Violencia doméstica contra la mujer: una encuesta en consultorios de atención primaria / Detection of domestic violence against women: survey in a primary health care clinic

According to Pan American Health Organization nearly 50% of women suffer chronic domestic violence in Latin America. We evaluated the prevalence of gender based violence (GBV) in women assisted in a University Outpatient Clinic in Buenos Aires. We used a survey originally developed by the International Planned Parenthood Federation (IPPF) in Spanish. The survey was distributed to a consecutive sample of women more than 18 years of age who attended the clinic. Participants were randomized to fill out the questionnaire anonymously (self-administered) or during an interview with the physician in order to test the sensitivity of these two different modalities of data collection. Of 360 eligible women 270, (75%) completed the questionnaire. The respondents had a median age of 45.4 years, only 33% had more than 7 years of formal education and 48% did not live with a partner. Of the 270 respondents, 120 (44%) women reported mistreatment at least once during their lifetime. Of these, 108 (40%) reported psychological GBV, 53 physical GBV and 45 reported sexual GBV. Most of the respondents suffered more than one type of violence. 46 (17%) women reported sexual abuse during childhood, 219 (81%) of participants never had been asked by their physician about domestic violence. Women interviewed by the physician reported GBV more frequently than those completing the self-administered survey (p <0.005). The survey developed by the IPPF is considered a useful tool for screening in a clinical setting.

De acuerdo a la Organización de la Salud, en América Latina cerca del 50% de las mujeres sufren violencia doméstica crónica. Se realizó esta investigación con el objetivo de estimar la prevalencia de violencia basada en género (VBG) en las mujeres que se atienden en el Programa de Medicina Interna General (PMIG) y comparar la frecuencia de detección de VBG bajo diferentes modalidades de encuesta. Se utilizó una muestra consecutiva de mujeres mayores de 18 años de edad que concurren al PMIG y aceptaron participar. Se utilizó la encuesta para detección de VBG desarrollada por la International Planning Parenthood Foundation. La mitad de la población completó la encuesta en forma anónima y a solas, y a la otra mitad el médico tratante le entregó el cuestionario al final de la consulta. Se repartieron 360 encuestas, se recuperaron 270. La edad promedio de la población fue 45.4 años, el 33 % poseía mas de 7 años de educación formal, el 48% no convivía en situación de pareja, el 56% tenía trabajo. Ciento veinte mujeres (44.4%) refirieron haber sufrido algún tipo de violencia en su vida. Ciento ocho informaron violencia psicológica, 53 violencia física y 45 violencia sexual. Cuarenta y seis mujeres (17.5%) relataron haber sufrido violencia sexual en la niñez. Cuarenta (14.8%) refirieron sufrir violencia en la actualidad. Las mujeres que respondieron la encuesta en forma anónima referían haber sufrido VBG con una frecuencia significativamente menor que las otras (P < 0.005). Al 93%de las encuestadas (219 mujeres) ningún médico les había preguntado sobre VBG en su vida. En conclusión,existe una alta prevalencia de VBG en la población encuestada.

[Our experience of 350 endoscopic polypectomies of the colon]. / La nostra esperienza su 350 polipectomie endoscopiche del colon.

The authors report their experience of the endoscopic removal of 350 polyps of the colon. Vegetating lesions of doubtful endoscopic appearance and nature were excluded from this study. Indications regarding intestinal cleaning and the most appropriate pharmacological preparation are given on the basis of personal experience. No patient had to be hospitalised and the colon was fully explored in all cases; the cecum was reached in 85% of cases. The maximum limit of endoscopic removal was 5 cm due to the greater risk of complications and presence of cancer on polyps. A total of up to 8 polyps were removed in a single session in cases of multiple polyposis. From 1986 to 1992 350 polypectomies were performed in 177 patients, of which 301 were adenoma (85.9%) and 49 mixed (14.1%). Adenomas were 80.5% tubular, 13.6% tubulo-villous and 4.3% villous. Cancer was found on polyps in 5 cases (1.6%). 146 polyps were found in the rectum (41.8%), 84 in the sigma (24%), 76 in the descending (21.7%), 21 in the transverse (6%), and 23 in the right colon (6.5%). Patients were aged between 3 and 81 years, and the most frequently affected age bracket was between 40-70 years. Follow-up consisted in checks at 6, 12 and 24 months in cases of adenoma and quarterly checks during the first year in the event of carcinoma in situ. The decision to use a diathermic loop or hot biopsy was made in relation to lesion size, reserving the former for polyps with diameters of over 8 mm. All polyps under 5 cm were removed and subjected to histological tests. No cases of early or late complications were reported in the 350 polypectomies performed. The authors indicate the criteria of choice which led to surgical resection of the first instance. In the event of in situ carcinoma, endoscopic removal is considered sufficient provided that it is radical. The following must be evaluated in the case of invasive carcinoma: tumor size, the degree of differentiation, lymphatic or vascular invasion and generic or specific risk factors linked to the individual patient.

The 'safety snare'--a ligature-placing snare to prevent haemorrhage after transection of large pedunculated polyps.

A modified snare has been fabricated in prototype form which permits the placement of a tightenable nylon loop ligature around the stalk of large polyps, which is then left in situ after withdrawal of the snare handle and endoscope. The clinical application of the safety snare is likely to be the prevention of immediate or delayed haemorrhage from the stalks of unusually large polyps, or after polypectomy in patients with bleeding diathesis. The use of the snare has proved practicable in preliminary clinical trials.

Hemangiomas of the large bowel. Report of a case.

This report concerns a 19-year-old man who complained of rectal bleeding of about one year's duration. Colonoscopy revealed a 10-cm segment of sigmoid colon characterized by the presence of multiple lesions identified as probable hemangiomas; one sessile dark tumor, 0.5 cm large, was snared endoscopically; histologic examination revealed a cavernous hemangioma. Three weeks later anterior resection was performed and histologic examination of the surgical specimen confirmed the diagnosis of hemangiomas.