Manejo endovascular de la isquemia crítica distal: análisis de una serie contemporánea

Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.

Inhalación masiva de amoniaco: reporte de dos casos / Massive ammonia inhalation: report of two cases

Ammonia (NH3) is an irritant and corrosive gas whose inhalation at high concentrations mainly occurs during agricultural and industrial activities, as occupational accidents. The extent and severity of the damage depends on the concentration and time of exposure to the toxic, which can cause skin, eye, respiratory and life-threatening injuries. We present two cases of patients acutely exposed to high concentrations of NH3. Both patients survived to the acute phase of the respiratory injury, but developed chronic lung derangements.

El amoniaco (NH3) es un gas irritante y corrosivo cuya inhalación aguda en altas concentraciones se produce principalmente durante accidentes laborales en el sector agrícola e industrial. La extensión y severidad del daño depende de la concentración y tiempo de exposición al tóxico, el cual puede causar lesiones a nivel cutáneo, ocular, respiratorio y riesgo vital. Presentamos dos casos de pacientes expuestos en forma aguda a NH3 en altas concentraciones. Ambos pacientes sobrevivieron a la fase aguda y evolucionaron con lesiones respiratorias crónicas.

Enfermedades respiratorias laborales en Chile: Ley 16.744 / Work related respiratory diseases in Chile – Law 16.744

Since 1968 Chile has two separate systems to manage the health problems of Chileans. One is devoted to prevent and care for all kind of diseases, from gestation to death, and the other one is devoted exclusively to work-related diseases and accidents. The last one has been very successful in lowering the work related accidents below 5 percent, rate that is similar to those of developed countries. The system has been replicated in other Latin-American countries. Occupational diseases, on the other hand, had been neglected by the system (although not in its design). The current article visit the most relevant aspects of the system and focus on the role of respiratory diseases specialists in the diagnosis and management of work related respiratory diseases.

Desde 1968 Chile cuenta con dos sistemas paralelos para manejar los problemas de salud de la población. Uno está orientado a prevenir y curar todo tipo de enfermedades, desde la gestación hasta la muerte; el otro está diseñado para preocuparse de las enfermedades y accidentes relacionados con la actividad laboral. Este último sistema ha sido muy exitoso en disminuir la accidentabilidad laboral, la que se ubica actualmente bajo el 5 por ciento, frecuencia similar a la observada en países desarrollados. Este sistema ha sido copiado en otros países de Latinoamérica. Las enfermedades ocupacionales han sido descuidadas por el sistema, aun cuando fueron adecuadamente consideradas en el cuerpo legal. El presente artículo presenta los aspectos más relevantes de este sistema y destaca el papel de los especialistas en enfermedades respiratorias en el diagnóstico y manejo de las enfermedades respiratorias ocupacionales.

Rendimiento de la fibrobroncoscopía en patología respiratoria: correlación entre patrón radiológico y positividad de la fibrobroncoscopía / Yield of fiber-bronchoscopy in respiratory pathology: correlation between the radiologic pattern and the fiber-bronchoscopy diagnosis

Se analizan, en forma prospectiva, 104 fibrobroncoscopias, realizadas en el Departamento de Enfermedades Respiratorias del Hospital San Juan de Dios, con el propósito de correlacionar el rendimiento de este procedimiento con el patrón radiológico. Se concluye que existe correlación entre la distribución radiológica y el diagnóstico final citohistológico de la broncoscopia

Amiloidosis sistémica primaria con compromiso pulmonar difuso: causa infrecuente de enfermedad intersticial: caso clínico / Diffuse lung involvement in primary amyloidosis as an infrequent cause of interstitial lung disease: report of one case

We report a 50 years old female, admitted to the hospital due to malaise lasting 7 months, with diffuse bilateral lung infiltrates and a progresive respiratory insufficiency, dying one month after admission. A transbronchial biopsy disclosed an extensive amyloid infiltration. The necropsy confirmed this finding and showed a systemic primary amyloidosis associated to a multiple myeloma

La ultraestructura de leishmania venezuelensis en humanos y gatos naturalmente infectados con leishmaniasis cutánea / The ultrastructure of leishmania venezuelensis in humans and cats naturally infected with cutaneous leishmaniasis

La ultraestructura de la Leishmania venezuelensis en humanos y gatos naturalmente infectados con leishmaniasis cutánea fue similar a la de otras especies conocidas de leishmania que producen enfermedad en humanos. Sin embargo, se observaron algunos hallazgos peculiares, tales como el diámetro promedio, el número y la distancia media entre los microtúbulos peliculares, la presencia de grandes megasomas, el desarrollo de vacuolas fagocíticas gigantes, la dispocisión de los túbulos en el corpúsculo parabasal, la presencia de microtúbulos por debajo de la membrana de la bolsa flagelar y la existencia de una organela excretoria en el polo posterior

El xenodiagnostico artificial en la enfermedad de Chagas. / Artificial xenodiagnosis in Chagas' disease

Se estudia una nueva tecnica de xenodiagnostico artificial, comparando la efectividad de diversos tipos de membranas y de anticoagulantes para favorecer la alimentacion, a temperatura ambiente, de ninfas de Rhodnius prolixus