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Introducción: El pronóstico de morir por sangrado digestivo permite individualizar el tratamiento y disminuir la letalidad. Objetivos: Identificar los factores pronósticos de mortalidad por sangramiento digestivo no variceal en pacientes graves. Métodos: Se estudiaron casos y controles en pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Docente Clínico Quirúrgico Joaquín Albarrán Domínguez entre el 1ro de enero 2018 al 31 de diciembre de 2019. El universo estuvo constituido por 1060 pacientes, se seleccionaron 154 pacientes (137 controles y 17 casos). Se aplicó el Chi cuadrado y el Odds ratio (IC= 95 por ciento). Resultados: Del total de pacientes estudiados, 11,3 por ciento fallecieron, la edad promedio fue 69 ± 11,58 (grupo control) y 75± 11,42 (grupo casos). Las alteraciones del equilibrio ácido-base tuvieron 7,4 riesgo de morir con (IC 95 por ciento 2,5-21,9), la hipoxia 1,1 (IC 95 por ciento 0,41-3,2), las variaciones del potasio 4,9 (IC 95 por ciento 1,54-16,1), hiperlactemia 16,9 (IC 95 por ciento 5,3-52,0), las desviaciones del sodio 6,5 (IC 95 % 0,8-51,4). Con ventilación mecánica 2,17 (IC 95 por ciento 0,6-7,0), el apoyo de aminas vasoactivas 16,9 (IC 95 por ciento5,30-52,0), la trasfusión de glóbulos rojos, 11,7 (IC 95 por ciento 3,1-4,3) y con tratamiento dialítico 47,5 (IC 95 por ciento 8,6-258.0), las complicaciones 3,4 (IC 95 por ciento 1,15-10,4). El tratamiento endoscópico fue 93,5 por ciento de grupo control y 41,3 por ciento del grupo de casos, con OR en 0,04 (IC 95 por ciento 0,01-0,15). Conclusiones: Los factores pronósticos identificados fueron: alteraciones del pH, del sodio, el potasio, elevación del lactato, la ventilación mecánica, transfusiones más de 250 mL de glóbulos rojos, apoyo de aminas vasoactivas, tratamiento dialítico, y complicaciones relacionadas con el sangrado. El tratamiento endoscópico fue un factor de protección(AU)

Introduction: The prognosis of dying from digestive bleeding allows individualizing treatment and reducing mortality. Objectives: To identify the prognostic factors of mortality due to nonvariceal gastrointestinal bleeding in seriously-ill patients. Methods: Cases and controls were studied in patients admitted to the intensive care unit of Joaquín Albarrán Domínguez Clinical-Surgical Teaching Hospital, between January 1, 2018 and December 31, 2019. The universe consisted of 1060 patients, 154 of which were selected to make up the sample (137 controls and 17 cases). Chi-square and odds ratio (CI: 95 percent) were applied. Results: Of the total of patients studied, 11.3 percent died, the average age was 69±11.58 (control group) and 75±11.42 (case group). Alterations in acid-base balance accounted for 7.4 as risk of dying (CI: 95 percent; 2.5-21.9), hypoxia accounted for 1.1 (CI: 95 percent; 0.41-3.2), variations in potassium accounted for 4.9 (CI: 95 percent; 1.54-16.1), hyperlacthemia accounted for 16.9 (CI: 95 percent; 5.3-52.0), and sodium deviations accounted for 6.5 (CI: 95 percent; 0.8-51, 4), mechanical ventilation accounted for 2.17 (CI: 95 percent; 0.6-7.0), vasoactive amines support accounted for 16.9 (CI: 95 percent; 5.30-52.0), red blood cell transfusion accounted for 11.7 (CI: 95 percent; 3.1-4.3), dialysis treatment accounted for 47.5 (CI: 95 percent; 8.6-258.0), and complications accounted for 3.4 (CI: 95 percent; 1.15-10.4). Endoscopic treatment was 93.5 percent in the control group and 41.3 percent in the case group, with odds ratio at 0.04 (CI: 95 percent; 0.01-0.15). Conclusions: The prognostic factors identified were alterations in pH, sodium, potassium, elevated lactate, mechanical ventilation, transfusions of more than 250 mL of red blood cells, vasoactive amine support, dialysis treatment, and complications related to bleeding. Endoscopic treatment was a protective factor(AU)

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La lesión de Dieulafoy es una causa poco frecuente de sangrado gastrointestinal alto, pero es una de las causas más frecuentes relacionadas con sangrado oculto y recurrente. La ubicación extragástrica de la lesión de Dieulafoy es rara. Por su localización la lesión de Dieulafoy duodenal es de difícil diagnóstico y manejo. La terapia endoscópica, combinada con inyección de adrenalina más terapia mecánica, reduce el riesgo de resangrado. En este artículo se presenta el caso de un paciente tratado en la Clínica Universitaria Colombia, así como la revisión del tema

Dieulafoy’s lesions do not usually cause upper gastrointestinal bleeding, but they are one of the most common causes of hidden and recurrent bleeding. An extra-gastric Dieulafoy lesion is rare, and, because of their location, Dieulafoy’s lesions in the duodenum are difficult to diagnosis and treat. Endoscopic injection therapy combined with adrenaline injections and mechanical therapy reduce the risk of rebleeding. This article describes the case of a patient treated at the Clínica Universitaria Colombia and reviews the topic of Dieulafoy’s lesions

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To evaluate the HLA class I and II profiles of a large group of patients with Chagas' disease, 176 patients presenting with pure cardiomyopathy with heart failure (N = 60), cardiomyopathy without heart failure (N = 18), pure digestive tract manifestations (N = 25), cardiac plus digestive disease (N = 40), and asymptomatic patients with positive serology for chronic Trypanosoma cruzi infection (N = 33) were studied. A total of 448 normal individuals were also studied in parallel. HLA class I and II specificities were determined using serology and oligonucleotide analysis. HLA-A30 antigen was overrepresented in the total group and in the subgroups presenting with the pure cardiac (with or without heart failure) or digestive form, conferring similar relative risks and etiologic fractions on all these presentation forms. Serologic HLA class II analysis showed that HLA-DQ1 conferred susceptibility to, while HLA-DQ7 antigen conferred protection against the development of the disease in the total group of patients. Oligonucleotide typing did not confirm the HLA class II associations obtained by serology, but showed that HLA-DQB1*06 alleles were underrepresented in the total group and in the subgroups presenting with pure digestive or cardiac disease, conferring closely similar relative risks and preventive fractions. Although asymptomatic patients showed a tendency to increased HLA-A30, they presented a significant increase of HLA-DQB1*0302 specificity. In conclusion, HLA-A30 antigen conferred susceptibility to, while HLA-DQB1*06 specificity conferred protection against, the development of the disease, regardless of the form of presentation, ie, cardiac or digestive tract disease.

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Presentamos a un hombre de 63 años con sangrado de tubo digestivo bajo secundario de leiomiosarcoma. El paciente fué operado, laparotomía. Se le resecó el tumor con un segmento de intestino y mesenterio. Se trató de incluir los ganglios linfáticos en la resección de la grasa mesentérica. Aunque estos leiomiosarcomas son lesiones raras, pueden aparecer como sangrado de fuentes desconocidas como en el presente caso. El paciente ha evolucionado muy bien después de 2 años de la cirugía descrita.

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The aim of this study was to assess the accuracy of the copper/zinc ratio (Cu/Zn ratio) in the evaluation of a large group of patients with digestive cancer compared to gender and age-matched control subjects. A total of 282 patients was studied and separated into three groups: group I (n=75), patients with digestive cancer, group II (n=112), patients with bening digestive disease, and group II (n=95), healthy subject. Serum levels of copper and zinc were measured by atomic absorption spectrophotometry. The results showed that the serum levels of copper (mg/dL) in patients with digestive cancer (91.6 ñ27.3, p<0.05) were significantly higher than in patients with benign digestive diseasde (75.8 ñ 19.8) or healthy subjects (54.4 ñ 8.9) and the serum levels of zinc (mg/dl) were significantly lower (68.7 ñ 21.9, p<0.05) compared to benign digestive disease patients (80.1 ñ 18.7) or healthy subjects (100 ñ 11.4 mg/dl). The Cu/Zn ratio was also significantly higher in patients with digestive cancer (1.45 ñ .58, p<0.05) than those with benign digestive disease (0.95 ñ 0.28) or healthy subjects (0.55 ñ 0.13). Considering a cutoff value of 0.87, the sensitivity of the copper/zinc ratio was 82.2 percent, with a specificity of 65.7 percent, a positive predictive value of 45.8 percent and a negative predictive value of 91.3 percent. In conclusion, Cu/Zn ratio was found to be considerably higher in patients with digestive cancer compared to age-and gender-matched controls, with a sensitivity of 82.2 percent that might be useful in the evaluation of suspected malignancy

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Foram estudados, de forma prospectiva e controlada com desenho metodológico tipo coorte, 145 pacientes portadores de afecçöes cirúrgicas de esôfago, estômago e eduodeno. O objetivo era avaliar os efeitos do estado nutricional sobre a incidência de complicaçöes infecciosas pós-operatórias. Essas incluíram infecçäo de ferida operatória, intrabdominal, pulmonar e septicemia. Os métodos utilizados para a avaliaçäo nutricional foram: dosagem de albumina sérica, contagem total de linfócitos, perda de peso e testes cutâneos de hipersensibilidade tardia. Dos 145 casos, 54 (37,2 por cento) eram de cancer, e 91 (62,8 por cento) de doenças benignas. A idade média foi de 49 ñ 16,54 anos, com variaçäo de 15 a 89. Oitenta e quatro (57,9) por cento eram do sexo masculino e 61 (42,1 por cento) do feminino. No grupo de cancer, nenhum dos critérios propostos previu risco relativo de complicaçöes infecciosas pós-operatórias ligadas ao estado nutricional. Por outro lado, no grupo de doenças benignas a hipoalbuminemia (p<0,0004) e linfocitopenia (p<0,0244), respectivamente com riscos relativos de 7,50 e 4,05, correlacionaram-se de forma significativa com complicaçöes infecciosas pós-operatórias. A perda de peso e os testes cutâneos de hipersensibilidade tardia näo se relacionaram com risco. Ao se analisar a relaçäo entre as variáveis nutricionais e o tipo de infecçäo no grupo de doenças benignas, verificou-se quea hipoalbuminemia se correlacionou diretamente com os diferentes tipos de infecçäo. Apesar de o material näo permitir conclusöes definitivas, alguns pontos se mostram de relevância e merecem novas investigaçöes: a) no grupo näo cancer, a hipoalbuminemia (<3,5g/dl) e a linfocitopenia (<1500/mm3), ao contrário dos testes cutâneos de hipersensibilidade tardia negativa e perda de peso superior a 10 por cento, se correlacionaram diretamente com riscos de complicaçöes infecciosas pós-operatórias; b) no grupo de cancer, nenhum dos testes de avaliaçäo nutricional utilizados pode ser considerado como indicador de risco para complicaçöes infecciosas pós-operatórias; c) para que se consiga predizer risco relativo de complicaçöes, em cirurgia do trato digestivo alto, é necessário separar casos de cancer e näo cancer.

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Se realizó este estudio prospectivo, en 784 gestantes atendidas en la consulta externa del Departamento de Gineco-Obstetricia del Hospital Cayetano Heredia de Lima, en los meses de Febrero y Marzo de 1990, con la finalidad de conocer la incidencia de enfermedades digestivas asociadas al embarazo y aportar con algunas pautas en su manejo terapéutico. En todos los casos, se realizaron exámenes de laboratorio, ecografías abdominal y pélvica, y en los casos atribuibles a Reflujo gastroesofágico, fueron sometidas al exámen endoscópico digestivo alto. Los resultados fueron: 73 casos, de las 784 gestantes (9.3 por ciento), presentaban dolencias digestivas. De estos 73 casos, se hallaron: estreñimiento en 49 casos (67.1 por ciento), reflujo gastroesofágico 12 casos (16.4 por ciento); hiperemesis gravídica 11 casos (15 por ciento), y pancreatitis aguda un caso (1.3 por ciento). No se detectaron casos con enfermedades hepáticas. Los 12 casos con reflujo gastroesofágico, fueron tratados con dieta y suspención oral que contenian antiácidos y alginato de magnesio. En 10 de estos casos, se obtuvo buena respuesta terapéutica. La endoscopía digestiva brindó efectividad diagnóstica, sin ninguna complicación obstétrica. El estudio mostró una incidencia habitual de estas enfermedades en el embarazo; las que en su mayor parte no son de grado severo; salvo las Pancreatitis agudas, que en nuestro caso evolucionó favirablemente. Las enfermedades hepáticas no detectables en este grupo de gestantes, si constituyen en ciertos casos, problemas en su manejo terapéutico. Ha de ser interesante desarrollar estudios similares en el futuro para confirmar estos resultados, en poblaciones de gestantes de Lima y otras ciudades del Perú.

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Antigen CA 19-9 was measured in the serum of a group of 16 patients with pancreatic cancer, in 19 patients with non-pancreatic gastrointestinal malignancies, and in 19 others with benign pancreatobiliary disease. The test showed a high sensitivity with a low specificity and a positive predictive value for diagnosis of pancreatic cancer when confronted with a group of controls that included both benign and malignant gastrointestinal disease. The low specificity was due to high CA 19-9 values in other gastrointestinal cancers, especially in carcinoma of the ampulla and the biliary tract. When the latter were added to the group of patients with pancreatic cancer, and the diagnostic accuracy of the test was re-evaluated, sensitivity, specificity and both positive and negative predictive values increased. Values of CA 19-9 over 100 U/ml are highly predictive of malignancy in patients with pancreato-biliary disease.

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