología muestra quiste coledociano 9x9x8cm, derivándose a centro terciario para abordaje quirúrgico, evolucionando en buenas condiciones. Se enfatiza conducta activa ante hiperbilirrubinemia neonatal por riesgo de etiología obstructiva.

Colecistectomía laparoscópica: experiencia en hospital tipo III: Hospital San José de Parral / Laparoscopic cholecystectomy: hospital type III experience

La colecistectomía laparoscópica (CL) es la técnica de elección en la litiasis vesicular. En el Hospital San José de Parral se inicia en marzo de 2005. El objetivo de este estudio es mostrar la experiencia durante estos 2 años con la CL en un hospital tipo III. Se realizó un estudio retrospectivo de pacientes operados con esta técnica desde marzo 2005 a marzo 2007. Se registraron: edad, sexo, estadía hospitalaria, complicaciones postoperatorias y conversiones. Además, se estudiaron 60 pacientes con colecistectomía clásica para realizar una comparación entre ambas técnicas. Fueron sometidos a CL 81 pacientes, siendo de estos un 95 por ciento de sexo femenino. La edad promedio fue 41 años (16-67 años). El promedio de hospitalizaciones fue 1 día, sin rehospitalizaciones. Existió una mayor estadía hospitalaria en colecistectomía clásica. El tiempo operatorio promedio fue 48 minutos (25-90 minutos). Se convirtió a cirugía abierta el 11 por ciento, destacándose como causas: síndrome adherencial y lecho sangrante. La única complicación postoperatoria fue un hemoperitoneo por falla de material. Como conclusión, la CL es el estándar de tratamiento en la colelitiasis, debido a sus ventajas respecto a la colecistectomía clásica. Hay mejor relación costo-efectividad, menor tiempo de hospitalización, integración rápida a su medio social y laboral, y mayor seguridad. En el Hospital San José de Parral, un recinto tipo III, se ha usado esta técnica durante 2 años, teniendo resultados óptimos comparables a nivel nacional e internacional.

Leucemia linfoma T del adulto en Chile: estudio clínico patológico y molecular de 26 pacientes / Adult T cell leukemia lymphoma in Chile: a clinical-pathological and molecular study of 26 patients

Background: Adult T cell leukemia lymphoma is a lymphoproliferative syndrome etiologically associated to human T cell lymphotropic virus type I. Aim: To describe the clinical and laboratory features of 26 caucasian chilean patients, with HTLV-I positive adult T-cell leukemia lymphoma (ATLL). Material and methods: Diagnostic criteria included clinical features, cell morphology, immunophenotype, HTLV-I serology and/or DNA analysis by southern blot or PCR. Results: According to the clinical presentation, 12 cases had the acute ATLL form, 6 had a lymphoma, 4 the chronic form and 4 had smoldering ATLL. The median presentation age was 50 years, younger than the Japanese patients, but significantly older than patients from other south american countries (eg Brasil, Jamaica, Colombia). The main clinical features: lymphadenopathy, skin lesions and hepatosplenomegaly, were similar in frequency to those of patients from other countries, except for the high incidence of associated neurological disease. Tropical spastic paraparesis (TSP) in our series of ATLL, was seen in one third of the patients (8/26). A T-cell immunophenotype was shown in all 26 cases and HTLV-I serology was positive in 25/26 patients. Molecular analysis on the seronegative patient showed clonal integration of proviral HTLV-I DNA into the lymphocytes DNA, and thus he may have been a poor responder to the retroviral infection. Proviral DNA integration was also demonstrated in 15/16 patients being clonal in 10, polyclonal in 3 (all smoldering cases) and oligoclonal in one. Conclusions: ATLL in Chile has similar clinical and laboratory features than the disease in other parts of the world, except for a younger age than japanese patients but older than those from other latin american countries and a high incidence of patients with associated TSP. Detailed morphological and immunophenotypic analysis of the abnormal circulating lymphocytes, together with the documentation of HTLV-I by serology and/or DNA analysis are key tests for the identification of this disease

Leucemia mieloide aguda MO: características clínicas y de laboratorio / Acute myeloid leukemia MO: clinical and laboratory features

Patients and methods: Eight patients, our of 368, with acute myeloid leukemia that were studied in the Hematology Laboratory of a public hospital in Santiago, were classified as LMA-MO. Results: Blast cell morphology was undifferentiated or of subtype FAB-L2 lymphoblastic leukemia with medium sized blasts, agranular basophilic cytoplasm, reticular nuclear chromatin and a prominent nucleolus. Cytochemical staining was negative for peroxidase and esterases, immunophenotyping showed the expression of one or more myeloid antigens (CD13, CD33) and was negative for lymphoid antigens. Immunocytochemical expression of myeloperoxidase was positive in the three cases where it was performed. Only one patient achieved complete remission and is free of disease after 36 months of follow up. All other patients died without obtaining remission, six shortly after the onser and one 12 months after. Conclusions: The diagnosis of LMA-MO is essential considering its dismal prognosis

Inmunofenotipo: características clínicas y laboratorio de la leucemia linfoblástica aguda en Chile: estudio de 500 niños y 131 adultos / Immunophenotype: clinical and laboratory characteristics of acute lymphoblastic leukemia in Chile: study of 500 children and 131 adults

We describe the clinical features and immunophenotype of 500 children and 131 adults with acute lymphoblastic leukemia (ALL), diagnosed between 1984 and 1993. Cases were classified according to immunophenotype in B-cell ALL accounted for 74 percent of cases and pro-B ALL was more common in children of less than 1 year (14 percent). B ALL was observed in 2 percent of children. Ten percent of children, mostly males, had T-cell ALL. The third part of these children had high leukocyte counts and a mediastinal mass. Children from Mapuche origin, compared with Caucasian had a lower proportion of common ALL (36 and 74 percent respectively) and a higher proportions of T-cell ALL (41 and 10 percent respectively). Among adults common ALL was the most common phenotype (72 percent) followe by T-cell ALL (15 percent), pro-B ALL (11 percent) and B-cell ALL (2 percent). There was a lower incidence of children with common ALL with positive cytoplasmatic immunoglobulin, compared to North American or European studies (2 and 15-33 percent respectively) and a higher proportion of adults with common ALL compared with pro-B cell ALL, in contrast to European studies that show a higher proportion of patients with pro-B cell ALL. No other immunophenotypic, clinical or laboratory differences were observed with ALL. No other immunophenotypic, clinical or laboratory differences were observed with ALL from developed countries. It is concluded that the immunophenotyping of ALL, allows a more precise diagnosis of this disease

Leucemia prolinfocítica, descripción de dos casos / Prolymphocytic leukemia, description of 2 cases

We present the clinical and laboratory features of 2 patients with B prolymphocitic leukemia. Both are females of the fith and seventh decade of life. One had the classical clinical picture of massive splenomegaly and a high white cell count, with characteristic prolymphocytes and the other was asymptomatic, with a low white cell count. The cells were positive to B cell lineage reagents with strong surface immunoglobuline (Ig) and unreactive to T cell antibodies. Analysis of Ig genes at the DNA level demonstrated that both cases had heavy-chain gene rearrangements, confirming the B-cell origin. These are the first patients of prolymphocytic leukemia described in Chile