Revisión documental sobre el software GeoGebra aplicado a la Cultura Física y el deporte

El software GeoGebra es muy útil en las simulaciones de movimientos físicos porque con la ayuda de este el profesional del deporte es capaz de interpretar con valores matemáticos y geométricos la realización de un lanzamiento, una acción que a simple vista es muy difícil descifrar. Sin embargo, a pesar de ser este recurso una vía recurrente para contribuir al desarrollo de la cultura física y el deporte, no ha sido muy generalizado su uso en esta área del conocimiento. Es por ello que los autores de esta investigación se proponen como objetivo: realizar una sistematización documental sobre el software Geogebra enfocado en la cultura Física para que se convierta en un referente a tener en cuenta para futuras innovaciones e investigaciones referente al tema. Con vistas a lograr esta meta consultaron un grupo de artículos en bases de datos de Scopus y Google Académico y publicados en los últimos cinco años referente al uso del Software GeoGebra y se visualizaron las características de este medio y los diversos beneficios que ha ofrecido a través del tiempo. Los artículos hallados se sistematizaron considerando la matriz de análisis, conteniendo aspectos preponderantes en cantidad de publicaciones durante el año 2021 con 12 publicaciones y menor cantidad de publicaciones durante el 2022. Se estudió un prototipo de 29 artículos, en los últimos cinco años referente al uso del Softwares educativos que implican al GeoGebra.

O software GeoGebra é muito útil na simulação de movimentos físicos porque com a ajuda dele o profissional do esporte consegue interpretar com valores matemáticos e geométricos a execução de um arremesso, ação muito difícil de decifrar a olho nu. Contudo, apesar deste recurso ser uma forma recorrente de contribuir para o desenvolvimento da cultura física e do desporto, a sua utilização nesta área do conhecimento não tem sido muito difundida. É por isso que os autores desta pesquisa propõem como objetivo: realizar uma sistematização documental sobre o software Geogebra voltado para a Cultura Física para que ele se torne uma referência a ser levada em conta para futuras inovações e pesquisas sobre o tema. do tempo. Os artigos encontrados foram sistematizados considerando a matriz de análise, contendo aspectos predominantes no número de publicações durante o ano de 2021 com 12 publicações e um menor número de publicações durante 2022. Foi estudado um protótipo de 29 artigos, nos últimos cinco anos quanto ao uso de software educacional que envolve o GeoGebra.

The GeoGebra software is very useful in simulating physical movements because with the help of it the sports professional is able to interpret with mathematical and geometric values the execution of a throw, an action that is very difficult to decipher with the naked eye. However, although this resource is a recurring way to contribute to the development of physical culture and sports, its use in this area of knowledge has not been very widespread. That is why the authors of this research propose as an objective: to carry out a documentary systematization on the Geogebra software focused on Physical culture so that it becomes a reference to be taken into account for future innovations and research on the topic. With a view to achieving this goal, they consulted a group of articles in Scopus and Google Scholar databases and published in the last five years regarding the use of GeoGebra Software and the characteristics of this medium, as well as the various benefits it has offered to users through time were visualized. The articles found were systematized considering the analysis matrix, containing predominant aspects in the number of publications during the year 2021 with 12 publications and a smaller number of publications during 2022. A prototype of 29 articles was studied, in the last five years regarding the use of Educational software that involves GeoGebra.

Tumores estromales gastrointestinales: evaluación clinicopatológica y sobrevida en el Hospital Rebagliati / Gastrointestinal stromal tumors: clinicopathologic and survival evaluation in Rebagliati Hospital

OBJETIVO: Determinar las manifestaciones clínicas, radiológicas, histopatológicas y sobrevida de los pacientes con Tumor Estromal Gastrointestinal (GIST) en el Hospital Nacional Edgardo Rebagliati Martins (HNERM), de Lima, Perú. MATERIAL Y MÉTODOS: El presente es un estudio descriptivo, retrospectivo. El cual se realizó a partir de las historias clínicas de 103 pacientes con GIST confirmado por inmunohistoquímica que fueron evaluados y tratados en el HNERM, desde Enero del 2002 hasta Diciembre de 2010. RESULTADOS: En los 103 pacientes el promedio de edad fue 64 años (entre 30 y 88 años). Predominó en mujeres (52%). El tiempo de enfermedad promedio fue 7 meses. La forma de presentación más frecuente fue sangrado digestivo (48.3%). El diagnóstico se hizo más por endoscopía (50.5%). La prevalencia por órganos fue más frecuente en estómago 56.3%. El promedio de tamaño fue 98mm, (49% entre 50mm y 100mm), el tumor de mayor tamaño alcanzaba 260 mm. El estadio tumoral más frecuente fue localizado (70.9%). Presentaron otro cáncer asociado el 9.7% de pacientes El patrón histológico predominante fue fusiforme 73.8%. El 84.5% tuvo bajo índice mitótico. La inmunohistoquímica mostró la expresión de KIT (CD 117) 94.17%, CD 34 77.5%, Vimentina 96.6%, NSE 84.9%, Alfa actina 52.7%, CD56 44.4%, S-100 32.3% y Actina 20.0%. La característica tomográfica más frecuente fue tumor heterogéneo (43.6%). La distribución según clasificación de riesgo fue: muy bajo riesgo 3.9%, bajo riesgo 28.2%, riesgo intermedio 37.7% y alto riesgo 30.1%. La resección quirúrgica completa se realizó en 87.4% de pacientes, 4.9% de pacientes recibió Imatinib. La sobrevida global acumulada a 5 años fue 31.07%. En el análisis bivariado se encontró asociación estadística entre el haber sobrevivido con: ausencia de cáncer asociado p= 0.004, CD 34 p=0.01, índice mitótico bajo p=0.00 y tratamiento quirúrgico recibido p= 0.000. En el análisis multivariado se encontró asociación estadística de mayor sobrevida con: los de menor tamaño del tumor p=0.015 (IC -3.67, -0.41), estadio tumoral localizado p=0.036 (IC -5.83, -0.19), menor índice mitótico p=0.038 (IC -0.86, 0.02), paciente asintomático p=0.009 (IC 1.25, 8.62), no recidiva del tumor p=0.01 (IC -8.49, -1.17) y el no presentar metástasis p=0.001 (IC 2.66, 10.62). CONCLUSIONES: Los resultados de nuestro estudio fueron similares a lo que reporta la literatura internacional. Los factores que se asociaron a mayor sobrevida fueron: haber recibido tratamiento quirúrgico, pacientes con menor tamaño tumoral, estadio tumoral localizado, índice mitótico bajo, paciente asintomático, no recidiva del tumor, no metástasis y no cáncer asociado.

OBJECTIVE: To determine the clinical, radiological, histopathological manifestations and survival of patients with gastrointestinal stromal tumor (GIST)in the National Hospital Edgardo Rebagliati Martins (HNERM) from Lima, Perú. MATERIAL AND METHODS: This is a descriptive and retrospective study, which was based on the medical records of 103 patients with confirmed GIST with immunohistochemical. All the patients were evaluated and treated at the HNERM, from January 2002 until December 2010. RESULTS: In 103 patients between 30 and 88 years the average age was 64 years. The tumor was more frequent in females (52%). The mean disease duration was 7 months. The most frequent form of presentation was gastrointestinal bleeding (48.3%). The diagnosis was made more by endoscopy (50.5%). The prevalence of GISTs by organs was more frequent in stomach (56.3%). The average size of the tumors was 98mm, 49% had a size between 50mm and 100mm, the largest tumor was 260 mm. Tumor stage more frequent was localized (70:9%). GIST associated with another cancer was 9.7% of patients. The predominant histologic pattern was fusiform (73.8%). The 84.5% had low mitotic index. Immunohistochemistry showed expression KIT (CD 117) was 94.17%, CD34 77.5%, Vimentin 96.6%, NSE 84.9%, alpha actin 52.7%, CD56 44.4%, S-100 32.3% and Actin 20%. The tomographic characteristic more frequent was heterogeneous tumor (43.6%).The distribution according to risk classification was: very low risk 3.9%, low risk 28.2, intermediate risk 37.7% and high risk 30.1%. Complete surgical resection was performed in 87.4% of patients and 4.9% of patients received imatinib. The cumulative overall survival at 5 years was 31.07%. In bivariate analysis statistical association was found between surviving with: no presence of cancer associated p = 0.004, CD 34 p = 0.01, low mitotic index p = 0.00 and received surgical treatment p = 0.000. In multivariate analysis one found statistical association of longer survival with smaller tumor size p = 0.015 (CI -3.67, -0.41), localized tumor stage p = 0.036 (CI -5.83, -0.19), lower mitotic index p = 0.038 (CI -0.86, 0.02), asymptomatic patient p=0.009 (CI 1.25, 8.62), no tumor recurrence p = 0.01 (CI -8.49, -1.17), and no metastasis p = 0.001 (CI 2.66, 10.62). CONCLUSIONS: The results of our study were similar to what was reported in international literature. Factors that were associated with longer survival were receiving surgical treatment, patients with smaller tumor size, tumor stage localized, low mitotic index, asymptomatic patient, not tumor recurrence, not metastasis and no cancer associated.

[Gastrointestinal stromal tumors: clinicopathologic and survival evaluation in Rebagliati Hospital]. / Tumores estromales gastrointestinales: evaluación clinicopatológica y sobrevida en el Hospital Rebagliati.

OBJECTIVE: To determine the clinical, radiological, histopathological manifestations and survival of patients with gastrointestinal stromal tumor (GIST) in the National Hospital Edgardo Rebagliati Martins (HNERM) from Lima, Perú. MATERIAL AND METHODS: This is a descriptive and retrospective study, which was based on the medical records of 103 patients with confirmed GIST with immunohistochemical. All the patients were evaluated and treated at the HNERM, from January 2002 until December 2010. RESULTS: In 103 patients between 30 and 88 years the average age was 64 years. The tumor was more frequent in females (52%). The mean disease duration was 7 months. The most frequent form of presentation was gastrointestinal bleeding (48.3%). The diagnosis was made more by endoscopy (50.5%). The prevalence of GISTs by organs was more frequent in stomach (56.3%). The average size of the tumors was 98 mm, 49% had a size between 50 mm and 100 mm, the largest tumor was 260 mm. Tumor stage more frequent was localized (70:9%). GIST associated with another cancer was 9.7% of patients. The predominant histologic pattern was fusiform (73.8%). The 84.5% had low mitotic index. Immunohistochemistry showed expression KIT (CD 117) was 94.17%, CD34 77.5%, Vimentin 96.6%, NSE 84.9%, alpha actin 52.7%, CD56 44.4%, S-100 32.3% and Actin 20%. The tomographic characteristic more frequent was heterogeneous tumor (43.6%).The distribution according to risk classification was: very low risk 3.9%, low risk 28.2, intermediate risk 37.7% and high risk 30.1%. Complete surgical resection was performed in 87.4% of patients and 4.9% of patients received imatinib. The cumulative overall survival at 5 years was 31.07%. In bivariate analysis statistical association was found between surviving with: no presence of cancer associated p = 0.004, CD 34 p = 0.01, low mitotic index p = 0.00 and received surgical treatment p = 0.000. In multivariate analysis one found statistical association of longer survival with smaller tumor size p = 0.015 (CI -3.67, -0.41), localized tumor stage p = 0.036 (CI -5.83, -0.19), lower mitotic index p = 0.038 (CI -0.86, 0.02), asymptomatic patient p=0.009 (CI 1.25, 8.62), no tumor recurrence p = 0.01 (CI -8.49, -1.17), and no metastasis p = 0.001 (CI 2.66, 10.62). CONCLUSIONS: The results of our study were similar to what was reported in international literature. Factors that were associated with longer survival were receiving surgical treatment, patients with smaller tumor size, tumor stage localized, low mitotic index, asymptomatic patient, not tumor recurrence, not metastasis and no cancer associated.

[Use of cyanoacrylate in the endoscopic therapy of gastric varices: experience in the National Hospital Edgardo Rebagliati Martins from 2006 to 2010]. / Uso de cianoacrilato en la terapia endoscópica de várices gástricas: experiencia en el Hospital Nacional Edgardo Rebagliati Martins del 2006 al 2010.

OBJECTIVE: To evaluate the therapeutic success of the injection of N-butyl-2 cyanoacrylate in the treatment of gastric varices. METHODS: Cross-sectional study included 33 patients with gastric varices who only received cyanoacrylate endoscopic therapy between 2006 and 2010. Intravariceally, cyanoacrylate was injected in a 1:1 dilution with lipiodol until the obliteration of varices. The therapeutic situation was: active bleeding, varices with stigmata of recent bleeding and secondary prophylaxis. Treatment success was evaluated according to hemostasis, recurrent bleeding and obliteration. RESULTS: Of the 33 patients, 3 (9.1%) were for active bleeding, 20 (60.6%) with stigmata of recent bleeding and 10 (30.3%) as secondary prophylaxis. Gastric varices were GOV2, 17 (51.5%); IGV1, 14 (42.4%); GOV1, 2 (6.1%). Hemostasis was achieved in 21 (91.3%) and in 2 (66.7%) of 3 patients with active bleeding. Five (15.6%) patients had recurrent bleeding and 2 of them used cyanoacrylate with successful hemostasis. Obliteration was achieved. Four patients died and one for failure of control bleeding. A high severity of Child-Pugh classification was related to treatment endoscopic failure (p=0.034). The main complication was bleeding after the injection of cyanoacrylate. CONCLUSIONS: Our results support the use of cyanoacrylate in the treatment of gastric varices with few major complications.

Uso de Cianoacrilato en la Terapia Endoscópica de Várices Gástricas: experiencia en el Hospital Nacional Edgardo Rebagliati Martins del 2006 al 2010 / Use of cyanoacrylate in the endoscopic therapy of gastric varices: experience in the National Hospital Edgardo Rebagliati Martins from 2006 to 2010

OBJETIVO: Evaluar el éxito terapéutico de la inyección de N-butil-2-cianoacrilato en el tratamiento de las várices gástricas. MATERIALES Y MÉTODOS: Estudio transversal que incluyó 33 pacientes con várices gástricas que sólo recibieron terapia endoscópica con cianoacrilato entre el 2006 al 2010. El cianoacrilato fue inyectado intravaricealmente en una dilución 1:1 con lipiodol hasta obtener la obturación de las várices. La situación terapéutica fue: Hemorragia activa, várices con estigmas de sangrado reciente y profilaxis secundaria. El éxito del tratamiento se evaluó según la hemostasia, recurrencia de sangrado y obturación. RESULTADOS: De los 33 pacientes, 3 (9.1%) fueron por hemorragia activa, 20 (60.6%) con estigmas de sangrado reciente y 10 (30.3%) como profilaxis secundaria. Las várices fueron GOV2, 17 (51.5%); IGV1, 14 (42.4%) y GOV1, 2 (6.1%). Se logró hemostasia total en 21 (91.3%) pacientes con sangrado agudo o reciente y en 2 (66.7%) de 3 sujetos con sangrado activo. En 5 (15.6%) pacientes hubo recurrencia de sangrado y 2 de ellos recibieron cianoacrilato con éxito de hemostasia. Se logró obturación en 25 (75.8%) del total de pacientes. Cuatro pacientes fallecieron, uno por fracaso del control de sangrado. La mayor severidad de clasificación Child-Pugh se relacionó con falla terapéutica (p=0.034). La complicación principal fue el sangrado post-inyección del cianoacrilato. CONCLUSIONES: Nuestros resultados favorecen el uso de cianoacrilato en el tratamiento de várices gástricas, con raras complicaciones mayores.

OBJECTIVE: To evaluate the therapeutic success of the injection of N-butyl-2-cyanoacrylate in the treatment of gastric varices. METHODS: Cross-sectional study included 33 patients with gastric varices who only received cyanoacrylate endoscopic therapy between 2006 and 2010. Intravariceally, cyanoacrylate was injected in a 1:1 dilution with lipiodol until the obliteration of varices. The therapeutic situation was: active bleeding, varices with stigmata of recent bleeding and secondary prophylaxis. Treatment success was evaluated according to hemostasis, recurrent bleeding and obliteration. RESULTS: Of the 33 patients, 3 (9.1%) were for active bleeding, 20 (60.6%) with stigmata of recent bleeding and 10 (30.3%) as secondary prophylaxis. Gastric varices were GOV2, 17 (51.5%); IGV1, 14 (42.4%); GOV1, 2 (6.1%). Hemostasis was achieved in 21 (91.3%) and in 2 (66.7%) of 3 patients with active bleeding. Five (15.6%) patients had recurrent bleeding and 2 of them used cyanoacrylate with successful hemostasis. Obliteration was achieved in 25 (75.8%). Four patients died and one for failure of control bleeding. A high severity of Child-Pugh classification was related to treatment endoscopic failure (p=0.034). The main complication was bleeding after the injection of cyanoacrylate. CONCLUSIONS: Our results support the use of cyanoacrylate in the treatment of gastric varices with few major complications.

[DIAGNOSTIC AND THERAPEUTIC COLONOSCOPY IN PEDIATRICS] / Colonoscopía diagnótica y terapéutica en pediatría.

Gastrointestinal bleeding in childhood is an uncommon problem, althought when it happens it maybe an emergency. Upper bleeding predominates, and when we consider lower bleeding, the principal cause are polyps. Recent evidence points out that polyps are responsible for bleeding in 77% of cases.We decided to study the clinical course, histologic characteristics and treatment in children with lower gastrointestinal bleeding. This investigation was held at Edgardo Rebagliati National Hospital during 1990 to 1996. Inclusion criteria were: younger than 14 years, gastrointestinal bleeding, and colonoscopy exam.100 colonoscopies were done in 74 children. Polyps were the cause for gastrointestinal bleeding in 71.6% of cases. In 14 children more than one colonoscopy was done. More than one polyp in 16 children were found. Ulcerative colitis was diagnosed in two cases, and intestinal tuberculosis in other two cases. Average age was 8.8 years, and 100% presented rectorragia and anemia.Polyps were located principally in rectum and sigmoid. Polipectomy was done in 94.34% of the cases, and it was technically succesful. We had only one complication (snare wire was trapped) but with no morbidity.Histological examination demonstrated that juvenile polyp was the most frequent type (56.66%), followed by tubular adenoma (11.32%), and Peutz-Jegher polyp in 3.77%. Treatment was polipectomy in all cases. Eleven procedures were done in the surgical room, and 19 in the endoscopy unit, with no complications in any of the cases.CONCLUSION: In children the main cause for lower gastrointestinal bleeding are polyps. All cases present with rectorragia or anemia, and juvenile polyps are the most frequent type. Colonoscopy is a safe method for diagnosis and treatment, which can be done in the endoscopy unit with mild sedation and with an anesthesist or pediatrician as assistants.

¿Es útil la relación urea/creatinina para diferenciar hemorragia digestiva alta de baja? / It is useful the urea/creatinine rate for differentiation of upper from lower gastrointestinal bleeding?

La hemorragia digestiva constituye un tercio de las hospitalizaciones de nuestro servicio. A veces es difícil diferenciar clínicamente la localización del sitio de sangrado. Se ha señalado que la relación urea/creatinina puede ayudar a definir el sitio de sangrado, pero que existe una gran superposición de resultados. Estudiamos 154 pacientes con hemorragia digestiva en forma prospectiva. Tuvieron hemorragia digestiva alta 123 (79.9 por ciento) pacientes con una relación urea/creatinina promedio de 62.27ñ29.13 y hemorragia digestiva baja 31 (20.1 por ciento) con una relación urea/creatinina de 39.49ñ13.83, diferencia estadísticamente significativa pero con una gran superposición de resultados. Definiendo hemorragia digestiva alta cuando existe una relación urea/creatinina mayor de 60, encontramos una gran especificidad (96.77 por ciento) pero una sensibilidad baja (51.22 por ciento); cuando tomamos los casos de enterorragia, que generalmente son los que pueden dar problema de diagnóstico, la especificidad alcanza 96.42 por ciento y la sensibilidad 46.15 por ciento. En conclusión, un valor de urea/creatinina mayor de 60 nos indica generalmente una hemorragia del tracto digestivo alto, pero un valor por debajo de 60 no es de valor diagnóstico.

[IT IS USEFULL THE UREA/CREATININE RATE FORDIFFERENTIATION OF UPPER FROM LOWER GASTROINTESTINAL BLEEDING?] / ?Es útil la relación Urea\Creatininapara diferenciar Hemorragia Digestiva Alta de Baja¿

Gastrointestinal bleeding constitutes a third part of the hospitalizations in our service. Some times is difficult to clinically distinguish the site of bleeding. It was pointed that the urea/creatinine ratio can help to define the site of bleeding, but there is a lot of superposition in the results. We studied prospectively 154 patients with gastrointestinal bleeding. 123 (79.9%) patients had upper gastrointestinal bleeding with an urea/creatinine ratio of 62.27 +/- 29.13 and 31(20.1%) patients had lower gastrointestinal bleeding with an urea/creatinine ratio of 39.49 +/- 13.83. This difference is statistically significant but has a lot of overlap results. Defining gastrointestinal bleeding as an urea/creatinine ratio greater than 60, we found a great specificity (96.77%) but a low sensibility (51.22). In addition, when we only took hematochezia cases, that usually is a diagnostic problem, the specificity was 96.42% and the sensitivity 46.15%. In conclusion, an urea/creatinine ratio greater than 60 usually indicate us an upper gastrointestinal bleeding, but values below of 60 isn't of diagnostic value.

Tuberculosis digestiva en el Hospital Nacional Edgardo Rebagliati Martins (HNERM): un estudio retrospectivo de 5 años (1993-1998) / Digestive tuberculosis in the Edgardo Rebagliati Martins Hospital (HERM): a retrospective study over a five-year period (1993-1998)

Introducción: La Tuberculosis es una patología bastante común en el Perú. Aunque hay evidencia de una disminución de la afección pulmonar, las variedades extrapulmonares, como la Tuberculosis Digestiva muestra un importante incremento en nuestro medio. El presente estudio tiene como finalidad determinar la incidencia, características clínicas, métodos diagnósticos, órganos comprometidos y tratamiento empleado en Tuberculosis Digestiva en el Area de Hospitalización del Departamento de Enfermedades del Aparato Digestivo del HNERM. Material y Método: Se revisaron 77 historias clínicas de pacientes egresados y diagnosticados de Tuberculosis Digestiva entre Enero de 1993 y Mayo de 1998. De estas 58 cumplieron criterios planteados. Resultados: La duración media de síntomas fue de 5.39 meses. Las características clínicas son inespecíficas. Los síntomas más frecuentes han sido baja de peso, diarrea crónica, dolor abdominal, y fiebre (más de 70 por ciento de casos). Los signos más comunes han sido dolor abdominal, ascitis y caquexia en más de 50 por ciento. Los exámenes de Laboratorio son típicos de enfermedad crónica y resaltan la Velocidad de sedimentación globular(VSG), elevada en 98 por ciento de casos, y el dosaje de Adenosin deaminasa (ADA) en líquido ascítico, elevado en 95 por ciento de casos cuando ha sido utilizado. Los exámenes Radiológicos son adyuvantes, permiten determinar la localización intestinal, compromiso de órganos, además de servir de ayuda para realización de exámenes invasivos. Un 27.58 por ciento de casos ha tenido localización gastrointestinal pura, 43 por ciento afección peritonal únicamente y 27.58 por ciento compromiso mixto (enteroperitoneal). Los exámenes endoscópicos han permitido el diagnóstico hasta en 90 por ciento de casos. La Laparoscopía ha permitido precisar compromiso peritoneal en 70 por ciento de casos. Seis pacientes de nuestra serie han requerido Laparotomía exploratoria para el diagnóstico. El tratamiento ha sido efectivo en 86 por ciento de casos evaluados con esquemas cortos de 6 a 9 meses. Conclusión: El diagnóstico de la Tuberculosis Digestiva sigue siendo tedioso, largo y costoso. La incidencia de ésta en nuestro Servicio de Hospitalización se ha incrementado desde 1993. Requiere de exámenes invasivos para el diagnóstico definitivo en la totalidad de casos revisados.

Manejo exitoso de hemorragia por várice yeyunal con escleroterapia y endoligadura: reporte de un caso / Successful handling of hemorrhages due to jejunal variceal vein with sclerotherapy and endoligature: a report on one case

Se reporta el caso de un paciente cirrótico, sometido previamente a escleroterapia de várices esofágicas y gastrectomía total, que presentó una hemorragia activa de várice yeyunal, en quien el tratamiento con escleroterapia y posterior endoligadura fue exitoso resolviendo el problema variceal.

[DIGESTIVE TUBERCULOSIS IN THE EDGARDO REBAGLIATI MARTINSHOSPITAL (HNERM): A RETROSPECTIVE STUDY OVER A FIVE-YEAR PERIOD (1993-1998)] / Tuberculosis digestiva en el Hospital NacionalEdgardo Rebagliati Martins(HNERM): Un estudio retrospectivo de 5 años(1993-1998).

INTRODUCTION: Tuberculosis is a common disease in Peru.Although there is evidence of the decrease in lung infections, abdominaltuberculosis and other extrapulmonary varieties show an increase in incidence. This study was performed in order lo determine incidence, clinical picture, diagnostic methods and procedures, compromised tissues and organs and treatment given to patients with Digestive Tuberculosis in the Hospitalization Area of the Digestive Disease Department of the Peruvian "Edgard Rebagliati Martins" Hospital in Lima-Peru, a 1-500 bed Center. METHODS: 77 clinical records were reviewed, of patients discharged and diagnosed with Abdominal or Digestive Tuberculosis between January 1993 to May 1998. Fifty eight of these records fuifilled the requirements. Results: The mean duration of symptoms was 5.49 months. The clinical characteristics are unspecific. The most frequent symptoms were weight loss, chronic diarrhea, abdominal pain and fever (over 70% of cases). The most common signs were abdominal pain, ascites and cachexia in more than 50% of the cases. The Laboratory tests are typical for chronic diseases and emphasize the erythrocite sedimentation rate that was high in 98% of cases. Adenosin Deaminase Assay (ADA) in ascific fluid was high in 95% of cases when peritoneal compromise was present and fluid could be obtained. The Radiology tests such as barium colon enema and intestinal transit tests were helpful together with Ultrasound and Computerized Tomography in detecting the intestinal location of the disease, the organs that had been affected as well assisting as to the decision to perform further invasive tests. We found 27.58% with gastrointestinal location, 43% with only peritoneal affection and 27.58% of mixed forms (gastrointestinal plus peritoneal). The endoscopic procedures have been decisive for the diagnosis of up to 90% of cases and Laparascopy has been of value, in up to 70% of the cases, for the detection of peritoneal affection. Six patients of our series have required exploratory Laparascopy for diagnosis. Treatment has been effective in 86% of cases. CONCLUSION: The diagnosis of Digestive Tuberculosis continues to be long, tedious and expensive. The incidence of this disease has increased in our Hospitalization Center since 1993. All cases reviewed require invasive procedures (endoscopic) or surgery for their final diagnosis. We emphasize the use of Laparoscopy tests for the evaluation of p0eritoneal affection.

[SUCCESSFUL HANDLING OF HEMORRHAGES DUE TO JEJUNALVARICEAL VEIN WITH SCLEROTHERAPY AND ENDOLIGATURE: A REPORT ON ONE CASE] / Manejo exitoso de hemorragia por váriceyeyunal con escleroterapia y endoligadura: Reporte de un caso.

A case of jejunal bleeding is reported. A 68-year-o1d man, who suffered previous gastrectomy and sclerotherapy for esophageal varices presented jejunal variceal bleeding. These varices were sclered and banded with good results.

Tratamiento con inyección endoscópica de la úlcera péptica sangrante / Endoscopic injection treatment of bleeding peptic ulcer

Objetivos: Fueron dos, 1)Determinar la eficacia de la terapia de inyección endoscópica (TIE) en pacientes con sangrado por úlcera péptica con .alto riesgo de recurrencia, y 2)Reconocer los factores de riesgo clínico-endoscópicos que influyen en la recurrencia de hemorragia y la mortalidad por esta patología. Métodos: Es un estudio retrospectivo que incluye 121 pacientes admitidos a una unidad especializada en el manejo de hemorragia digestiva debido a una úlcera péptica con sangrado activo o vaso visible no sangrante, entre Marzo de 1994 y Febrero de 1996, y a los que se les realizó TIEcon adrenalina. Resultados: Se logró éxito en la hemostasia endoscópica inicial en 119 pacientes (99.1 por ciento), en un paciente la hemorragia persistió (0.9 por ciento), y en otro no se pudo realizar la TIE por inaccesibilidad. La hemostasia definitiva se alcanzó en 93 pacientes (77.5 por ciento), y hubo recurrencia en 28 (23.5 por ciento).Se remitió a cirugía a 26 pacientes (21.5 por ciento). El examen univariado demostró que la recurrencia de la hemorragia estuvo relacionada con la presencia de shock (p=0.002), hematemesis (p=0.02),edad mayor de 60 años (p=0.009), número de unidades transfundidas (p=O.OOOOO) y tamaño de la úlcera mayor de 2cm (p=0.018). La mortalidad global en nuestros pacientes fue de 10 por ciento, y la mortalidad operatoria de 34.6 por ciento. Los factores asociados significativamente con la mortalidadfueron la recurrencia de la hemorragia (p=0.000003), presencia de enfermedad concomitante (p=0.05), la presencia de úlcera gástrica (p=0.021), además de la edad (mayores de 60años), presencia de.shock y tamaño de la úlcera mayor de 2cm (P=0.05). Conclusiones: La TIE es un procedimiento útil en el tratamiento de la hemorragia por úlcera péptica con alto riesgo de recurrencia (hemorragia activa o vaso visible), habiéndose obtenido la hemostasia definitiva en el 77.5 por ciento...

Background: Objectives were two. (1) to determine the efficiency of the endoscopic injection therapy (EIT) in patients suffering from bleeding caused by peptic ulcer disease with high risk of recurrence, and (2) to recognize clinical and endoscopical risk factors that influence recurrence of hemorrhage and mortality from this pathology. Methods: This is a retrospective study that included 121 patients, who were admitted by a unit specialized in managing gastrointestinal hemorrhage owing to peptic ulcer with active bleeding or non-bleeding visible vessel, and who underwent EIT with epinephrine between March, 1994 and February, 1996. Results: Initial success was achieved in 119 patients who underwent EIT (99.1 per cent). Bleeding persisted in one patient (0.9 per cent), and in another one, EIT was not successful because of inaccessible location. Definite hemostasis was achieved in 93 patients (77.5 per cent) and there was recurrence in 28 cases (23.5 per cent). Twenty-six patients underwent surgical therapy (21.5 per cent).The univariable analysis showed that hemorrhage recurrence was related to the presence of shock (p=0.002), hematemesis (p=0.2), age over 60 (p=0.009), number of blood units transfused (p=O.OOOOO) and ulcer diameter larger than 2 cm (p=0.018). The global mortality in our patients was of 10 per cent, and surgical mortality was of 34.6 per cent. Factors significantly related to mortality were hemorrhage recurrence (p=0.000003), presence 01concomitant disease (p=0.05), and presence of gastric ulcer (p=0.021), in addition to age (over 60), presence of shock and ulcer diameter larger than 2 cm (p=0.05). Conclusion: EIT is a valuable procedure for the treatment of hemorrhage caused by peptic ulcer with high risk of recurrence (active hemorrhage or visible vessel), with a definite hemostasis of 77.5 per cent...

[ENDOSCOPIC INJECTION TREATMENT OF BLEEDING PEPTIC ULCER] / Tratamiento con Inyección endoscópicade la úlcera péptica sangrante.

BACKGROUND: Objectives were two. (1) to determine theefficiency of the endoscopic injection therapy (EIT) in patients suffering from bleeding caused by peptic ulcer disease with high risk of recurrence, and (2) to recognize clinical and endoscopical risk factors that influence recurrence of hemorrhage and mortality from this pathology. METHODS: This is a retrospective study that included 121 patients, who were admitted by a unit specialized in managing gastrointestinal hemorrhage owing to peptic ulcer with active bleeding or non-bleeding visible vessel, and who underwent EIT with epinephrine between March, 1994 and February, 1996.RESULTS: Initial success was achieved in 119 patients who underwent EIT (99,1%). Bleeding persisted in one patient (0,9%), and in another one, EIT was not sucessful because of inaccessible location. Definite hemostasis was achieved in 93 patients (77,5%) and there was recurrence in 28 cases (23,5%). Twenty-six patients underwent surgical therapy (21,5%). The univariable analysis showed that hemorrhage recurrence was related to the presence of shock (p = 0,002), hematemesis (p = 0,2), age over 60 (p = 0,009), number of blood units transfused (p = 0,00000) and ulcer diameter larger than 2 cm (p = 0,018). The global mortality in our patients was of 10%, and surgical mortality was of 34,6%. Factors significantly related to mortality were hemorrhage recurrence (p = 0,000003), presence of concomitant disease (p = 0,05), and presence of gastric ulcer (p = 0,021), in addition to age (over 60), presence of shock and ulcer diameter larger than 2 cm (p = 0,05).CONCLUSION: EIT is a valuable procedure for the treatment of hemorrhage caused by peptic ulcer with high risk of recurrence (active hemorrhage or visible vessel), with a definite hemostasis of 77,5%. The presence of shock, hematemesis, age over 60, transfusion requirements of more than 3 blood units, and ulcer diameter of more than 2 cm are factors that increase the probability of hemorrhage recurrence after EIT. Mortality is significantly related to the presence of hemorrhage recurrence, concomitant diseases and gastric ulcer in addition to clinical and endoscopical factors mentioned above, with the exception of hematemesis and transfusion requirement. A prompt surgery after detection of a major bleeding recurrence in patients with the risk factor already described and a coordinate action with a surgery team experienced in digestive hemorrhage would influence favorably the mortality rate of this disease.

Síndrome de inmunodeficiencia adquirida (SIDA): predominancia de las manifestaciones digestivas en su perfil clínico de presentación en Lima / Adquired immunodeficiency syndrome (AIDS): digestive manifestations dominance in its clinical profile of presentation in Lima, PE

Se estudian nueve casos de Síndrome de Inmunodeficiencia Adquirida (SIDA), en el Hospital Nacional "Edgardo Rebagliati Martins" - Instituto Peruano de Seguridad Social de Lima-Perú, observados en el curso de los últimos veintiocho meses y que cumplen con los requisitos propuestos por el "Center for Disease Control" (CDC) de Atlanta. Ocho pacientes (89%) fueron homosexuales, los cuales referían contacto íntimo con extranjeros: en USA (dos) y en Lima (seis). La única mujer tenía el antecedente de múltiples transfusiones hace tres años en un hospital de París (Francia). La edad promedio fué de 39 años y el tiempo de enfermedad promedio fué de 8 meses. La mayoría se presentó con: diarrea crónica (100%), baja de peso (100%), síndrome general (100%), fiebre (77%), muguet oral (78%) y molestias proctológicas (45%). Los exámenes auxiliares mostraron anemia (78%), velocidad de sedimentación incrementada (100%), hipoalbuminemia (78%), linfopenia periférica (100%) y definida anergia cutánea (100%). El estudio de las subpoblaciones de linfocitos T (OKT4 y OKT8) se encontró alterado en 9/9 (100%), lo que demostró la severa depresión de la inmunidad celular; la detección de anticuerpos contra el Virus de la Inmunodeficiencia humana (HIV) 9/9 (100%) y la prueba de Western blot positiva 6/6 (100%) fueron diagnósticas. Candidiasis oral y/o esofágica presentaron 78%; infecciones intestinales severas y recurrentes con enteropatógenos "clasicos" en nuestro medio (Salmonella, Shigella, E. coli, etc.) 56%; infestación recurrente con Giardia lamblia 33%; un paciente presentó meningitis por Cryptococcus neoformans, que luego se diseminó, el mismo paciente fué atacado sistémicamente por el Citomegalovirus (CMV); otro paciente mostró evidencias de CMV en orina y títulos diagnósticos de actividad de este virus en sangre...