Clinical utility of endoscopy and barium swallow X-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass.

BACKGROUND: The main clinical consequence of sliding hiatal hernia (SHH) is gastroesophageal reflux disease (GERD). Endoscopy and barium swallow X-ray are commonly used to diagnose SHH. We aimed to assess the clinical utility of endoscopy and X-ray in the diagnosis of SHH in morbidly obese patients before and after gastric bypass (GBP). METHODS: Ninety-two patients underwent reflux symptoms evaluation, upper gastrointestinal endoscopy, and barium swallow X-ray before and 6 months after banded GBP. The performance of endoscopy in diagnosing SHH was assessed, taking X-ray as reference. Endoscopy and X-ray were tested as predictors of SHH with GERD. RESULTS: SHH was more prevalent when characterized by X-ray than endoscopy either before (33% vs. 17%; P = 0.017) or after GBP (26% vs. 7%; P = 0.001). Endoscopy showed low sensitivity (or=94%) in diagnosing SHH. Before GBP, more patients with SHH had GERD compared to patients without SHH using either X-ray (83% vs. 58%; P = 0.016) or endoscopy (94% vs. 61%; P = 0.009). After GBP, only patients with radiologic evidence of SHH showed higher prevalence of GERD compared to patients without SHH (50% vs. 26%; P = 0.037). SHH patients also reported weekly or daily vomit more often than patients without SHH (59% vs. 32%; P = 0.026). CONCLUSIONS: In morbidly obese patients, X-ray is superior to endoscopy in diagnosing SHH either before or after banded GBP. In patients treated with this technique, the utilization of X-ray may help in the management of reflux symptoms and frequent vomit.

Perfil do paciente diabético internado na unidade de terapia intensiva do Hospital Nossa Senhora da Conceição em 2006 / Patient’s profile of diabetic admitted in the intensive care unit of Nossa Senhora da Conceição Hospital in 2006

Introdução: O diabete melito é uma doença com alta prevalência em todo o mundo. Portadores desta patologiasão mais vulneráveis a desenvolverem complicações agudas e crônicas e são mais propensos a serem admitidosem uma unidade de terapia intensiva.Objetivo: Traçar o perfil do paciente diabético internado na unidade de terapia intensiva do Hospital Nossa Senhora da Conceição em 2006.Métodos: Foi realizado um estudo exploratório transversal na UTI adulta do HNSC na cidade de Tubarão. Para todos pacientes inclusos no estudo foramcoletados dados de interesse dos prontuários médicos e acompanhado as suas evoluções. Resultados: Entre os pacientes deste estudo, 26,2%tinham o diagnóstico prévio de diabetes. O uso de insulina na admissão, apesar da preferência pela via subcutânea,não reduziu o desenvolvimento de insuficiência renal. Conclusão: Verificou-se uma alta prevalência de diabetesnesta UTI. Diabéticos utilizam mais insulina em comparação ao não diabético. A insulina por via endovenosa ainda é muito pouco utilizada em nossoserviço, mesmo que, na literatura, demonstra-se uma diminuição de comorbidades como na taxa dedesenvolvimento de insuficiência renal aguda.

Background: Diabetes Mellitus is a disease with high prevalence around the world. These patients with thispathology have more chances to get acute and chronic complications and they are more frequently to be admittedin an intensive care unit. Objective: The aim of this study was to analyze thepatientÆs profile of diabetic admitted in the intensive care unit of Nossa Senhora da Conceição Hospital in 2006. Methods: The exploratory and transversal study was done in adult ICU of NSCH in the city of Tubarão. All the data was obtained from the patientsæ medical charts for this study. Results: Among all the patients in this study, 26,2%had the previous DM diagnosis. The insulin use in ICU of NSCH, did not reduce the kidney injury developmentalthough the mainly administration route was the subcutaneous. Conclusion: It was observed a high DM prevalencein this ICU. Diabetic patients use more insulin than a non-diabetic person. The insulin by intravenous administration route is still rarely used in this service,even several studies show that this kind of presentation reduces the mortality and decrease the cormorbid like kidney injury.