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The approach to mediastinal injuries is one of the most exciting procedures for the chest surgeon. Lateral thoracotomy or sternotomy is usually used, although there are other procedures. With the development of thoracoscopic surgery implemented by Jacoveus, it has been perfected above all with better equipment and technological implements, although it has become clear to our work group in which cases it should be used and in which cases it should not. In some mediastinal lesions the endoscopic approach is possible and not feasible in others. In this work group, we have been able to implement the two-port surgical approach for the resection of some mediastinal lesions, as in this case, which is already in addition to the technique proposed in this Service.

Background: We have observed that patients with descending necrotizing mediastinitis show bilateral lower lobes atelectasis before pleural effusion that finally forms empyema. Successful treatment of mediastinitis emphasizes optimal early drainage of neck, mediastinum, and antibiotic therapy. Methods: Exploratory study to determine the presence of segmental atelectasis as incipient sign of mediastinitis. We studied patients from August 2018 to July 2019 with tomographies. Results: We evaluated 25 patients operated due to Mediastinitis at our hospital, from August 2018 to July 2019. Ten (40%) were females and 15 (60%) were male patients. Twenty-one (84%) patients showed atelectasis and 4 (16%) did not have atelectasis. Of the patients that showed atelectasis, 17 (81%) were bilateral, 2 (9.5%) were right sided, and 2 (9.5%) were left sided. We also analyzed the occurrence of pleural effusion in this group. Fifteen (60%) patients had pleural effusion and 10 (40%) did not. Of the total patients with pleural effusion 11 (73.3%) were bilateral, 3 (20%) of the right side, and 1 (6.6%) of the left side. Conclusions: Atelectasis is a sign that we can find in most patients that will develop empyema and we assume that it is associated with lymph nodes inflammation, but it is necessary to develop other protocols to confirm that hilar lymph congestion is the cause of atelectasis. As atelectasis of lower lobes is a sign of imminent sepsis, we always decide to do mediastinal drainage when we find them associated with neck abscess. We are proposing a modification of the endo classification to decide surgery.

En el México antiguo se tenía conocimiento de enfermedades propias del sistema respiratorio que fueron una causa importante de mortalidad en la población. Severas epidemias en el siglo XVI asolaron y produjeron la muerte a nueve de cada 10 indígenas. Los médicos prehispánicos se desempeñaban como médicos-hechiceros y atendían las enfermedades físicas y espirituales que aquejaban a la población. Se ha identificado un conocimiento médico importante propio de cada cultura, que explicaba las enfermedades dependiendo de las creencias religiosas e intentaba resolver los problemas de salud que aquejaban a la población en esa época.

Antecedentes: Existe poca información acerca del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área totalmente nueva y equipada. Objetivo: Analizar el rendimiento clínico y el uso de recursos de la nueva UCI respiratoria (UCIR) de un hospital grande de tercer nivel. Método: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 17 de julio de 2017 al 17 de julio de 2018. Se usa el método ajustado de Rapoport para obtener el índice de rendimiento clínico estandarizado (IRCE) y el índice de uso de recursos estandarizado (IRURE). Resultados: De 354 pacientes fueron excluidos los reingresos, los pacientes aún hospitalizados y aquellos a quienes se limitó o retiró el tratamiento. En 301 pacientes la sobrevida hospitalaria fue del 63%, mientras que la sobrevida esperada fue del 67.7%. El IRCE fue −1.03 y el IRURE fue 0.05, situando el resultado en coordenadas dentro de dos desviaciones estándar en el gráfico de Rapoport. Hubo una diferencia estadísticamente significativa en la sobrevida comparando el periodo de estudio con resultados de la UCIR obtenidos antes de su reubicación (63 vs. 55%, p = 0.01). Conclusiones: En su primer año de funcionamiento, la nueva UCIR tuvo mejor rendimiento clínico que la antigua, sin modificación en el uso de recursos.

Se han escrito miles de artículos sobre Ernesto Guevara, identificado como Che Guevara. Sin embargo, el trabajo de est personaje como médico solo ha sido reconocido en pocas ocasiones. Por ello, consideramos de interés presentar su labor de investigación en el Hospital General de México, institución en la que intentó conseguir una beca, lo que propició que trabajara en el recién formado Servicio de Alergia, fundado por el doctor Mario Salazar Mallén a principios de la década de 1950.

Background: There is a progressive increase in nontuberculous mycobacteria (NTM) in pulmonary and extrapulmonary infections that might cause confusion with the Mycobacterium tuberculosis complex. To determine the frequency of finding NTM in clinical samples from patients diagnosed with active tuberculosis, with negative acid-alcohol-resistant bacilli (acid-fast bacillus [AFB]) in a third-level specialty hospital's mycobacterial laboratory between January 2013 and December 2014. Methods: This is a prospective, descriptive study where isolated strains of biological material were studied in Lowenstein–Jensen and BACTEC MGIT 960 cultures. Results: Clinical samples of 120 patients were studied, with pulmonary samples of 99/120 (82%) and extrapulmonary samples of 21/120 (18%). We identified NTM in 37/120 samples (30.8%), of which 16 in pulmonary, 13 in genitourinary, 3 in bone marrow, and 5 in various specimens. Mycobacterium avium was isolated in 20 samples, Mycobacterium intracellulare in seven samples, and various other species of NTM in the other 10 samples. Conclusion: To establish adequate treatment, we point out the importance of identifying the presence of NTM in the clinical samples of active tuberculosis patients with negative AFB, as possibly becoming confused with M. tuberculosis and which is essential in deciding which treatment is the most adequate.

Massive hemoptysis is a life-threatening event that requires emergency treatment. The aim of this study was to assess the effects of bronchial artery embolization on survival in cases of massive hemoptysis. This prospective study included 24 consecutive patients with massive hemoptysis who were treated with catheterization and embolization of the bronchial arteries. Assessments at 24 hours, 30, 120, and 180 days were performed. Nine cases of multidrug-resistant tuberculosis, six of bronchiectasis, four of lung cancer, and five with diverse pathology were treated. Three patients died of hemoptysis within the following 24 hours, two at 10 days, one at 33 days, and one at 120 days; another patient died of pneumonia. Bleeding was controlled in 16 cases at 180 days. Four patients were subjected to lung resection. Kaplan-Meier survival analysis revealed an accumulative survival at 30 days of 75%, at 120 days 70.84%, and at 180 days of 66.67% (standard error of 0.0962 with 95% CI). Embolization of bronchial arteries allowed the immediate control of massive hemoptysis in the majority of cases. Operators must be skilled and experienced. [ABSTRACT FROM AUTHOR]

Most individuals infected with Mycobacterium tuberculosis (Mtb) have latent tuberculosis (TB), which can be diagnosed with tests (such as the QuantiFERON‐TB Gold test [QFT]) that detect the production of IFN‐γ by memory T cells in response to the Mtb‐specific antigens 6 kDa early secretory antigenic target EsxA (Rv3875) (ESAT‐6), 10 kDa culture filtrate antigen EsxB (Rv3874) (CFP‐10), and Mtb antigen of 7.7 kDa (Rv2654c) (TB7.7). However, the immunological mechanisms that determine if an individual will develop latent or active TB remain incompletely understood. Here we compared the response of innate and adaptive peripheral blood lymphocytes from healthy individuals without Mtb infection (QFT negative) and from individuals with latent (QFT positive) or active TB infection, to determine the characteristics of these cells that correlate with each condition. In active TB patients, the levels of IFN‐γ that were produced in response to Mtb‐specific antigens had high positive correlations with IL‐1β, TNF‐α, MCP‐1, IL‐6, IL‐12p70, and IL‐23, while the proinflammatory cytokines had high positive correlations between themselves and with IL‐12p70 and IL‐23. These correlations were not observed in QFT‐negative or QFT‐positive healthy volunteers. Activation with Mtb‐soluble extract (a mixture of Mtb antigens and pathogen‐associated molecular patterns [PAMPs]) increased the percentage of IFN‐γ–/IL‐17–producing NK cells and of IL‐17–producing innate lymphoid cell 3 (ILC3) in the peripheral blood of active TB patients, but not of QFT‐negative or QFT‐positive healthy volunteers. Thus, active TB patients have both adaptive and innate lymphocyte subsets that produce characteristic cytokine profiles in response to Mtb‐specific antigens or PAMPs. These profiles are not observed in uninfected individuals or in individuals with latent TB, suggesting that they are a response to active TB infection. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the occurrence of adverse events during a multifaceted program implementation.Design: Cross-sectional secondary analysis.Setting: The respiratory-ICU of a large tertiary care center.Participants: Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used.Interventions: The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented.Main Outcome Measures: Rates of adverse events (episodes per 1000 patient/days).Results: Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97).Conclusions: A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU. [ABSTRACT FROM AUTHOR]

Background: Resident alveolar macrophages, dendritic cells, and immigrating neutrophils (NEU) are the first cells to contact Mycobacterium tuberculosis in the lung. These cells, and additional lymphoid cells in the developing granuloma, release a series of components that may concentrate in the serum and affect disease progression. Purpose: The aim of this study was to investigate the effect of the serum from tuberculosis (TB) patients and their household contacts (HHC) on the nuclear morphology of NEU. Materials and methods: NEU from healthy (HLT) people were incubated with sera from patients with active pulmonary TB, their HHC, and unrelated people. Changes in the nuclear morphology of NEU were analyzed by light and electron microscopy. Results: Sera from patients with TB induced changes in the nuclear morphology of NEU that included pyknosis, swelling, apoptosis, and netosis in some cases. Sera from some HHC induced similar changes, while sera from HLT people had no significant effects. Bacteria did not appear to participate in this phenomenon because bacteremia is not a recognized feature of nonmiliary TB, and because sera from patients that induced nuclear changes maintained their effect after filtration through 0.22 µm membranes. Neither anti-mycobacterial antibodies, TNFα, IL-6, IFNγ, or IL-8 participated in the phenomenon. In contrast, soluble mycobacterial antigens were likely candidates, as small quantities of soluble M. tuberculosis antigens added to the sera of HLT people led to the induction of nuclear changes in NEU in a dose-dependent manner. Conclusion: These results might help to detect subclinical TB within HHC, thus leading to a recommendation of prophylactic treatment. [ABSTRACT FROM AUTHOR]

Background: There is a progressive increase in nontuberculous mycobacteria (NTM) in pulmonary and extrapulmonary infections that might cause confusion with the Mycobacterium tuberculosis complex. To determine the frequency of finding NTM in clinical samples from patients diagnosed with active tuberculosis, with negative acid-alcohol-resistant bacilli (acid-fast bacillus [AFB]) in a third-level specialty hospital's mycobacterial laboratory between January 2013 and December 2014. Methods: This is a prospective, descriptive study where isolated strains of biological material were studied in Lowenstein-Jensen and BACTEC MGIT 960 cultures. Results: Clinical samples of 120 patients were studied, with pulmonary samples of 99/120 (82%) and extrapulmonary samples of 21/120 (18%). We identified NTM in 37/120 samples (30.8%), of which 16 in pulmonary, 13 in genitourinary, 3 in bone marrow, and 5 in various specimens. Mycobacterium avium was isolated in 20 samples, Mycobacterium intracellulare in seven samples, and various other species of NTM in the other 10 samples. Conclusion: To establish adequate treatment, we point out the importance of identifying the presence of NTM in the clinical samples of active tuberculosis patients with negative AFB, as possibly becoming confused with M. tuberculosis and which is essential in deciding which treatment is the most adequate. [ABSTRACT FROM AUTHOR]

We performed a retrospective chart review to evaluate the indications for endotracheal intubation via flexible fiberoptic bronchoscopy in patients who were scheduled for surgery or who were hospitalized in the intensive care unit of our 1,100-bed, tertiary care university hospital. We reviewed 9,201 clinical records of anesthetic procedures during which endotracheal intubation had been performed from January to December 2002. We identified 66 patients who had been intubated with flexible fiberoptic bronchoscopy. On preanesthetic examination, 61 of these patients had been found to be poor candidates for conventional laryngoscopic intubation--51 because of abnormal head and neck anatomy and 10 because of reduced visual access to the airway (Mallampati class IV). The remaining 5 patients were intubated via flexible fiberoptic bronchoscopy after conventional intubation had failed during emergency surgery. Our study emphasizes (1) the importance of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to have fiberoptic bronchoscopes and an anesthesiologist or bronchoscopist skilled in their use available in operating suites and intensive care units. [ABSTRACT FROM AUTHOR]