Heller myotomy and laparoscopic fundoplication in achalasia. A retrospective experience.

BACKGROUND: Laparoscopic myotomy associated with fundoplication is a useful therapeutic resource for the treatment of achalasia. The aim of the study was to analyze the outcomes of the surgical treatment of achalasia in a group of patients treated at the Hospital Naval de la Secretaría de Marina and at the Hospital Español in Veracruz during a 6-year period. METHODS: Eleven patients were submitted to myotomy and fundoplication. Variables analyzed were age, gender, symptom duration, surgical complications, surgical time, day/stay, and postoperative morbidity. RESULTS: Mean age was 41.7 years ± 7.69 years; 63.64% of the patients were male and 36.36% were female. Average time from symptom onset was 2.5 ± 1.38 years. All patients had received previous unsuccessful medical and endoscopic treatment. Diagnosis was confirmed by esophagogram, endoscopy and manometry. All patients underwent Heller myotomy and fundoplication. Operative time was 140.4 ± 26.2 min. Average days/stay was 3.7 ± 1.4 days. Postoperative course was satisfactory in all patients and there was no perioperative mortality. Average follow-up was 3.8 ± 2.3 years. CONCLUSIONS: In our group, laparoscopic myotomy with fundoplication was a safe procedure offering excellent results comparable with those published in the literature. There is controversy about the type of fundoplication; therefore, the choice is at the discretion of the surgeon.

[Neumopathies in patients with primary immunodeficiencies in treatment with intravenous gammaglobulin]. / Neumopatías en pacientes con inmunodeficiencias primarias en tratamiento con gammaglobulina intravenosa.

BACKGROUND: The primary immunodeficiency diseases cause a deficit in the production of antibodies. The chronic sinopulmonary disease is common and their clinic symptoms are diverse (pneumonia, bronchiectasis). OBJECTIVE: To know the frequency and type of pulmonary abnormalities in patients with primary immunodeficiency in treatment with intravenous immunoglobulin. MATERIAL AND METHODS: 24 files of patients with primary immunodeficiency were selected. Age, sex, primary immunodeficiency type, time of immunoglobulin treatment, chest X-ray finding, pulmonary computed tomography of high resolution (HRCT) and pulmonary function tests were registered. Measures of central tendency were calculated. RESULTS: There was no predominance of gender; the average age was 14 years old. The common variable immunodeficiency and the Bruton's hypogammaglobulinemia represented 91% of the patients. The X-ray of thorax was abnormal in 33%, although there were not bronchiectasis. The high-resolution computed tomography scan (HRCT) was abnormal in 67%, and 75% had bronchiectasis. CONCLUSIONS: The pulmonary complications are common despite therapy with intravenous immunoglobulin. The HRCT is better than X-ray in these patients.

[Outbreak of Coxiella burnetii pneumonia]. / Brote epidémico de neumonía por Coxiella burnetii.

OBJECTIVE: The aim of this study was to describe an outbreak of Q fever pneumonia in the North of Spain. MATERIAL AND METHODS: We report 60 cases of Coxiella burnetii pneumonia in a rural area with 16,000 inhabitants during January and February 2003. The diagnosis was serologically confirmed by indirect immunofluorescence. RESULTS: Mean age of the patients was 46 years and the male/female ratio was 2.5. Overall, 52% of the patients lived in urbanized areas and contact with animals was declared in only 7% of patients. Sixty percent of patients were hospitalized. The most frequent clinical presentation was an acute febrile process (100%) and headache (80%); respiratory symptoms were infrequent. The most common liver function alteration was elevated transaminase levels (35%). Radiologic evidence of a single lobar or segmental alveolar opacity was found in 87% of patients, and most commonly affected the lower lobes. Chest radiographs returned to normal in 70% of patients within the two first months. Empirical treatment consisted of beta-lactams and macrolides in 38%, macrolides alone in 8%, and quinolones in 23%; 27% were treated with beta-lactams alone. No deaths occurred. CONCLUSIONS: Coxiella burnetii infection is very prevalent in the north of Spain and should be suspected and investigated when outbreaks of a pneumonic illness occur.

Brote epidémico de neumonía por Coxiella burnetii / Outbreak of Coxiella burnetii pneumonia

Objetivo. El propósito del estudio es describir un brote epidémico de neumonía por Coxiella burnetii que ocurrió en un área rural del norte de España. Material y métodos. Se describen 60 casos de neumonía por C. burnetii en un área rural de 16.000 habitantes del norte de España durante enero y febrero de 2003. El diagnóstico fue confirmado serológicamente por inmunofluorescencia indirecta. Resultados. La edad media fue de 46 años siendo la relación varón/mujer de 2,5. El 52% de los pacientes vivían en un área urbana y solamente el 7% referían contacto con animales. Fueron hospitalizados el 60% de los pacientes. La clínica más frecuente fue un proceso febril agudo (100%) y cefalea (80%) con escasos síntomas respiratorios. La alteración hepática más frecuente fue la elevación de las transaminasas (35%). Las alteraciones radiológicas consistieron en una condensación alveolar lobular o segmentaria en el 87% de los pacientes siendo los lóbulos inferiores los más frecuentemente afectados. La radiografía de tórax se normalizó en el 70% de los pacientes en los primeros 2 meses. El tratamiento empírico utilizado con mayor frecuencia fueron los betalactámicos asociados a macrólidos en el 38%, solamente macrólidos en el 8% y quinolonas en el 23% de los casos. El 27% de los pacientes fueron tratados únicamente con betalactámicos. Ningún paciente falleció. Conclusiones. La infección por C. burnetii es muy prevalente en el norte de España y debe de ser sospechada e investigada en aquellos casos de brote epidémico neumónico (AU)

Objective. The aim of this study was to describe an outbreak of Q fever pneumonia in the North of Spain. Material and methods. We report 60 cases of Coxiella burnetii pneumonia in a rural area with 16,000 inhabitants during January and February 2003. The diagnosis was serologically confirmed by indirect immunofluorescence. Results. Mean age of the patients was 46 years and the male/female ratio was 2.5. Overall, 52% of the patients lived in urbanized areas and contact with animals was declared in only 7% of patients. Sixty percent of patients were hospitalized. The most frequent clinical presentation was an acute febrile process (100%) and headache (80%); respiratory symptoms were infrequent. The most common liver function alteration was elevated transaminase levels (35%). Radiologic evidence of a single lobar or segmental alveolar opacity was found in 87% of patients, and most commonly affected the lower lobes. Chest radiographs returned to normal in 70% of patients within the two first months. Empirical treatment consisted of beta-lactams and macrolides in 38%, macrolides alone in 8%, and quinolones in 23%; 27% were treated with beta-lactams alone. No deaths occurred. Conclusions. Coxiella burnetii infection is very prevalent in the north of Spain and should be suspected and investigated when outbreaks of a pneumonic illness occur (AU)

La gammagrafía como método de estudio en el sindrome esofágico / Gammagraphic as a study method of oesophagic syndrome

El objetivo de la presesnte comunicación es el de ponderar como método de estudio a la gammagrafía radioisotópica en enfermos con manifestaciones clínicas de compromiso visceral del esófago, ya como patología propia o como repercusión sistémica de otras enfermedades . Para ello se realizaron exploraciones del esófago en 27 pacientes consecuctivos de diferentes sexos luego de evaluaciones clínicas, radiológicas y endoscópicas, y las mismas se llevaron a cabo con la gammacámara utilizando Tecnecio 99 como radioisótopo. Se anotaron los sintomas cardinales de cada enfermo, las patologías encontradas, se demostraron alteraciones en 15 casos que consistieron principalmente en registros anormales de la función motora. Se destaca que la radiografía rutinaria de contraste y la endoscopía previa pusieron de manifiesto anormalidades en tan sólo una minoría de ellos. Debido al alto indice de neoplasias esofágicas en el NOA creemos conveniente que los pacientes con sindrome esofágico de origen incierto deben ser sometidos a una gammagrafía si estudios diagnósticos previos no revelan anomalías de importancia

La gammagrafía como método de estudio en el sindrome esofágico / Gammagraphic as a study method of oesophagic syndrome

El objetivo de la presesnte comunicación es el de ponderar como método de estudio a la gammagrafía radioisotópica en enfermos con manifestaciones clínicas de compromiso visceral del esófago, ya como patología propia o como repercusión sistémica de otras enfermedades . Para ello se realizaron exploraciones del esófago en 27 pacientes consecuctivos de diferentes sexos luego de evaluaciones clínicas, radiológicas y endoscópicas, y las mismas se llevaron a cabo con la gammacámara utilizando Tecnecio 99 como radioisótopo. Se anotaron los sintomas cardinales de cada enfermo, las patologías encontradas, se demostraron alteraciones en 15 casos que consistieron principalmente en registros anormales de la función motora. Se destaca que la radiografía rutinaria de contraste y la endoscopía previa pusieron de manifiesto anormalidades en tan sólo una minoría de ellos. Debido al alto indice de neoplasias esofágicas en el NOA creemos conveniente que los pacientes con sindrome esofágico de origen incierto deben ser sometidos a una gammagrafía si estudios diagnósticos previos no revelan anomalías de importancia