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Objetivos: Cuantificar donantes, personas que aceptan tratamientos invasivos, que firmarían órdenes de no reanimar, que avalarían transfusiones a personas contra su voluntad, que aceptan el aborto, la eutanasia y la investigación experimental, en todos los casos vinculando la respuesta con fundamentaciones. Materiales y Métodos: Diseño prospectivo, de observación, longitudinal, analítico. En 2007-2008, se estudiaron 848 adolescentes de 13 escuelas públicas de enseñanza media del área de responsabilidad de un hospital del Gobierno de la Ciudad Autónoma de Buenos Aires, en quienes se aplicó una encuesta autoadministrada abierta-cerrada. Se interrogó sobre situaciones vinculadas a aspectos bioéticos. Resultados: Los donantes representan el 75% de la muestra, el 46% desea que le implementen todo tratamiento posible, el 30% firmaría una orden de no reanimación, el 32% avala las transfusiones a Testigos de Jehová, el 57% acepta el aborto; el 81%, la eutanasia; el 62%, la investigación experimental. No hay diferencias de aceptación del aborto y la eutanasia entre católicos y no creyentes (p 0,10 y 0,30, respectivamente). En el análisis multivariado, la implementación de todo tipo de tratamiento se vinculó a no firmar una orden de no reanimar (p 0,0000) y a no respetar la voluntad de los Testigos de Jehová (p 0,0024). La aceptación de la eutanasia se vincula con la aceptación de aborto (p 0,0000) y firmar una orden de no reanimar (p 0,0266). Conclusiones: Los valores más votados fueron la veracidad y la justicia. La escuela media es un sitio de alto impacto para educar en bioética y derechos de ciudadanía(AU)

Objectives: To quantify donors, people who would accept invasive treatments, who would sign orders not to resuscitate, who would support transfusions to persons against their will, who would accept abortion, euthanasia, and experimental research, in all cases supporting their choices with foundations. Materials and Methods: Prospective, observational, longitudinal and analytical study. During 2007-2008, 848 teenagers belonging to 13 public high schools in the area of responsibility of a hospital from Gobierno de la Ciudad Autónoma de Buenos Aires were studied. They were given a self-administered opened-closed survey which included questions about situations linked to bioethical aspects. Results: Donors represent 75% of the sample, 46% wish to get any possible treatment, 30% would sign a do-not-resuscitate order, 32% support transfusions to Jehovah's Witnesses, 57% accept abortion, 81% euthanasia, 62% experimental research. There are no differences on acceptance of abortion and euthanasia between Catholics and non-believers (p 0.10 and 0.30, respectively). In the multivariate analysis, the implementation of all kinds of treatment was linked to a refusal to sign a do-not-resuscitate order (p 0.0000) and to not respecting the will of the Jehovah's Witnesses (p 0.0024). The acceptance of euthanasia links itself, in the analysis multivariate, to accepting abortion (p 0.0000) and to signing a do-not-resuscitate order (p 0.0266). Conclusions: The majority vote in favor of veracity and justice. High school is a high impact point to educate on bioethics and rights of citizenship(AU)

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Introducción: La educación médica debería garantizar la formación de profesionales competentes que posean los conocimientos, las destrezas y las actitudes planificados en la capacitación. En general, los programas no tienen en cuenta a la urgencia, que no figura como materia específica en los programas de grado. Objetivos: Cuantificar las competencias adquiridas por los internos en el Departamento de Urgencias y en Terapia Intensiva, estableciendo el grado de cumplimiento entre lo planificado y lo logrado; desglosar el grado de cumplimiento según las diferentes áreas de la competencia clínica. Materiales y Métodos: Diseño prospectivo, de observación, longitudinal, analítico. Se incluyeron 93 alumnos del ciclo clínico que realizaron el internado rotatorio (2000-2009). Se valoró el cumplimiento de 37 competencias que se clasificaron por área: actitudes, conocimientos y destrezas, en números de 9, 5 y 23, respectivamente. Resultados: El cumplimiento global de las competencias en el área de emergentología y terapia intensiva es del 61,18% (IC95% 59,20-63,13). Al desglosar por área de la competencia clínica, se halla que las actitudes fueron del 66,26%; los conocimientos, del 63,28% y las destrezas, del 58,15%. Clasificándolas según el grado de cumplimiento, se establece una escala con cumplimiento alto (76-100%), medio (51-75%) y bajo (<51%). Conclusiones: Los aspectos actitudinales y cognitivos de las competencias tuvieron un cumplimiento medio. La mitad de las competencias vinculadas a destrezas tuvo un cumplimiento medio-alto.(AU)

Introduction: Medical education should guarantee the formation of competent professionals with the knowledge, skills and attitudes planned in training. Generally programs do not bear in mind the urgency, which does not appear as a specific subject in the university. Objectives: To quantify the competitions acquired by the boarders in the Emergency Department and the Intensive Care Unit, establishing the degree of fulfillment between what was planned and what was achieved; to perceive the degree of fulfillment according to the different areas of clinical competition. Materials and Methods: Prospective, observational, longitudinal and analytical study. We included 93 students from the clinical cycle who performed rotating boarding school (2000-2009). Fulfillment of 37 competitions classified by area: attitudes, knowledge and skills, in numbers of 9, 5 and 23, respectively, was evaluated. Results: The global fulfillment of the competitions was 61.18% (CI95%: 59.20-63.13). Specifically, in each area of the clinical competition, we found that the attitudes were 66.26%, knowledge 63.28% and skills 58.15%. Classifying them according to the degree of fulfillment, a scale is established: high (76-100%), medium (51-75%) and low (<51%). Conclusions: Attitude and cognitive aspects of the competitions had average fulfillment. Half of the competitions linked to skills had average-high fulfillment.(AU)

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Objetivos. Establecer la importancia de la profilaxis para prevenir la hemorragia digestiva en pacientes críticos, determinar los predictores del desarrollo de hemorragia digestiva en estos enfermos y cuantificar la neumonía intrahospitalaria. Materiales y métodos. Diseño prospectivo, observacional, longitudinal. Se estudiaron 3438 pacientes durante dos años. Luego de aplicar los criterios de exclusión y de eliminación, se evaluó a 3213 pacientes. La muestra fue consecutiva, se formaron dos grupos: con profilaxis (sucralfato o ranitidina) y sin profilaxis. Se registraron los siguientes datos: puntaje Apache II, disfunciones, diagnósticos de riesgo, hemorragia digestiva, neumonía intrahospitalaria, mortalidad. Resultados. Incidencia de hemorragia digestiva: 4,57%; con profilaxis frente a sin profilaxis: 4,64% y 4,50% (p = 0,91). Predictores de hemorragia digestiva en análisis multivariado: trauma grave (p = 0,0004), insuficiencia respiratoria (p = 0,0021), pancreatitis (p = 0,0202), insuficiencia renal aguda (p = 0,0220) y ayuno (p <0,0001). En pacientes con puntaje Apache II ≥15: trauma grave (p = 0,0228) y ayuno (p = 0,0000). Incidencia de neumonía intrahospitalaria 10,05%; con profilaxis y sin profilaxis: 11,47% y 8,68% (p = 0,001)(AU)

Objectives. Set the importance of prophylaxis for gastrointestinal bleeding in criticallly ill patients; determine predictors of gastrointestinal bleeding and quantify hospital-acquired pneumonia. Materials and methods. Prospective, observational and longitudinal design. A total of 3438 patients were studied during two years. After applying exclusion and elimination criteria, 3213 patients were left. It was a consecutive sample, and there were two groups; with prophylaxis (sucralfate or ranitidine) and without prophylaxis. Apache II, organ failures, risk diagnoses, digestive tract bleeding, hospital-acquired pneumonia and mortality were registered. Results. Gastrointestinal bleeding incidence: 4.57%, with vs. without prophylaxis: 4.64% vs. 4.50% (p = 0.91). Gastrointestinal bleeding predictors in the multivariate analysis: serious trauma: (p = 0.0004), respiratory failure (p = 0.0021), pancreatitis (p = 0.0202), acute renal failure (p = 0.0220) and fasting (p <0.0001). In Apache II ≥15 patients: serious trauma (p = 0.0228) and fasting (p = 0.0000). Incidence of hospital-acquired pneumonia: 10.05%, with vs. without prophylaxis: 11.47% vs. 8.68% (p = 0.001). Conclusions. Prophylaxis did not reduce gastrointestinal bleeding, it was associated with serious trauma, respiratory failure, pancreatitis, acute renal failure and fasting, and considering only patients with the worst Apache II score, it was associated with serious trauma and fasting. Acquired pneumonia was higher in the prophylaxis group.(AU)

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AIMS: The aims of this study were to quantify donors among the investigated area, quantify arguments and myths about the donation and transplantation process, and fix predetermined donation variables in a logistical model. MATERIALS AND METHODS: We used an analytical, prospective design, using 848 students from 13 high schools in the Velez Sarsfield Hospital area in an open-closed inquiry. RESULTS: Females were 57.74% and average age was 16.64 +/- 0.06 years, including 65.09% Catholics. The 642 potential donors represented 75% of the study population with the fundamental aim being to "give life" (44.85%). The 193 (22.75%) opposed subjects cited as a principal reason fear and distrust (40.41%). There were 40.21% who had discussed the donation subject with their families. In our study 76.41% believed that human organ traffic exists and 36.88% thought that it is due to corruption. Also, 56.01% fear premature extraction of their organs. In addition, 73.23% of teenagers considered that individuals who refused to donate have the right to receive organs (P = not significant between donors and not a donor). The family discussion and the lack of fear about premature extraction were donation signals. About the low level of donation 43.27% blamed the government (lack of campaigns, information, and knowledge) whereas other reasons were fear, lack of clarity and distrust. In our study 49.17% seemed to wish to increase donation if they received more information. CONCLUSIONS: Individuals predispose to donation represented the great majority of the queried teenagers; education and family discussion were remarkable factors favoring the decision.

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INTRODUCTION: The colonics polyps according to their number, size, location, age of presentation and mainly, according to their histology, have the potentiality of malignant degeneration, which makes of a continuous study and pursuit susceptible. OBJECTIVES: To evaluate the relation between the histologic type of the colon polyps, its location, the degree of dysplasia, the size, its possible commitment by carcinoma, the age, sex and the handling that has occurred them, in a series of 684 patients of the National Institute of Enfermedades Neoplásicas (INEN) between the 1 of January from 1974 to the 31 of March of the 2004. MATERIAL AND METHODS: The revision of clinical histories of 840 patients with the diagnosis of colon polyp was made who attended the service of Gastroenterology of the INEN between the 1 of January from 1974 to the 31 of March of 2004 and a card predesigned for each clinical history filled. The study is of observational, analytical type and of cross section. 1162 resecteds polyps evaluated themselves in this period. 156 patients by diagnosis related to cancer and familiar adenomatouspoliposis did not include themselves. The final sample was of 684 patients, in whom it was 1057 polyps. Other endoscopic findings were: internal hemorrhoids (172), colonic diverticulosis (50), anal fissure (4), and nonspecific ulcerative colitis (2). The statistical processing was made with program SPSS 12. For the qualitative variables the method of the Chi-square was used, for the quantitative variables analyzed the average, the rank and the variance. RESULTS: 1057 polyps extirpated, by means of the endoscopy polipectomy were 1016, with colectomy were 32 and with transanal resection without colectomy they 9. Within the histology of the 1057 polyps, 331 was briefed (31.3%) that were hyperplasic, 448 (42.4%) adenomas, 278 (26.3%) others and 35 (8.2%) adenocarcinomas on adenomas. The average age was of 50 years, was no significant difference with sex. The location but frequence of the adenomas was in the left colon (76.6%). Adenocarcinoma (carcinomas on adenomas), was present mainly in polyps villous type, with dysplasia severe and greater to 10 mm. Nevertheless, in smaller polyps of 5mm with dysplasia severe, was a polyp invaded by cancer, that represents the 0,8% of millimetric polyps. The made handling was mainly endoscopic, with 96% of the resected polyps this way, also slogan transanal resection and segmental colonic resection. The colectomy was necessary in 3% of all the made interventions, dysplasia severe or carcinoma was made in adenomatous polyps with, and in greater percentage in greater polyps of 20 mm (53%). The single polipectomy was sufficient in the level of invasion Haggitt 0. In patients with level of invasion Haggitt 1 and 2, the single polipectomy was the election treatment. On the other hand, in polyps with level of invasion Haggitt 3 and 4, the colectomy was the election treatment. One briefed two complications, one of perforation and peritonitis and another one of digestive hemorrhage loss (both: 0.29%), without mortality events. CONCLUSIONS: The Evaluation of colonic polyps in INEN is predominantly by endoscopy. The polyps are more frequent over the 50 years and have preferred location in the left colon. The carcinoma is more probable with severe dysplasia and greater size of the adenoma. All polyps, from the millimetric ones, including the hyperplasic, must be considered marks of neoplasia and extirpated in its totality.

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Introducción: Los pólipos colónicos de acuerdo a su número, tamaño, localización, edad de presentación y sobre todo, de acuerdo a su estirpe histológica, tienen la potencialidad de degeneración maligna, lo que los hace susceptibles de un continuo estudio y seguimiento. Objetivos: Evaluar la relación entre el tipo histológico de los pólipos de colón, su localización, el grado de displasia, el tamaño, su eventual compromiso por carcinoma, la edad, el sexo y el manejo que se les ha dado, en una serie de 684 pacientes del Instituto Nacional de Enfermedades Neoplásicas (INEN) entre el 1 de enero de 1974 al 31 de marzo del 2004. Material y métodos: Se realizó la revisión de historias clínicas de 840 pacientes con el diagnóstico de pólipo de colon que asistieron al Servicio de Gastroenterología del INEN entre el 1 de enero de 1974 al 31 de marzo de 2004 y se llenó una ficha prediseñada para cada historia clínica. El estudio es de tipo observacional, analítico y de corte transversal. Se evaluaron en este periodo 1162 pólipos resecados. No se incluyeron 156 pacientes por diagnóstico relacionado con cáncer y poliposis adenomatosa familiar. La muestra final fue de 684 pacientes, en los que se encontró 1057 pólipos. Otros hallazgos endoscópicos fueron: hemorroides internas (172), diverticulosis colónica (50), fisura anal (4), y colitis ulcerativa no específica (2). El procesamiento estadístico se realizó con el programa SPSS 12. Para las variables cualitativas se empleó el método de Chi-cuadrado, para las variables cuantitativas se analizaron la media, el rango y la varianza. Resultados: Se extirparon 1057 pólipos, mediante la polipectomía endoscópica fueron 1016, con uso de colectomía fueron 32 y con resección transanal sin colectomía fueron 09. Dentro de la histología de los 1057 pólipos, se consignaron 331 (31.3 por ciento) que fueron hiperplásicos, 448 (42.4 por ciento) adenomas, 278 (26.3 por ciento) otros y 35 (8.2 por ciento) adenocarcinomas sobre adenomas...

Introduction: The colonics polyps according to their number, size, location, age of presentation and mainly, according to their histology, have the potentiality of malignant degeneration, which makes of a continuous study and pursuit susceptible. OBJECTIVES: To evaluate the relation between the histologic type of the colon polyps, itslocation, the degree of dysplasia, the size, its possible commitment by carcinoma, the age, sex and the handling that has occurred them, in a series of 684 patients of the National Institute of Enfermedades Neoplásicas (INEN) between the 1 of January from 1974 to the 31 of March of the 2004. MATERIAL AND METHODS: The revision of clinical histories of 840 patients with the diagnosis of colon polyp was made who attended the service of Gastroenterology of the INEN betweenthe 1 of January from 1974 to the 31 of March of 2004 and a card predesigned for each clinical history filled. The study is of observational, analytical type and of cross section. 1162 resecteds polyps evaluated themselves in this period. 156 patients by diagnosis related to cancer and familiar adenomatouspoliposis did not include themselves. The final samplewas of 684 patients, in whom it was 1057 polyps. Other endoscopic findings were: internal hemorrhoids (172), colonic diverticulosis (50), anal fissure (4), and nonspecific ulcerative colitis (2). The statistical processing was made with program SPSS 12. For the qualitative variables the method of the Chi-square was used, for the quantitative variables analyzed theaverage, the rank and the variance. RESULTS: 1057 polyps extirpated, by means of the endoscopy polipectomy were 1016, with colectomy were 32 and with transanal resection without colectomy they 9. Within the histologyof the 1057 polyps, 331 was briefed (31.3 per cent) that were hyperplasic, 448 (42.4 per cent) adenomas,278 (26.3 per cent) others and 35 (8.2 per cent) adenocarcinomas on adenomas. The average age was of50 years, ...

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We report two cases of successfully endoscopy therapy with argon plasma in upper gastrointestinal bleeding secondary a complication of endoscopic sphynterotomy, who fails to previous injectotherapy attempts. The bleeding control was complete and without complications.

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Con los objetivos de detectar las disfunciones orgánicas (DO) predictoras de mortalidad, en un modelo multivariado, establecer diferencias entre pacientes clínicos, quirúrgicos y cardiológicos en relación al desarrollo de disfunciones y mortalidad, buscar el mejor modelo matemático para estimar los pesos de las distintas disfunciones y confeccionar un score y comparar los resultados de la aplicación del nuevo score en relación a la cuantificación simple de las disfunciones, en un diseño prospectivo, observacional y longitudinal se estudiaron 699 pacientes de una muestra consecutiva ingresada a terapia intensiva. Se obtuvieron pesos de las DO a partir del estadístico de Wald, del coeficiente beta y de los odds ratio, confeccionándose un score con la suma de los mismos. Las disfunciones que se mostraron como predictoras de mortalidad fueron en orden decreciente según el peso: la neurológica, respiratoria, cardiovascular, metabólica, hepática y renal. No fueron predictoras las disfunciones hematológica y digestiva. En la población cardiológica ninguna disfunción fue variable predictora. El score originado a partir del estadístico de Wald presentó un área ROC superior al área de la cuantificación de las disfunciones con menor error standard y valores significativos para pendiente y linealidad a diferencia del otro método, presentando mejor discriminación en el punto de mayor exactitud diagnóstica para identificar a quienes tenían más riesgo de fallecer(AU)

With the objectives of detecting organic dysfunctions (DO) predictors of mortality, in a model multivariate, establish differences between patients clinical, surgical and cardiological in relation to the development of dysfunctions and mortality, look for the best mathematical model to estimate the weights of the different dysfunctions and make a score and compare the results of the application of the new score in relation to quantification simple of dysfunctions, in a prospective design, observational and longitudinal were studied 699 patients from a consecutive sample admitted to intensive therapy. Weights were obtained from the DO to from the Wald statistic, from the beta coefficient and of the odds ratio, making a score with the sum of them. The dysfunctions that were shown as predictors of mortality were in decreasing order according to the weight: the neurological, respiratory, cardiovascular, metabolic, hepatic and renal. They were not predictors the hematological and digestive dysfunctions. In the cardiological population no dysfunction it was variable predictor. The score originated from of the Wald statistic presented a superior ROC area to the area of ​​quantification of dysfunctions with lower standard error and significant values for slope and linearity unlike the another method, presenting better discrimination in the point of greatest diagnostic accuracy to identify those who had more risk of dying(AU)

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