ABSTRACT
Introducción: Las varices esofágicas son canales vasculares que unen la circulación venosa portal y la sistémica. Se forman como consecuencia de la hipertensión portal, predominantemente en la submucosa del tercio inferior del esófago. Objetivo: Caracterizar a pacientes con rotura de varices esofágicas según principales variables clinicoepidemiológicas y terapéutico-endoscópicas. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal de 20 pacientes con hemorragia digestiva alta por rotura de varices esofágicas, los cuales recibieron tratamiento endoscópico con bandas elásticas en el Servicio de Gastroenterología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de noviembre de 2016 a febrero de 2018. En el análisis estadístico se utilizó el porcentaje como medida de resumen y se aplicó la prueba de independencia de la Χ2 para identificar alguna asociación significativa entre variables. Resultados: Existió un predominio del sexo masculino (80,0 %) y del grupo etario de 51 a 60 años (40,0 %). La mayoría de los afectados presentó cirrosis hepática (60,0 %) como causa de la hipertensión portal y hematemesis (50,0 %) como forma de hemorragia digestiva alta; asimismo, el gran tamaño de las varices fue el principal factor de riesgo asociado a la rotura (70,0 %) y, luego de practicado el tratamiento endoscópico, no se produjo resangrado en la casi totalidad de los pacientes (95,0 %). Conclusiones: La aplicación de este procedimiento terapéutico resultó ser satisfactoria y no provocó complicación alguna.
Introduction: The esophageal varicose veins are vascular channels that unite the portal venous and systemic circulation. They are formed as consequence of the portal hypertension, predominantly in the submucosa of the inferior section of the esophagus. Objective: To characterize patients with break of esophageal varicose veins according to main clinical epidemiological and therapeutic-endoscopic variables. Methods: An observational, descriptive and longitudinal study of 20 patients with upper digestive bleeding due to break of esophageal varicose veins was carried out, they received endoscopic treatment with banding in the Gastroenterology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from November, 2016 to February, 2018. In the statistical analysis the percentage was used as summary measure and the chi-square test was applied to identify the existence of some significant association among variables. Results: There was a prevalence of the male sex (80.0 %) and the 51 to 60 age group (40.0 %). Most of the patients presented liver cirrhosis (60.0 %) as cause of the portal hypertension and hematemesis (50.0 %) as form of upper digestive bleeding; also, the great size of the esophageal varicose veins was the main risk factor associated with the break (70.0 %) and, after the implementation of the endoscopic treatment, there was no second bleeding in almost all the patients (95.0 %). Conclusions: The application of this therapeutic procedure was satisfactory and it didn't cause any complication.
Subject(s)
Esophageal and Gastric Varices , Ligation , Hematemesis , Gastroenterology , Hypertension, Portal , Liver CirrhosisABSTRACT
ABSTRACT Introduction: Acute graft-versus-host disease (GVHD) is one of the major causes of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) and has become the subject of several studies to understand and treat it. Objective: This study does a descriptive analysis of the apoptotic index (AI) evaluation and intestinal permeability (IP) alterations in association with the clinical, endoscopic and histopathological data on patients undergoing AHSCT, with emphasis on acute intestinal graft-versus-host disease (GVHD) diagnosis. Methods: Thirty-one patients were divided into two groups—one of patients with a clinical GVHD diagnosis and one of those without GVHD diagnosis. Results: Thirteen deaths (41.9%) occurred during the study period, thereby reaffirming the severity of the alterations found in the patients. Fifteen patients subjected to 21 esophagogastroduodenoscopy procedures prior to D + 90 post-transplant had visible endoscopic alterations and 19 biopsies revealed histological alterations to the stomach and duodenum. Higher apoptotic indices, not reaching statistical significance, were observed in patients who died of graft versus host disease (GVHD), in the more acute forms of GVHD and where clinical GVHD was present. The intestinal permeability evaluation was performed on nine patients able to undergo it in the three proposed study periods, which showed alterations, some of which were pronounced even during pre-transplant and, therefore, the pre-conditioning phase. Conclusion: Clinical judgment remains a fundamental tool in the diagnosis of GVHD. This study points to the known limitations of traditional diagnostic aids (endoscopy and histology) and points to new methods not usually employed in clinical practice.
Subject(s)
Humans , Male , Female , Transplantation, Homologous , Biopsy , Endoscopy, Digestive System , Hematopoietic Stem Cell Transplantation , Graft vs Host Disease/diagnosis , HistologyABSTRACT
Introducción: En la formación del residente de Gastroenterología todavía se perciben limitaciones en cuanto al tratamiento, la prevención y la pesquisa de neoplasias del sistema digestivo, lo que indica la necesidad de un proceso pedagógico que tipifique y eleve la importancia de una praxis asistencial más coherente y comprometida con las necesidades de salud de la población. Desarrollo: Los referentes epistemológicos sobre este tema revelan una limitada sistematización de la dimensión asistencial respecto a la atención a pacientes con tumores digestivos, pues no se ha logrado integrar el diagnóstico, la prevención y la terapéutica en la intervención holística endoscópica de los especialistas de esta rama de la medicina. Conclusiones: La dinámica praxiológica, endoscópica y asistencial que se propone en esta investigación deviene lógica de sistematización formativa que favorece el perfeccionamiento de la práctica clinicoendoscópico-asistencial de este especialista en la atención holística a pacientes con neoplasias del tracto gastrointestinal.
Introduction: In the training of the Gastroenterology resident are still limitations perceived as for the treatment, prevention and investigation of the digestive system neoplasms, what indicates the necessity of a pedagogic process that typifies and elevate the importance of a more coherent and committed assistance practice with the population's health needs. Development: The epistemological referents on this topic reveal a limited systematization of the assistance dimension regarding care to patients with digestive tumors, because it has not been possible to integrate the diagnosis, prevention and therapy in the holistic endoscopic intervention of the specialists of this branch of medicine. Conclusions: The praxiologic, endoscopic and assistance dynamic that is suggested in this investigation becomes logic of training systematizing that favors the improvement of this specialist's clinicoendoscopic-assistance practice in the holistic care to patients with gastrointestinal tract neoplasms.