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Increasing evidence demonstrate that the electron transfer chain plays a critical role in controlling the effector functions of macrophages. In this work, we have generated a Ndufs4-/- murine macrophage cell lines. The Ndufs4 gene, which encodes a supernumerary subunit of complex I, is a mutational hotspot in Leigh syndrome patients. Ndufs4-/- macrophages showed decreased complex I activity, altered complex I assembly, and lower levels of maximal respiration and ATP production. These mitochondrial respiration alterations were associated with a shift towards a pro-inflammatory cytokine profile after lipopolysaccharide challenge and improved ability to phagocytose Gram-negative bacteria.

Usutu virus (USUV) is an African mosquito-borne flavivirus closely related to West Nile, Japanese encephalitis, Zika, and dengue viruses. USUV emerged in 1996 in Europe, where quickly spread across the continent causing a considerable number of bird deaths and varied neurological disorders in humans, including encephalitis, meningoencephalitis, or facial paralysis, thus warning about USUV as a potential health threat. USUV replication takes place on the endoplasmic reticulum (ER) of infected cells, inducing ER stress and resulting in the activation of stress-related cellular pathways collectively known as the integrated stress response (ISR). The alpha subunit of the eukaryotic initiation factor eIF2 (eIF2α), the core factor in this pathway, is phosphorylated by stress activated kinases: protein kinase R (PKR), PKR-like endoplasmic reticulum kinase (PERK), heme-regulated inhibitor kinase (HRI), and general control non-repressed 2 kinase (GCN2). Its phosphorylation results, among others, in the downstream inhibition of translation with accumulation of discrete foci in the cytoplasm termed stress granules (SGs). Our results indicated that USUV infection evades cellular stress response impairing eIF2α phosphorylation and SGs assembly induced by treatment with the HRI activator ArsNa. This protective effect was related with oxidative stress responses in USUV-infected cells. Overall, these results provide new insights into the complex connections between the stress response and flavivirus infection in order to maintain an adequate cellular environment for viral replication.

Abstract Candida albicans is a frequent aetiologic agent of sepsis associated with high mortality in immunocompromised patients. Developing new antifungal therapies is a medical need due to the low efficiency and resistance to current antifungal drugs. Here, we show that p38γ and p38δ regulate the innate immune response to C. albicans. We describe a new TAK1‐TPL2‐MKK1‐ERK1/2 pathway in macrophages, which is activated by Dectin‐1 engagement and positively regulated by p38γ/p38δ. In mice, p38γ/p38δ deficiency protects against C. albicans infection by increasing ROS and iNOS production and thus the antifungal capacity of neutrophils and macrophages, and by decreasing the hyper‐inflammation that leads to severe host damage. Leucocyte recruitment to infected kidneys and production of inflammatory mediators are decreased in p38γ/δ‐null mice, reducing septic shock. p38γ/p38δ in myeloid cells are critical for this effect. Moreover, pharmacological inhibition of p38γ/p38δ in mice reduces fungal burden, revealing that these p38MAPKs may be therapeutic targets for treating C. albicans infection in humans.

Flaviviruses are RNA viruses that constitute a worrisome threat to global human and animal health. Zika virus (ZIKV), which was initially reported to cause a mild disease, recently spread in the Americas, infecting millions of people. During this recent epidemic, ZIKV infection has been linked to serious neurological diseases and birth defects, specifically Guillain-Barrè syndrome (GBS) and microcephaly. Because information about ZIKV immunity remains scarce, we assessed the humoral response of immunocompetent mice to infection with three viral strains of diverse geographical origin (Africa, Asia and America). No infected animals showed any sign of disease or died after infection. However, specific neutralizing antibodies were elicited in all infected mice. Considering the rapid expansion of ZIKV throughout the American continent and its co-circulation with other medically relevant flaviviruses, such as West Nile virus (WNV), the induction of protective immunity between ZIKV and WNV was analyzed. Remarkably, protection after challenge with WNV was observed in mice previously infected with ZIKV, as survival rates were significantly higher than in control mice. Moreover, previous ZIKV infection enhanced the humoral immune response against WNV. These findings may be relevant in geographical areas where both ZIKV and WNV co-circulate, as well as for the future development of broad-spectrum flavivirus vaccines.Emerging Microbes & Infections (2017) 6, e81; doi:10.1038/emi.2017.68; published online 20 September 2017

En ocasiones la acalasia esofágica necesita de una esofagogastrectomía, de ahí que se elija la vía transhiatal, de preferencia la realizada por mínimo acceso y con el empleo de un flebo-extractor. El objetivo de nuestro trabajo es valorar el empleo de un flebo-extractor como sustituto de la disección esofágica transhiatal mínimamente invasiva, en una paciente con acalasia esofágica. Se realizó este abordaje en una enferma de 37 años con disfagia, dilatación esofágica importante y desnutrición proteico-energética, después de ser operada en 2 ocasiones de esofagomiotomía mínimamente invasiva, por una acalasia esofágica. La cirugía duró 4 horas, sin complicaciones y con una estadía de 4 días. La esofagectomía transhiatal mínimamente invasiva, en algunos enfermos con acalasia, tiene todos los beneficios del mínimo acceso, y con el empleo de un flebo- extractor, se agiliza el proceder de forma segura.Esophageal achalasia occasionally requires esophagogastrectomy, hence the transhiatal way is selected, preferably using minimal access and fleboextractor. The objective of this paper is to assess the use of fleboextractor as a replacement of minimally invasive transhiatal esophageal dissection in a patient with esophageal achalasia. This procedure was performed in a 37 years-old patient with disphagia, major esophageal dilation and protein-energetic undernourishment, who had been operated on twice from esophageal achalasia by using minimally invasive esophagomyotomy. The operation lasted 4 hours, without further complications and 4 day-length of stay at hospital. The minimally invasive transhiatal esophagectomy carries all the advantages of the minimum access procedure for some patients with achalasia, and the use of a fleboextractor can speed up the surgical procedure in a safe way.

West Nile virus (WNV) is a neurovirulent mosquito-borne flavivirus. High WNV virulence was mainly associated with lineage 1 strains, but recent outbreaks have unveiled circulation of highly virulent lineage 2 strains. Co-expression of flavivirus prM and E glycoproteins drives the assembly of recombinant subviral particles (RSPs) that share antigenic features with virions. Mouse immunization with lineage 1 WNV RSPs induced a potent humoral response against WNV with production of neutralizing antibodies. A single inoculation of RSPs formulated with Al(OH)3 as adjuvant protected mice against a lethal challenge with WNV strains from lineage 1 or 2. The cross-reactivity of the response elicited by these RSPs was analyzed against the related flavivirus Usutu virus (USUV), which shares multiple ecological and antigenic features with WNV. Immunization with WNV-RSPs increased specific, although low, antibody titers found upon subsequent USUV infection.

Foot-and-mouth disease virus non-structural protein 3A plays important roles in virus replication, virulence and host-range; nevertheless little is known on the interactions that this protein can establish with different cell components. In this work, we have performed in vivo dynamic studies from cells transiently expressing the green fluorescent protein (GFP) fused to the complete 3A (GFP3A) and versions including different 3A mutations. The results revealed the presence of a mobile fraction of GFP3A, which was found increased in most of the mutants analyzed, and the location of 3A in a continuous compartment in the cytoplasm. A dual behavior was also observed for GFP3A upon cell fractionation, being the protein equally recovered from the cytosolic and membrane fractions, a ratio that was also observed when the insoluble fraction was further fractioned, even in the presence of detergent. Similar results were observed in the fractionation of GFP3ABBB, a 3A protein precursor required for initiating RNA replication. A nonintegral membrane protein topology of FMDV 3A was supported by the lack of glycosylation of versions of 3A in which each of the protein termini was fused to a glycosylation acceptor tag, as well as by their accessibility to degradation by proteases. According to this model 3A would interact with membranes through its central hydrophobic region exposing its N- and C- termini to the cytosol, where interactions between viral and cellular proteins required for virus replication are expected to occur.

West Nile virus (WNV) is a worldwide distributed mosquito-borne flavivirus that naturally cycles between birds and mosquitoes, although it can infect multiple vertebrate hosts including horses and humans. This virus is responsible for recurrent epidemics of febrile illness and encephalitis, and has recently become a global concern. WNV requires to transit through intracellular acidic compartments at two different steps to complete its infectious cycle. These include fusion between the viral envelope and the membrane of endosomes during viral entry, and virus maturation in the trans-Golgi network. In this study, we followed a genetic approach to study the connections between viral components and acidic pH. A WNV mutant with increased resistance to the acidotropic compound NH4Cl, which blocks organelle acidification and inhibits WNV infection, was selected. Nucleotide sequencing revealed that this mutant displayed a single amino acid substitution (Lys 3 to Glu) on the highly basic internal capsid or core (C) protein. The functional role of this replacement was confirmed by its introduction into a WNV infectious clone. This single amino acid substitution also increased resistance to other acidification inhibitor (concanamycin A) and induced a reduction of the neurovirulence in mice. Interestingly, a naturally occurring accompanying mutation found on prM protein abolished the resistant phenotype, supporting the idea of a genetic crosstalk between the internal C protein and the external glycoproteins of the virion. The findings here reported unveil a non-previously assessed connection between the C viral protein and the acidic pH necessary for entry and proper exit of flaviviruses.

Usutu virus (USUV) is an African mosquito-borne flavivirus closely related to West Nile virus and Japanese encephalitis virus, which host range includes mainly mosquitoes and birds, although infections in humans have been also documented, thus warning about USUV as a potential health threat. Circulation of USUV in Africa was documented more than 50 years ago, but it was not until the last decade that it emerged in Europe causing episodes of avian mortality and some human severe cases. Since autophagy is a cellular pathway that can play important roles on different aspects of viral infections and pathogenesis, the possible implication of this pathway in USUV infection has been examined using Vero cells and two viral strains of different origin. USUV infection induced the unfolded protein response, revealed by the splicing of Xbp-1 mRNA. Infection with USUV also stimulated the autophagic process, which was demonstrated by an increase in the cytoplasmic aggregation of microtubule-associated protein 1 light chain 3 (LC3), a marker of autophagosome formation. In addition to this, an increase in the lipidated form of LC3, that is associated with autophagosome formation, was noticed following infection. Pharmacological modulation of the autophagic pathway with the inductor of autophagy rapamycin resulted in an increase in virus yield. On the other hand, treatment with 3-methyladenine or wortmannin, two distinct inhibitors of phosphatidylinositol 3-kinases involved in autophagy, resulted in a decrease in virus yield. These results indicate that USUV virus infection upregulates the cellular autophagic pathway and that drugs that target this pathway can modulate the infection of this virus, thus identifying a potential druggable pathway in USUV-infection.

La acatisia es uno de los efectos adversos más frecuentes de los antipsicóticos. El presente artículo es una revisión de los aspectos epidemiológicos, clínicos y terapéuticos, así como de sus repercusiones en la aceptación del tratamiento por parte del paciente. Se subraya tanto la importancia de la vivencia subjetiva como elemento diagnóstico como el papel que otros fármacos, psicotropos o no, desempeñan en su etiología.

Phosphatidylinositol-4,5-bisphosphate, PI(4,5)P(2), is a phospholipid which plays important roles in clathrin-mediated endocytosis. To investigate the possible role of this lipid on viral entry, two viruses important for animal health were selected: the enveloped vesicular stomatitis virus (VSV) - which uses a well characterized clathrin mediated endocytic route - and two different variants of the non-enveloped foot-and-mouth disease virus (FMDV) with distinct receptor specificities. The expression of a dominant negative dynamin, a PI(4,5)P(2) effector protein, inhibited the internalization and infection of VSV and both FMDV isolates. Depletion of PI(4,5)P(2) from plasma membrane using ionomycin or an inducible system, and inhibition of its de novo synthesis with 1-butanol revealed that VSV as well as FMDV C-S8c1, which uses integrins as receptor, displayed a high dependence on PI(4,5)P(2) for internalization. Expression of a kinase dead mutant (KD) of phosphatidylinositol-4-phosphate-5-kinase Iα (PIP5K-Iα), an enzyme responsible for PI(4,5)P(2) synthesis that regulates clathrin-dependent endocytosis, also impaired entry and infection of VSV and FMDV C-S8c1. Interestingly FMDV MARLS variant that uses receptors other than integrins for cell entry was less sensitive to PI(4,5)P(2) depletion, and was not inhibited by the expression of the KD PIP5K-Iα mutant suggesting the involvement of endocytic routes other than the clathrin-mediated on its entry. These results highlight the role of PI(4,5)P(2) and PIP5K-Iα on clathrin-mediated viral entry.

West Nile virus (WNV) is a neurovirulent single stranded RNA mosquito-borne flavivirus, whose main natural hosts are birds, but it also infects humans and horses. Nowadays, no human vaccine is commercially available and clinical treatment is only supportive. Recently, it has been shown that RNA transcripts, mimicking structural domains in the non-coding regions (NCRs) of the foot-and mouth disease virus (FMDV) induce a potent IFN response and antiviral activity in transfected cultured cells, and also reduced mice susceptibility to FMDV. By using different transcripts combinations, administration schedules, and infecting routes and doses, we have demonstrated that these FMDV RNA transcripts protect suckling and adult mice against lethal challenge with WNV. The protective activity induced by the transcripts was systemic and dependent on the infection route and dose. These results confirm the antiviral potential of these synthetic RNAs for fighting viruses of different families relevant for human and animal health.

McArdle disease is caused by lack of glycogen phosphorylase (GP) activity in skeletal muscle. Patients experience exercise intolerance, presenting as early fatigue and contractures. In this study, we investigated the effects produced by a lack of GP on several genes and proteins of skeletal muscle in McArdle patients. Muscle tissue of 35 patients and 7 healthy controls were used to identify abnormalities in the patients' transcriptomic profile using low-density arrays. Gene expression was analyzed for the influence of variables such as sex and clinical severity. Differences in protein expression were studied by immunoblotting and 2D electrophoresis analysis, and protein complexes were examined by two-dimensional, blue native gel electrophoresis (BN-PAGE). A number of genes including those encoding acetyl-coA carboxylase beta, m-cadherin, calpain III, creatine kinase, glycogen synthase (GS), and sarcoplasmic reticulum calcium ATPase 1 (SERCA1), were found to be downregulated in patients. Specifically, compared to controls, GS and SERCA1 proteins were reduced by 50% and 75% respectively; also, unphosphorylated GS and SERCA1 were highly downregulated. On BN-PAGE analysis, GP was present with GS in two muscle protein complexes. Our findings revealed some issues that could be important in understanding the physiological consequences of McArdle disease: (i) SERCA1 downregulation in patients could result in impaired calcium transport in type II (fast-twitch) muscle fibers, leading to early fatigability during exercise tasks involving type II fibers (which mostly use glycolytic metabolism), i.e. isometric exercise, lifting weights or intense dynamic exercise (stair climbing, bicycling, walking at a very brisk pace), (ii) GP and GS were found together in two protein complexes, which suggests a new regulatory mechanism in the activity of these glycogen enzymes.

A pesar del intenso esfuerzo realizado en la investigación sobre la discinesia tardía, y de que se han logrado avances, sobre todo en lo referido a la epidemiología, persisten (y nacen nuevos) interrogantes que la convierten en un problema clínico bien intrigante. Los conocimientos actuales deberían incitar a reflexionar sobre el uso de neurolépticos, fármacos eficaces y seguros si se utilizan correctamente.

West Nile virus (WNV) is a neurovirulent mosquito-borne flavivirus, which main natural hosts are birds but it also infects equines and humans, among other mammals. As in the case of other plus-stranded RNA viruses, WNV replication is associated to intracellular membrane rearrangements. Based on results obtained with a variety of viruses, different cellular processes have been shown to play important roles on these membrane rearrangements for efficient viral replication. As these processes are related to lipid metabolism, fatty acid synthesis, as well as generation of a specific lipid microenvironment enriched in phosphatidylinositol-4-phosphate (PI4P), has been associated to it in other viral models. In this study, intracellular membrane rearrangements following infection with a highly neurovirulent strain of WNV were addressed by means of electron and confocal microscopy. Infection of WNV, and specifically viral RNA replication, were dependent on fatty acid synthesis, as revealed by the inhibitory effect of cerulenin and C75, two pharmacological inhibitors of fatty acid synthase, a key enzyme of this process. However, WNV infection did not induce redistribution of PI4P lipids, and PI4P did not localize at viral replication complex. Even more, WNV multiplication was not inhibited by the use of the phosphatidylinositol-4-kinase inhibitor PIK93, while infection by the enterovirus Coxsackievirus B5 was reduced. Similar features were found when infection by other flavivirus, the Usutu virus (USUV), was analyzed. These features of WNV replication could help to design specific antiviral approaches against WNV and other related flaviviruses.

In recent years clinical evidence has emphasized the importance of the mtDNA genetic background that hosts a primary pathogenic mutation in the clinical expression of mitochondrial disorders, but little experimental confirmation has been provided. We have analyzed the pathogenic role of a novel homoplasmic mutation (m.15533 A>G) in the cytochrome b (MT-CYB) gene in a patient presenting with lactic acidosis, seizures, mild mental delay, and behaviour abnormalities. Spectrophotometric analyses of the respiratory chain enzyme activities were performed in different tissues, the whole muscle mitochondrial DNA of the patient was sequenced, and the novel mutation was confirmed by PCR-RFLP. Transmitochondrial cybrids were constructed to confirm the pathogenicity of the mutation, and assembly/stability studies were carried out in fibroblasts and cybrids by means of mitochondrial translation inhibition in combination with blue native gel electrophoresis. Biochemical analyses revealed a decrease in respiratory chain complex III activity in patient's skeletal muscle, and a combined enzyme defect of complexes III and IV in fibroblasts. Mutant transmitochondrial cybrids restored normal enzyme activities and steady-state protein levels, the mutation was mildly conserved along evolution, and the proband's mother and maternal aunt, both clinically unaffected, also harboured the homoplasmic mutation. These data suggested a nuclear genetic origin of the disease. However, by forcing the de novo functioning of the OXPHOS system, a severe delay in the biogenesis of the respiratory chain complexes was observed in the mutants, which demonstrated a direct functional effect of the mitochondrial genetic background. Our results point to possible pitfalls in the detection of pathogenic mitochondrial mutations, and highlight the role of the genetic mtDNA background in the development of mitochondrial disorders.

BACKGROUND: Mutations in the PYGM gene encoding skeletal muscle glycogen phosphorylase (GP) cause a metabolic disorder known as McArdle's disease. Previous studies in muscle biopsies and cultured muscle cells from McArdle patients have shown that PYGM mutations abolish GP activity in skeletal muscle, but that the enzyme activity reappears when muscle cells are in culture. The identification of the GP isoenzyme that accounts for this activity remains controversial. METHODOLOGY/PRINCIPAL FINDINGS: In this study we present two related patients harbouring a novel PYGM mutation, p.R771PfsX33. In the patients' skeletal muscle biopsies, PYGM mRNA levels were ∼60% lower than those observed in two matched healthy controls; biochemical analysis of a patient muscle biopsy resulted in undetectable GP protein and GP activity. A strong reduction of the PYGM mRNA was observed in cultured muscle cells from patients and controls, as compared to the levels observed in muscle tissue. In cultured cells, PYGM mRNA levels were negligible regardless of the differentiation stage. After a 12 day period of differentiation similar expression of the brain and liver isoforms were observed at the mRNA level in cells from patients and controls. Total GP activity (measured with AMP) was not different either; however, the active GP activity and immunoreactive GP protein levels were lower in patients' cell cultures. GP immunoreactivity was mainly due to brain and liver GP but muscle GP seemed to be responsible for the differences. CONCLUSIONS/SIGNIFICANCE: These results indicate that in both patients' and controls' cell cultures, unlike in skeletal muscle tissue, most of the protein and GP activities result from the expression of brain GP and liver GP genes, although there is still some activity resulting from the expression of the muscle GP gene. More research is necessary to clarify the differential mechanisms of metabolic adaptations that McArdle cultures undergo in vitro.

En los últimos años, el interés de los psiquiatras por los trastornos del movimiento provocados por el uso de psicofármacos ha aumentado considerablemente. La discinesia tardía es el más severo. Debido a su heterogeneidad se han individualizado dos subsíndromes; discinesia y distonía tardías. En el artículo se presenta un caso de distonía que respondió parcialmente a la clozapina. Se discute el diagnóstico diferencial entre distonía secundaria a neurolépticos y distonía psicógena.

INTRODUCCIÓN: se presentan las 4 primeras pacientes operadas de hemitiroidectomía videoendoscópica en el Hospital "Hermanos Ameijeiras", para introducir una técnica que elimine la cicatriz en el cuello de los(as) pacientes que necesitan un tratamiento quirúrgico por una enfermedad tiroidea. MÉTODOS: se escogieron 4 pacientes con nódulos benignos del tiroides menores de 3 cm, remitidas para tratamiento quirúrgico por el servicio de endocrinología de nuestro centro, de enero a junio de 2009. Se les explicó en detalles el proceder y firmaron un consentimiento informado para participar en el estudio. RESULTADOS: en las 4 pacientes se pudo realizar la operación planificada, el promedio de tiempo quirúrgico fue de 2,9 h. El efecto cosmético fue mayor en las pacientes 2, 3 y 4 al no quedar ninguna cicatriz en el cuello. La laringoscopia posoperatoria demostró movilidad normal de las cuerdas vocales en las 4 pacientes. CONCLUSIONES: la cirugía videoendoscópica del tiroides es una realidad que no podemos obviar, y realmente tiene un único impacto demostrado hasta el momento actual, que es la posibilidad de eliminar la cicatriz residual en el cuello que tanto preocupa a los(as) pacientes jóvenes.INTRODUCTION: these are the cases of the first patients operated on of Hemithyroidectomy by videoendoscopy in "Hermanos Ameijeiras" Clinical Surgical Hospital to introduce a technique eliminating the neck scar of patients needing surgical treatment by thyroid disease. METHODS: four patients presenting with benign thyroid nodules referred to surgical treatment by Endocrinology service of our institution from January to June, 2009. Procedure was explained in details and they signed the informed consent to participate in study. RESULTS: in four patients it was possible to perform the planned operation; the surgical time average was of 2, 9 hr. Cosmetic effect was greater in patients 2, 3 and 4 without neck scar. Postoperative laryngoscopy showed a normal motility of vocal cords in the four patients. CONCLUSIONS: thyroid videoendoscopy surgery is a reality that cannot be obviated and with a unique impact proved until present time that is the possibility to eliminate the neck residual scar so worrying for young patients.

El condrosarcoma de laringe es un tumor raro que se localiza fundamentalmente en el cartílago cricoides. El objetivo de este artículo fue la presentación de un paciente con un condrosarcoma gigante de cartílago cricoides, que fue diagnosticado y tratado en el Servicio de Cirugía General del Hospital «Hermanos Ameijeiras». Se describen los principales aspectos de la presentación clínica de la enfermedad, así como el resultado de los estudios de diagnóstico y la técnica quirúrgica empleadaLaryngeal chondrosarcoma is a rare tumor mainly located in the cricoid cartilage. The objective of this article was to present the case of a patient with giant chondrosarcoma of the cricoid cartilage diagnosed and treated at “Hermanos Amejeiras” hospital general surgery service. The main aspects of the clinical presentation of this disease together with the results of diagnosing studies and the surgical technique performed in this case were described

Los pacientes con bocio localizado en el mediastino posterior deben ser sometidos a resección quirúrgica por la posibilidad de compromiso de los órganos vecinos o de malignidad. Se presenta el caso de un paciente previamente operado por un bocio con probable prolongación endotorácica que fue intervenido pero continuó con manifestaciones de compresión traqueal. Tras una segunda operación fallida, ahora por vía transesternal, fue remitido a nuestro servicio por una estenosis traqueal isquémica. En el estudio preoperatorio se demostró que se mantenía una masa tumoral aproximadamente de 10 cm, retrotraqueal, que comprimía y deformaba la tráquea. Además presentaba osteomielitis del esternón. Fue intervenido mediante toracotomía derecha y se logró extirpar alrededor de 95 % de la masa tumoral. El estudio radiofarmacológico posoperatorio no demostró captación del isótopo en el mediastino. Se hacen consideraciones sobre la indicación de la cirugía y las vías de abordaje utilizadas. Al momento de preparar este manuscrito (6 meses después de la operación) el paciente se encuentra bien, en espera del tratamiento definitivo de la estenosis traqueal isquémicaPatients with posterior mediastinal goiter should be subjected to surgical resection because of the possibility of affecting neibouring organs or developing malignacy. This paper presented the case of a patient that had been previously operated from a goiter with possible endothoracic prolongation but continued suffering tracheal compression. After a second failed transternal surgery, he was refered to our service with ischemic tracheal stenosis. The preoperative study showed a 10cm retrotracheal tumoral mass that pressed and distorted the trachea. He also had sternal osteomyelitis. Then, he underwent right thoracotomy and roughly 95% of the mass was removed. The post-surgical radiopharmacological study did not reveal isotope uptake in the mediastinum. Surgery indications and the ways of approach used in this case were considered. At the time of preparing this manuscript (6 months after surgery), the patient was in good condition and just waiting for definitive treatment of his ischemic tracheal stenosis

El diagnóstico de la tuberculosis pleural es difícil por la presentación inespecífica y la pobre eficiencia de los métodos diagnósticos tradicionales cuando de esta se trata. Se realizó un estudio retrospectivo de 6 pacientes a quienes se realizó el diagnóstico de tuberculosis pleural mediante videotoracoscopia, ante el fracaso de los métodos tradicionales. El objetivo fue conocer el valor de la videotoracoscopia en el diagnóstico de la tuberculosis pleural. Cinco de los 6 pacientes eran del sexo masculino y el paciente de menor edad tenía 25 años y el de mayor, 70 años. Los síntomas principales fueron dolor torácico y fiebre. El derrame tenía carácter seroso y en la pleura se observaron las lesiones blanquecinas típicas. Hubo una conversión (16,7 %) porque la pleura engrosada no permitió la entrada del endoscopio. En todos los pacientes la muestra tomada permitió realizar el diagnóstico de tuberculosis pleural. No hubo complicaciones y todos los pacientes recibieron tratamiento específico. En los casos de derrame pleural de causa no precisada, la videotoracoscopia es útil para el diagnóstico de la tuberculosis pleural, pues demuestra las lesiones típicas y permite obtener muestras para estudio

Se presenta un paciente del sexo femenino, atendida por el Servicio de Cirugía General del Hospital Clinicoquirúrgico «Hermanos Ameijeiras» en julio de 2002. La paciente tenía 49 años de edad y presentaba disfagia de varios años de evolución, que fue empeorando progresivamente. En los estudios realizados se encontraron dos divertículos epifrénicos en el tercio distal del esófago, uno de los cuales crecía hacia la derecha y el otro hacia la izquierda del órgano. Ello se corroboró con una endoscopia, que no detectó ninguna patología esofágica asociada. En la manometría se halló un trastorno inespecífico de la motilidad esofágica. Se realizó una doble diverticulectomía por toracotomía izquierda, sin accidentes quirúrgicos o complicaciones postoperatorias. Después de más de 2 años de evolución, la paciente no refiere disfagia ni ha presentado recidiva diverticular

Los quistes congénitos del pulmón son un grupo diverso de anomalías que pueden ser únicos o múltiples y variar grandemente en su volumen. Por lo regular están confinados a un segmento o lóbulo y son asiento frecuente de infección. Se presenta el caso de un quiste broncogénico intrapulmonar gigante acompañado de hipoplasia de la arteria pulmonar izquierda y del lóbulo pulmonar superior ipsilateral. Se hacen consideraciones relacionadas con el origen del quiste, su relación con la hipoplasia arterial y pulmonar y se discuten las posibles causas de la atelectasia y edema posoperatorios, que llevaron a la necesidad de completar la neumonectomía ante un cuadro séptico severoThe congenital lung cysts are a group of diverse abnormalities, unique or multiple, and of different volumes. Generally, they are confined to a segment or lobe and they are a frequent site of infection. The case of a bronchogenic intrapulmonary giant cyst accompanied with hypoplasia of the left pulmonary artery and of the upper ipsilateral pulmonary lobe, is reported. Considerations are made on the origin of the cyst, and on its connection with arterial and pulmonary hypoplasia. The possible causes of postoperative atelactasis and edema, leading to the need of completing pneumonectomy in the face of a severe septic picture, are discussed

El derrame pleural es una de las lesiones que con frecuencia son consultadas al cirujano: en demanda de obtención de material tisular para biopsia, tras el fallo reiterado de la punción citológica o para tratar enfermos con derrame incontrolable. Objetivos: Evaluar la utilidad de la videotoracoscopía en el diagnóstico y tratamiento de pacientes portadores de un derrame pleural. Métodos: Estudio retrospectivo sobre una base de datos prospectiva, que comprende 73 pacientes consecutivos a quienes se les practicó una videotoracoscopía para diagnóstico y tratamiento de un derrame pleural, tratados entre enero de 1997 y julio de 2004. Resultados: Al sexo masculino correspondieron 43 pacientes y 30 al femenino. Treinta y nueve (52,4 %) tenían una enfermedad maligna, con predominio de pulmón y mama, como causa del derrame. El 71,2 % de los casos fueron operados con intención diagnóstica. Entre las causas no tumorales sobresalen la inflamación pleural crónica (10), empiema (7), pleuritis aguda y subaguda (5) y tuberculosis pleural (4). El proceder terapéutico más frecuente fue la pleurodesis con talco en derrames malignos. En 69 pacientes (94,5 %) el proceder fue útil. Tres sufrieron complicaciones posoperatorias, 2 insuficiencia respiratoria y 1 enfisema subcutáneo. Fallecieron 3 (4,1 %), 2 de ellos por insuficiencia respiratoria que no permitió la separación del ventilador mecánico. Conclusiones: La videotoracoscopía es una herramienta útil en el manejo de los casos portadores de un derrame pleural, cuando no se ha logrado obtener el diagnóstico y para realizar la pleurodesis con talcoThe pleural effusion is one of the lesions that are frequently consulted with the surgeon to obtain tissue material for biopsy after the reiterated failure of the cytological puncture, or to treat patients with uncontrollable effusion. Objective: to evaluate the usefulness of the video-assisted thoracoscopy in the diagnosis and treatment of patients carriers of a pleural effusion. Methods: Retrospective study that includes 73 patients in a row that underwent video-assisted thoracoscopy for diagnosis and treatment of a pleural effusion treated between January 1997 and July 2004. Results: 43 patients were males and 30 females. 39 (52.4 %) had a malignant disease, with predominance of lung and breast, because of the effusion. 71.2 % of the cases were operated on with diagnostic intention. Chronic pleural swelling (10), empyema (7), acute and subacute pleuritis (5) and pleural tuberculosis (4) stood out among the non-tumoral causes. The most common therapeutic procedure was pleurodesis with talcum in malignant effusions. In 69 patients (94.5 %), the procedure was useful. 3 suffered from postoperative complications, 2 respiratory failure and 1 subcutaneous emphysema. 3 died (4.1 %), 2 of them due to respiratory failure that did not allow the separation from the mechanical ventilator. Conclusions: Video-assisted thoracoscopy is a useful tool in the management of the patients carriers of pleural effusion, when the diagnosis has not been made and to perform the pleurodesis with talcum

Las fístulas broncopleurales posoperatorias asociadas o no a empiema constituyen una fuente importante de morbimortalidad en pacientes que han sufrido resecciones pulmonares, principalmente cuando se tratan enfermedades malignas. El objetivo de este artículo es revisar los resultados obtenidos en el tratamiento de 6 pacientes tratados entre 1997 y 2003. La operación previa fue neumonectomía derecha en 5 pacientes y lobectomía superior derecha en uno. Las causas de la operación fueron traumatismo, tumores benignos y malignos y tuberculosis. En los 6 pacientes se utilizó mioplastia con el dorsal ancho para la obliteración de la cavidad pleural remanente. Las técnicas complementarias comprendieron el uso de colgajos pediculados de músculo intercostal (3 pacientes), mioplastia con el músculo pectoral mayor y toracoplastia parcial en un paciente cada una. La complicación más frecuente fue la fuga aérea mantenida por más de 10 días. Todos los pacientes mantenían el cierre bronquial al año de la operaciónThe postoperative bronchopleural fistulas associated or not with empyema are an important source of morbimortality in patients that have suffered from pulmonary resections, mainly when malignant diseases are treated. The purpose of this article is to review the results obtained in the treatment of six patients from 1997 to 2003. The previous operation was right pneumonectomy in five patients and upper right lobectomy in one. The causes of the operation were traumatism, benign and malignant tumors and tuberculosis. In the six patients, it was used myoplasty with the wide dorsal for the obliteration of the remaining pleural cavity. The complementary techniques comprised the use of pedicled flaps of intercostal muscle (3 patients), myoplasty with the pectoralis major and partial thoracoplasty in a patient, each one. The most frequent complication was the aerial leakage maintained for more than ten days. All the patients kept the bronchial closure a year after the operation

La resección en manguito con conservación de parénquima pulmonar está indicada en una amplia variedad de lesiones tumorales benignas y malignas, así como inflamatorias endobronquiales. Se realizó la revisión de 6 pacientes a los cuales a 3 se les había practicado resección carinal y a 3 lobectomía en manguito. Las causas fueron un tumor carcinoide típico de bronquio superior izquierdo, un tumor mucoepidermoide de bronquio principal izquierdo con invasión de carina y los restantes fueron carcinomas epidermoides: 2 de bronquio principal derecho que infiltraba la carina y 2 del bronquio del lóbulo superior derecho que protruían hacia el bronquio principal. Las indicaciones fueron la toma de carina por el tumor,3 un tumor de bajo grado (carcinoide típico) con infiltración del bronquio principal correspondiente y en 2 pacientes que se consideró su estado general ofrecía alto riesgo de complicaciones y mortalidad si se realizaba una neumonectomía. Hubo una sola complicación que fue la sobreinfección de un pulmón atelectásico y no se presentó mortalidad posoperatoria. Se realizó la revisión de la literatura médica. La resección en manguito es una opción adecuada en el tratamiento quirúrgico de enfermos con lesiones endobronquiales benignas, tumores de bajo grado de malignidad y en casos seleccionados de carcinomas bronquialesThe resección in sleeve with pulmonary conservation of parénquima is indicated in an ample variety of benign tumorlike injuries and you vitiate, as well as inflammatory endobronquiales. The revision of 6 patients was made to who to 3 them carinal resección had practiced 3 and to lobectomía in sleeve. The causes were a typical carcinoide tumor of left superior bronchus, a mucoepidermoide tumor of left main bronchus with carina invasion and the rest were epidermoides carcinomas: 2 of main bronchus straight that infiltrated the carina and 2 of the bronchus of the superior lobe straight that protruían towards the main bronchus. The indications were the taking of carina by the tumor, 3 a tumor of low degree (carcinoide typical) with infiltration of the corresponding main bronchus and in 2 patients who considered their general state it offered stop risk of complications and mortality if a neumonectomía were made. There was a single complication that was the sobreinfection of a atelectásico lung and mortality did not appear posoperatoria. The revision of medical Literature was made. The resección in sleeve is an option adapted in the surgical treatment of patients with benign endobronquiales injuries, tumors of low degree of malignidad and in selected cases of bronchial carcinomas