Tracheoesophageal fistulas are uncommon and present diverse etiologies, among which is burning of the esophagus due to caustic ingestion. Herein, we report the case of a 27-year-old male patient having ingested a caustic substance 14 days prior and presenting burning retrosternal pain, weakness, productive cough with purulent sputum and dyspnea accompanied by hoarseness for the preceding 24 h. Endoscopy of the upper digestive tract revealed a tracheoesophageal fistula. Treatment consisted of cervical exclusion of the esophageal transit, together with gastrostomy. Subsequently, the nutrient transit was reconstructed through pharyngocoloplasty. The postoperative evolution was favorable.

Keywords: Tracheoesophageal fistula/etiology; Tracheoesophageal fistula/surgery; Esophageal perforation/chemically induced; Colon/surgery

Objective: To evaluate the epidemiological and clinical aspects of acute mediastinitis and to characterize its treatment. Methods: A retrospective study conducted through review of the medical charts of patients diagnosed with acute mediastinitis at the Hospital Escola da Faculdade de Medicina do Triângulo Mineiro (Triângulo Mineiro Medical School Hospital) between 1987 and 2004. Results: A total of 21 patients were studied. Most (76.2%) were male, and the mean age was 52.5 years. Six patients (28.6%) died. The most common cause (in 38.1%) was median sternotomy, followed by esophageal perforation (in 33.3%) and cervical infection (in 14.3%). Staphylococcus aureus and Staphylococcus epidermidis were the causative agents most frequently isolated. In most cases, the treatment of choice was antibiotic therapy accompanied by surgery. The most frequent complications of the acute mediastinitis were pleural effusions (in 23.8%) and osteomyelitis (in 19.0%). The average hospital stay was 26.6 days. Conclusion: Acute mediastinitis is a serious complication of some diseases and procedures. Despite its low incidence, the mortality rate is high. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative agents. The treatment used was antibiotic therapy accompanied by surgery.

A 35 year-old black woman, previously healthy, who complained about chronic cough and shortness of breath was investigated after non-response of symptoms. Her chest X-ray and high resolution chest CT-scan were normal. She presented with abnormal spirometry, a mild restrictive disturbance. After a negative initial clinical investigation, an open lung biopsy was indicated. Multiple microscopic peribronchiolar tumorlets carcinoids - neuroendocrine cell hyperplasia was revealed. The authors emphasize the importance of an early diagnosis of this unusual entity and discuss its possible pathophysiological mechanisms.

Keywords: Lung diseases. Neuroendocrine cell. Bronchiolitis. Carcinoid. Tumorlets.