Bioactive scaffolds with enhanced supramolecular motion promote recovery from spinal cord injury.

The signaling of cells by scaffolds of synthetic molecules that mimic proteins is known to be effective in the regeneration of tissues. Here, we describe peptide amphiphile supramolecular polymers containing two distinct signals and test them in a mouse model of severe spinal cord injury. One signal activates the transmembrane receptor ß1-integrin and a second one activates the basic fibroblast growth factor 2 receptor. By mutating the peptide sequence of the amphiphilic monomers in nonbioactive domains, we intensified the motions of molecules within scaffold fibrils. This resulted in notable differences in vascular growth, axonal regeneration, myelination, survival of motor neurons, reduced gliosis, and functional recovery. We hypothesize that the signaling of cells by ensembles of molecules could be optimized by tuning their internal motions.

Recomendación para la sospecha, manejo y seguimiento del compromiso cardiovascular en pacientes con Síndrome Inflamatorio Multisistémico en Pediatría asociado a COVID-19 (PIMS-TC). Declaración de Posición de la Sociedad Chilena de Pediatría (SOCHIPE) y Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR) / Recommendation for the recognition, management and follow up of cardiovascular compromise in patients with Pediatric Multisystemic Inflammatory Syndrome associated with COVID-19 (PIMS-CT). Position statement of Chilean Scientific Societies

Desde la aparición de la pandemia por SARS-CoV-2, la población pediátrica ha sido menos afectada por la enfermedad tanto en frecuencia como en severidad. Sin embargo, desde abril de este año se han reportado casos de presentación y gravedad variables, caracterizados por fenómenos inflamato rios que afectan múltiples órganos, condición denominada Síndrome Inflamatorio Multisistémico Pediátrico (PIMS). La literatura describe frecuente compromiso cardíaco, hasta en un 80%. Este se caracteriza por injuria miocárdica con significativa elevación de biomarcadores: Troponinas séricas I/T, BNP o NT-ProBNP, unido a diversos grados de disfunción ventricular, pericarditis, valvulitis y arritmias. Además, se ha evidenciado la presencia de compromiso coronario el cual puede ocurrir hasta en un 23% de los casos, en un rango que va desde dilataciones hasta aneurismas. El seguimien to cardiológico hospitalizado y ambulatorio se ha sistematizado en base a los fenotipos clínicos de presentación: injuria miocárdica (miocarditis, valvulitis, pericarditis), shock (habitualmente de tipo "vasopléjico"), manifestaciones tipo Enfermedad de Kawasaki y aquellos casos PIMS que no cumplen con la clínica de los tres precedentes. Este último grupo es el que representa el mayor desafío en el cor to, mediano y seguimiento a largo plazo. Por esta razón se requiere un equipo multidisciplinario para su manejo. Considerando la alta frecuencia del compromiso cardíaco en el PIMS y la importancia de lograr un consenso en su manejo y seguimiento, se presentan estas recomendaciones según el estado actual del conocimiento de esta patología recientemente descrita.

Since the onset of the SARS-CoV-2 pandemic, the pediatric population has been less affected by the disease both in frequency and severity. However, since April cases of variable presentation and severity characterized by inflammatory phenomena that affect multiple organs have been reported, a condition called Multisystem Inflammatory Syndrome in Children (MIS-C). The literature has reported frequent cardiac involvement, up to 80%. This is characterized by myocardial injury with a significant increase of biomarkers such as serum troponins I and T, BNP, or NT-ProBNP coupled with varying degrees of ventricular dysfunction, pericarditis, valvulitis, and arrhythmias. Coronary compromise has also been described, which can occur in up to 23% of cases, and ranges from dila tations to aneurysms. Inpatient and outpatient cardiology follow-up has been systematized based on the clinical phenotypes such as myocardial injury (myocarditis, valvulitis, pericarditis), shock (usua lly vasoplegic), Kawasaki disease-type manifestations, and those MIS-C that do not comply with the clinic of the previous three. This last group represents the main challenge in the short-, medium- and long-term follow-up, therefore, it is necessary a multidisciplinary team for managing these patients. Considering the high frequency of cardiac compromise in MIS-C, and the importance of reaching a consensus regarding its management and follow-up, we present these recommendations according to the current state of knowledge regarding this recently described pathology.

[Recommendation for the recognition, management and follow up of cardiovascular compromise in patients with Pediatric Multisystemic Inflammatory Syndrome associated with COVID-19 (PIMS-CT). Position statement of Chilean Scientific Societies]. / Recomendación para la sospecha, manejo y seguimiento del compromiso cardiovascular en pacientes con Síndrome Inflamatorio Multisistémico en Pediatría asociado a COVID-19 (PIMS-TC). Declaración de Posición de la Sociedad Chilena de Pediatría (SOCHIPE) y Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR).

Since the onset of the SARS-CoV-2 pandemic, the pediatric population has been less affected by the disease both in frequency and severity. However, since April cases of variable presentation and severity characterized by inflammatory phenomena that affect multiple organs have been reported, a condition called Multisystem Inflammatory Syndrome in Children (MIS-C). The literature has reported frequent cardiac involvement, up to 80%. This is characterized by myocardial injury with a significant increase of biomarkers such as serum troponins I and T, BNP, or NT-ProBNP coupled with varying degrees of ventricular dysfunction, pericarditis, valvulitis, and arrhythmias. Coronary compromise has also been described, which can occur in up to 23% of cases, and ranges from dila tations to aneurysms. Inpatient and outpatient cardiology follow-up has been systematized based on the clinical phenotypes such as myocardial injury (myocarditis, valvulitis, pericarditis), shock (usua lly vasoplegic), Kawasaki disease-type manifestations, and those MIS-C that do not comply with the clinic of the previous three. This last group represents the main challenge in the short-, medium- and long-term follow-up, therefore, it is necessary a multidisciplinary team for managing these patients. Considering the high frequency of cardiac compromise in MIS-C, and the importance of reaching a consensus regarding its management and follow-up, we present these recommendations according to the current state of knowledge regarding this recently described pathology.

Trauma cardiaco en pediatría / Cardiac trauma in pediatrics

El trauma cardiaco constituye una entidad infrecuente en pediatría que requiere de toma de decisiones rápidas y oportunas, además de un manejo óptimo para obtener una mejor sobrevida de los pacientes. En esta revisión en base a un caso clínico, se actualiza el tema de trauma cardiaco, se describen los tipos más frecuentes, las diferentes formas clínicas de presentación y el enfrentamiento terapéutico. Palabras clave: Trauma cardiaco, penetrante cardiaca, cirugía cardiaca.

Cardiac trauma is an uncommon entity in pediatrics that requires quick and timely decision making, as well as optimal management to obtain a better survival of patients. In this review based on a case report, the issue of cardiac trauma is updated, the most frequent types, the different clinical forms of presentation and the therapeutic confrontation are described.

Encapsulation of Lactobacillus plantarum ATCC 8014 and Pediococcus acidilactici ATCC 8042 in a freeze-dried alginate-gum arabic system and its in vitro testing under gastrointestinal conditions.

The aim of this study was to investigate the viability of Pediococcus acidilactici ATCC 8042 and Lactobacillus plantarum ATCC 8014 in a freeze-dried capsules system prepared with sodium alginate and gum arabic using the extrusion technique. The capsules made with alginate 2% (w/v)/gum arabic 2% (w/v) showed higher hardness (7.12 ± 0.71 N), with highly cohesive (0.81 ± 0.02) and elastic (0.99 ± 0.00) features on the Texture Profile Analysis (TPA), as well as higher sphericity with 1.75 ± 0.12 mm y 1.73 ± 0.13 mm diameter axes and regularity in their surface by Scanning Electron Microscopy (SEM). The use of skimmed milk at 10% as a cryoprotector in the freeze-drying process allowed the obtention of high viability percentages (88% a 96%) for both strains. Best results of viability for P. acidilactici encapsulated was with the use of alginate 2% (w/v)/gum arabic 2% (w/v) (92%±2.65), and L. plantarum with the use of alginate 2% (w/v) (84.71%±10.33) during the gastrointestinal environment challenge.

Dolor precordial en pediatría: puesta al día / Precordial pain in pediatrics: update

El dolor precordial en pediatría representa un bajo porcentaje del total de consultas, sin embargo genera una alta preocupación tanto en los padres como en el equipo de salud. En general se trata de un proceso benigno y la etiología cardíaca es infrecuente, alcanzando apenas el 1-4%. En el presente trabajo de actualización se revisan las diferentes etiologías, con el propósito de identificar factores que orienten a etiología cardíaca y así derivar al especialista u hospitalizar en forma oportuna si se requiere.

The chest pain in pediatrics represents a low percentage of the total of consultations, nevertheless it generates a high concern both in the parents and in the health team. In general, it is a benign process and the cardiac etiology is infrequent, reaching only 1-4%. In the present update work, the different etiologies are reviewed, in order to identify factors that guide the cardiac etiology and thus refer to the specialist or hospitalize in a timely manner if required.

[Role of surgery in Saprochaete capitata (S. capitata) sepsis in a patient with acute myeloid leukemia]. / Rol de la cirugía en el manejo de la infección invasora por Saprochaete capitata.

Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.

Rol de la cirugía en el manejo de la infección invasora por Saprochaete capitata / Role of surgery in Saprochaete capitata (S. capitata) sepsis in a patient with acute myeloid leukemia

Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.

Compromiso nodal y extranodal detectado con PET/CT en linfoma en etapificación / Nodal and extranodal involvement detected by PET/CT in staging lymphoma

Objective: To describe visible nodal and extra-nodal involvement using PET/CT in the different types and subtypes of lymphoma in staging. Patients and method: PET/CT with F18-FDG were reviewed in patients with lymphoma staging, determining frequency and location of nodal and extra-nodal involvement, and intensity of F18-FDG uptake measured by SUVmax. Results: Of the 102 patients with NHL (average SUVmax 13.0 ± 9.7), 86.3% had nodal involvement (51.9% on both sides of the diaphragm, 24.5% only above the diaphragm), and 66.7% extra-nodal compromise (42.6% bone marrow, 22.1% muscle, 16.2% renal). Of the 30 patients with HL (average SUVmax 14.6 ± 6.0), 100% had nodal involvement (63.3% only above the diaphragm, 36.7% above and below the diaphragm), and 30% had extra-nodal involvement (66.7% bone marrow, 22.2% lung). Conclusion: PET/CT is the method of choice in the staging of lymphoma, allowing the detection of nodal and extra-nodal disease in both HL and NHL.

Objetivo: Describir el compromiso nodal y extranodal visible con PET/CT en los distintos tipos y subtipos de linfoma en etapificación. Pacientes y método: Se revisaron los PET/CT con F18-FDG realizados a pacientes con linfoma en etapificación, determinando frecuencia y localización del compromiso nodal y extranodal, e intensidad de captación de F18-FDG medida mediante SUVmax. Resultados: De los 102 pacientes con LNH (SUVmaxpromedio 13,0±9,7), un 86,3% presentó compromiso nodal (51,9% a ambos lados del diafragma, 24,5% sólo sobre el diafragma) y 66,7% compromiso extranodal (42,6% médula ósea, 22,1% muscular, 16,2% renal). De los 30 pacientes con LH (SUVmax promedio 14,6±6,0), el 100% tuvo compromiso nodal (63,3% sólo sobre el diafragma, 36,7% sobre y bajo el diafragma), y 30% compromiso extranodal (66,7% médula ósea, 22,2% pulmón). Conclusión: El PET/CT es el método de elección en la etapificación del linfoma, permitiendo detectar enfermedad nodal y extranodal, tanto en LH como en LNH.

Ocurrence of equine cavitary myiasis (Gasterophilus spp) and its relation with secondary gastric ulcers of the squamous mucosa in Temuco, Chile / Ocurrencia de miasis cavitaria equina (Gasterophilus Spp) y su relación con las úlceras gástricas secundarias en la mucosa escamosa en Temuco, Chile / Ocorrência da miíase cavitária equina (Gasterophilus spp) e sua relação com as ulceras gástricas secundarias na mucosa escamosa em Temuco, Chile

The aim of this study was to determine the ocurrence of equine cavitary myiasis (Gasterophilus spp) in the CholChol slaughtering house in Temuco, Chile and its relation with the presentation of secondary gastric ulcers in the non-glandular squamous mucosa of the horses' (Equus caballus) stomachs. Of 240 stomachs evaluated post mortem, 145 were selected and characterized as positive to gasterophilosis (60.4%), of which 75 were males (20 stallions and 55 geldings) and 70 were mares, with ages ranging from 1 to 16 years. Every stomach was evaluated, characterized and photographed post mortem. Information about sex, age, location of the Gasterophilus larvae, presence and degree of ulceration of the squamous mucosa, were recorded in the respective forms and posteriorly digitalized. Global analysis of the location of larvae in the stomach of horses positive to gasterophilosis, established that 91.7% were located in the glandular mucosa, while 8.3% were located in the squamous mucosa. In the stomachs with presence of larvae in the antral/piloric regions of the glandular mucosa, 87.6% had secondary ulcers in the nonglandular squamous mucosa, due to the increase in the gastric fill line following alterations in gastric emptying, of which 69% were classified in categories 3 to 4 with a number of larvae higher tan 30, while 18.6% were found in categories 1 or 2 with less than 30 larvae per site. Regarding the location of larvae in the squamous mucosa, 8.3% of the stomachs showed primary mechanic ulcers, all classified between grades 1 and 2. Of all the animals evaluated, 62.1% had more tan 60 larvae, of which 60.1% had grade 3 or 4 secondary squamous ulcers, 15.9% had between 30 and 60 larvae per site, and 14.5% had less than 30 larvae per site. The study showed significant statistical dependence (p<0.05) between the number of larvae located in the glandular mucosa and the degree of severity of the secondary gastric ulcers in the squamous mucosa. Concluding, a high ocurrence of cavitary gastric myiasis was observed in slaughtering horses in the south of Chile, with squamous ulcers secondary to abnormal gastric emptying being the most frequent observation, which makes evident the need to continue research and management control of this pathology in horses.> <0.05) between the number of larvae located in the glandular mucosa and the degree of severity of the secondary gastric ulcers in the squamous mucosa. Concluding, a high ocurrence of cavitary gastric myiasis was observed in slaughtering horses in the south of Chile, with squamous ulcers secondary to abnormal gastric emptying being the most frequent observation, which makes evident the need to continue research and management control of this pathology in horses.

El objetivo del presente estudio fue determinar la ocurrencia de miasis cavitaria equina (Gasterophilus spp) en el centro de faenado Chol-Chol de Temuco, Chile y su relación con la presentación de úlceras gástricas secundarias en la mucosa escamosa (aglandular) del estómago de caballos (Equus caballus). De 240 estómagos evaluados post mortem, fueron seleccionados y caracterizados 145 estómagos positivos a Gasterophilosis (60,4%), de los cuales 75 provenían de animales machos (20 enteros y 55 castrados) y 70 hembras, con un rango de edad entre 1 y 16 años. Cada estómago fue evaluado, caracterizado y fotografiado post mortem. Los datos de sexo, edad, ubicación de las larvas de Gasterophilus, presencia y grado de ulceración en la mucosa escamosa, fueron diligenciados en los formatos respectivos y posteriormente digitalizados. Al analizar en forma global la ubicación de las larvas en el estómago de caballos positivos a Gasterophilosis, se estableció que el 91,7% (133/145) se ubicaron en la mucosa glandular, mientras que el 8,3% (12/145) se ubicaron en la mucosa escamosa. En los estómagos con presencia de larvas en la región antro pilórica de la mucosa glandular, el 87,6 (127/145) presentaron ulceraciones secundarias en la mucosa escamosa (aglandular), debido al aumento de la línea de llenado por alteración en el vaciamiento gástrico, de las cuales 69,0% (100/145) estuvieron clasificadas entre los categorías 3 y 4 con un numero de larvas mayores a 30, mientras que el 18,6% (27/145) se encontraron en las categorías 1 y 2 con un numero de larvas por sitio menor de 30. Con respecto a la ubicación de las larvas en la mucosa escamosa, evidencio la presencia de úlceras primarias de carácter mecánico en el 8,3% (12/145), siendo clasificadas en su totalidad entre los grados 1 y 2. El 62,1% de los animales tuvo una cantidad de larvas mayor a 60, de los cuales el 60,1% (88/145), presentaron úlceras escamosa secundarias en los grados 3 y 4. El 15,9% (23/145) presentaron una población de larvas por sitio entre 30 y 60 y el 14,5% (21/145) presento una población de menos de 30 larvas por sitio. El estudio demostró que hubo dependencia estadística significativa (p<0,05) entre el número de larvas ubicadas en la mucosa glandular y el grado de severidad de las úlceras gástricas secundarias en la mucosa escamosa. Se puede concluir que existe una elevada ocurrencia de miasis cavitarias gástricas en los caballos de faenados en el sur de Chile, siendo las ulceras escamosas secundarias al mal vaciamiento gástrico las de mayor frecuencia, por lo que se hace necesario realizar más investigaciones y concientización sobre el manejo de estas patologías en este tipo de animales.> <0,05) entre el número de larvas ubicadas en la mucosa glandular y el grado de severidad de las úlceras gástricas secundarias en la mucosa escamosa. Se puede concluir que existe una elevada ocurrencia de miasis cavitarias gástricas en los caballos de faenados en el sur de Chile, siendo las ulceras escamosas secundarias al mal vaciamiento gástrico las de mayor frecuencia, por lo que se hace necesario realizar más investigaciones y concientización sobre el manejo de estas patologías en este tipo de animales.

O objetivo do presente estudo foi determinar a ocorrência da miíase cavitária equina (Gasterophilus spp) no centro do abatedouro Chol-Chol de Temuco, Chile, e sua relação com a apresentação de ulceras gástricas secundárias na mucosa escamosa (aglandular) do estomago de cavalos (Equus caballus). Dos 240 estômagos avaliados post mortem, foram selecionados e caracterizados 145 estômagos positivos a gasterofilose (60,4%), dos quais 75 provinham de animais machos (20 inteiros e 55 castrados) e 70 fêmeas com um rango de idade entre 1 e 16 anos. Cada estomago foi avaliado, caracterizado e fotografado post mortem. Os dados de sexo, idade, localização das larvas de Gasterophilus, presencia e grau de ulceração na mucosa escamosa, foram diligenciados nos formatos respectivos e posteriormente digitalizados. Ao analisar em forma global a localização das larvas no estomago de cavalos positivos a gasterofilose. Se estabeleceu que o 91,7% (133/145) se localizaram na mucosa glandular, enquanto que o 8,3% (12/145) se localizaram na mucosa escamosa. Nos estômagos com presença de larvas na região antro pilórica da mucosa glandular, o 87,6% (127/145) apresentaram ulcerações secundarias na mucosa escamosa (aglandular), devido ao aumento da linha de preenchimento por alteração no esvaziamento gástrico, das quais 69% (100/145) estiveram classificadas entre as categorias 3 e 4 com um número de larvas maiores a 30, enquanto que o 18,6% (27/145) se encontraram nas categorias 1 e 2 com um número de larvas por sitio menor de 30. Com respeito a localização das larvas na mucosa escamosa, se evidenciou a presença de ulceras primarias de carácter mecânico em 8,3 (12/145), sendo assim classificadas em sua totalidade entre os graus 1 e 2. O 62,1% dos animais teve uma quantidade de larvas maior a 60, dos quais o 60,1% (88/145), apresentaram ulceras escamosas secundarias nos graus 3 e 4. O 15,9% (23/145) apresentaram uma população de larvas por sitio entre 30 e 60; e o 14,5% (21/145) apresentou uma população de menos de 30 larvas por sitio. O estudo demostrou que houve dependência estatística significativa (p<0,05) entre o número de larvas localizadas na mucosa glandular e o grau de severidade das ulceras gástricas secundarias na mucosa escamosa. Pode-se concluir que existe uma elevada ocorrência de miíase cavitária gástrica nos cavalos de abatedouros no sul do Chile, sendo as ulceras escamosas secundarias ao esvaziamento defeituoso, as de maior frequência, pelo que se faz necessário realizar mais pesquisas e conscientização sobre o manejo de estas patologias em este tipo de animais.> <0,05) entre o número de larvas localizadas na mucosa glandular e o grau de severidade das ulceras gástricas secundarias na mucosa escamosa. Pode-se concluir que existe uma elevada ocorrência de miíase cavitária gástrica nos cavalos de abatedouros no sul do Chile, sendo as ulceras escamosas secundarias ao esvaziamento defeituoso, as de maior frequência, pelo que se faz necessário realizar mais pesquisas e conscientização sobre o manejo de estas patologias em este tipo de animais.

[Recombinant tissue plasminogen activator for the management of intracardiac thrombi in newborns]. / Activador del plasminógeno tisular recombinante en el manejo de trombos cardiacos en recién nacidos.

INTRODUCTION: The incidence of cardiac thrombi in newborns has increased with the use of central venous catheters. Thrombolysis with recombinant tissue plasminogen activator (rTPA) has been used as an alternative to heparin in life threatening giant thrombus and embolization. The aim of this study is to describe the response and complications related to the use of rTPA in the management of life- threatening cardiac thrombi in newborns. PATIENTS AND METHOD: The medical records of 8 newborn were reviewed in a retrospective study, of whom 7 were preterm with cardiac thrombi, and rTPA was used in all of them. RESULTS: The patients included 4 males with a mean weight of 1580 gr. The principal pathology was sepsis (7/8), all of them used venous central catheter. The superior vena cava was the most frequent location, with a mean time of installation before the diagnosis of 12 days. RN 7/8 thrombi were located in the right atrium with a size between 7 to 20 mm. Three patients received low molecular weight heparin prior to using rTPA. They received between 1 to 5 cycles with rTPA. In 4 patients complete resolution of the thrombus was achieved in a mean of 3.5 days. Four patients had intracranial haemorrhage grade I, without sequelae at follow-up. There were no deaths or embolism. CONCLUSION: This study is the first series of infants treated with rTPA in Chile, and where its use has quickly achieved complete resolution of the thrombus in 50% of cases, and partially in the others, thus reducing the secondary life-threatening risk of this disease.

Activador del plasminógeno tisular recombinante en el manejo de trombos cardiacos en recién nacidos / Recombinant tissue plasminogen activator for the management of intracardiac thrombi in newborns

Introducción: La incidencia de trombos cardíacos en recién nacidos (RN) ha aumentado con el uso de catéteres venosos centrales. La trombólisis con activador del plasminógeno tisular recombinante (rTPA) se ha utilizado como alternativa a la heparina en trombos gigantes con riesgo vital y de embolización. Nuestro objetivo fue describir la respuesta y las complicaciones relacionadas con el uso del rTPA en el manejo de trombos cardíacos con riesgo vital en RN. Pacientes y método: Estudio retrospectivo de 8 RN, 7 prematuros, con trombos cardíacos en los cuales se utilizó rTPA. Se analizó la edad gestacional y al diagnóstico, peso, sexo, enfermedades asociadas, hemograma, niveles de fibrinógeno, dímero D, tiempo parcial de tromboplastina activada y de protrombina, antes y al término de la infusión de rTPA. El diagnóstico del trombo se realizó por ecocardiografía doppler. La indicación de rTPA fue trombo mayor de 10 mm o que ocupara más del 50% de la cavidad donde se localizaba; aumento del tamaño a pesar del tratamiento con heparina, aspecto fragmentado y lobulado con riesgo embólico pulmonar o sistémico o que comprometiera la función valvular o cardíaca. Resultados: Cuatro hombres; peso promedio de 1.580 g. La principal enfermedad fue la sepsis (7/8), se usó catéter venoso central en todos, la vena cava superior fue la localización más frecuente, con tiempo promedio de instalación previo al diagnóstico de 12 días. En 7/8 RN los trombos se ubicaron en la aurícula derecha, con un tamaño entre 7 a 20 mm. Tres pacientes recibieron heparina de bajo peso molecular previo al uso de rTPA, se realizaron entre uno a 5 ciclos con rTPA. En 4 pacientes se logró resolución completa del trombo a los 3,5 días en promedio. No hubo embolia ni fallecidos. Cuatro pacientes presentaron hemorragia intracraneana grado I, sin secuelas en el seguimiento. Conclusión: Este estudio constituye la primera serie de neonatos tratados con rTPA en Chile, lográndose la resolución completa del trombo en un 50% de los RN y parcial en el resto, permitiendo con ello disminuir el riesgo vital secundario a este proceso patológico.

Introduction: The incidence of cardiac thrombi in newborns has increased with the use of central venous catheters. Thrombolysis with recombinant tissue plasminogen activator (rTPA) has been used as an alternative to heparin in life threatening giant thrombus and embolization. The aim of this study is to describe the response and complications related to the use of rTPA in the management of life- threatening cardiac thrombi in newborns. Patients and method: The medical records of 8 newborn were reviewed in a retrospective study, of whom 7 were preterm with cardiac thrombi, and rTPA was used in all of them. Results: The patients included 4 males with a mean weight of 1580 gr. The principal pathology was sepsis (7/8), all of them used venous central catheter. The superior vena cava was the most frequent location, with a mean time of installation before the diagnosis of 12 days. RN 7/8 thrombi were located in the right atrium with a size between 7 to 20 mm. Three patients received low molecular weight heparin prior to using rTPA. They received between 1 to 5 cycles with rTPA. In 4 patients complete resolution of the thrombus was achieved in a mean of 3.5 days. Four patients had intracranial haemorrhage grade I, without sequelae at follow-up. There were no deaths or embolism. Conclusion: This study is the first series of infants treated with rTPA in Chile, and where its use has quickly achieved complete resolution of the thrombus in 50% of cases, and partially in the others, thus reducing the secondary life-threatening risk of this disease.

Diagnóstico y manejo precoz de la gangrena de fournerr / Early diagnosis and management of fournier´s gangrene

Aim: The aim of this study is to report the results of a series of patients diagnosed with Fournier’s gangrene underwent surgical debridement plus broad-spectrum antibiotics in the emergency department of the Hospital Barros Luco-Trudeau (HBLT) between 2009 and 2013, in terms of mortality associated with the disease. Material and Methods: Between 2009 and 2013, a case series of patients with diagnosis of Fournier’s gangrene treated in the Emergency Department of the Hospital Barros Luco-Trudeau. The outcome variable was mortality attributed to the disease (MAD). Other variables were: age, sex, comorbidities, focus of origin, waiting time for antibiotic treatment and surgery to start, number of surgical debridement and agents isolated from cultures. Descriptive statistics were used, with calculation of measures of central tendency and dispersion. Results: During the study period, 56 patients were identified with diagnosis of Fournier’s gangrene (60.7 percent were male) with a mean age of 52 years (23-75 years old). The MAD was 48.2 percent. The most common comorbidity was diabetes (66.6 percent). The more prevalent focus of origin was anorectal pathology (42.9 percent). The average waiting time from diagnosis to initiation of antibiotic therapy and surgery was 40 minutes (15-80) and 580 minutes (20-4320), respectively. The required surgical debridement average was 4. Isolated on the intraoperative tissue cultures agent was E. coli (51.8 percent). Conclusion: Mortality attributable to Fournier’s gangrene is similar to that observed in the literature.

Objetivo: El objetivo de este estudio es comunicar los resultados observados en una serie de pacientes con diagnóstico de gangrena de Fournier sometidos a aseo quirúrgico con debridamiento más terapia antibiótica de amplio espectro, en el Servicio de Urgencias del Hospital Barros Luco Trudeau (HBLT), entre los años 2009 y 2013, en términos de mortalidad asociada a la enfermedad. Material y Método: Serie de casos de pacientes con diagnóstico de gangrena de Fournier tratados en el Servicio de Urgencias del Hospital Barros Luco-Trudeau entre 2009 y 2013. La variable resultado fue mortalidad atribuida a la enfermedad (MAE). Otras variables de interés fueron: edad, sexo, patologías asociadas, foco de origen, tiempo de espera para el inicio del tratamiento antibiótico y cirugía, número de aseos y agentes aislados en los cultivos. Se utilizó estadística descriptiva, con cálculo de medidas de tendencia central y dispersión. Resultados: En el período en estudio se identificaron 56 pacientes con diagnóstico de Gangrena de Fournier (60,7 por ciento eran masculinos), con un promedio de edad de 52 años (23-75 años). La MAE fue 48,2 por ciento. La patología asociada más frecuente fue la diabetes (66,6 por ciento). El foco de origen más prevalente fue la patología anorrectal (42,9 por ciento). El tiempo promedio de espera desde el diagnóstico hasta el inicio de la terapia antibiótica y la cirugía fue de 40 minutos (15-80) y 580 minutos (20-4320) respectivamente. El promedio de aseos requeridos fue de 4. El agente más aislado en los cultivos de tejido intraoperatorio fue Escherichia coli (51,8 por ciento). Conclusión: La mortalidad atribuible a la Gangrena de Fournier es similar a la observada en la literatura.

Trauma penetrante mediástinico por bala / Transmediastinal gunshot wound treated conservatively

Los pacientes con heridas de mediastino son sometidos en un alto porcentaje a intervenciones quirúrgicas con una alta mortalidad. Pueden agruparse en aquellos que requieren cirugía o en aquellos que serán evaluados y mantenidos en observación. El 50 por ciento de los heridos por bala en el mediastino sufrirá intervención de emergencia. La selección se efectúa según la condición hemodinámica de ingreso. Menos de un 10 por ciento de los pacientes estables requerirá una operación. Caso clínico: Presentamos el caso de un paciente varón de 22 años sin antecedentes mórbidos tratado en el Hospital Barros Luco Trudeau, herido por arma de fuego, hemodinámicamente estable cuyo proyectil ingresó por vía medioesternal, atravesando el esternón y alojándose en mediastino anterior, por delante del corazón y los grandes vasos, cuya evolución y estudio descartó lesiones viscerales. Se estudió con radiografía de tórax, ecocardiografía, tomografía computarizada (TC) de tórax con contraste y laboratorio de rutina. Se realizó monitorización, se inició tratamiento antibiótico de amplio espectro y analgesia. Su evolución fue satisfactoria. A 2 años de seguimiento se encuentra clínicamente normal. Los heridos en el mediastino, hemodinámicamente estables, pueden ser evaluados y seleccionados en forma segura con TC de tórax. Hay un grupo de pacientes sin lesión mayor, que evolucionan satisfactoriamente y que no requieren cirugía.

Patients with mediastinal trauma are subjected to numerous surgical procedures and have a high mortality. Fifty percent of patients will require emergency surgery and its indication depends on their hemodynamic condition on admission. Less than 10% of hemodynamically stable patients will require surgery. Case report: A 22 years old male with a transmediastinal gunshot wound. The bullet crossed the sternum and lodged in the anterior mediastinum in front of the heart and great vessels, without causing visceral lesions. A chest X ray, echocardiography, CT scan and routine laboratory were performed. The patient was treated with antimicrobials and analgesics with a satisfactory evolution. After two years of follow up, he is in good conditions.

Adenocarcinoma gástrico difuso positivo por HER-2 en inmunohistoquímica e hibridación fluorescente / HER-2-positive diffuse gastric adenocarcinoma through immunohistochemistry and fluorescent hybridization

HER-2 is a biomarker participating in tumor cell’s biology that has been thoroughly studied in breast cancer, but it can also be overexpressed in other neoplasms like gastric cancer. In this setting there are more reported cases about HER-2 positive immunohistochemistry in intestinal subtype than in diffuse subtype; in those cases, staining is limited to basolateral membrane. Positivity may be verified through fluorescent hybridization. This case is about a 30-year-old man diagnosed with diffuse gastric carcinoma from a total gastrectomy surgical specimen, in which 3+ HER-2 immunohistochemistry is confirmed in the totality of the plasma membrane of mucosa cells and is sustained using fluorescent hybridization for HER-2.

HER-2 es un biomarcador que colabora con la biología de la célula tumoral y ha sido ampliamente estudiado en cáncer de mama, pero también puedesobreexpresarse en otras neoplasias como el cáncer gástrico. En este escenario se reportan más casos deinmunohistoquímica positiva por HER-2 en el subtipo intestinal con respecto al subtipo difuso; en dichos casos, la tinción se limita a la membrana basolateral. Los casos positivos pueden ser verificados a través de hibridación fluorescente in situ. Se presenta el casode un sujeto masculino de 30 años con diagnóstico de carcinoma gástrico difuso a través de un espécimenquirúrgico de gastrectomía total, a la cual se le confirma mediante inmunohistoquímica 3+ para HER-2 enla totalidad de la membrana celular de las células de la mucosa y corroborado utilizando la técnica hibridaciónfluorescente in situ para HER-2.

Schwannoma retroperitoneal: Caso clínico / Retroperitoneal schwannoma: Report of one case

Background: Retroperitoneal schwannoma is an uncommon and usually benign condition. We report a 51-year-old woman presenting with a palpable pelvic tumor. The patient was operated on and during the intervention, two retroperitoneal tumors were found and resected. The postoperative course was favorable. Pathology confirmed the diagnosis of retroperitoneal benign shwannomas. After eight years of follow up, there is no evidence of malignant transformation.

[Retroperitoneal schwannoma. Report of one case]. / Schwannoma retroperitoneal. Caso clínico.

Retroperitoneal schwannoma is an uncommon and usually benign condition. We report a 51-year-old woman presenting with a palpable pelvic tumor. The patient was operated on and during the intervention, two retroperitoneal tumors were found and resected. The postoperative course was favorable. Pathology confirmed the diagnosis of retroperitoneal benign shwannomas. After eight years of follow up, there is no evidence of malignant transformation.

[Spontaneous pneumomediastinum. Review of eight cases]. / Neumomediastino espontáneo (síndrome de Hamman): una enfermedad benigna mal diagnosticada.

BACKGROUND: Hamman syndrome or spontaneous pneumomediastinum is uncommon and its clinical manifestations are chest pain, dyspnea and subcutaneous emphysema. AIM: To report a series of patients with spontaneous pneumomediastinum. MATERIAL AND METHODS: Medical records of patients with the diagnosis of pneumomediastinum, managed between 2002 and 2007 in a public hospital, were retrieved and reviewed. RESULTS: Eight patients aged between 16 and 41 years (five males) were identified. The most common symptom was chest pain and the most common sign was subcutaneous emphysema. A chest X ray was performed in all and a chest CT scan in seven. AH were managed conservatively with oxygen, analgesia and rest. No patient required surgery and the evolution was favorable. CONCLUSIONS: The most common presenting complaint of spontaneous pneumomediastinum is chest pain and its management does not require surgery.

[Umbilical cord hematopoietic precursors transplantation. Report of five patients]. / Trasplante con precursores hematopoyéticos de cordón umbilical en adultos con neoplasias hematológicas en Chile: serie clínica.

Hematopoietic precursors transplantation is a therapeutic alternative for leukemia, some metabolic diseases and some immune deficiency syndromes. In its allogeneic variety leukemia eradication is based in the conditioning prior to transplantation and the allograñ effect against leukemia. Umbilical cord blood is an alternative source of hematopoietic precursors when there are no HLA compatible relatives available. Between 2003 and 2007 we have performed five umbilical cord blood transplant in adult patients in a University hospital. All patients had malignant diseases. Conditioning protocols were ablative in all except in one patient and in all, more than one unit of umbilical cord blood was used. Hematopoietic engraftment was confirmed in all patients and the main complications registered were infectious and associated to immunosuppression.