How can we reduce maternal mortality due to preeclampsia? The 4P rule

Abstract In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention - Vigilant Prenatal Care - Timely Delivery (Parturition) - Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.

La consecución del funcionamiento psicológico pleno: la dimensión de crecimiento personal / Achieving full psychological functioning: the dimension of personal growth

Los grandes avances médicos logrados en las últimas décadas han posibilitado un inusitado aumento de la esperanza de vida en buena parte de la población mundial, especialmente en los países desarrollados. Sin embargo, este notable incremento de la salud física de las personas contrasta con las elevadas cifras de enfermedades mentales que asolan en numerosas sociedades contemporáneas. En aras de prevenir y reducir la alta incidencia de problemas de salud mental, en los últimos años estamos asistiendo a un creciente interés por el estudio científico de los recursos psicológicos personales como garante de un funcionamiento psicológico pleno. En consonancia con este planteamiento, numerosos enfoques psicológicos enfatizan la importancia de promover el desarrollo de las capacidades y potencialidades individuales, en la medida en que esta dimensión de crecimiento personal se erige en uno de los factores más genuinos y representativos del bienestar psicológico. El presente trabajo pretende profundizar en la comprensión de este pilar esencial del bienestar humano. En primer lugar, se realiza un sucinto recorrido histórico del constructo crecimiento personal, desde su pionera concepción aristotélica hasta su operativización por parte de psicólogos relevantes como Maslow, Rogers, Jung o Frankl, entre otros. Estas aportaciones conforman la raíz por la que se nutre la psicología contemporánea a la hora de explicar y definir este tópico. En concreto, y apoyándonos en diferentes teorías, enfoques y corrientes psicológicas ampliamente aceptadas en la actualidad, analizamos en este artículo aquellos recursos más estrechamente asociados al crecimiento personal, entre los que se encuentran la autodeterminación, el estado de fiujo, el mindfulness, la compasión y el capital psicológico.(AU)

The great medical advances achieved in the last decades have allowed an unusual increase in life expectancy in a large part of the world population, especially in developed countries. However, this remarkable improvement in the physical health of people contrasts with the high numbers of mental illnesses that plague in many contemporary societies. In order to prevent and reduce the high incidence of mental health problems, in recent years we are witnessing a growing interest in the scientific study of personal psychological resources as a guarantor of full psychological functioning. In line with this approach, numerous psychological proposals emphasize the importance of promoting the development of individual capacities and potentialities, to the extent that this dimension of personal growth stands as one of the most genuine and representative factors of psychological well-being. This paper aims to deepen the understanding of this core pillar of human well-being. Firstly, there is a brief historical journey of the personal growth construct, from its pioneering Aristotelian conception to its operationalization by relevant psychologists such as Maslow, Rogers, Jung or Frankl, among others. These contributions constitute the root for which contemporary psychology is nourished when explaining and defining this topic. In particular, and relying on different theories, approaches, and psychological currents widely accepted today, secondly, we analyze in this paper those resources most closely associated with personal growth, among which are self-determination, fiow, mindfulness, compassion, and psychological capital.(AU)

Mortalidade materna: perfil clínico e epidemiológico de uma maternidade pública do Amazonas / Maternal mortality: clinical and epidemiological profile of a public maternity hospital in Amazonas

Objetivo: Avaliar o perfil clínico e epidemiológico das mortes maternas ocorridas em uma maternidade pública de Manaus no período de janeiro de 2016 a dezembro de 2019. Métodos: Trata-se de um estudo do tipo descritivo e retrospectivo realizado a partir de dados contidos em prontuários médicos do Serviço de Arquivo Médico e Estatística (SAME) da Maternidade Ana Braga na cidade de Manaus-AM. A amostra foi constituída por pacientes admitidas na Maternidade Ana Braga e que evoluíram com óbito no ciclo gravídico puerperal, que consiste em grávidas, em trabalho de parto, que deram à luz ou que abortaram dentro de um período de até 42 dias. Resultados: Foram avaliados 29 prontuários de pacientes que foram a óbito no ciclo gravídico puerperal. Essas mulheres tinham entre 14 e 42 anos de idade. Quanto à escolaridade, 56,3% delas tinham ensino médio. Quanto à etnia, as mulheres negras e pardas representaram a maioria, as solteiras, o maior percentual. No óbito materno, observou-se que 10 mulheres realizaram menos de seis consultas pré-natal, a principal via de parto foi a cesariana e o choque séptico foi o mais prevalente como causa de morte. Conclusão: Esse resultado sugere a necessidade de avaliação do acesso oportuno das gestantes à assistência pré-natal, ao parto e ao puerpério adequada, além de melhorias na promoção de políticas públicas que busquem a redução da mortalidade materna.(AU)

Objective: To evaluate the clinical and epidemiological profile of maternal deaths that occurred in a public maternity hospital in Manaus from January 2016 to December 2019. Methods: This is a descriptive and retrospective study carried out based on data contained in medical records doctors from the Medical Archive and Statistics Service (SAME) of the Ana Braga Maternity Hospital in the city of Manaus-AM. The sample consisted of patients admitted to the Ana Braga Maternity Hospital and who died in the pregnancy-puerperal cycle, which consists of pregnant women, in labor, who gave birth or who aborted within a period of up to 42 days. Results: Were evaluated 29 records of patients who died in the pregnancy-puerperal cycle, these women were between 14 and 42 years old, and 56.3% had high school education. As for ethnicity, black and brown women represented the majority, single women the highest percentage. In maternal death, it was observed that 10 women had less than six prenatal consultations, the main mode of delivery was cesarean section and septic shock was the most prevalent cause of death. Conclusion: This result suggests the need to assess the timely access of pregnant women to adequate prenatal care, childbirth and postpartum care, in addition to improvements in the promotion of public policies that seek to reduce maternal mortality.(AU)

Psychometric properties of the Spanish version of the Patient Health Questionnaire-9 in users of the Ecuadorian public health care system

Introduction: Depression is one of the most prevalent public health problems worldwide and remains an underdiagnosed disease, especially in developing countries. The availability of instruments that permit detecting this problem is essential for reducing the burden of this disorder. The aim of this study was to examine the psychometric properties (factor structure, sex invariance, internal consistency, and convergent and divergent validity) of the Spanish version of the PHQ-9 (Patient Health Questionnaire-9). Method: A sample of 366 public hospital users in Ecuador was recruited and accordingly completed a survey that included sociodemographic data, the PHQ-9, and other standards of measurement such as the Beck Depression Inventory-II (BDI-II), the Generalised Anxiety Disorder Scale (GAD-7), the Positive and Negative Affect Scale (PANAS), and the Quality-of-Life Index (QLI). Results: The unidimensional factor model of the PHQ-9 provided the best fit for the data. The PHQ-9 assesses depressive symptoms equivalently in both sexes, and presents high internal consistency, as well as good convergent and divergent validity with the other constructs. Conclusion: The application of the PHQ-9 could aid in the screening of patients with depressive symptomatology in the Ecuadorian public health system (EPHS).

Introducción: La depresión es uno de los problemas de salud pública más prevalentes a nivel mundial, y suele ser subdiagnosticada especialmente en países en vías de desarrollo. Contar con instrumentos que permitan realizar un cribado de este problema es fundamental para reducir el costo de este trastorno. El objetivo de este artículo fue examinar las propiedades psicométricas (estructura factorial, invarianza en función del sexo, consistencia interna, validez convergente y divergente) de la versión española del PHQ-9 (Patient Health Questionnaire-9). Método: Se reclutó una muestra de 366 usuarios de un hospital público en Ecuador, los cuales respondieron una encuesta que incluía datos sociodemográficos, el PHQ-9, el inventario de depresión de Beck-II (BDI-II), la Escala de Trastorno de Ansiedad Generalizada-7 (GAD-7), la Escala de Afecto Positivo y Negativo (PANAS), y el índice de calidad de vida (QLI). Resultados: El modelo unidimensional del PHQ-9 proporcionó mejor ajuste de los datos. El PHQ-9 evalúa síntomas depresivos de forma equivalente en ambos sexos y presenta una elevada consistencia interna, así como una buena validez convergente y divergente con el resto de los constructos. Conclusión: La administración del PHQ-9 podría apoyar el cribado de pacientes con sintomatología depresiva en el sistema público de salud ecuatoriano (SSPE).

Pictorial size perception in schizophrenia

In this study, we compared visual pictorial size perception between healthy volunteers (CG) and an experimental group (EG) of people diagnosed with schizophrenia. We have been using paintings by Salvador Dalí and Rorschach plates to estimate visual pictorial size perception. In this transversal, ex post facto, and quasi-experimental study, we observed differences between EG and CG. Schizophrenic in-patients perceived sizes about 1.3-fold greater than healthy volunteers (p=0.006), implying that pictorial size perception is altered in some way in schizophrenia. Considering the present and previous results, this measurement of diameter size of first pictorial perception may be a useful estimate of some aspects of perceptual alterations that may be associated with psychotic symptoms in prodromal and acute schizophrenic episodes and other related mental states. Eventually, this may help in preventing people from evolving to acute episodes.

Avaliação das condições higiênico-sanitárias no açougue de um hipermercado em um município da baixada santista / Evaluation of hygienic-sanitary conditions in the butcher of a hypermarket in a municipality of baixada santista

As boas práticas nos serviços de alimentação são imprescindíveis para a garantia de qualidade e segurança dos alimentos. Objetivou-se nesta pesquisa avaliar as condições higiênico-sanitárias de um açougue em hipermercado no município de Guarujá-SP. O estudo de caráter observacional foi realizado in loco, e teve como ferramenta de pesquisa o check-list baseado nas portarias RDC 275/2002 e RDC 216/2004 da ANVISA, e logo após a avaliação foi coletado dez amostras dos principais pontos críticos do setor para análise microbiológica. Observou-se no estabelecimento que, mesmo atendendo uma grande porcentagem de conformidades em relação às boas práticas, foram detectadas dez amostras positivas para diversas bactérias Gram ­ e Gram +, o que pode representar risco eminente à segurança dos alimentos

Good practices in food services are essential for quality assurance and food safety. The objective of this research was to evaluate the hygienic-sanitary conditions of a butcher shop in a hypermarket in Guarujá-SP. The observational study was carried out on site, and had as research tool the checklist based on ANVISA RDC 275/2002 and RDC 216/2004, and shortly after the evaluation was collected ten samples of the main critical points of the sector. for microbiological analysis. It was observed that even meeting a high percentage of compliance with good practices, the establishment presented the ten positive samples for several gram ­ and gram + bacteria which may represent an imminent risk to food safety

Avaliação das condições higiênico-sanitárias no açougue de um hipermercado em um município da Baixada Santista / Evaluation of hygienic-sanitary conditions in the butcher of a hypermarket in a municipality of Baixada Santista

As boas práticas nos serviços de alimentação são imprescindíveis para a garantia de qualidade e segurança dos alimentos. Objetivou-se nesta pesquisa avaliar as condições higiênico-sanitárias de um açougue em hipermercado no município de Guarujá-SP. O estudo de caráter observacional foi realizado in loco, e teve como ferramenta de pesquisa o check-list baseado nas portarias RDC 275/2002 e RDC 216/2004 da ANVISA, e logo após a avaliação foi coletado dez amostras dos principais pontos críticos do setor para análise microbiológica. Observou-se no estabelecimento que, mesmo atendendo uma grande porcentagem de conformidades em relação às boas práticas, foram detectadas dez amostras positivas para diversas bactérias Gram – e Gram +, o que pode representar risco eminente à segurança dos alimentos.

Good practices in food services are essential for quality assurance and food safety. The objective of this research was to evaluate the hygienic-sanitary conditions of a butcher shop in a hypermarket in Guarujá-SP. The observational study was carried out on site, and had as research tool the checklist based on ANVISA RDC 275/2002 and RDC 216/2004, and shortly after the evaluation was collected ten samples of the main critical points of the sector. for microbiological analysis. It was observed that even meeting a high percentage of compliance with good practices, the establishment presented the ten positive samples for several gram – and gram + bacteria which may represent an imminent risk to food safety.

Time spent and time management in homework in elementary school students: a person-centered approach / Tiempo y gestión del tiempo dedicado a los deberes en Educación Primaria: un enfoque centrado en la persona

BACKGROUND: Based on a person-centered approach, the aim ofthis study is to identify different profiles of students based on the time they spend on homew he differences between them in the amount of homework done and academic achievement. METHOD: With a sample of 968 students of Primary Education analysis of latent profiles (LPA) and ANOVA were carried out. Once the student profiles were identified, a MANOVA was conducted to analyze the differences between the motivational profiles in the amount of homework assignments done and in academic achievement. RESULTS: We differentiated four profiles of students that differentially combine the time they dedicate to their homework and the use they make of that time. CONCLUSIONS: Of the profiles identified, two can be considered more effective (those that manage time better), and two can be classified as less effective (those that manage time worse). The two profiles that best manage the time spent on homework are also those that do the most homework, and have higher academic achievement. Likewise, the two profiles of students who manage time worst are those who do the least homework, and who have lower academic achievement

ANTECEDENTES: partiendo de un enfoque centrado en la persona, el propósito de este trabajo es identificar diferentes perfiles de estudiantes en función del tiempo que dedican a los deberes escolares y de la gestión que hacen de ese tiempo; así como también analizar las diferencias entre ellos en la cantidad de deberes realizados y en el rendimiento académico. MÉTODO: con una muestra de 968 estudiantes de Educación Primaria, se llevaron a cabo análisis de perfiles latentes (LPA) y ANOVA. Una vez identificados los perfiles de estudiantes se realizó un MANOVA para analizar las diferencias entre los perfiles motivacionales en la cantidad de deberes realizados y en el rendimiento. RESULTADOS: se han podido diferenciar cuatro perfiles de estudiantes que combinan de manera distinta el tiempo que dedican a los deberes y la gestión que hacen de ese tiempo. CONCLUSIONES: de los perfiles identificados, dos pueden considerarse más eficaces (los que gestionan mejor el tiempo) y otros dos pueden catalogarse como menos eficaces (los que gestionan peor el tiempo). Los dos perfiles que gestionan mejor el tiempo son también los que realizan más cantidad de deberes y tienen un rendimiento académico más alto; y los dos que gestionan peor el tiempo son los que realizan menos cantidad de deberes y tienen un rendimiento académico más bajo

Perfiles de self-handicapping y autoestima y su relación con las metas de logro / Profiles of self-handicapping and self-esteem, and its relationship with achievement goals

El presente trabajo pretende profundizar en el conocimiento del self-handicapping académico. Dos son los objetivos de este estudio: (a) identificar posibles perfiles de estudiantes a partir de la combinación del self-handicapping (conductual y alegado) y la autoestima; y (b) analizar las diferencias entre estos perfiles en cuanto a sus metas de logro (aprendizaje, aproximación al rendimiento, evitación del rendimiento y evitación del trabajo). Participaron en la investigación 1028 estudiantes universitarios. Para la obtención de los perfiles se realizó un análisis de perfiles latentes. Las diferencias entre perfiles en las metas de logro se analizaron mediante un MANCOVA, tomando como covariables el género y el curso. Se obtuvieron cinco perfiles de estudiantes: BA/ASH (baja autoestima y alto self-handicapping); BA/ASHA (baja autoestima y alto self-handicapping alegado); BA/ASHC (baja autoestima y alto self-handicapping conductual); MA/MSH (moderada autoestima y moderado self-handicapping); y MA/BSH (moderada autoestima y bajo self-handicapping). Estos perfiles se diferenciaron entre sí significativamente en cuanto a sus metas de logro. Los resultados de este trabajo contribuyen a la comprensión de las características motivacionales de los estudiantes self-handicappers. Dado lo disfuncional que resultan estas estrategias, se plantean algunas pautas psicoeducativas dirigidas a la prevención del self-handicapping en el contexto académico

The present work aims to deepen the knowledge of academic self-handicapping. This study has two objectives: a) to identify different profiles of students according to the combination of self-handicapping (behavioral and claimed) and self-esteem; and (b) to analyze the differences between these profiles in the use of achievement goals (learning, performance-approach, performance-avoidance, and work-avoidance). 1,028 university students participated in the research. Latent profile analysis was applied to obtain the profiles. We conducted a MANCOVA to examine the differences between profiles in achievement goals. Gender and course were estimated as covariates. Five student profiles were obtained: LSE/HSH (low self-esteem and high self-handicapping); LSE/HCSH (low self-esteem and high claimed self-handicapping); LSE/HBSH (low self-esteem and high behavioral self-handicapping); MSE/MSH (medium self-esteem and medium self-handicapping); and MSE/LSH (medium self-esteem and low self-handicapping). These profiles differed significantly from each other in terms of their achievement goals. The results of this study contribute to understanding the motivational characteristics of self-handicappers students. Given the dysfunctional nature of these strategies, some psychoeducational guidelines are proposed for the prevention of academic self-handicapping

Academic goals and self-handicapping strategies in university students

In highly competitive settings like university, the fear of failure leads some students to protect their self-worth using self-handicapping strategies. The present investigation examines to what extent academic goals are related to those tactics in university students. Specifically, MANCOVA was applied to estimate statistical differences linked to behavioral and claimed self-handicapping strategies according to the level (high/medium/low) of four types of academic goal (achievement approach, achievement avoidance, mastery approach, and work avoidance). Degree, year in school, and gender were entered as covariates. 940 students (86.5% women) from University of A Coruña (M = 20.44; SD = 1.73) participated. Results show that: (a) both behavioral and claimed self-handicapping are promoted by egooriented goals (achievement avoidance, F(2, 937) = 23.56, p < .001, ηp 2 = .048; achievement approach, F(2, 937) = 7.49, p < .001, ηp 2 = .016); (b) work avoidance goals are related to behavioral self-handicapping (F(2, 937) = 9.09, p < .001, ηp 2 = .019), but are not statistically linked to claimed self-handicapping; and (c) mastery approach goals are significantly, negatively related to both types of self-handicapping (F(2, 937) = 20.09, p < .001, ηp 2 = .041). Psychological and educational implications of the findings are discussed (AU)

No disponible

Derrame pleural neoplásico: diagnóstico e tratamento / Malignant pleural effusion: diagnosis and treatment

Aproximadamente 10 por cento de todos os pacientes com câncer apresentam derrame pleural durante a evoluçäo de sua doença. Dos pacientes com câncer disseminado, 50 por cento iräo apresentar derrame pleural. Em 65 por cento das vezes os derrames pleurais neoplásicos ocorrem em mulheres devido à maior incidência dos cânceres de mama e ginecológico. Considerando todos os derrames pleurais constituídos por exsudato, 24 a 50 por cento säo secundários a doenças malignas. A distinçäo entre o derrame pleural neoplásico e derrames pleurais de outras etiologias é de fundamental importância, devendo a conduta terapêutica ser a mais específica possível. Säo considerados os aspectos relevantes no diagnóstico, diagnóstico diferencial e tratamento dos derrames pleurais neoplásicos.

Prevalencia de lesiones premalignas y malignas del cérvix uterino. conocimientos, actitudes y prácticas en las mujeres residentes en el área de salud de Guamaní / Prevalencia of injuries premalignas and you vitiate of the uterine cervix: knowledge and practicas attitudes in the resident women in the area of Guamani health

El cáncer del cuello uterino es el tumor maligno que con mayor frecuencia afecta a las mujeres de la ciudad de Quito. El Registro Nacional de Tumores publicado por SOLCA arroja una tasa truncada de incidencia de 34,0 por 100 000 habitantes, ocupando el quinto lugar en Latinoamérica después de Perú, Brasil, Paraguay y Colombia. En el período 1985-1994, la razón entre tumor IN SITU: INVASOR no ha experimentado cambios importantes; esta neoplasia se identifica principalmente con la pobreza. Con la finalidad de medir la prevalencia de lesiones premalignas y malignas del cérvix uterino y su relación con factores de riesgo en una población pobre, se realizó un estudio transversal desde el 10 de junio de 1996 al 23 de junio de 1997, a 3 009 mujeres mayores a los 19 años de edad y residentes en el Area de Salud de Guamaní. Con anterioridad, en esta misma área a 574 moradoras se determinaron las actitudes, conocimientos, creencias y prácticas sobre el cáncer del cuello uterino y el examen de Papanicolaou; lo que permitió identificar que el 50 por ciento de ellas desconocían la verdadera utilidad del examen, además de ignorar la existencia de métodos de detección precoz del cáncer. También es necesario anotar que el 60 por ciento de este conjunto de mujeres no acudían a los servicios de salud pública cuando se sentían enfermas. Para determinar el número de encuestas a aplicar, se utilizó la fórmula de muestreo aleatorio simple, y la muestra se asignó a través de la atención en cada una de las unidades de salud del Area. La edad media en las 3 009 mujeres estuvo en 33,2 años, el 76,73 por ciento de éstas expresaron que fueron econónicamente inactivas y el 24 por ciento de escolaridad baja (centro de alfabetización, primaria incompleta y analfabetas). A base de un examen de histología se ratificó una prevalencia de 2,3 por ciento de lesiones preinvasivas (1,5 por ciento de LIEBG, 0,8 por ciento de LIEAG) y 0,23 por ciento de cáncer invasor. La edad promedio en las LIEBG fue de 32,8 años, en las LIEAG, 36,4 años; y, el cáncer invasor se manifestó a los 58,5 años. Hubo prevalencias más altas con diferencias estadísticamente significativas al comparar el grupo de 35 a 49 años de edad con el de 20 a 34 años (3,5 por ciento vs 1,9 por ciento) (p=0,009), y, entre el grupo de 50 o más años con el de 20 a 34 años (4 por ciento vs 1,9 por ciento)(p=0,05)...

Neutrófilos de baixa densidade em pacientes com câncer / Low density neutrophils in patients with cancer

Em 16 portadores de neoplasia maligna, 11 de mama e cinco de pulmäo, estudou-se a distribuiçäo de células obtidas por centrifugaçäo do sangue periférico em gradientes de Ficoll-Hypaque com densidades crescentes, de 1,050 a 1,200. Pacientes com neoplasias malignas, em vigência de poliquimioterapia e/ou radioterapia, apresentaram diminuiçäo no percentual de linfócitos e aumento no percentual de neutrófilos, com conseqüente diminuiçäo na relaçäo entre linfócitos e neutrófilos (L/N), quando se analisou a distribuiçäo de células obtidas em todas as densidades estudadas. Estas alteraçöes decorrem da diminuiçäo na densidade de neutrófilos, provavelmente como conseqüência da ativaçäo destas células. A "contaminaçäo" do material obtido por centrifugaçäo em gradiente com d = 1,076 näo tem sido considerada em muitos estudos sobre funçöes de linfócitos, neutrófilos e monócitos em pacientes com neoplasias malignas, podendo-se questionar resultados obtidos quando o grau de homogeneidade das células separadas näo foi avaliado.

Effect of glucan immunotherapy on monocyte phagocytic activity and delayed hypersensitivity skin tests in patients with carcinoma

Glucan, a linear beta-1,3 polyglucose moiety derived from the inner cell wall of Saccharomyces cerevisiae, has been demonstrated to be a potent immunomodulator agent with anti-tumor, anti-infectious and haematopoietic stimulating properties in laboratory animals. In this study, patients with carcinoma received bi-weekly infections of glucan SC (18 patients), IV (11 patients and were compared with 11 patients as a control group. There was significant (p<0.05) increase in the number of delayed hypersensitivity positive skin tests with ubiquitous antigens after 4 months in treated patients. Macrophage activity, as evaluated by the capacity to ingest zymosan or zymosan-C3 particles, was depressed at the beginning of treatment and increased significantly (p<0.05) after 3 months of SC or 6 months of IV glucan administration. Theses results encourage further studies on the clinical usefulness of glucan as an adjuvant in human cancer immunotherapy.

Linfoma no Hodgkin del esofago

Background. The Hodgkin Lynphonas and not Hodgkin ones sometimes involucrate the mediastinum with some frecuency associate with sistemic disease and even so its rarely that this disorders may appear with symptoms referred to in the anatomic site. The disphagia due to the esophagus in some cases the lymphomas not Hodkin is considered the rare appears as on odd case of the illness. Method: in case of malignant lyphoma is described with presence of the esopahagus in a man 61 years old with progresive disphagia compromisig the esophagus, with 9 months of evolution thoegth the structure of esophagus. Endoscopaly and radiologicall qualyfied as peptic; left supraclaviculary limpth node, esophagus-bronchial fistula and asophagus-mediastinic. He was checked by swallowed barium and endoscopy, as well as, biopsy of ganglios disease, TAC of the torax and accepting Dawson opinion to define primary or secondary lymphoma. Results: the TAC of the torax showed a tumoral process in the 3rd. or inferior section of the esophagus and esophagus-bronchial fistula, as well as, mediastinic-esophagus. The hitopatology of biopsy of supraclavicular ganglio and lasser curvature ganglio of stomach showed: lymphama not Hodgkin of higt grade of malignity limphoblastic type but not convoluting (W.F.). Conclusions the first case of lymphoma not Hodgkin with on affection of the esophagus, primary appearance to dyshagia appears in SOLCA s Hospital in Quito.