Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis.

BACKGROUND: Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. CASE PRESENTATION: We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. CONCLUSION: Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.

Hacia una reinterpretación de la ciencia normal: Kuhn y la física de su tiempo (1940-1951) / Towards a reinterpretation of Normal Science: Kuhn and the Physics of his time (1940-1951)

Este artículo habla de la experiencia de Thomas Kuhn como físico: su educación en la disciplina,su servicio como experto durante la Segunda Guerra Mundial, y su investigación doctoral.Estudiamos un lapso de tiempo que va de 1940 a 1951. El objetivo en última instancia es ofrecerbase empírica para valorar una afirmación como la de Mara Beller (1999), que dice que la descripciónkuhniana de la ciencia normal está parcialmente basada en circunstancias y experiencias personales,no sólo en los datos históricos o en la evidencia disponible de la sociología de la ciencia.En este artículo se establece que dicha tesis es plausible(AU)

This paper deals with Thomas Kuhn’s experience as a physicist — his training in the field, hisbrief period as a physicist during World War II, and his doctoral research — from 1940 to 1951. Itsaim is to offer a basis to assess statements as Mara Beller’s (1999) that Kuhn’s account of normalscience is partially founded on personal circumstances and experience, and not only on the historicalrecord or available evidence from the sociology of science — a thesis here considered highlycredible(AU)