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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: 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.

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.

XPN is a rare form of chronic pyelonephritis. It is more common in middle age women. Clinical presentation involves malaise, fever, flank pain, weight loss, and is usually associated to urinary calculi or UTI. Usual laboratory findings include anemia, high CRP and liver dysfunction. As for images, both computed tomography and magnetic resonance imaging can show characteristic findings and the extension of the lesion. Antibiotics may be given in case of acute infection, but the treatment of choice is nephrectomy, with the objective of removing all the compromised tissue.

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.

Gastrectomy represents the main treatment for gastric adenocarcinoma. This procedure is associated with substantial morbidity and mortality. The aim of this study was to evaluate the postoperative mortality changes across the study period and to identify predictive factors of 30-day mortality after elective gastrectomy for gastric cancer.This was a retrospective cohort study of a prospective database from a single centre. Patients treated with an elective gastrectomy from 1996 to 2014 for gastric adenocarcinoma were included. We compared postoperative mortality between four time periods: 1996-2000, 2001-2005, 2006-2010, and 2011-2014. Univariate and multivariate analyses were applied to identify predictors of 30-day postoperative mortality.We included 1066 patients (median age 65 years; 67% male). The 30-day mortality rate was 4.7%. Mortality decreased across the four time periods; from 6.5% to 1.8% (P = 0.022). In the univariate analysis, age, ASA score, albumin3.5, multivisceral resection, splenectomy, intrathoracic esophagojejunal anastomosis, R status, and T status were significantly associated with postoperative mortality. In the multivariate analysis, ASA class 3 (OR 10.06; CI 1.97-51.3; P = 0.005) and multivisceral resection (OR 1.6; CI 1.09-2.36; P = 0.016) were associated with higher postoperative 30-day mortality; surgery between 2011 and 2014 was associated with lower postoperative 30-day mortality (OR 0.55; CI 0.33-0.15; P = 0.030).There was a decrease in postoperative 30-day mortality during this 18-year period at our institution. We have identified ASA score and multivisceral resection as predictors of 30-day mortality for elective gastrectomy for cancer.

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.

The laparoscopic approach for the treatment of gastric tumors has many advantages.To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital.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.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.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.

To review the post-operative morbidity and mortality of total esophagogastrectomy (TEG) with second barrier lymphadenectomy (D2) with interposition of a transverse colon and to determine the oncological outcomes of TEG D2 with interposition of a transverse colon.This study consisted of a retrospective review of patients with a cancer diagnosis who underwent TEG between 1997 and 2013. Demographic data, surgery protocols, complications according to Clavien-Dindo classifications, final pathological reports, oncological follow-ups and causes of death were recorded. We used the TNM 2010 and Japanese classifications for nodal dissection of gastric cancer. We used descriptive statistical analysis and Kaplan-Meier survival curves. A P-value of less than 0.05 was considered statistically significant.The series consisted of 21 patients (80.9% men). The median age was 60 years. The 2 main surgical indications were extensive esophagogastric junction cancers (85.7%) and double cancers (14.2%). The mean total surgery time was 405 min (352-465 min). Interposition of a transverse colon through the posterior mediastinum was used for replacement in all cases. Splenectomy was required in 13 patients (61.9%), distal pancreatectomy was required in 2 patients (9.5%) and resection of the left adrenal gland was required in 1 patient (4.7%). No residual cancer surgery was achieved in 75.1% of patients. A total of 71.4% of patients had a postoperative complication. Respiratory complications were the most frequently observed complication. Postoperative mortality was 5.8%. Median follow-up was 13.4 mo. Surgery specific survival at 5 years of follow-up was 32.8%; for patients with curative surgery, it was 39.5% at 5 years.TEG for cancer with interposition of a transverse colon is a very complex surgery, and it presents high post-operative morbidity and adequate oncological outcomes.

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.

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

Recent studies have linked changes in peripheral chemokine concentrations to the presence of both addictive behaviors and psychiatric disorders. The present study further explore this link by analyzing the potential association of psychiatry comorbidity with alterations in the concentrations of circulating plasma chemokine in patients of both sexes diagnosed with alcohol use disorders (AUD). To this end, 85 abstinent subjects with AUD from an outpatient setting and 55 healthy subjects were evaluated for substance and mental disorders. Plasma samples were obtained to quantify chemokine concentrations [C-C motif (CC), C-X-C motif (CXC), and C-X3-C motif (CX3C) chemokines]. Abstinent AUD patients displayed a high prevalence of comorbid mental disorders (72%) and other substance use disorders (45%). Plasma concentrations of chemokines CXCL12/stromal cell-derived factor-1 (p