Úlcera gastroduodenal isquémica como complicación de la quimioembolización transarterial hepática de hepatocarcinoma / Ischemic gastroduodenal ulcer as a complication of hepatic hepatocarcinoma transarterial chemoembolization

La quimioembolización transarterial hepática es uno de los tratamientos del carcinoma hepatocelular irresecable en el que se han descrito de forma infrecuente lesiones isquémicas asociadas. Ante la aparición de sintomatología gastrointestinal alta inusual o que exceda el denominado síndrome postquimiembolización tras el procedimiento debe valorarse la realización de una gastroscopia para descartar la aparición de dichas complicaciones. Las variantes anatómicas con origen común de arterias gástricas y hepáticas pueden favorecer la migración de las microesferas hacia territorio gástrico obligando a valorar la eventual modificación de la técnica para prevenirlo.

Transarterial hepatic chemoembolization is one of the treatments of unresectable hepatocellular carcinoma in which associated ischemic lesions have been described infrequently. When unusual upper gastrointestinal symptoms or exceeding the so-called post-chemoembolization syndrome after the procedure, the performance of a gastroscopy should be assessed to rule out the occurrence of these complications. The anatomical variants with common origin of gastric and hepatic arteries can favor the migration of the microspheres into gastric territory, forcing the possible modification of the technique to prevent it.

Impacto de la triple terapia aplicada a pacientes con úlcera gastroduodenal / Impact of triple therapy on patients with peptic ulcer

Se realizó un estudio de intervención terapéutica en 57 pacientes a quienes se les diagnosticó úlcera péptica gastroduodenal en el Servicio de Endoscopia del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, de septiembre del 2009 a igual mes del 2010, con vistas a evaluar el impacto de la triple terapia establecida para esta afección. En la serie se observó una mayor incidencia de la úlcera gastroduodenal en el grupo etario de 36-45 años, así como un predominio del sexo masculino, con un tiempo de evolución de la enfermedad que superó los 12 meses. Igualmente, los afectados presentaron epigastralgia como el síntoma más frecuente, y la gastritis antral eritematosa y la úlcera duodenal como afecciones más comunes, con una elevada positividad de Helicobacter pylori y una reacción favorable luego de aplicado el tratamiento para erradicarlo.

A therapeutic intervention study was conducted in 57 patients who were diagnosed with peptic ulcer at the Endoscopy Department of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital of Santiago de Cuba, from September 2009 to the same month of 2010, in order to assess the impact of the triple therapy on this condition. In the series a higher incidence of the peptic ulcer was observed in the group aged 36-45 years, as well as a prevalence of the male sex, with a time of disease progression that exceeded 12 months. Likewise, patients presented with epigastralgia as the most frequent symptom, and erythematous antral gastritis and duodenal ulcer as the most common conditions, with high Helicobacter pylori positivity and a favorable reaction after applying the treatment to eliminate it.

Comportamiento de la úlcera gastroduodenal perforada / Behavior of the perforated gastroduodenal ulcer

INTRODUCCIÓN: la úlcera gastroduodenal perforada continúa siendo un problema importante para el cirujano. OBJETIVO: caracterizar a los pacientes con úlceras gastroduodenales perforadas en un periodo de 4 años. MÉTODOS: se realizó un estudio descriptivo y retrospectivo en el Hospital Militar Central Dr. Carlos J. Finlay. Se seleccionaron 140 historias clínicas de pacientes a quienes se les efectuó intervención quirúrgica urgente por presentar úlcera gastroduodenal perforada, desde enero de 2004 a diciembre de 2008. Las variables recogidas fueron: edad, sexo, ocupación, localización de las perforaciones, hábitos tóxicos, procederes quirúrgicos empleados y complicaciones posoperatorias. RESULTADOS: predominó el grupo de edad de 51 a 60 años, la ocupación obrera y el sexo masculino. Las perforaciones duodenales fueron las más frecuentes. El tabaquismo, consumo de café y alcoholismo se consideraron los hábitos tóxicos predominantes en los pacientes. El proceder quirúrgico más empleado fue la sutura y epiploplastia. La sepsis de la herida quirúrgica y la peritonitis resultaron ser las complicaciones más frecuentes. CONCLUSIONES: Los pacientes atendidos por úlcera gastroduodenal perforada correspondieron fundamentalmente al sexo masculino, mayores de 50 años de edad con úlcera duodenal y consumidores de café, tabaco, alcohol, y fueron tratados con sutura y epiploplastia

INTRODUCTION: the perforated gastroduodenal ulcer remains as a significant problem for surgeon. OBJECTIVE: to characterize the patients presenting with perforated gastroduodenal ulcers over four years. METHODS: a retrospective and descriptive study was conducted in the Dr. Carlos J. Finlay Central Military Hospital. A total of 140 medical records were selected from patients underwent an urgent surgical intervention due to perforated gastroduodenal ulcer from January, 2004 to December, 2008. Variables included were: age, sex, occupation, perforations locations, toxic habits, surgical procedures used and postoperative complications. RESULTS: there was predominance of 51 to 60 age group, occupation and male sex. The more frequent were the duodenal perforations. Smoking, coffee habits and alcoholism were the predominant toxic habits in patients. The more used surgical procedure was the suture and epiploplasty. The surgical wound sepsis and the peritonitis were the more frequent complications

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica / Stress ulcer prophylaxis in pediatric intensive care units

OBJETIVO: Avaliar a utilização de profilaxia para úlcera de estresse (UE), em pacientes internados, de cinco unidades de terapia intensiva pediátrica (UTIP) de Porto Alegre (RS). MÉTODOS: Estudo multicêntrico, prospectivo, transversal, observacional. Foram avaliados os prontuários dos pacientes internados em dia definido para visitação, entre abril de 2006 e fevereiro de 2007, excluindo os avaliados em visitas anteriores e aqueles com hemorragia digestiva alta na admissão. Foram avaliados a idade, o gênero, o diagnóstico na admissão, a gravidade da doença, o uso de profilaxia para UE, a sua justificativa e o medicamento profilático utilizado como primeira escolha. As variáveis foram descritas como frequências absoluta e relativa, ou média e desvio padrão/mediana, e intervalo interquartil (IQ). Os testes qui-quadrado de Pearson, de tendência linear, ou exato de Fisher foram utilizados para avaliar as associações. O nível de significância adotado foi de 5 por cento, sendo estatisticamente significativo p < 0,05. RESULTADOS: Foram avaliados 398 pacientes, sendo 57 por cento do gênero masculino. A mediana de idade foi de 16 meses (IQ4-65) e mediana de permanência em UTIP foi de 4 dias (IQ1-9). O principal motivo de internação foi doença respiratória (32,7 por cento). Usaram profilaxia 77,5 por cento dos pacientes, variando de 66 a 91 por cento; a ventilação mecânica (22,3 por cento) foi a justificativa mais prevalente, seguida de rotina informal do serviço (21,4 por cento). Apenas uma das UTIP tinha protocolo assistencial para profilaxia de UE. A ranitidina foi o medicamento mais empregado (84,5 por cento). CONCLUSÕES: O uso de profilaxia para UE foi prática frequente nas UTIP avaliadas, sendo a ranitidina a droga de escolha. Entre as justificativas, a ventilação mecânica e o uso baseado em rotinas institucionais foram as mais prevalentes.

OBJECTIVE: To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil. METHODS: This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5 percent (p < 0.05). RESULTS: 398 patients (57 percent male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7 percent). Most patients received stress ulcer prophylaxis (77.5 percent; range, 66-91 percent). Mechanical ventilation (22.3 percent) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4 percent). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5 percent of cases). Evidence of minor gastrointestinal bleeding was found in 3 percent of patients; none had clinically significant bleeds. CONCLUSIONS: Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.