Background: Trauma is the leading cause of death in young patients and thoracic trauma (TT) is (1981-1990, 1991-2000, 2001-2010 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. (Rev Med Chile 2018; 146: 196-205)

Introducción: Los traumatismos torácicos por armas de fuego (TTAF) son cada vez más frecuentes. Objetivo: Describir características clínicas, morbilidad, mortalidad y la evolución a través del tiempo de hospitalizados por TTAF. Material y método: Estudio analítico longitudinal. Período enero 1981- diciembre 2018. Revisión base de datos, protocolos prospectivos y fichas clínicas. Se utilizó planilla Microsoft Excel ® y programa SPSS24 ® con chicuadrado 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.

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Primary cardiac tumors. Experience in 72 casesBackground: 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.

In selected patients with MG, extended transsternal thymectomy in MG has good immediate and long-term results.