Linfoma esofágico primário / Primary esophageal lymphoma

We describe the case of a 54 year old woman seen with an esophageal mass diagnosed as a primary esophageal lymphoma. The main symptom was dysphagia of seven months duration. The treatment consisted in resection of the tumor, and reconstruction of the defect with a reversed pleural flap, followed by a chemotherapy regimen that consisted of five drugs, cyclophosphamid, prednisone, doxorubicin, rituximab and vincristine (R-CHOP). The patient developed an esophageal pleural fistula treated with pleural drainage and irrigation that closed in 45 days. Two and one half years later she is doing well and disease free.

Pathological and ultrastructural analysis of surgical lung biopsies in patients with swine-origin influenza type A/H1N1 and acute respiratory failure

BACKGROUND: Cases of H1N1 and other pulmonary infections evolve to acute respiratory failure and death when co-infections or lung injury predominate over the immune response, thus requiring early diagnosis to improve treatment. OBJECTIVE: To perform a detailed histopathological analysis of the open lung biopsy specimens from five patients with ARDS with confirmed H1N1. METHODS: Lung specimens underwent microbiologic analysis, and examination by optical and electron microscopy. Immunophenotyping was used to characterize macrophages, natural killer, T and B cells, and expression of cytokines and iNOS. RESULTS: The pathological features observed were necrotizing bronchiolitis, diffuse alveolar damage, alveolar hemorrhage and abnormal immune response. Ultrastructural analysis showed viral-like particles in all cases. CONCLUSIONS: Viral-like particles can be successfully demonstrated in lung tissue by ultrastructural examination, without confirmation of the virus by RT-PCR on nasopharyngeal aspirates. Bronchioles and epithelium, rather than endothelium, are probably the primary target of infection, and diffuse alveolar damage the consequence of the effect of airways obliteration and dysfunction on innate immunity, suggesting that treatment should be focused on epithelial repair.

The reversed gastric tube revisited: a useful esophageal replacement for benign disease

Although spaning long esophageal defects using a reversed tube of the greater curvature has been available for nearly a century, frequent complications relegated the method to the shelf for much of the period. This revists the technique in the modern setting. The esophagus, plus or minus, the pharynx was replaced in 80 patientes using a revrsed gastric tube. Patientes with cancer were excluded. Sixty-five had caustic stenosis, including 44 patients with acute perforation and 15 with burns of the pharymx and stomach. Follow-up was two months to 15 yars. Using criteria suggested by Visick et al, 44 patients ( 58.6 por cento ) had no Symptoms; 20 ( 26.6 por cento ) had mild complaints, and eight individuals ( 10.6 por cento ) had frequent or severe symptoms. The operation itseft caused three deaths ( 3.7 por cento ). A reversed gastric tube can safely replace the entire esophagus and pharynx. With 85.2 por cento of 75 patients evaluated showing good to excellent results and hospital mortality of 3.7 por cento. We believe this operation can take its place alongside of other established techniques