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Resumen Introducción: El traumatismo torácico (TT) es una causa importante de morbilidad y mortalidad, presente en el 25-50% de la mortalidad por traumatismo. El TT contuso (TTC) es el tipo más frecuente de TT según las diferentes publicaciones internacionales. Objetivo: Nuestros objetivos son describir las características, tratamientos, morbilidad y mortalidad en pacientes hospitalizados por TTC en nuestra institución. Material y Métodos: Estudio descriptivo transversal desde enero-1981 a diciembre-2017. Revisión de una base de datos prospectiva, protocolos quirúrgicos y fichas clínicas. Se describen y comparan las características de los TTC. Se calcularon índices de gravedad de traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 pacientes hospitalizados por TT, 1.719 (41,3%) TTC. Hombres 1.327 (77,2%), edad promedio 46,7±18,8 años. Se consideró TT aislado 966 (56,2%), asociado a lesiones extratorácicas 753 (43,8%) y de estos 508 (29,6%) eran politraumatizados. Mecanismo: Accidente de tránsito 838 (48,7%), caída de altura 279 (16,2%). Lesiones y hallazgos torácicos: fractura costal 1.294 (75,3%), neumotórax 752 (43,1%). Tratamiento: médico 874 (50,8%), pleurotomía 704 (41%) y cirugía torácica 141 (8,2%). Período de hospitalización 9,2 ± 9,5 días. Según IGT: ISS promedio 14,1 ± 11,1, RTS-Tpromedio 11,5 ± 1,5, TRISS promedio 6,6. Morbilidad en 297 (17,3%), mortalidad en 68 (4%). Discusión: La causa principal de los TTC fue el accidente de tránsito. La fractura costal correspondió a la lesión torácica más frecuente. La mayoría requirió solo tratamiento médico. La mortalidad fue menor a la esperada según IGT.

Prosthetic valve replacement is the standard treatment for aortic valvulopathy. Due to the structural valve deterioration of biological prosthesis and the anticoagulation requirements of mechanical valves, the repair of aortic valve disease is receiving more attention in recent years. The Ozaki technique consists in the reconstruction of a trileaflet valve using autologous pericardium. We report our first two cases of successful reconstruction of the aortic valve using this technique with 12-month echocardiographic and 24-month clinical follow up.

Introducción: El traumatismo penetrante cardíaco (TPC) es una lesión poco frecuente y con alta morbilidad y mortalidad.Objetivo: Analizar la evolución de características clínicas, anatómicas, gravedad, morbilidad y mortalidad de pacientes operados por TPC.Materiales y Método: Estudio analítico de pacientes tratados quirúrgicamente por TPC en Hospital Clínico Regional “Dr. Guillermo Grant Benavente”, Concepción, Chile. Se analizaron los periodos: enero-1990 a diciembre-2004 y enero-2005 a diciembre-2019. Se comparó: sexo, edad, lesiones asociadas, agente y mecanismo del traumatismo, comportamiento fisiopatológico, ubicación anatómica de la lesión, clasificaciones del traumatismo cardíaco Attar, Saadia y OIS-AAST, IGT (índices de gravedad del traumatismo): ISS, RTS-T y TRISS, morbilidad y mortalidad según periodos. Se realizó análisis estadístico con SPSS25®, se utilizaron las pruebas chi-cuadrado, exacta de Fisher y Mann-Whitney. Se consideró significativo un valor p

Resumen Introducción: El hemotórax masivo (HM) se puede definir como el acúmulo súbito de ≥ 1.500 ml de sangre en la cavidad pleural o débito ≥ 200 ml/h de sangre en 3-4 h por pleurotomía; es considerada una complicación traumática grave. Objetivo: Describir las características clínicas, índices de gravedad de traumatismo (IGT), morbilidad y variables asociadas a mortalidad en pacientes con hemotórax masivo por traumatismo torácico operados (HMTT). Materiales y Método: Estudio analítico longitudinal. Período enero de 1981 a diciembre de 2018. Revisión prospectiva de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de HMTT. Se calcularon IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Para mortalidad se realizó análisis univariado con cálculo de Odds Ratio. Resultados: Total 4.306 traumatismos torácicos (TT), HMTT 119 (2,8%). Hombres 112 (94,1%), edad promedio 32 ± 13,2 años, 91 (76,5%) pacientes presentaron TT aislado, 28 (23,5%) asociado a lesiones extratorácicas, de estos, 23 (19,3%) fueron politraumatismos. Fueron traumatismos penetrantes 102 (85,7%). El HMTT se atribuyó principalmente a: lesión de pared en 38 (31,9%) y lesión pulmonar en 29 (24,4%). De las cirugías torácicas: 87 (73,1%) fueron urgentes (≤ 4 h), 10 (8,4%) precoces (> 4-24 h) y 22 (18,5%) diferidas (> 24 h). Hospitalización postoperatoria promedio 7,9 ± 6,4 días. Según IGT: ISS promedio 17,4 ± 9,6, RTS-T promedio 10,2 ± 2,7, TRISS promedio 12,7. Morbilidad 46 (38,7%) y mortalidad 15 (12,6%). Discusión: Los HMTT se atribuyeron principalmente a lesiones de pared y lesión pulmonar. En la mayoría se requirió cirugía torácica de urgencia. La mortalidad observada es semejante a la esperada según IGT. Existen variables asociadas a mayor mortalidad.

Resumen Introducción: Los traumatismos torácicos por armas de fuego (TTAF) son cada vez más frecuentes. Objetivos: Describir características clínicas, morbilidad, mortalidad y la evolución a través del tiempo de hospitalizados por TTAF. Materiales y Método: Estudio analítico longitudinal. Período enero de 1981-diciembre de 2018. Revisión base de datos, protocolos prospectivos y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24® con chi cuadrado y de Mann-Whitney. Descripción de características de TTAF en pacientes hospitalizados y comparación por períodos. Se calcularon índices de gravedad del traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.306 pacientes hospitalizados por traumatismo torácico (TT), 205 (4,8%) hospitalizados por TTAF. Hombres: 188 (91,7%), edad promedio 28,8 ± 11,2 años, TTAF aislado 115 (56,1%), asociado a lesiones extratorácicas 90 (43,9%), de estos 55 (26,8%) se consideraron politraumatismos. Mecanismo: Agresión 193 (94,1%), autoagresión 11 (5,4%) y accidental 1 (0,5%). Lesiones y/o hallazgos torácicos más frecuentes: Hemotórax 127 (62,0%), neumotórax 96 (46,8%) y contusión pulmonar 51 (24,9%). Tratamiento definitivo: Pleurotomía 88 (42,9%), cirugía 71 (34,6%) y tratamiento médico 46 (22,4%). Mediana de hospitalización 7 días. Según IGT: ISS promedio 16,7 ± 11,7, RTS-T promedio 11,1 ± 2,1, TRISS promedio 9,6. Morbilidad: 44 (21,5%). Mortalidad: 14 (6,8%). En los diferentes períodos, se observó aumento de politraumatismos y TRISS, sin cambios en mortalidad. Discusión: La mayoría de los TTAF fueron aislados. Aproximadamente un tercio de los pacientes requirió cirugía. La mortalidad observada es menor a la esperada. Se observan cambios en los TTAF a través del tiempo.

Background Lungs are the second location in frequency of hydatidosis or cystic echinococcosis. Aim To characterize the clinical manifestations, diagnosis, findings and treatment of patients hospitalized for a pulmonary hydatid cyst (PHC). Materials and methods Review of databases, medical records, operation notes and death certificates of patients admitted to a Chilean regional hospital with a PHC. Results Four hundred twenty-nine cases were identified and complete data was obtained from 368 patients aged 34 ± 19 years, 224 (60,9%)men. The most common clinical manifestations were cough in 269 (73%) and chest pain in 217 (59%). The most frequent locations were the right lung in 210 (57%) and lower lobes in 218 (59%). One hundred eighty-seven cysts (51%) were complicated. Conservative surgery (cystectomy) was performed in 308 (84%). Postoperative morbidity was observed in 77 (21%) and mortality in 6 (2%) patients. Recurrence was observed in 28 (8%) patients. There was a significant reduction in morbidity, mortality, reoperations, and postoperative days over time. Conclusions In these patients, pulmonary hydatidosis was diagnosed mainly during working ages and half of patients had a complicated cyst.

Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.

Background: Primary cardiac tumors have a low incidence, and their presentation form and clinical course are not well known. Aim: To describe the characteristics, treatment, follow up and survival of patients with primary cardiac tumors (PCT). Material and Methods: Review of all surgical procedures for PCT performed between 1984 and 2019 in a regional general hospital. The information was obtained from surgical protocols, surgical and pathology databases, medical records and registries of the Chilean National Identification Service. The clinical features of patients, immediate and long term outcomes are described. Results: Seventy-two surgical procedures for PCT were reviewed. Patients’ age was 55 ± 15 years and 60% were women. The most common histological types were myxoma in 49 patients (68%), papillary fibroelastoma in 13 (18%) and sarcoma in 6 (8.3%). Forty-nine (68.1%) were symptomatic and all tumors were found on echocardiography. Fifty-one (71%) were in the left atrium, 10 (14%) in the aortic valve and eight (11%) in the right atrium. The surgical procedures were tumor resection in 48 patients (67%) and resection and repair with patch in 23 (32%). Mean postoperative stay was 6.6 ± 4.4 days, eight patients (11%) had complications and no patient died in the immediate postoperative period. Long term survival was higher in patients with benign PCT as compared with those with malignant tumors. Conclusions: Most PCTs in this group of patients were benign neoplasms and the most common tumors were myxomas. The main diagnostic method is echocardiography and the prognosis of surgical treatment is excellent when the tumors are benign. (Rev Med Chile 2020; 148: 327-335)

Lungs are the second location in frequency of hydatidosis or cystic echinococcosis.To characterize the clinical manifestations, diagnosis, findings and treatment of patients hospitalized for a pulmonary hydatid cyst (PHC).Review of databases, medical records, operation notes and death certificates of patients admitted to a Chilean regional hospital with a PHC.Four hundred twenty-nine cases were identified and complete data was obtained from 368 patients aged 34 ± 19 years, 224 (60,9%)men. The most common clinical manifestations were cough in 269 (73%) and chest pain in 217 (59%). The most frequent locations were the right lung in 210 (57%) and lower lobes in 218 (59%). One hundred eighty-seven cysts (51%) were complicated. Conservative surgery (cystectomy) was performed in 308 (84%). Postoperative morbidity was observed in 77 (21%) and mortality in 6 (2%) patients. Recurrence was observed in 28 (8%) patients. There was a significant reduction in morbidity, mortality, reoperations, and postoperative days over time.In these patients, pulmonary hydatidosis was diagnosed mainly during working ages and half of patients had a complicated cyst.

Background: Coronary artery bypass grafting (CABG) is the best treatment for a large group of patients with coronary artery disease. Aim: To describe early and late results of patients treated with CABG at our Center. Patients and Methods: Revision of data bases, surgical protocols and clinical registers of patients operated between January 2006 and December 2008. Results: Of 1.003 cardiac surgeries performed during the period, 658 corresponded to isolated CABG (78% in men). The median age of patients was 62 years. Left common coronary artery lesions was found in 135 cases (20%), 555 patients (84%) had hypertension and 231 (35%) were diabetics. Four-hundred thirty (65%) had stable angina and 211 (32%) had a recent myocardial infarction. Twenty-two had left ventricular ejection fraction < 30%. In 248 (38%), a low Additive EuroSCORE risk was found. Emergency surgery was required in 36 (6%) patients. Use of extracorporeal circulation was required in 466 patients (71%). Within 30 days of surgery, complications were recorded in 105 patients (16%) (15 (2%) stroke, 14 (2%) myocardial infarction, 7 (1%) mediastinitis, and in 14 (2%) a reoperation for bleeding). Thirteen patients died (2%). Among the 303 patients with stable angina and preserved left ventricular function, two died (0,7%). Survival at 1, 3 and 5 years was 97,4%, 93,8% y 90,9% respectively. Major adverse cardiac and cerebrovascular events at five years occurred in 20%, stroke in 4%, myocardial infarction in 3% and reintervention in 2%. Seven percent of patients had recurrence of angina. Conclusions: We describe a heterogeneous series of patients. The immediate and late results are comparable with international communications.

Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.

Coronary artery bypass grafting (CABG) is the best treatment for a large group of patients with coronary artery disease.To describe early and late results of patients treated with CABG at our Center.Revision of data bases, surgical protocols and clinical registers of patients operated between January 2006 and December 2008.Of 1.003 cardiac surgeries performed during the period, 658 corresponded to isolated CABG (78% in men). The median age of patients was 62 years. Left common coronary artery lesions was found in 135 cases (20%), 555 patients (84%) had hypertension and 231 (35%) were diabetics. Four-hundred thirty (65%) had stable angina and 211 (32%) had a recent myocardial infarction. Twenty-two had left ventricular ejection fraction30%. In 248 (38%), a low Additive EuroSCORE risk was found. Emergency surgery was required in 36 (6%) patients. Use of extracorporeal circulation was required in 466 patients (71%). Within 30 days of surgery, complications were recorded in 105 patients (16%) (15 (2%) stroke, 14 (2%) myocardial infarction, 7 (1%) mediastinitis, and in 14 (2%) a reoperation for bleeding). Thirteen patients died (2%). Among the 303 patients with stable angina and preserved left ventricular function, two died (0,7%). Survival at 1, 3 and 5 years was 97,4%, 93,8% y 90,9% respectively. Major adverse cardiac and cerebrovascular events at five years occurred in 20%, stroke in 4%, myocardial infarction in 3% and reintervention in 2%. Seven percent of patients had recurrence of angina.We describe a heterogeneous series of patients. The immediate and late results are comparable with international communications.

Background: Thymectomy improves clinical outcomes and decreases the need for medical treatment in patients with myasthenia gravis (MG). Aim: To describe the immediate and long-term results of extended transsternal thymectomy (ETT) in patients with MG. Material and Methods: A review of databases, surgical protocols, clinical records and interviews of patients subjected to extended transsternal thymectomy for MG between 1990 and 2016. Perioperative clinical characteristics, anticholinesterase treatment, immediate and remote surgical results were analyzed and patients were followed from one to 10years. Results: We studied 58 patients aged 35 ± 14years (72%) women. In the preoperative period, according to Osserman classification, nine patients (15,5%) were in grade I, eight (13,8%) in grade IIA 8 and 40 (69%) in grade IIB. The pathological study of the surgical piece showed thymic hyperplasia in 39 cases (67,2%). Four patients had postoperative complications but none died. In the Follow-up at 1, 3, 5, 8 and 10years the Masaoka palliation rate was 71.7, 77.5, 67.7, 70.0 and 70,6% respectively. The figures for remission rate were 13.0, 15.0,19.4, 35.0 and 35,3% respectively. The figures for Zielinski positive results were 79.6, 87.5, 87.1, 90.0 and 82,4% respectively. The DeFilippi score improved by 80.4, 87.5, 87.1, 90.0 and 82.4% respectively. The Myasthenia Gravis Foundation of America Post-Intervention State improved by 67.4, 77.5, 77.5, 75.0 and 70,6% respectively. Mean Myasthenia Gravis Activities of daily living (MGADL) and Myasthenia Gravis Quality of life scale 15 (MGQOL 15) were 1.65 and 6.31 respectively. Conclusions: In selected patients with MG, extended transsternal thymectomy in MG has good immediate and long-term results.

Background: Trauma is the leading cause of death in young patients and thoracic trauma (TT) is responsible for 25-35% of trauma deaths. Aim: To describe and compare features, trauma severity indexes and morbidity of patients admitted for TT in the past three decades. Material and Methods: Review of a TT database, operative notes and medical records of patients. These were separated by decade of admission (1981-1990, 1991-2000, 2001-2010). TT characteristics were compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results: A total of 3,068 TT were reviewed. In the 1981-1990 period, 604 cases of TT were registered (19.7%), in the 1991-2000 period, 1,070 cases (34.9%) and in the 2001-2010 period, 1,394 cases (45.4%) (p < 0.05). The ages of patients in each of these periods were 34.9 ± 15.5, 33.9 ± 16.2 and 35.7 ± 18.2 years respectively (p < 0.05). The proportion of patients aged 65 years or more were 6.6, 7.7 and 10.1% respectively, the proportion of females was 6.1, 9.4 and 12.0%, respectively. The causing agents per decade were knife wounds in 51.5, 61.1 and 60.0% of cases respectively, firearms in 2.5, 3.3 and 5.0% of cases respectively, multiple trauma in 13.9, 14.5 and 9.0% respectively and morbidity in 18.7, 19.7 and 11.7%, respectively. The ISS per decade was 11.9 ± 6.5, 12.9 ± 6.9 and 10.4 ± 6.8 respectively. No significant difference were found in mortality (1.5, 3.0, 2.0% respectively) or TRISS score (2.7, 3.2 and 3.8% respectively). Conclusions: An increase in the number of hospital admission for TT has occurred in the last three decades, with an increase in the proportion of admissions of subjects aged 65 years or more, females and with firearm injuries.

La cirugía de la aorta ascendente y cayado con circulación extra corpórea requiere de una canulación arterial que permita asegurar una perfusión sistémica adecuada y disminuir las complicaciones neurológicas. El sitio ideal de canulación es aún un tema de discusión entre los cirujanos. Entre las alternativas de abordaje están la canulación periférica (arteria femoral), la canulación central extratorácica (arterias axilar, subclavia o carótidas) y la canulación central intratorácica (aorta, arteria innominada). La canulación de la arteria innominada es una técnica que se puede realizar sin necesidad de una segunda incisión, es un vaso de fácil abordaje y habitualmente de gran calibre. Permite entregar un flujo cerebral y visceral anterógrado y, en caso de cirugía sobre el cayado, el pinzamiento de la arteria a nivel de su origen permite entregar una perfusión cerebral selectiva anterógrada. Se describen la técnica quirúrgica y los reparos operatorios que nos parecen importantes en su realización.

Penetrating aortic ulcer (PAU) is an ulceration of an atherosclerotic plaque which disrupts the aortic internal elastic lamina and that can evolve to an intramural hematoma (IH), aortic dissection or aortic rupture. We report two cases with PAU. A 73-years-old-woman with a history of hypertension, presented with acute chest pain of three days of evolution and a hypertensive emergency. An electrocardiogram showed ST-segment elevation and elevated cardiac enzymes. Computed tomography (CT) scans showed and acute ascending aortic mural hematoma secondary to PAU and hemopericardium. Replacement of ascending aorta was performed with a vascular prosthesis with extracorporeal circulation (ECC). PAU and IH were confirmed by histopathology. A 62-years-old woman with a history of hypertension, diabetes and chronic obstructive pulmonary disease, consulted for abdominal pain of two days of evolution. A thoracic-abdominal CT scan visualized an uncomplicated PAU and an abdominal aortic aneurysm. Because of abdominal pain and signs of peritoneal irritation, an exploratory laparotomy was performed finding a typhlitis. Resection and ileo-ascendo-anastomosis were performed. A new CT scan showed PAU with high risk of rupture without a clinical acute aortic syndrome. The patient was operated replacing the ascending aorta with a vascular prosthesis using ECC. Three PAU were found. Histopathology confirmed the diagnosis. Both patients evolved without postoperative complications.

Thymectomy improves clinical outcomes and decreases the need for medical treatment in patients with myasthenia gravis (MG).To describe the immediate and long-term results of extended transsternal thymectomy (ETT) in patients with MG.A review of databases, surgical protocols, clinical records and interviews of patients subjected to extended transsternal thymectomy for MG between 1990 and 2016. Perioperative clinical characteristics, anticholinesterase treatment, immediate and remote surgical results were analyzed and patients were followed from one to 10years.We studied 58 patients aged 35 ± 14years (72%) women. In the preoperative period, according to Osserman classification, nine patients (15,5%) were in grade I, eight (13,8%) in grade IIA 8 and 40 (69%) in grade IIB. The pathological study of the surgical piece showed thymic hyperplasia in 39 cases (67,2%). Four patients had postoperative complications but none died. In the Follow-up at 1, 3, 5, 8 and 10years the Masaoka palliation rate was 71.7, 77.5, 67.7, 70.0 and 70,6% respectively. The figures for remission rate were 13.0, 15.0,19.4, 35.0 and 35,3% respectively. The figures for Zielinski positive results were 79.6, 87.5, 87.1, 90.0 and 82,4% respectively. The DeFilippi score improved by 80.4, 87.5, 87.1, 90.0 and 82.4% respectively. The Myasthenia Gravis Foundation of America Post-Intervention State improved by 67.4, 77.5, 77.5, 75.0 and 70,6% respectively. Mean Myasthenia Gravis Activities of daily living (MGADL) and Myasthenia Gravis Quality of life scale 15 (MGQOL 15) were 1.65 and 6.31 respectively.In selected patients with MG, extended transsternal thymectomy in MG has good immediate and long-term results.

Trauma is the leading cause of death in young patients and thoracic trauma (TT) is responsible for 25-35% of trauma deaths.To describe and compare features, trauma severity indexes and morbidity of patients admitted for TT in the past three decades.Review of a TT database, operative notes and medical records of patients. These were separated by decade of admission (1981-1990, 1991-2000, 2001-2010). TT characteristics were compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated.A total of 3,068 TT were reviewed. In the 1981-1990 period, 604 cases of TT were registered (19.7%), in the 1991-2000 period, 1,070 cases (34.9%) and in the 2001-2010 period, 1,394 cases (45.4%) (p0.05). The ages of patients in each of these periods were 34.9 ± 15.5, 33.9 ± 16.2 and 35.7 ± 18.2 years respectively (p0.05). The proportion of patients aged 65 years or more were 6.6, 7.7 and 10.1% respectively, the proportion of females was 6.1, 9.4 and 12.0%, respectively. The causing agents per decade were knife wounds in 51.5, 61.1 and 60.0% of cases respectively, firearms in 2.5, 3.3 and 5.0% of cases respectively, multiple trauma in 13.9, 14.5 and 9.0% respectively and morbidity in 18.7, 19.7 and 11.7%, respectively. The ISS per decade was 11.9 ± 6.5, 12.9 ± 6.9 and 10.4 ± 6.8 respectively. No significant difference were found in mortality (1.5, 3.0, 2.0% respectively) or TRISS score (2.7, 3.2 and 3.8% respectively).An increase in the number of hospital admission for TT has occurred in the last three decades, with an increase in the proportion of admissions of subjects aged 65 years or more, females and with firearm injuries.

Background Diabetic patients are a group of primary interest in the study of myocardial revascularization. Aim To compare coronary artery bypass grafting surgery (CABG) and percutaneous angioplasty with stents (PCI-S) in diabetic patients with coronary three-vessel or left main coronary artery disease. Material and methods Meta-analysis of MEDLINE randomized controlled studies comparing CABG and PCI-S in diabetic patients. The primary outcome measure was major adverse cardiovascular events (MACCE), death, myocardial infarction, cerebrovascular accident (CVA) and coronary re-intervention. Secondary outcomes were the individual components of MACCE. Results Three studies comparing CABG and PCI-S met the inclusion criteria. One thousand sixty two patients were studied: 565 in the CABG group and 597 in the PCI-S group. At one year follow up MACCE occurred in 24.9 and 12.7% of patients in PCI-S and CABG groups, respectively (Odds ratio (OR) 2.27; 95% confidence intervals (CI) 1.66-3.09). There were no differences in death or myocardial infarction. Strokes were less common in the PCI-S group (OR 0.25, 95% CI0.09-0.68) and coronary re-intervention was required with higher frequency in the PCI-S group (OR 5.32, 95% CI 3.27-8.67). Conclusions In diabetic patients with three-vessel coronary disease or left main coronary artery, revascularization with CABG had significantly less MACCE at one year than those treated with PCI-S. Stroke frequency was higher in CABG, coronary re-intervention was higher in PCI-S. These results must be interpreted cautiously.

Objectives: To describe and evaluate factors associated with morbidity and mortality in surgically treated parapneumonic empyemas (PNE). Method: Retrospective review between January 2000 and August 2006. We described clinical features and we performed univariate and multivariate analysis to find the factors associated with morbidity and mortality. SPSS 15.0 program was used in the statistical analysis. Results: 242 of343 surgically treated empyemas (70.6%) were paraneumonic. Of these 165 (68.2%) were men, average age 52.1 years, 229 (94.6%) were community-acquired pneumonia (CAP) and 13 (5.4%) nosocomial. Germs were isolated in pleural fluid in 57 (23.6%). Surgical procedures were: 183 (75.6%) decortications, 49 (20.2%) pleurotomies, 7 (2.9%) video-assisted surgery and 3 (1.2%) decortications with pulmonary resection. Complications occurred in 65 cases (26.9%) and 16 patients died (6.6%). We found variables associated with morbidity and mortality. Conclusions: PNE is the most common cause of empyema, mostly associated with CAP and germs are difficult to identify. Decortication is the most common surgical treatment. Morbidity and mortality are present. Variables associated with morbidity and mortality were identified in this clinical series.

Pleural empyema. Retrospective review of 343 patients Background: Pleural empyema still has a dismal prognosis. Aim: To describe features and prognostic factors of patients with pleural empyema subjected to surgical procedures. Material and Methods: Retros-pective review of 343 patients with pleural empyema (mean age 52 years, 71% males), that were subjected to any type of surgical procedure. Criteria for diagnosis of empyema were a positive culture, a fluid pH of less than 7.2 or a compatible macroscopic appearance of the fluid. Results: Empyema was secondary to pneumonia in 243 patients (71%), secondary to surgical procedures in 41 patients (12%), secondary to trau-ma in 19 patients (5.5%), secondary to a lung abscess in 10 patients (3%), tuberculous in 10 patients (3%), neoplastic in two cases (0.6%), secondary to pneumothorax in 2 cases (0.6%) and of unknown origin in 13 patients (4%). A microorganism was isolated from pleural fluid in 89 patients (26%). The surgical procedures performed were 251 decortications by thoracotomy (73%), 70 pleurotomies (20%), 11 video assisted surge-ries (3%), seven decortications with lung resections and four fenestrations. Complications were recorded in 104 patients (30%), 29 patients were re-operated (8.5%) and 31 died (10%), all due to sepsis. Conclusions: The main cause of pleural empyema is pneumonia. In most patients, microorganisms are not isolated from pleural fluid, thoracotomy with decortication is the most frequent surgical procedure. There is a high rate of complications and mortality.Key words: Empyema, thoracotomy, pneumonia.ResumenObjetivos: Describir caracteristicas, resultados inmediatos y evaluar factores asociados a morbi-mortalidad de Empiema Pleural (EP) con tratamiento quirurgico. Metodo: Revision retrospectiva. Periodo: enero 2000 - agosto 2006. Se describen caracteristicas, resultados inmediatos y factores asociados a morbi-mortalidad. Se utilizo programa SPSS 15.0. Se considero significativo p < 0,05. Resultados: 343 pacientes

Diabetic patients are a group of primary interest in the study of myocardial revascularization.To compare coronary artery bypass grafting surgery (CABG) and percutaneous angioplasty with stents (PCI-S) in diabetic patients with coronary three-vessel or left main coronary artery disease.Meta-analysis of MEDLINE randomized controlled studies comparing CABG and PCI-S in diabetic patients. The primary outcome measure was major adverse cardiovascular events (MACCE), death, myocardial infarction, cerebrovascular accident (CVA) and coronary re-intervention. Secondary outcomes were the individual components of MACCE.Three studies comparing CABG and PCI-S met the inclusion criteria. One thousand sixty two patients were studied: 565 in the CABG group and 597 in the PCI-S group. At one year follow up MACCE occurred in 24.9 and 12.7% of patients in PCI-S and CABG groups, respectively (Odds ratio (OR) 2.27; 95% confidence intervals (CI) 1.66-3.09). There were no differences in death or myocardial infarction. Strokes were less common in the PCI-S group (OR 0.25, 95% CI0.09-0.68) and coronary re-intervention was required with higher frequency in the PCI-S group (OR 5.32, 95% CI 3.27-8.67).In diabetic patients with three-vessel coronary disease or left main coronary artery, revascularization with CABG had significantly less MACCE at one year than those treated with PCI-S. Stroke frequency was higher in CABG, coronary re-intervention was higher in PCI-S. These results must be interpreted cautiously.

Hamman syndrome or spontaneous pneumomediastinum is uncommon and its clinical manifestations are chest pain, dyspnea and subcutaneous emphysema.To report a series of patients with spontaneous pneumomediastinum.Medical records of patients with the diagnosis of pneumomediastinum, managed between 2002 and 2007 in a public hospital, were retrieved and reviewed.Eight patients aged between 16 and 41 years (five males) were identified. The most common symptom was chest pain and the most common sign was subcutaneous emphysema. A chest X ray was performed in all and a chest CT scan in seven. AH were managed conservatively with oxygen, analgesia and rest. No patient required surgery and the evolution was favorable.The most common presenting complaint of spontaneous pneumomediastinum is chest pain and its management does not require surgery.

Background: Hamman syndrome or spontaneous pneumomediastinum is uncommon and its clinical manifestations are chest pain, dyspnea and subcutaneous emphysema. Aim: To report a series of patients with spontaneous pneumomediastinum. Material and methods: Medical records of patients with the diagnosis of pneumomediastinum, managed between 2002 and 2007 in a public hospital, were retrieved and reviewed. Results: Eight patients aged between 16 and 41 years (five males) were identified. The most common symptom was chest pain and the most common sign was subcutaneous emphysema. A chest X ray was performed in all and a chest CT scan in seven. All were managed conservatively with oxygen, analgesia and rest. No patient required surgery and the evolution was favorable. Conclusions: The most common presenting complaint of spontaneous pneumomediastinum is chest pain and its management does not require surgery (Rev Med Chile 2009; 137: 1045-50). (Key words: Chest pain; Mediastinal emphysema; Subcutaneous emphysema)

Spontaneous retroperitoneal hematoma is a rare condition. We report a 78 year-old man with progressive pain in his right thigh and hip lasting one week. The pain subsequently was associated with abdominal pain in the right lower quadrant. Physical examination revealed pain to deep palpation of the area, associated with a diffuse positive rebound pain. An abdominal and pelvis CT scan showed an extensive mesenteric hematoma. During surgery, a large retroperitoneal encapsulated hematoma, without evidence of active bleeding, was found and drained. Pathology confirmed the diagnosis and was negative for cancer.

Spontaneous retroperitoneal hematoma is a rare condition. We report a 78 year-old man with progressive pain in his right thigh and hip lasting one week. The pain subsequently was associated with abdominal pain in the right lower quadrant. Physical examination revealed pain to deep palpation of the area, associated with a diffuse positive rebound pain. An abdominal and pelvis CT scan showed an extensive mesenteric hematoma. During surgery, a large retroperitoneal encapsulated hematoma, without evidence of active bleeding, was found and drained. Pathology confirmed the diagnosis and was negative for cancer (Rev Med Chile 2007; 135: 1044-7). (Key words: Hematoma; Mesenteric arteries; Radiography; Dual-energy Scanned projection)