Introduction: Esophagectomy presents a high postoperative morbidity. However, the definitions used are variable. A multinational group (esophagectomy complications consensus group; ECCG) proposed standardized definitions. Aim: To evaluate postoperative complications in esophagectomy according to the definitions proposed by the ECCG. Materials and Method: We conducted a retrospective cohort study, based on a prospective database. Patients undergoing esophagectomy for cancer between 1996 and 2018 at one center were included. The definitions of postoperative complications according to the ECCG were applied. Results: We included 215 patients (64% men, age 67 [31-82] years). Sixty-four percent had some comorbidity. There was a predominance of squamous carcinoma with 68%. The most frequent tumor location was the lower third of the esophagus (48%). An open approach was used in 74% and minimally invasive in 26%. Total postoperative morbidity was 67%. The most frequent complications were respiratory complications, which reached 27%. The leakage of the esophagogastric anastomosis reached 25%, 24% were type II (did not require surgical reoperation). There was a vocal cord paresis in 7%, all were classified as type I (did not require specific therapy). A chylous fistula was presented in 2%, in 1% they were treated with parenteral nutrition (type II) and in 1% a reoperation was performed (type III). Conclusion: Esophagectomy is associated with a high morbidity. The main complications are respiratory and gastrointestinal. The use of consensus definitions allows standardization and grading of complications.

Resumen Introducción: La esofagectomía presenta una alta morbilidad postoperatoria. Sin embargo, las definiciones de las complicaciones son variables. Un grupo multinacional (esophagectomy complications consensus group; ECCG) propuso definiciones estandarizadas. Objetivo: Evaluar las complicaciones postoperatorias en esofagectomía según las definiciones propuestas por el ECCG. Materiales y Método: Realizamos un estudio de cohorte retrospectivo, a partir de una base de datos prospectiva. Se incluyeron pacientes sometidos a una esofagectomía por cáncer entre 1996 y 2018 en un centro. Se aplicaron las definiciones de las complicaciones postoperatorias según el ECCG. Resultados: Se incluyeron 215 pacientes (Hombres 64%; edad 67 [31-82] años). Un 64% presentaban alguna comorbilidad. Existió un predominio de carcinoma escamoso con un 68%. La ubicación tumoral más frecuente fue el tercio inferior del esófago (48%). Se utilizó un abordaje abierto en 74% y mínimamente invasivo en 26%. La morbilidad postoperatoria total fue de 67%. Las complicaciones más frecuentes fueron las respiratorias alcanzando un 27%. En total, un 25% de los pacientes presentó una filtración de la anastomosis esofagogástrica, de las cuales un 24% fueron tipo II (no requirieron una reintervención quirúrgica). Se produjo una paresia de cuerda vocal en 7%, todas tipo I (no requirieron terapia específica). Se presentó una fístula quilosa en 2%, en 1% se trataron con nutrición parenteral (tipo II) y en 1% se realizó una reintervención (tipo III). Conclusión: La esofagectomía se asocia a una alta morbilidad. Las principales complicaciones son las respiratorias y las gastrointestinales. La utilización de las definiciones de consenso permite una estandarización y graduación de las complicaciones.

RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.

ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

Introduction Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.

Resumen Introducción El tratamiento quirúrgico del cáncer esofágico se asocia a una alta morbimortalidad. El abordaje mínimamente invasivo se ha introducido con el objetivo de disminuir la morbilidad postoperatoria. Objetivo Describir la técnica y los resultados de la esofagectomía mínimamente invasiva (EMI) transtorácica en posición semiprono. Métodos Estudio de cohorte descriptivo. Se incluyeron pacientes con una EMI electiva por cáncer entre abril de 2013 y mayo de 2017. Se registraron variables demográficas, perioperatorias, anatomía patológica y la sobrevida. Resultados Incluimos 33 pacientes (24 hombres, edad 69 años, 91% con comorbilidades). La ubicación predominante del tumor fue en los tercios medio e inferior del esófago (90%). Quince (45%) pacientes recibieron neoadyuvancia. No existieron casos de conversión a toracotomías. La reconstrucción se realizó con estómago en un 93%. Se realizó anastomosis cervical en 66% y torácica en 30%. El tiempo operatorio fue de 420 (330-570) minutos y el sangrado de 200 (20-700) cc. La mortalidad a 90 días fue de 0%. La morbilidad global fue de 78%, se registró un 15% de neumonía y un 9% requirió una reoperación. La estadía hospitalaria fue de 23 (11-81) días. La histología fue carcinoma escamoso en 51% y adenocarcinoma en 45%. Los márgenes fueron RO en 87%. El recuento ganglionar alcanzó 30 (9-45) ganglios. La sobrevida global a 2 años es 68%. Conclusión Los resultados preliminares de esta técnica son favorables; sin ningún caso de mortalidad postoperatoria. Los resultados oncológicos demuestran un alto porcentaje de cirugía RO y adecuado recuento ganglionar.

Abstract Having instruments validated in Chile for Erectile Dysfunction (ED), motivated the validation of the Spanish version of the International Index of Erectile Function (IIEF), in Chilean population. A non-experimental quantitative study of non-probabilistic sample was carried out for convenience, with 95 adult males from three health centers (Concepción, Talcahuano and Santiago), during November 2012 and June 2013. Blind experts conducted a clinical interview using DSM-V criteria and medical-surgical causes of ED. After the pilot application and adaptation of the IIEF, version IIEF-Ch was achieved by applying it to the entire sample. The results were analyzed with SPSS 15.0, obtaining high correlation between variables (X2: 956,533) and high sample adequacy (0,893); two factors that explain 81.59% of the variance of the instrument, with high reliability (.971) and adequate criterion validity, high sensitivity (84.5%) and acceptable specificity (91.9%). The IIEF-Ch is a valid and reliable instrument for studies on ED in Chile.

Resumen Contar con instrumentos validados en Chile para Disfunción Eréctil (DE), motivó el validar la versión española del Índice Internacional de Función Eréctil (IIEF), en población chilena. Se realizó un estudio cuantitativo no experimental transversal, de muestra no probabilística por conveniencia, con 95 varones adultos de tres centros de salud (Concepción, Talcahuano y Santiago), durante Noviembre 2012 y Junio 2013. Expertos ciegos realizaron entrevista clínica utilizando criterios DSM-V y causas médico-quirúrgicas de DE. Luego de aplicación piloto y adaptación del IIEF, se logró la versión IIEF-Ch aplicándola a toda la muestra. Se analizaron los resultados con SPSS 15.0, obteniéndose alta correlación entre variables (X2: 956.533) y alta adecuación muestral (0,893); dos factores que explican el 81.59% de la varianza del instrumento, con alta confiabilidad (.971) y adecuada validez de criterio, alta sensibilidad (84.5%) y especificidad aceptable (91.9%). La IIEF-Ch es un instrumento válido y confiable para estudios sobre DE en Chile.

Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.

Libman-Sacks endocarditis is a non-infectious valvular damage associated with autoimmune disorders such as Systemic Lupus Erythematosus and Antiphospholipid Syndrome. We report a 17-year-old female consulting in the emergency room due to a right hemiparesis and aphasia. A magnetic resonance imaging showed multiple infarctions in the territory of the left middle cerebral artery, presumably of embolic origin. A trans-esophageal echocardiogram showed a vegetation in the mitral valve. Blood cultures were negative. Antinuclear antibodies and serological tests for antiphospholipid syndrome were positive. Oral anticoagulation was started and the patient was discharged. After six months of follow up, antiphospholipid antibodies are still positive.

Background: Human bocavirus (HBoV) is a newly discovered parvovirus found in children with acute respiratory tract infections (ARTI). Objectives: To describe the epidemiological and clinical profile of children < 5 years old consulting for ARTI, comparing cases of HBoV monoinfection and coinfection with other known respiratory viruses. Furthermore, we aimed to estimate the prevalence of viral shedding in asymptomatic children and perform phylogenetic analysis. Patients and Methods: We investigated the presence of HBoV in nasopharyngeal secretions from children consulting for AlRTI and among asymptomatic controls, between 2007 and 2008, by polymerase chain reaction. Results: HBoV was detected in 79 (21.8%) of 362 nasopharyngeal swabs obtained from children with ARTI. In 60/79 (76%), coinfection with other respiratory viruses was confirmed. Most common symptoms were cough, fever and rhinorrhea. Children infected only with HBoV showed significantly lower frequencies of respiratory distress, oxygen requirements and hospital admission than those with coinfection. HBoV was detected in 6/16 (37.5%) samples from asymptomatic children. The phylogenetic analysis of viruses from Chilean patients revealed that circulating HBoV was closely related to original strains. Conclusions: HBoV was found either in symptomatic and asymptomatic children. The severity of the disease was greater when HBoV was associated to other respiratory viruses.

Introducción: Bocavirus humano (HBoV) es un nuevo parvovirus encontrado en niños con infecciones respiratorias agudas (IRA). Objetivos: Describir la epidemiología y perfil clínico en niños < 5 años con IRA, comparando aquellos con HBoV como único agente identificado, con los que tenían co-infección con otro virus respiratorio. Además se evaluó su prevalencia en niños asintomáticos, y se realizó análisis filogenético. Materiales y Métodos: Se investigó la presencia de HBoV, por medio de reacción de polimerasa en cadena, en muestras de secreción nasofaríngea obtenida en niños con IRA y en controles asintomáticos, entre 2007 y 2008. Resultados: Se detectó HBoV en 79 (21,8%) de 362 muestras obtenidas en pacientes con IRA. En 60/79 (76%), se demostró co-infección. Los síntomas más frecuentes fueron tos, fiebre y rinorrea. Los pacientes con HBoV como único agente identificado mostraron frecuencias significativamente menores de dificultad respiratoria, requerimiento de oxígeno y hospitalización, comparado con los co-infectados. HBoV se detectó en 6/16 (37,5%) muestras de niños asintomáticos. El análisis filogenético de las cepas chilenas demuestra estrecha relación con las cepas originales. Conclusiones: HBoV está presente en niños chilenos con IRA y asintomáticos. La gravedad de la enfermedad fue mayor en el grupo con co-infección.

Endometriosis is a common, chronic, benign, estrogen dependent gynecological disorder associated to pelvic pain and infertility. Its main characteristic is the presence of endometrial tissue outside the uterus. The prevalence of pelvic endometriosis ranges between 6% and 10% women during their reproductive years. Clinical symptoms of pelvic endometriosis are pelvic pain, dysmenorrhea, dispareunia and infertility. Distal ileum endometriosis is an uncommon cause of intestinal obstruction with a frequency of 7% to 23% of all cases with intestinal involvement. We report two patients, 30 and 34 years old, with terminal ileum endometriosis and intestinal obstruction that required surgery and intestinal resection. Both patients are well one year after the operation

Meckel's diverticulum has a 2% incidence in the general population. Only 4% to 30% of all patients with Meckel's diverticulum develop complications. Most Meckel's diverticulum complications appear in patients aged 10 years or less. Among these, Meckel's diverticulum volvulus is unusual with a 3% incidence. We report a 64 years old patient with a Meckel's diverticulum volvulus associated with intestinal obstruction and peritonitis. Plain abdominal X rays showed air-fluid levels. An abdominal and pelvic CAT scan showed small bowel loops forming an inflammatory mass and filled with intestinal fluids inside the pelvis. During surgery an inflammatory mass encapsulating a twisted Meckel's diverticulum originating from the terminal ileon was observed. A segmental resection of the diverticulum's base and primary anastomosis in two planes with polyglycolic acid suture, was performed. The patient had an uneventful postoperative period with no complications. The histopathological report did not found heterotopic gastric mucosa or pancreatic tissue in the diverticulum's wall

La incidencia del divertículo de Meckel es de 2% en la población general. Las complicaciones de los divertículos de Meckel se presentan en 4 a 30% de las personas afectadas, más de 50% de los casos complicados se producen en pacientes menores de 10 años de edad. El vólvulo del divertículo de Meckel es una complicación poco frecuente con una incidencia de 3,2%. Reportamos el caso clínico de un paciente de 64 años que se presenta con vólvulo de un divertículo de Meckel asociado a obstrucción intestinal y peritonitis. La radiografía de abdomen demostró niveles hidroaéreos compatibles con el diagnóstico de obstrucción intestinal. En la tomografía abdominal y pelviana se observan asas de intestino delgado con pared engrosada, aglutinadas en un plastrón y llenas de contenido líquido localizadas en la pelvis. Los hallazgos de la cirugía fueron asas de yeyuno e ileon muy dilatadas, hacia la región periumbilical e hipogástrica se observa un plastrón inflamatorio dentro del cual se encuentra un divertículo de Meckel volvulado que se origina del ileón terminal, se realiza resección de un segmento intestinal de 4 cm, donde está la base del divertículo, y anastomosis primaria con sutura continua de ácido poliglicólico en dos planos. El paciente se recuperó sin complicaciones en el postoperatorio. El estudio histopatológico no encontró mucosa heterotópica gástrica o tejido pancreático en la pared del divertículo