Perforación esofágica espontánea

Resumen La perforación esofágica espontánea es una forma rara de ruptura del grosor de la pared del esófago sano, de manera no traumática. Es característico verla en pacientes de mediana edad, con obesidad y alcohólicos, que tienen episodios violentos de náuseas y vómitos. El tratamiento de la perforación esofágica espontánea depende de varios factores, como la etiología, sitio de la perforación, tiempo transcurrido desde la perforación hasta el diagnóstico, el grado de la contaminación del peritoneo o mediastino, comorbilidades, y estado general del paciente. En este artículo se presenta el caso de un paciente con enfisema subcutáneo en la parte superior del tórax, cuello y cara; con taquicardia de 115 latidos por minuto, hemograma con 18 mil leucocitos con predominio de neutrófilos. Se le realizaron radiografías de tórax y senos paranasales, donde se observa aire entre partes blandas y hueso. Se le realiza tratamiento quirúrgico con cierre de la perforación por toracotomía izquierda, se deja alimentación por sonda nasogástrica y antibióticos por 7 días.

Abstract Spontaneous esophageal perforation is a rare form of non-traumatic rupture of the thickness of the wall of the healthy esophagu. It is observed in middle-aged, obese, and alcoholic patients who have violent episodes of nausea and vomiting. Treatment of spontaneous esophageal perforation depends on several factors, such as the etiology, site of the perforation, time from perforation to diagnosis, degree of contamination of the peritoneum or mediastinum, comorbidities, and general condition of the patient. This article presents the case of a patient with subcutaneous emphysema in the upper part of the chest, neck and face; with a heart rate of 115 beats per minute, with a blood count of 18,000 leukocytes with a predominance of neutrophils. X-rays of the chest and paranasal sinuses were performed, where air is observed between soft tissue and bone. Surgical treatment is performed with closure of the perforation by left thoracotomy, feeding by nasogastric tube and antibiotics is left for 7 days.

Displasia fibrosa en seno etmoidal y esfenoidal: a propósito de un caso

Resumen La displasia fibrosa es una enfermedad del hueso, benigna, idiopática, de base genética y de progresión lenta, que se caracteriza por el reemplazo progresivo del hueso normal con tejido fibrótico, entremezclado con trabéculas óseas irregulares. El cráneo también es un sitio frecuente de afectación, los huesos del complejo craneofacial, incluida la mandíbula, el maxilar, la base y la bóveda craneal, son los principalmente afectados. Los huesos etmoidales, esfenoidales, frontales y temporales son afectados con poca frecuencia. En este artículo se presenta un caso de una paciente con cefalea y dolor en hemicara derecha, exoftalmos y edema periorbitario ipsilateral. Luego del examen físico, se realizó tomografía computarizada y biopsia del tumor, llegando al diagnóstico de displasia fibrosa de seno etmoidal y esfenoidal. Se maneja en forma conservadora, con seguimiento cada 6 meses para evaluar evolución. Es un caso con una localización infrecuente, y que debe ser cuidadosamente evaluado para adoptar la conducta terapéutica correcta.

Abstract Fibrous dysplasia is a slowly progressive, genetically based, benign, idiopathic bone disease characterized by progressive replacement of normal bone with fibrotic tissue, interspersed with irregular bone trabeculae. The skull is also a frequent site of involvement, the bones of the craniofacial complex, including the mandible, the maxilla, the base and the cranial vault, are mainly affected. The ethmoid, sphenoid, frontal, and temporal bones are affected at a low rate. This article presents a case of a patient with headache and pain in the right side, exophthalmos, and ipsilateral periorbital edema. After the physical examination, a computed tomography and biopsy of the tumor were performed, reaching the diagnosis of fibrous dysplasia of the ethmoid and sphenoid sinus. Conservative management is given, with follow-up every 6 months to assess evolution. It is a case with an infrequent location, and it must be carefully evaluated to take therapeutic behavior.

[Nutrient utilization in children with acute diarrhea fed with formulas containing chicken and soybean]. / Utilización de nutrientes en niños con diarrea aguda alimentados con formula a base de pollo y de soya.

The objective of this study was to measure in children with acute diarrhea the apparent absorption and retention of the macronutrients and some micronutrient present in a formula prepared with chicken and a formula prepared with soybean protein. Fourteen male children (9 months old) with acute diarrhea were assigned to each of these formulas and the consumption and excretion of the studied nutrients were monitored during 48 h. The results showed that the children assigned to the chicken formula consumed more protein and less fat than those in the soybean protein formula. These differences however were associated with differences in the composition of the formulas offered rather than to differences in protein or fat utilization. Fecal mass (800 g/48 h) was similar in both groups and the macronutrient content of the feces, reflected well the amount consumed. The apparent absorption of fat (63%), nitrogen (75%) and carbohydrates (78%) resulted similar in both groups and there were no differences in the retention of nitrogen which approximated 55%. The digestible energy and the metabolizable energy of both formulas, also resulted equal. In general the children excreted more urinary ammonia and less creatinine than healthy children but there were no differences in the excretion of these metabolites between the children assigned to the chicken or to the soybean protein formulas. The retention of Zn (47%) and Ca (72%) were also similar in both groups and they excreted a high (0.17 mg/48 hr) but similar amount of Vitamin A. In summary, these results showed that from a nutritional point of view, the chicken and the soybean protein formulas were equally utilized during the acute phase of diarrhea.

[Serum lipids and vitamin A, C and E concentrations in an adult population of Caracas City]. / Lípidos séricos y niveles de las vitaminas A, C y E en una población adulta de la ciudad de Caracas.

Lipid profiles as well as vitamins A, C and E were determined in a sample of 90 men and 151 women with ages within 35 and 50 years old. Comparing the lipid profiles obtained in the study with the limits established by the National Cholesterol Education Program, resulted that a little more than 60% of the group had total cholesterol and LDL cholesterol levels in the desirable range, 20 to 30% had levels in the marginal range while 10 to 15% had levels in the high risk range. This distribution of the risk is more favorable than that observed in populations with a high risk of heart diseases such us the British or American populations, which show a substantially higher segment of the people in the high risk level. When the protective effect of the HDL cholesterol was included in the estimation of the risk by calculating the indexes: Total cholesterol/HDL chol., LDL Chol/HDL chol. or Total Chol-HDL chol. 65 to 80% of the population had values within the normal range and the first of these indexes, indicated that the men had a higher risk than the women. Integrating both methods of estimating the risk and considering that the risk of the individuals in the marginal range defined by the National Cholesterol Education Program is minimal unless they have two additional risk factors, it appears that an important segment (20-30%) of the studied population may benefit from programs aiming to reduce other risk factors such as smoking, high blood pressure, diabetes or overweight. The vitamin levels measured in this study indicated that the vast majority of the population had their levels in the safe range but an important segment had vitamin C serum levels indicative of poor consumption of this vitamin. Since vitamin C is high in fruits and vegetables we concluded that the studied population had a low consumption of these foods. Due to the existing evidence of a protective effect of fruits and vegetables in heart and other chronic diseases it was concluded that institutions such as the one studied here should engage in preventive campaigns emphasizing a reduction of both risk factors and the consumption of saturated fats. The results of this study also indicate that the consumption of fruits and vegetables should be encouraged.

[The effect of lactation time on the macronutrient and mineral composition of milk from Venezuelan women]. / Variaciones temporales en la composición y aporte de macronutrientes y minerales en leches maternas de mujeres venezolanas.

Human milk is considered the ideal food for the infant and it has been extensively used to estimate its nutrient requirements. The objective of this paper was to determine the effect of lactation time on the macronutrient an mineral content of milks obtained from Venezuelan women and also to compare this with the established nutrient requirements of the infant. For this purpose 83 milk samples from 45 low income mothers were analyzed at the colostrum (48 h to 54 d) and mature states of lactation (1.3 and 6 months). The results showed that colostrum had a higher protein and a lower fat content than mature milks whereas its content of energy and carbohydrate was similar to mature milk. The iron and calcium content of the milk remained unchanged during the whole study whereas Zn and Cu decreased and increased with lactation time respectively. In contrast, phosphorous and magnesium increased up to 3rd month of lactation and remained constant there after. The macronutrient content of 850 ml of the analyzed milk almost completely fulfilled the daily infant requirements established in the US (RDA) and Canada (RNI). The mineral content of this volume of milk however was insufficient to cover the infants requirements particularly those established in the US. The most notorious deficiency in these milks was in Fe since they could fulfill only 11% the infants RDA for this mineral. The infant mineral requirements established in Canada are substantially lower than those defined in the US and therefore the analyzed milks could totally fulfill the Canadian infant daily requirements of Mg, Fe and Ca and more than 70% and 80% of the requirements of Zn and P. In general, the results of this study showed that the nutrient content of the analyzed milks agree well with those reported in the literature for women from different parts of the world including developed and underdeveloped areas. At the same time they pointed out the differences in the definition of the infant nutrient requirements set by different countries and also emphasize the fact that human milk, which by definition is the natural source of nutrients for the human infant apparently is incapable of fulfilling its daily requirements.

Brewery waste as a substitute for soy protein in soy-brewer's yeast mixtures to feed broiler chickens.

We examined the replacement of soy isolated protein by a solid fraction coming from brewery liquid waste, in the preparation of soy protein and brewer's yeast mixtures (50:50) to feed growing chickens. The replacement of 20 percent soy protein by brewery waste protein to the diet, showed no significant differences in the growth and food intake of the chickens, when compared with soy protein fed chickens. Protein Efficiency Ratio (PER) and Net Protein Ratio (NPR) values of the diets were also very similar and the concentration of plasma and liver lipids remained approximately the same. Higher levels of brewery waste reduced the performance of chickens although total lipids, cholesterol and triacylglycerols in plasma, as well as total lipids and cholesterol in liver were not affected. The data reported here indicated that brewery waste can be used as a complementary protein source in broiler chicken diets.

[Agreement between animal and vegetable protein digestibility measured in vivo and in vitro and its effect on the chemical score]. / Grado de concordancia entre la digestibilidad de proteínas animales y vegetales medidas in vivo e in vitro y su efecto sobre el computo químico.

Protein digestibility is a key factor in the determination of protein quality using the chemical score. Since there are several methods available for determining protein digestibility the purpose of this study was to compare three methods in vitro (pH drop, pH stat and pepsin digestibility) and two methods in vivo (true and apparent digestibility in rats) in the determination of the protein digestibility of: casein, soy protein isolate, fish meal, black beans, corn meal and wheat flour. The results showed that in the case of highly digestible proteins all methods agreed very well. However, this agreement was much less apparent in the case of protein with digestibilities below 85%. As a result, the chemical score of these proteins varied substantially depending upon the method used to determine its digestibility. Thus, when the chemical score of the proteins analyzed was corrected by the true protein digestibility measured in rats, they ranked as: casein 83.56, soy 76.11, corn-beans mixtures (1:1) 58.14, fish meal 55.25, black beans 47.93, corn meal 46.06 and wheat flour 32.77. In contrast, when the chemical score of these proteins was corrected by the pepsin digestibility method, the lowest quality was assigned to fish meal. In summary, this results pointed out that for non conventional proteins of for known proteins which have been subjected to processing, protein digestibility should be measured in vivo.

Nutritional evaluation of the soy-whey milk analog La colina.

The milk analog La colina is a product which contains mainly whey, soy protein isolate and vegetable oil, designed for infants since one year, children, adolescents and adults of all ages. The concept behind this product is to offer an alternative to milk consumption which during the last decade has decreased dramatically in Venezuela mainly due to its high price and low availability. Accordingly, the purpose of this study was to evaluate nutritionally this new product in order to determine if from a nutritional stand point it could represent a valid alternative to milk consumption. The results showed that La Colina offers the same amount of protein, energy, vitamin A, calcium, phosphorus and potassium as whole milk powder and more sodium, iron and zinc. In addition, a rat assay showed that the energy in these two products is equally available and even though the proteins in La colina are 3.9% less digestible, their quality determined by growth, PER or the nitrogen retained are excellent and identical to the quality of the proteins in milk. These results agreed with the theoretical chemical score of the proteins of this new product, which indicated that the amino acid profile of the mixture can fulfill the amino acid requirements of children, adolescents an adults. Both milk and La colina are products with a high fat content. The fat in this new product however, is vegetable oil and therefore it has a more convenient fatty acid profile than whole milk and about one third of its cholesterol. In short, these results showed that La Colina from a nutritional point of view is an excellent alternative to milk consumption.