Enfermedades raras en la infancia. Visión gastroenterológica / Rare Diseases in Childhood. Gastroenterological View

Introducción: Las enfermedades raras conforman las afecciones de baja prevalencia que asociadas a los medicamentos huérfanos representan un problema sanitario y social mundial. Objetivo: Revisar los aspectos más sobresalientes relacionados con las enfermedades raras, con una visión gastroenterológica, y su repercusión en la infancia. Métodos: Se realizaron búsquedas no estructuradas de publicaciones en español e inglés en PubMed, Google Scholar, Scimago, SciELO, desde enero 2010 hasta agosto 2021. Se usaron los términos: enfermedades raras, conceptualización, prevalencia, epidemiología, medicamentos huérfanos y ética. Análisis y síntesis de la información: Se revisaron las enfermedades raras en la infancia, criterios conceptuales, epidemiología global, enfermedades más reconocidas con énfasis en gastroenterología. Se destacó la prevalencia, vínculo genético, importancia social, dilema diagnóstico y categorías; repercusión de los tratamientos con medicamentos huérfanos, sus costos y problemas éticos. Se resaltó la incidencia de enfermedades digestivas y el valor de la endoscopia y la biopsia en el diagnóstico. Conclusiones: Se documentaron las enfermedades raras en la infancia, y se analizaron como problema mundial, sanitario y social. El desarrollo de la técnica y de la ciencia, resultaron contribuciones decisivas que variaron criterios sobre diferentes afecciones catalogadas como raras(AU)

Introduction: Rare diseases are the conditions of low prevalence associated with orphan drugs and they represent a global health and social problem. Objective: To review the most outstanding aspects related to rare diseases, with a gastroenterological view, and their impact on childhood. Methods: Unstructured searches for publications in Spanish and English in PubMed, Google Scholar, Scimago, SciELO were conducted, from January 2010 to August 2021. The terms rare diseases, conceptualization, prevalence, epidemiology, orphan drugs and ethics were used. Analysis and synthesis of information: Rare diseases in childhood, conceptual criteria, global epidemiology, and the most well-known diseases with emphasis on gastroenterology were reviewed. Prevalence, genetic link, social importance, diagnostic dilemma and categories, also the impact of orphan drug treatments, their costs and ethical problems were highlighted. The incidence of digestive diseases and the value of endoscopy and biopsy in diagnosis were highlighted. Conclusions: Rare diseases in childhood were documented and analyzed as a global health and social problem. The development of technique and science were decisive contributions that varied criteria on different conditions classified as rare(AU)

Doenças digestivas em idosos e fatores associados à duração da permanência na unidade Hepatologia e Gastroenterologia do Hospital Universitário de Ensino de Lomé (Togo) / Digestive diseases in elderly and factors associated with length of stay in the hepatology and gastroenterology unit of the campus teaching hospital of lome (togo)

ABSTRACT BACKGROUND: The digestive pathologies are frequent in the elderly and often have a latent and atypical symptomatology. OBJECTIVE: To assess the epidemiological and evolutionary current data on digestive diseases in the elderly, and look for factors associated with length of hospital stay. METHODS: Retrospective study of 10 years, including patients aged 60 and over hospitalized for digestive diseases in the Gastroenterology Department of the Campus Teaching Hospital of Lome, Togo. RESULTS: Of 5933 hospitalized patients, there were 1054 patients (17.8%) aged 60 years and over with a digestive pathology (526 men and 528 women). The average age was 69.5 years ±7.9 ranging from 60 to 105 years. The average length of hospital stay was 7.45 days ±6.2 ranging from 1 to 44 days. HIV prevalence was 2.4%. In order of decreasing frequency, there were hepatobiliary pathologies (54.3%) with a predominance of cirrhosis and liver cancer, eso-gastroduodenal pathologies (23.1%) with predominance of ulcers, gastric cancer and esophageal cancer, intestinal pathologies (8.7%) with a predominance of food poisoning, pancreatic pathologies (4.2%) with a predominance of pancreatic cancer and peritoneal pathologies (1.4%). Gastric cancer was the second digestive cancer found after liver cancer. Pancreatic head cancer was the second disease after gastric cancer which need a transfer in a surgical ward (P=0.031). There were 204 deaths (19.4%). The longest duration of hospitalization was due to gastric cancer (9.16 days). CONCLUSION: Hepatobiliary diseases were the most frequent and associated with a high death rate and a long hospital stay.

RESUMO CONTEXTO: As patologias digestivas são frequentes no idoso e têm geralmente uma sintomatologia latente e atípica. OBJETIVO: Avaliar os dados epidemiológicos e de evolução sobre as doenças digestivas nos idosos, e procurar fatores associados ao período de permanência hospitalar. MÉTODOS: Estudo retrospectivo de 10 anos, incluindo pacientes com idades de 60 ou mais, hospitalizados para doenças digestivas no Departamento de Gastroenterologia do Hospital Universitário de Ensino de Lomé, Togo. RESULTADOS: De 5933 pacientes hospitalizados, havia 1054 pacientes (17,8%) com idade de 60 anos ou mais com uma patologia digestiva (526 homens e 528 mulheres). A idade média foi de 69,5 anos ± 7,9 variando de 60 a 105 anos. A duração média da estadia hospitalar foi de 7,45 dias ±6,2 variando de 1 a 44 dias. A prevalência do HIV foi de 2,4%. Em ordem de diminuição da frequência, houve patologias hepatobiliares (54,3%) com predominância de cirrose e câncer hepático, patologias do esôfago-gastroduodenal (23,1%) com predominância de úlceras, câncer gástrico e câncer esofágico, patologias intestinais (8,7%) com predominância de intoxicação alimentar, patologias pancreáticas (4,2%) com predominância de câncer pancreático e patologia peritoneal (1,4%). O câncer gástrico foi o segundo câncer digestivo encontrado após o câncer de fígado. Câncer de cabeça pancreática foi a segunda doença após o câncer gástrico, que necessitou transferência para a enfermaria cirúrgica (P=0,31). Houve 204 mortes (19,4%). A maior duração da internação foi devido ao câncer gástrico (9,16 dias). CONCLUSÃO: As doenças hepatobiliares foram as mais frequentes e associadas a uma elevada taxa de mortalidade e a uma longa estadia hospitalar.

Avaliação do comportamento dos níveis séricos de HMGB1 e IL-6 como preditores de infecção, injúria renal aguda e mortalidade em pacientes cirróticos com varizes sangrantes / Evaluation of the behavior of levels of hmgb1 and il6 as predictors of infection, acute kidney injury and mortality in cirrhotic patients with variceal bleeding

ABSTRACT BACKGROUND: Gastroesophageal varices and associated bleeding are a major cause of morbidity and mortality in cirrhotic patients. OBJECTIVE: To evaluate the potential role of the biomarkers HMGB1 (High Mobility Group Box 1) and IL-6 (Interleukin-6) as predictors of infection, acute kidney injury and mortality in these patients. METHODS: It is a prospective, observational study that included 32 cirrhotic patients with variceal bleeding. RESULTS: The subjects'mean age was 52±5 years and 20 (62.5%) were male. The average MELD was 17.53±5 and the average MELD-Na was 20.63±6.06. Thirty patients (93.3%) patients were Child-Pugh class B or C. Infection was present in 9 subjects (28.1%), acute kidney injury was present in 6 (18.1%) and 4 (12.5%) patients died. The median serum levels of HMGB1 were 1487 pg/mL (0.1 to 8593.1) and the median serum level of IL-6 was 62.1 pg/mL (0.1 to 1102.4). The serum levels of HMGB1 and IL-6 were significantly higher in patients who developed infection, acute kidney injury and death (P<0.05). The Spearman's correlations for HMGB1 and IL-6 were 0.794 and 0.374 for infection, 0.53 and 0.374 for acute kidney injury and 0.467 and 0.404 for death, respectively. CONCLUSION: Serum levels of HMGB1 and IL-6 were higher in patients with the three studied outcomes. HMGB1 serum levels showed a high correlation with infection and a moderate correlation with acute kidney injury and death, while IL-6 showed a moderate correlation with infection and death and a low correlation with acute kidney injury.

RESUMO CONTEXTO: Varizes esofagogástricas são a maior causa de morbimortalidade em pacientes cirróticos. OBJETIVO: Avaliar o papel de biomarcadores, High Mobility Group Box 1 (HMGB 1) e interleucina-6 (IL-6) como preditores de infecção, injúria renal aguda e mortalidade nestes pacientes. MÉTODOS: Estudo prospectivo, observacional que incluiu 32 pacientes com cirrose hepática na fase aguda do sangramento. RESULTADOS: A média de idade dos pacientes foi de 52±5 anos sendo 20 (62,5%) do gênero masculino. A média do MELD foi de 17,53±5 e a média do MELD-Na 20,63±6,06. Trinta (93,3%) pacientes foram classificados como Child B ou C. Complicação infecciosa esteve presente em 9 (28,1%) pacientes, injúria renal aguda em 6 (18,1%) e 4 (12,5%) evoluíram para o óbito. A mediana do nível sérico de HMGB 1 foi de 1487 pg/mL (0,1- 8593,1) e da IL-6 foi de 62,1pg/mL (0,1-1102,4). Os níveis séricos de HMGB 1 e IL-6 foram significativamente maiores nos pacientes que evoluíram com infecção, injúria renal aguda e óbito (P<0,05). Os valores da correlação de Spearman para os níveis séricos de HMGB 1 e IL-6 foram de 0,794 e 0,374 para infecção, 0,53 e 0,374 para injuria renal aguda e 0,467 e 0,404 para óbito, respectivamente. CONCLUSÃO: Níveis séricos de HMGB 1 e IL-6 foram maiores nos três desfechos estudados. Níveis séricos de HMGB 1 apresentaram alta correlação para com o desfecho infecção e moderada correlação para com injúria renal aguda e óbito, enquanto os níveis séricos de IL-6 apresentaram moderada correlação para com infecção e óbito e baixa correlação para com injúria renal aguda.

Osteoporosis: parte II: en enfermedades hepáticas y del tubo digestivo / Osteoporosis: part II: in liver and digestive tract diseases

The present review addresses liver and gastrointestinal diseases that are more frequently associated to osteopenia and osteoporosis. For each disease, we describe the prevalence and physiopathology of these bone metabolism conditions. The purpose is to create awareness of this scenario and prompt early analysis if these patients, and in other cases, to provide prophylaxis and treatment of these disorders.

En esta revisión se abordan las enfermedades hepáticas y del tubo digestivo que con mayor frecuencia se asocian a osteopenia y osteoporosis. En cada patología describimos la prevalencia y fisiopatología de estas afecciones del metabolismo óseo. El objetivo es dar a conocer esta realidad e inducir a que estos pacientes sean estudiados precozmente, en otros casos aplicar la profilaxis y tratar estos desórdenes.

Prevalência de sinais e sintomas digestórios em trabalhadoras rurais e fatores associados / Prevalence of digestive signs and symptoms and associated factors among rural workers

Objetivo: Conhecer a prevalência de sinais e sintomas digestórios em trabalhadoras rurais e identificar fatores associados mais frequentes. Métodos Estudo transversal que incluiu 182 trabalhadoras rurais maiores de 18 anos e de agricultura de hortifrutigranjeiros. Para avaliar a consistência interna dos dados utilizou-se o coeficiente alfa de Cronbach. Para comparar médias entre os grupos, o teste t de Student foi aplicado para amostras independentes. Em caso de assimetria, foi utilizado o teste de Mann-Whitney. Resultados A prevalência de sinais e sintomas digestórios relatados foi 31,9%. Os sinais e sintomas digestórios relatados foram: dor epigástrica (27,4%), regurgitação (18,1%), inchaço (9,9%), náusea (9,9%) e vômitos (6,0%). Conclusão A prevalência de sinais e sintomas digestórios relatados por trabalhadoras rurais foi alto e esteve associado a idade maior de 60 anos, utilização de pesticidas agrícolas e ascendência italiana.

Objective: To determine the prevalence of digestive signs and symptoms in rural workers and identify frequently associated factors. Methods This cross-sectional study included 182 rural and horticultural farm workers aged 18 years or older. To assess internal data consistency, the Cronbach’s alpha coefficient was used. To compare means between groups, student’s t-test was used for independent samples. The Mann–Whitney test was used in cases of asymmetry. Results The prevalence of digestive signs and symptoms was 31.9%. The signs and symptoms included epigastric pain (27.4%), regurgitation (18.1%), bloating (9.9%), nausea (9.9%), and vomiting (6.0%). Conclusion The prevalence of digestive signs and symptoms reported by rural workers was high and was associated with being older than 60 years, using agricultural pesticides, and being of Italian descent.

The Disease and Treatment of the Frontline Soldiers in Han Dynasty / 의사학

This paper purports to identify and analyze the medical information of the frontline soldiers in the Northwest borderland provinces of Han Dynasty, especially Juyan and Dunhuang region, through an heuristic reading of the Juyan Bamboo Slips and the Dunhuang Bamboo Slips of the Han Dynasty. My findings are as follows. The most frequent disease found in the bamboo slips was the external injury. The injury of the frontline soldiers mainly occurred from the quarrels among armed soldiers using weapons. The bamboo slips also demonstrate that the quarrels usually arose due to the fierce tension caused by the frontier line service such as heavy guard activity and labour duty. Undernourishment and chronic stress the soldiers suffered might be another reasons. The second most common disease harassing the soldiers was exogenous febrile disease. In most cases reviewed in this paper, the exogenous febrile disease was usually concurrent with complex symptoms such as chills, fever, headache, etc. The bamboo slips show that the exogenous febrile disease was related to the harsh climate of the Northwest provinces, featuring extremely dry weather and the large magnitude of diurnal temperature fluctuations. In addition, the annual temperature range in the Northwest province was huge, fluctuating between very cold and dry winter and very hot and dry summer. The third most common disease this study identified was the disorder of the digestive system and respiratory system. However, these two types of disease were virtually indistinguishable in the bamboo slips, because the ancient Chinese chroniclers did not distinguish them, usually dubbing both diseases simply 'abdominal pain.' It should be mentioned that a few slips mention contagious disease such as dysentery and dermatolosis, and sudden death, as well. Overall, the bamboo slips demonstrate extremely poor status of the soldiers' heath condition and poor medical environment surrounding the soldiers stationing in the Northwest borderland military camps. The records also show that acupuncture, applying a plaster, drugs were the most common medical treatment. Drugs among them was the most frequently used. Whereas Acupuncture, applying a plaster were very rarely used. Medication has been used in three ways: powdered medicine, medicinal decoction and pill. Medicinal decoction was the most commonly used way.

Association of sociodemographic and clinical factors with the self-image and self-esteem of individuals with intestinal stoma / Assoiação dos fatores sociodemográficos e clínicos à autoimagem e autoestima dos indivíduos com estoma intestinal

Objective: To evaluate the clinical and sociodemographic factors and correlate them to the self-image and self-esteem. Methods: A study conducted at Ostomy Pole of PousoAlegre. The data were collected between December 2012 and May 2013. This was a non-probabilistic, by convenience, sample. For data collection, the Rosenberg Self-Esteem Scale/UNIFESP-EPM and Body Investment Scale were used. For statistical analysis, chi-squared test, Kruskal-Wallis test and Spearman correlation were used. Levels of significance of 5% (p ≤ 0.05) were considered. Results: Participants had a mean score of 10.81 in the Rosenberg Self-Esteem Scale/UNIFESP. Regarding Body Investment Scale results, the mean total score was 38.79; the mean in the domain of body image was 7.74, and for personal touch, 21.31. When comparing data related to the stoma and sociodemographic profiles with the Rosenberg Self-Esteem Scale/UNIFESP and Body Investment Scale, we realize that all patients demonstrated a decrease in self-esteem and self-image. Individuals were over 60 years old, male, retired, married and were not participants in support group/association. With regard to the characteristics of the stoma, those permanent colostomized had as causes of stoma implementation inflammatory disease and neoplasia; stomata measured between 20 and 40 mm; these people used two-piece devices. People who have not been notified that would be subjected to the stoma and in whom no demarcation was done showed worsening in self-esteem and self-image in relation to other features related to injury and sociodemographic data. Conclusion: Patients who participated in this study had low self-image and self-esteem in all characteristics of the stoma and in sociodemographic data, meaning that these individuals had negative feelings about their own bodies. .

Objetivo: Avaliar os fatores sociodemográficos e clínicos e correlacioná-los à autoimagem e autoestima. Métodos: Estudo realizado no Polo dos Estomizados de Pouso Alegre. Os dados foram coletados entre dezembro de 2012 e maio de 2013. A amostra foi por não probabilística, por conveniência. Para coleta de dados, foram utilizadas a Escala de Autoestima Rosenberg/UNIFESP-EPM e a escala BodyInvestmentScale. Para análise estatística, foram utilizados os testes do Qui-quadrado e de Kruskal-Wallise a correlação de Spearman. Foram considerados os níveis de significância 5% (p ≤ 0,05). Resultados: Os participantes apresentaram a média de 10,81 na Escala de Autoestima Rosenberg/UNIFESP-EPM. Com relaação à escala BodyInvestmentScale, a média do escore total foi 38,79; a médianos domínios imagem corporal foi de 7,74 e no toque pessoal, 21,31. Ao comparamos os dados relacionados ao estoma e sociodemográficos com a Escala de Autoestima Rosenberg/UNIFESP-EPM e com escala BodyInvestmentScale, percebemos que todos os pacientes apresentaram queda na autoestima e na autoimagem. Os indivíduos estavam na faixa etária acima de 60 anos, sexo masculino, eram aposentados e casados e não participavam de grupo de apoio/associação. Com relação às características do estoma, os indivíduos com colostomia permanente tinham como causas da realização do estoma doença inflamatória e neoplasia; os estomas mensuravam entre 20 a 40 mm; eles utilizavam dispositivo com duas peças. Pessoas que não foram comunicadas de que iriam ser submetidas ao estoma, e em que não foi realizada a demarcação apresentaram piora na autoestima e na autoimagem com relação às outras características relacionadas à lesão e às sociodemográficas. Conclusão: Pacientes que participaram deste estudo apresentaram baixa na autoimagem e autoestima em todas as características do estoma e nos dados sociodemográficos, significando que esses indivíduos tinham sentimentos negativos em relação ao próprio corpo.

Atresia esofágica y fístula traqueoesofágica: evolución y complicaciones postquirúrgicas / Esophageal atresia and tracheoesophagic fistula: evolution and postsurgical complications

Esophageal atresia (EA) and tracheoesophageal fistula are congenital anomalies associated with respiratory and gastrointestinal morbidity. Objective: The aim of this study was to describe clinical characteristics of patients with EA and TEF during childhood, specially focused on respiratory and gastrointestinal complications. Methods: We reviewed the clinical charts from fifteen patients admitted to our hospital and who were followed locally between 1995 and 2007. Results: Gross classification distribution was: A: 0, B: 0, C: 12, D: 2, E: 1. Waterston distribution was Al: 6, B1: 1, B2: 4y C2: 4. Associated malformations to EA and TEF were 7/15. Main morbidity during the follow up period was: Recurrent pneumonia: 6/15, recurrent wheezing 12/15, tracheomalacia in 9/15 and apnea in one patient. Fistula re-opening in 3/15, Gastro esophageal reflux in 15/15 esophagic stenosis in 7/15. All patients were admitted to the hospital at least once during the follow up and in 12/15 of this were due to respiratory causes. Conclusions: EA and TEF after surgical repair have significant respiratory and gastrointestinal morbidity and frequent admission to the hospital during the first years of life.

La Atresia esofágica (AE) con o sin fístula traqueoesofágica (FTE) es una malformación congénita que se asocia a complicaciones respiratorias y digestivas. Objetivo: Describir las características de estos pacientes, su morbilidad respiratoria, digestiva y hospitalizaciones en su evolución a largo plazo. Materiales y Métodos: Se revisaron en forma retrospectiva 15 fichas de pacientes con diagnóstico de FTE evaluados por el equipo de Neumología Pediátrica de la Universidad Católica de Chile entre 1995 y 2007. Resultados: N = 15 pacientes, sexo masculino 9 diagnóstico el primer día de vida 13/15 pacientes. Clasificación de Gross: A= 0, B= 0, C= 12, D= 2, E= 1. Clasificación de Waterston Al: 6, Bl: 1, B2: 4 y C2: 4 Malformaciones asociadas: en 7/15. Complicaciones respiratorias: Neumonía recurrente 8/15, sibilancias recurrentes 12/15, Recurrencia de fístula: 3 /15 pacientes, Apnea: 1 paciente, Traqueomalacia (TM) (9/15). Complicaciones digestivas: Reflujo gastroesofágico 15/15, Estenosis esofágica: II15. Un paciente requirió cirugía de Nissen. Todos los pacientes se hospitalizaron en al menos una oportunidad y en el 12/15 la causa fue respiratoria. Conclusión: La FTE es una enfermedad de resolución quirúrgica con alta morbilidad respiratoria, digestiva y frecuentes hospitalizaciones en los primeros años de vida.

Cirugías digestivas más frecuentes en Chile, excluyendo colo-rectal / Rates of digestive surgery in Chile during 2004 and 2005: analysis of hospital discharge data, excluding colorectal interventions

Introducción: A pesar de efectuarse una gran cantidad de operaciones en nuestro país, se desconoce la real cifra de estas intervenciones. Objetivo: Determinar por una parte cuales son las operaciones de patología benigna más frecuente y por otra parte, el número de pacientes con diversos cánceres del tracto gastrointestinal proximal. Material y Método: Se solicitó al Departamento de Estadísticas del Ministerio de Salud los egresos hospitalarios totales del país, los egresos por sistema público y privado y el total de operados de ambos sistemas de salud para el cáncer gástrico, esofágico, pancreático, vesícula biliar, hepático y vías biliares. También el número total de operados de las 3 patologías quirúrgicas benignas más frecuentes: apendicectomía, colecistectomía y herniorrafia. Resultados: El sistema público de salud representa cerca del 90 por ciento de los egresos hospitalarios de cáncer gástrico, de vesícula biliar y esofágicos, mientras que para el cßncer pancreático y hepático el sistema privado de salud muestra un importante aumento en egresos anuales. La tasa global de operabilidad para estos cánceres varia entre 15 y 35 por ciento. Durante el año 2005 se realizaron en el Sistema Público de Salud (SPS) 710 gastrectomías por cáncer gástrico, 63 esofaguectomías por cáncer esofágico, 90 pancreatoduodenectomías por cáncer de páncreas y 40 lobectomías hepáticas por cáncer hepático. La apendicectomía fue la operación más frecuente en el SPS, seguido de la colecistectomía y la herniorrafia. A lo largo de Chile se apreció una diferencia muy importante en la tasa de colecistectomías laparoscópicas, la que varió entre 15 por ciento y 87 por ciento. Conclusiones: Dada la baja frecuencia observada en algunos cánceres digestivos (esófago, páncreas, hepático) se puede plantear una mayor concentración en pocos centros para lograr resultados acordes al concepto de "alto volumen quirúrgico". Respecto a la colecistectomía laparoscópica, debe hacerse un esfuerzo...

Background: Twenty five years ago, biliary surgery accounted for 30 to 50 percent of all operations performed in a general surgical service. We have no information of the changes in the frequency in surgical interventions in the last years. Aim: To determine, using hospital discharge data, which are the most common surgical interventions in Chile. Material and Methods: Databases with hospital discharge data from all the hospitals in Chile during 2004 and 2005, available at the Ministry of Health website, were consulted. Colorectal operations were exduded from the analysis. Results: In public hospitals during 2005, 710 gastrectomies for gastric cancer, 63 esophagectomies for esophageal cancer, 90 pancreatoduodenectomies for pancreatic cancer and 40 lobectomies for liver cancer, were performed. Appendectomy was the most common operation performed in the private health system, followed by cholecystectomy and hernia repair. The rate of laparoscopic cholecysctectomy varied from 15 to 87 percent in different regions of Chile. Ninety percent of hospital discharges for gastric cancer occur in the public health system, whereas an important increase in discharges for pancreatic and liver cancer, is observed in the private sector. The global operability rate for these tumors varied between 15 and 35 percent. Conclusions: Due to the low number of operations registered for certain digestive tumors, these interventions should be concentrated in high volume centers to increase the efficiency of the system. An effort is required to implement laparoscopic cholecystectomy in some regions of the country.

Análisis crítico del registro de epicrisis del equipo de cirugía digestiva Hospital Base Valdivia / Critical analysis on epicrisis records of the digestive surgery team at the Hospital Base Valdivia

El registro de las patologías que se presentan en un servicio clínico es fundamental para conocer la realidad de dicha institución y las necesidades que éste debe suplir a la población que cubre. El Equipo de Cirugía Digestiva del HBV mantiene un registro controlado de las patologías que son tratadas ahí, además de las distintas variables que las afectan, en base a las epicrisis confeccionadas al momento del alta de cada paciente. El objetivo de este trabajo es realizar un análisis acabado de la base de datos y evaluar críticamente el método de confección existente, además de conocer las patologías que se tratan diariamente y su epidemiología local. Se revisa el registro de las epicrisis del Equipo de Cirugía Digestiva del HBV, durante el periodo comprendido entre enero y diciembre de 2006, las que se encuentran registradas en una planilla Excel que incluye variables como edad, sexo, procedencia, tipo de intervención y complicaciones para cada diagnóstico realizado, y se analizan entre sí; éstas demuestran que durante dicho año, debieron ser hospitalizados 884 pacientes, la mayoría de sexo femenino y edad avanzada, exceptuando en los adolescentes que, aunque minoría, predomina el sexo masculino. El número mensual de pacientes permanece estable durante todo el año. La patología más frecuente es la hepatobiliar (37,3 por ciento), donde destaca la patología litiásica (53,4 por ciento); en segundo lugar se presentan las neoplasias (23,4 por ciento) destacando el cáncer colorrectal (34,5 por ciento) y gástrico (28 por ciento). El 69,3 por ciento de las patologías requirió algún tipo de intervención quirúrgica, 52,3 por ciento de carácter electivo. Dentro de las pocas complicaciones que se presentaron (11,3 por ciento) destacan infección de herida operatoria, neumonía intrahospitalaria y filtración de anastomosis. A pesar de los alentadores resultados, existe una pérdida no despreciable de epicrisis y por lo tanto un subregistro de la realidad y además una gama...

Saneamiento ambiental y enfermedades de transmisión digestiva en el municipio Plaza de la Revolución, 1992-1997 / Environmental sanitation and digestive transmitted diseases in the municipality of Plaza de la Revolución, 1992-1997

Se presenta un estudio ecológico, donde se exponen los resultados de algunos indicadores de saneamiento ambiental (calidad del agua y lugares con contaminación hídrica, recolección de desechos sólidos y evacuación de residuales líquidos) y el comportamiento de la morbilidad por enfermedades de transmisión digestiva como hepatitis, enfermedades diarreicas agudas e intoxicación alimentaria en el municipio Plaza de la Revolución, en el período comprendido entre 1992 y el primer semestre de 1997. La información se obtuvo a partir de los datos primarios de atenciones médicas del departamento de Estadística Municipal y del Departamento de Salud Ambiental Municipal. Se calcularon tasas de incidencia por áreas de salud, canales endémicos y tendencias. Se manifiestan deficiencias en cuanto a la potabilidad del agua y en el manejo de los desechos sólidos y residuales líquidos. Se aprecia correspondencia entre la morbilidad y la potabilidad del agua

Procesos mórbidos en adolescentes recluidos en el penal de La Victoria / Morbid process in adolescents detained in the La Victoria penitentiary

Con el propósito de determinar los procesos mórbidos en delincuentes juveniles recluidos en la Penitenciaría Nacional de La Victoria, se realizó una investigación prospectiva descrictiva, observacional de corte transversal, de marzo a julio de 1994, mediante un cuestionario elaborado para estos fines. Encontramos 76 reclusos entre la edad de 13 a 19 años, todos de sexo masculino. Las patologías más frecuentemente encontradas estuvieron relacionadas con el aparato digestivo y la piel: cólicos abdominales y dolor en el epigastrio con ardor, así como escabiasis y pitiriasis versicolor. El 50//de los adolescentes había perdido peso en la prisión. Ninguno de ellos tenía educación secundaria, 23.9//eran analfabetos y el 93.1//tenían menos de un año recluidos

Disease profiles in Chinese in Hong Kong: an analysis of the primary diagnoses in 561 acute hospital medical admissions.

Little is known about the disease profiles in Chinese living in an urbanized community like Hong Kong. Accordingly, the discharge summaries of 561 acute hospital medical admissions were reviewed and the primary diagnoses (the main reason for admission or the most important clinical problem) were coded according to the International Classification of Diseases. Our data indicate that cardiovascular diseases are the most important cause of acute medical admissions and mortality and that gastrointestinal hemorrhage is very common amongst the Chinese in Hong Kong.

Malformaciones del tubo digestivo / Malformation of the digestive system

Se examinaron 124.324 recién nacidos consecutivos en la Maternidad del Hospital Clínico de la Universidad de Chile en busca de malformaciones congénitas, como parte del Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC). Se encontraron 149 niños con alguna malformación del tubo digestivo, lo que representa una prevalencia al nacimento del 11,9 por 10000 nacidos vivos. La incidencia de cada malformación fue similar que en la muestra total del ECLAMC, salvo en hernia diafragmática (2,56/1,28 por 10.000 respectivamente; p> 0,01). Los factores de riesgo para tener un hijo malformado (enfermedades agudas y crónicas maternas del primer trimestre del embarazo, metrorragia, agentes físicos como exposición a radiaciones ionizantes, ademas de escolaridad de los padres, presentación fetal, tipo de parto, edad de la madre, número de abortos previos, edad gestacional y peso de nacimiento) fueron significativamente mas frecuentes entre los antecedentes de los recién nacidos malformados que en sus controles, pero no se tomaron medidas para evitar sesgos de recuerdo e información

Aparato digestivo senil / The elderly's digestive system

Con el envejecimiento se producen alteraciones fisiológicas en todo el aparato digestivo, con atrofia y disminución de la capacidad funcional de manera más o menos intensa, con modificación de sus características preservándose la capacidad de adaptación a las nuevas condiciones fisiológicas que acompañan al viejo hasta la muerte. Se analizan las principales patologías digestivas que se asocian con el envejecimiento y los diferentes factores que inciden en ellas. Se describen las consecuencias clínicas de estas alteraciones y la prevalencia clínica de determinadas patologías haciendo notar las dificultades diagnósticas y los medios diagnósticos utilizados en algunas de ellas

Complicacioens gastrointestinales en pacientes con transplante renal / Gastrointestinal complications in patients with renal transplant

De 110 pacientes con transplante renal, 30 (27%) desarrollaron complicaciones gastrointestinales y hepáticas. En orden de frecuencia fueron gastroenteritis, hepatitis, úlcera péptica, colitis amibiana, obstrucción intestinal, pancreatitis y colangitis. Estas complicaciones deben manejarse de manera similar a como se tratan los pacientes que no reciben inmunosupresión y la profilaxis es importante. La mortalidad fue de 23%