miR-430 microRNA Family in Fishes: Molecular Characterization and Evolution.

The miR-430 microRNA family has been described in multiple fish species as one of the first microRNAs expressed by the zygote. It has been suggested that this family is implicated in maternal mRNA elimination, but may also play a role in steroidogenesis, sexual differentiation, and flatfish metamorphosis. The miR-430 sequences have been found in multiple-copy tandem clusters but evidence of their conservation outside of teleost fishes is scarce. In the present study, we have characterized the tandem repeats organization of these microRNAs in different fish species, both model and of interest in aquaculture. A phylogenetic analysis of this family has allowed us to identify that the miR-430 duplication, which took place before the Chondrostei and Neopterygii groups' divergence, has resulted in three variants ("a", "b", and "c"). According to our data, variant "b" is the most closely related to the ancestral sequence. Furthermore, we have detected isolated instances of the miR-430 repeat subunit in some species, which suggests that this microRNA family may be affected by DNA rearrangements. This study provides new data about the abundance, variability, and organization of the miR-430 family in fishes.

Chronic toxicity of shrimp feed added with silver nanoparticles (Argovit-4®) in Litopenaeus vannamei and immune response to white spot syndrome virus infection.

In recent years, the application of silver nanoparticles (AgNPs) as antibacterial compounds has been widely used in human and veterinary medicine. In this work, we investigated the effects of AgNPs (Argovit-4®) as feed additives (feed-AgNPs) on shrimp (Litopenaeus vannamei) using three different methods: 1) chronic toxicity after 28 days of feeding, 2) Effects against white spot syndrome virus (WSSV) challenged by oral route, and 3) transcriptional responses of immune-related genes (PAP, ProPO, CTL-3, Crustin, PEN3, and PEN4) following WSSV infection. The results showed that the feed-AgNPs did not interfere with the growth and survival of shrimp. Also, mild lesions in the hepatopancreas were recorded, proportional to the frequency of the feed-AgNP supply. Challenge test versus WSSV showed that feeding every 7 days with feed-AgNPs reduced mortality, reaching a survival rate of 53%, compared to the survival rates observed in groups fed every 4 days, daily and control groups of feed-AgNPs for the 30%, 10%, and 7% groups, respectively. Feed-AgNPs negatively regulated the expression of PAP, ProPO, and Crustin genes after 28 days of treatment and altered the transcriptional responses of PAP, ProPO, CTL-3, and Crustin after WSSV exposure. The results showed that weekly feeding-AgNPs could partially prevent WSSV infection in shrimp culture. However, whether or not transcriptional responses against pathogens are advantageous remains to be elucidated.

Genome Sequences of 408 SARS-CoV-2 Strains Obtained from Nasopharyngeal Swabs in La Araucanía Region, Southern Chile.

Here, we announce the genome sequences of 408 strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) obtained from nasopharyngeal swabs in the Araucanía Region, Southern Chile. The genomes obtained are valuable to expand the availability of useful genomic data for future epidemiological studies of SARS-CoV-2 in Chile and worldwide.

Tumor fibroso solitario de la pleura / Solitary fibrous tumor of the pleura

El tumor fibroso solitario de la pleura (TFSP) representa una neoplasia benigna de evolución habitualmente silente, hallazgo incidental y heterogeneidad en su presentación. Raramente se malignizan y la sintomatología se relaciona fundamentalmente con el compromiso por compresión de las estructuras vecinas. Su tratamiento es la cirugía. Se describe el caso de un paciente masculino de 49 años con antecedentes de hipertensión arterial, diabetes mellitus y obesidad que consultó al Servicio de urgencias por disnea. Se solicitó tomografía de tórax que evidenció voluminosa masa de densidad de partes blandas en hemitórax izquierdo con desplazamiento del mediastino y descenso del diafragma del mismo lado. La fibrobroncoscopia no evidenció lesión endoluminal. Fue evaluado por Cirugía del Tórax. Se realizó abordaje de la masa mediante toracotomía postero lateral izquierda. El estudio anatomopatológico informó formación tumoral de 25 × 16 × 13 cm, peso de 1905 gr y en la microscopía se describió proliferación celular fibroblástica, células fusiformes de núcleos pequeños ovoides y escaso citoplasma dispuestas en haces desordenados con colágeno interpuesto. La inmunohistoquímica informó vimentina y CD34 positivos. Se realizó el diagnóstico de tumor fibroso solitario de la pleura. La evolución posterior fue buena.

The solitary fibrous tumor of the pleura (SFTP) represents a benign neoplasm of commonly silent evolution, incidental finding and heterogeneous presentation. It rarely becomes malignant and symptoms mainly result from the involvement of neighboring structures due to compression. It is treated with surgery. We describe the case of a 49-year-old male patient with history of arterial hypertension, diabetes mellitus and obesity who consulted the Emergency Services because he was experiencing dyspnea. We requested chest tomography that showed a voluminous soft tissue density mass in the left hemithorax with mediastinal shift and decreased diaphragm on the same side. The fibrobronchoscopy didn't show endoluminal lesion. The patient was evaluated by the Thorax Surgery staff. The mass was treated by means of left posterolateral thorachotomy. The anatomopathological study reported the formation of a tumor of 25 × 16 ×13 cm and 1905 gr, and the microscopy described fibroblast cell proliferation, spindle cells of small ovoid nuclei and very little cytoplasm placed in disorganized bundles with collagen interposition. The immunohistochemistry disclosed positive vimentin and CD34. The patient was diagnosed with solitary fibrous tumor of the pleura, with good subsequent evolution.

Silver nanoparticles induce histopathological alterations in juvenile Penaeus vannamei.

The objective of this study was to evaluate the histopathological alterations in juvenile Penaeus vannamei caused by silver nanoparticles (AgNPs) for two types of experiments: at sublethal concentrations of 3.6 to 7.1 µg/µL of metallic silver (Ag) for a short period up to 72 h and for 2.6 to 7.9 µg of Ag/µL for the long period up to 264 h. The severity degree of the changes was evaluated and the histopathological index (Hi) was determined in both experiments using the necrosis (cellular dead) as an indicator. The pathological changes in the striated muscle, gills, antennal gland, circulatory system, heart, lymphoid organ, and connective tissue are described. The histopathological effects were similar for the two experiments without a direct relationship with the concentrations. In the short-term experiment, the values of Hi were higher (2.34 ± 0.41 at 48 hpi and 1.91 ± 0.39 at 72 hpi) compared with the long-term experiment (values between 0.57 ± 0.36 to 1.74 ± 0.57 at 264 hpi). The observed pathologies are similar to those caused by other metals, with the exception of the agglomerations of black particles in the gills, lymphoid organ, and muscle, which has not been previously reported. This work shows that silver nanoparticles cause damage to shrimp in sublethal concentrations.

Evaluation of a new Argovit as an antiviral agent included in feed to protect the shrimp Litopenaeus vannamei against White Spot Syndrome Virus infection.

In this study, four experimental assays were conducted to evaluate the use of a new silver nanoparticle formulation named Argovit-4, which was prepared with slight modifications to enhance its biological activity against white spot syndrome virus (WSSV) in shrimp culture. The goals of these assays were to (1) determine the protective effect of Argovit-4 against WSSV, (2) determine whether Argovit-4 supplemented in feed exhibits toxicity towards shrimp, (3) determine whether Argovit-4 as antiviral additive in feed can prevent or delay/reduce WSSV-induced shrimp mortality, and (4) determine whether Argovit-4 supplemented in feed alters the early stages of the shrimp immune response. In bioassay 1, several viral inocula calibrated at 7 SID50(shrimp infectious doses 50% endpoint) were exposed to 40, 100, 200 and 1,000 ng/SID50 of Ag+ and then intramuscularly injected into shrimp for 96 h. In bioassay 2, shrimp were fed Argovit-4 supplemented in feed at different concentrations (10, 100 and 1,000 µg per gram of feed) for 192 h. In bioassay 3, shrimp were treated with Argovit-4 supplemented in feed at different concentrations and then challenged against WSSV for 192 h. In bioassay 4, quantitative real-time RT-qPCR was performed to measure the transcriptional responses of five immune-relevant genes in haemocytes of experimental shrimp treated with Argovit-4 supplemented in feed at 0, 6, 12, 24 and 48 h. The intramuscularly injected Argovit-4 showed a dose-dependent effect (p < 0.05) on the cumulative shrimp mortality from 0-96 h post-infection. In the second bioassay, shrimp fed Argovit-4 supplemented in feed did not show signs of toxicity for the assayed doses over the 192-h experiment. The third and fourth bioassays showed that shrimp challenged with WSSV at 1,000 µg/g feed exhibited reduced mortality without altering the expression of some immune system-related genes according to the observed level of transcriptional. This study is the first show that the new Argovit-4 formulation has potential as an antiviral additive in feed against WSSV and demonstrates a practical therapeutic strategy to control WSSV and possibly other invertebrate pathogens in shrimp aquaculture.

Silver nanoparticles enhance survival of white spot syndrome virus infected Penaeus vannamei shrimps by activation of its immunological system.

The global aquaculture has shown an impressive growth in the last decades contributing with a major part of total food fish supply. However, it also helps in the spread of diseases that in turn, causes great economic losses. The White Spot Syndrome Virus (WSSV) is one of the major viral pathogen for the shrimp aquaculture industry. Several attempts to eliminate the virus in the shrimp have been addressed without achieving a long-term effectiveness. In this work, we determine the capacity of the commercial non-toxic PVP-coated silver nanoparticles to promote the response of the immune system of WSSV-infected shrimps with or without an excess of iron ions. Our results showed that a single dose of metallic silver in the nanomolar range (111 nmol/shrimp), which is equivalent to 12 ng/mL of silver nanoparticles, produces 20% survival of treated infected shrimps. The same concentration administered in healthy shrimps do not show histological evidence of damage. The observed survival rate could be associated with the increase of almost 2-fold of LGBP expression levels compared with non-treated infected shrimps. LGBP is a key gene of shrimp immunological response and its up-regulation is most probably induced by the recognition of silver nanoparticles coating by specific pathogen-associated molecular pattern recognition proteins (PAMPs) of shrimp. Increased LGBP expression levels was observed even with a 10-fold lower dose of silver nanoparticles (1.2 ng/shrimp, 0.011 nmol of metallic silver/shrimp). The increase in LGBP expression levels was also observed even in the presence of iron ion excess, a condition that favors virus proliferation. Those results showed that a single dose of a slight amount of silver nanoparticles were capable to enhance the response of shrimp immune system without toxic effects in healthy shrimps. This response could be enhanced by administration of other doses and might represent an important alternative for the treatment of a disease that has still no cure, white spot syndrome virus.

Effect of silver nanoparticles on the metabolic rate, hematological response, and survival of juvenile white shrimp Litopenaeus vannamei.

White spot syndrome virus (WSSV) is highly lethal and contagious in shrimps; its outbreaks causes an economic crisis for aquaculture. Several attempts have been made to treat this disease; however, to date, there is no effective cure. Because of their antimicrobial activities, silver nanoparticles (AgNPs) are the most studied nanomaterial. Although the antiviral properties of AgNPs have been studied, their antiviral effect against viral infection in aquaculture has not been reported. The AgNPs tested herein are coated with polyvinylpyrrolidone (PVP) and possess multiple international certifications for their use in veterinary and human applications. The aim of this work was to evaluate the survival rate of juvenile white shrimps (Litopenaeus vannamei) after the intramuscular administration of AgNPs. For this, different concentrations of metallic AgNPs and PVP alone were injected into the organisms. After 96 h of administration, shrimp survival was more than 90% for all treatments. The oxygen consumption routine rate and total hemocyte count remained unaltered after AgNP injection, reflecting no stress caused. We evaluated whether AgNPs had an antiviral effect in shrimps infected with WSSV. The results revealed that the survival rate of WSSV-infected shrimps after AgNP administration was 80%, whereas the survival rate of untreated organisms was only 10% 96 h after infection. These results open up the possibility to explore the potential use of AgNPs as antiviral agents for the treatment of diseases in aquaculture organisms, particularly the WSSV in shrimp culture.

Enfermedad de Castleman de localización torácica / Intrathoracic Castleman's disease

Antecedentes: la enfermedad de Castleman es conocida como hiperplasia linfática angiofolicular y se caracteriza por crecimiento masivo del tejido linfático. Histológicamente hay tres categorías: hialino-vascular, tipo células plasmáticas y mixto. Se describen dos variantes clínicas: monocéntrica (localizada) y multicéntrica. Objetivo: presentar nuestra experiencia en el manejo de esta enfermedad haciendo énfasis en su compromiso mediastinal y pulmonar. Material y métodos: revisión de historias clínicas e informes patológicos. Resultados: se identificaron 5 pacientes, 1 mujer y 4 hombres, con edad promedio de 58,5 años. Tres pacientes presentaron la forma localizada y dos la multicéntrica. Los síntomas fueron: dolor torácico en dos casos, astenia en 1 caso y síndrome POEMS (polineuropata, organomegalia, endocrinopata y pico monoclo-nal) en 2 casos. Se realizó toracotomía y resección en 2 casos, lobectomía superior derecha en bloque con la lesión mediastinal en 1 caso, biopsia de masa apical en 1 caso y biopsia ganglionar por mediastinoscopia en 1 caso. Se realizó reoperación por sangrado en 1 caso. Tres pacientes presentaron la forma hialino-vascular y 2 la variante de células plasmáticas. Un paciente resecado se perdió de seguimiento. Los pacientes con síndrome POEMS fallecieron, uno al 8° día por neumonía intrahospitalaria y otro al 6° mes por sepsis. Los enfermos resecados restantes cursan buena evolución. Conclusiones: se recomienda la resección quirúrgica en pacientes con enfermedad de Castleman variedad localizada, la cual es curativa. Los pacientes con la variedad multicéntrica no se benefician con esta terapéu-tica, pero son pasibles de quimioterapia o radioterapia o combinación de ambas.

Background: Castleman's disease, known as angio follicular lymph node hyperplasia, is characterized by the massive growth of lymphoid tissue. Histollogically there are three categories: hyaline-vascular, plasm cell type and mixed type. Two clinical variantis have been described: monocentric (localized) and multicentric. Objective: to describe our experience in the treatment of this disease, focusing on itis mediastinal and pulmonary afecton. Method: review of clinical records and pathological reportis. Resultis: 5 patentis (1 female and 4 male), within an age -range of 58, 5 years were screened. Three patentis were afected by the localized type and two by the multicentric type. The symptoms were: thoracic pain in two of the cases, asthenia in one and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy and monoclonal changes) in 2 cases. We performed thoracotomy and resecton in two cases, upper right side lobectomy in block with the mediastinal lesion in 1 case, apical mass biopsy in 1 case and lymph node biopsy by mediastinoscopy in one case. We performed reoperaton by bleeding in one case. Three patentis presented the hyaline vascular type and two, the plasma-cell type. We lost track of a resectoned patent. Those patentis with POEMS syndrome died, one of them of intra-hospital pneumonia on the eighth day, and another of sepsis on the sixth month. The remaining resectoned patentis are evolving well. Conclusions: on patentis presenting localized type Castleman's disease, we recommend surgical resecton, which is a curative therapy. Patentis presenting the monocentric type do not beneft from this therapy and are passible of chemotherapy and /or radiotherapy.

Mediastinitis necrotizante descendente: dieciseis años de experiencia / The descending necrotizing mediastinitis

Antecedentes: La mediastinitis necrotizante descendente es una entidad poco frecuente de alta mortalidad que se origina en procesos sépticos orofaríngeos o cervicales mal drenados. El pasaje de material infectado se realiza a través del espacio parafaríngeo, y de allí por el espacio retrovisceral hacia el mediastino posterior.Objetivos: Definir los parámetros para diagnosticar en forma temprana esta afección y lograr así instaurar rápidamente la conducta quirúrgica agresiva que nos permita disminuir la elevada tasa de mortalidad de esta severa complicación. Lugar de aplicación: Hospital nacional universitario. Diseño: Retrospectivo y descriptivo. Población: Práctica hospitalaria. Material y método: Entre 1995 y 2011 fueron tratados 12 pacientes con mediastinitis necrotizante (7 hombres y 5 mujeres). El foco fue absceso dentario en 9 y absceso amidgalino, absceso pos-fractura de maxilar y mastoiditis, en 1 caso respectivamente. Todos presentaron edema cervical, fiebre y dolor y fueron estudiados con radiología convencional y TAC cervicotorácica de inicio. El tiempo de demora entrela primera consulta y la atención en nuestro hospital fue de más de 72 hs en el 75% de los pacientes. Todos fueron operados por un doble abordaje, cervical y torácico. A 4 pacientes se les realizó abordaje torácico bilateral.Resultados: Las complicaciones fueron: distres respiratorio en 7, bronconeumonía en 3, hemorragia cervical e infección urinaria en1. Fueron reoperados 4 paciente. La mortalidad fue del 33% (4 de 12 pacientes).Conclusión: Si bien la mediastinitis necrotizante descendente es una entidad rara, su gravedad obliga a considerarla como complicaciónante todo absceso cervical no drenado. La TAC cervicotorácica en estos pacientes, sumada a una conducta terapéutica quirúrgica agresivason las claves para un diagnostico precoz y un tratamiento efectivo.

Mediastinitis necrotizante descendente: Dieciséis años de experiencia

Antecedentes: La mediastinitis necrotizante descendente es una entidad poco frecuente de alta mortalidad que se origina en procesos sépticos orofaríngeos o cervicales mal drenados. El pasaje de material infectado se realiza a través del espacio parafaríngeo, y de allí por el espacio retrovisceral hacia el mediastino posterior. Objetivos: Definir los parámetros para diagnosticar en forma temprana esta afección y lograr así instaurar rápidamente la conducta quirúrgica agresiva que nos permita disminuir la elevada tasa de mortalidad de esta severa complicación. Lugar de aplicación: Hospital nacional universitario. Diseño: Retrospectivo y descriptivo. Población: Práctica hospitalaria. Material y método: Entre 1995 y 2011 fueron tratados 12 pacientes con mediastinitis necrotizante (7 hombres y 5 mujeres). El foco fue absceso dentario en 9 y absceso amidgalino, absceso pos-fractura de maxilar y mastoiditis, en 1 caso respectivamente. Todos presentaron edema cervical, fiebre y dolor y fueron estudiados con radiología convencional y TAC cervicotorácica de inicio. El tiempo de demora entre la primera consulta y la atención en nuestro hospital fue de más de 72 hs en el 75% de los pacientes. Todos fueron operados por un doble abordaje, cervical y torácico. A 4 pacientes se les realizó abordaje torácico bilateral. Resultados: Las complicaciones fueron: distres respiratorio en 7, bronconeumonía en 3, hemorragia cervical e infección urinaria en 1. Fueron reoperados 4 paciente. La mortalidad fue del 33% (4 de 12 pacientes). Conclusión: Si bien la mediastinitis necrotizante descendente es una entidad rara, su gravedad obliga a considerarla como complicación ante todo absceso cervical no drenado. La TAC cervicotorácica en estos pacientes, sumada a una conducta terapéutica quirúrgica agresiva son las claves para un diagnostico precoz y un tratamiento efectivo.(AU)

Background: The descending necrotizing mediastinitis is a slightly frequent entity of high mortality that originates itself in septic oropharyngeal processes or poorly drained cervicals. The passage of infected material is realized across the parapharyngeal area and hence for the retrovisceral area towards the back mediastinum. Objective: To define the diagnostic parameters to recognize prematurely this affection and to select rapidly the effective surgical treatment which help us diminish the high rate of mortality of this severe complication. Setting: University Nacional Hospital. Design: Retrospective and descriptive. Population: Hospital practice. Material and method: Between 1995 and 2011, 12 patients, including seven men and five women were treated with necrotizing mediastinitis. The critical area was an abscess toothwort for 9 and tonsil abscess for 2, abscess post-fractures of maxillary and mastoiditis in 1 respectively. They all presented cervical edema, fever and pain and they were studied by conventional radiology and cervicothoracic TAC in the beginning. The time of delay between the first consult and the visit in our hospital was over 72 h. in 75% of the cases. They all were treated with double medical approach, both cervical and thoracic. On the other hand, 4 patients faced only thoracic bilateral medical approach. Results: The medical complications arised were: respiratory distress in 7, bronchopneumonia in 3, cervical hemorrhage and urinary infection in 1. 4 were re-operated. The mortality was 33% (4 out of 12 patients). Conclusion: Though the descending necrotizing mediastinitis is a rare entity, its seriuosness forces us to consider it as a critical medical issue while tackling any cervical abscess not drained. Under these circumstances the cervicothoracic TAC, along with an aggressive therapeutic surgery, is the key factor to obtain a precocious diagnosis and an effective treatment.(AU)

Double-stranded RNA against white spot syndrome virus (WSSV) vp28 or vp26 reduced susceptibility of Litopenaeus vannamei to WSSV, and survivors exhibited decreased susceptibility in subsequent re-infections.

The antiviral effect of vp28 or vp26 double-stranded (ds) RNA upon single or consecutive white spot syndrome virus (WSSV) intramuscular challenges with a high infectious dose was evaluated. The vp28 dsRNA showed the highest protection both in single (LT(50)=145h at 10d and 98h at 20d post treatment [dpt]) or consecutive (LT(50)=765h) WSSV challenges compared to vp26 dsRNA (LT(50)=126h at 10 d and 57h at 20dpt vs. consecutive challenge LT(50)=751h). Single WSSV challenges showed that animals treated with vp28 or vp26 dsRNA gradually lost the antiviral effect as virus challenge occurred at 10dpt (cumulative mortality 63% vs. 80%, respectively) or 20dpt (87% vs. 100%, respectively). In contrast, animals treated with vp28 or vp26 dsRNA and consecutively challenged with WSSV showed and extended lower susceptibility to WSSV. All dead animals were WSSV-positive by one-step PCR, whereas all surviving shrimp from single or continuous challenges were WSSV-negative as determined by reverse transcription (RT)-PCR. In conclusion, shrimp treated with a single administration of vp28 or vp26 dsRNA and consecutively challenged with WSSV showed a stronger and longer antiviral response than shrimp exposed once to WSSV at 10 or 20dpt.

Perforaciones y rupturas del esófago torácico y abdominal: rol de la sutura primaria / Perforations and ruptures of the thoracic and abdominal esophagus: role of primary suture

Introducción: Las perforaciones y rupturas del esófago torácico y abdominal son afecciones muy graves que se presentan en la urgencia y conllevan altas tasas de morbimortalidad, por la sepsis que se instala rápidamente y un diagnóstico frecuentemente tardío. A pesar de existir una falta de consenso sobre la técnica de reparación a emplear, existe una tendencia creciente a considerar a la sutura primaria como la técnica más efectiva. Objetivo: Presentar nuestra experiencia resaltando la ventaja de la sutura primaria como la técnica de reparación, independientemente del tiempo trnscurrido entre la perforación y el tratamiento. Lugar de aplicación: Hospital Público nacional asociado a Universidad estatal. Diseño: Retrospectivo, observacional. Población: Se presentan 27 pacientes con perforaciones y rupturas del esófago torácico y abdominal; 1 en esófago superior, 6 en tercio medio y 20 en esófago inferior y abdominal. Material y Métodos: De los 27 pacientes, 12 se debieron a dilataciones, 7 fueron supturas espontáneas, 7 por cuerpo extraño y 1 lesión quirúrgica. Se realizó tratamiento quirúrgico en 25 pacientes y conservador para 2. Se efectuaron 19 suturas primarias, 4 exclusiones bipolares y 2 esofagectomías. Resultados: La mortalidad global fue del 18,5% (5/27) y la de los pacientes suturados fue del 5,26% (1/19). Conclusiones: La perforación al igual que la ruptura del esófago torácico y abdominal producen una elevada morbimortalidad. En nuestra experiencia, la sutura primaria fue la técnica más empleada y la preconizamos para tratar a estos pacientes, independientementes del tiempo transcurrido entre la injuria y la intervención quirúrgica.(AU)

Perforaciones y rupturas del esófago torácico y abdominal: rol de la sutura primaria / Perforations and ruptures of the thoracic and abdominal esophagus: role of primary suture

Introducción: Las perforaciones y rupturas del esófago torácico y abdominal son afecciones muy graves que se presentan en la urgencia y conllevan altas tasas de morbimortalidad, por la sepsis que se instala rápidamente y un diagnóstico frecuentemente tardío. A pesar de existir una falta de consenso sobre la técnica de reparación a emplear, existe una tendencia creciente a considerar a la sutura primaria como la técnica más efectiva. Objetivo: Presentar nuestra experiencia resaltando la ventaja de la sutura primaria como la técnica de reparación, independientemente del tiempo trnscurrido entre la perforación y el tratamiento. Lugar de aplicación: Hospital Público nacional asociado a Universidad estatal. Diseño: Retrospectivo, observacional. Población: Se presentan 27 pacientes con perforaciones y rupturas del esófago torácico y abdominal; 1 en esófago superior, 6 en tercio medio y 20 en esófago inferior y abdominal. Material y Métodos: De los 27 pacientes, 12 se debieron a dilataciones, 7 fueron supturas espontáneas, 7 por cuerpo extraño y 1 lesión quirúrgica. Se realizó tratamiento quirúrgico en 25 pacientes y conservador para 2. Se efectuaron 19 suturas primarias, 4 exclusiones bipolares y 2 esofagectomías. Resultados: La mortalidad global fue del 18,5% (5/27) y la de los pacientes suturados fue del 5,26% (1/19). Conclusiones: La perforación al igual que la ruptura del esófago torácico y abdominal producen una elevada morbimortalidad. En nuestra experiencia, la sutura primaria fue la técnica más empleada y la preconizamos para tratar a estos pacientes, independientementes del tiempo transcurrido entre la injuria y la intervención quirúrgica.

Quilotórax: táctica diagnóstica y terapéutica / Chylothorax: diagnostic methodology and treatment

Antecedentes: El quilotórax es el acumulo de quilo en la cavidad pleural, secundario a una pérdida desde el conducto torácico, produciendo alteraciones cardiorrespiratorias, metabólicas y nutritivas. Objetivo: Analizar la metodología diagnóstica y terapéutica aplicada en pacientes con quilotórax. Diseño: Análisis retrospectivo de historias clínicas. Método: Desde enero de 1994 hasta mayo de 2004 se incluyeron 7 pacientes, 6 varones y 1 mujer, con una edad promedio de 40,4 años (rango 24-56). Todos los pacientes presentaron disnea y tos seca. A todos los enfermos se les realizó radiografía y TAC de tórax, estudio de triglicéridos (TG), colesterol y láctico deshidrogenasa (LDH) del líquido pleural, y en un paciente se indicó la linfografía radioisotópica. Todos los enfermos recibieron tratamiento inicial con avenamiento pleural, alimentación oral selectiva y parenteral parcial o total, y en dos casos se indicó tratamiento quirúrgico (Operación de Lampson) ante el fracaso del tratamiento inicial. Resultados: Los dos pacientes a quienes se les realizó la ligadura del conducto torácico tuvieron buena evolución. De los cinco restantes, 3 evolucionaron favorablemente, 1 paciente no concurrió a los controles y otro falleció sin resolver el quilotórax. La mortalidad fue del 14,2 por ciento (1 de 7 pacientes). Conclusiones: El quilotórax es de presentación infrecuente. Se sospecha por la clínica, la radiografía simple de tórax, la TAC, y se confirma por la medición de TG, colesterol y LDH en líquido pleural. Todos los pacientes son tratados inicialmente con drenaje pleural, dieta selectiva y/o parenteral, reservando la conducta quirúrgica ante el fracaso de éstos (AU)