[Factors related to a suboptimal bowel preparation for colonoscopy]. / Factores relacionados a una subóptima preparación intestinal para la colonoscopía.

INTRODUCTION: Colonoscopy is the standard method for the evaluation of the colon. A suitable intestinal cleaning is critical for the effectiveness and security of the procedure, but unfortunately there is a high proportion of suboptimal bowel preparation. OBJECTIVE: To identify factors related to suboptimal bowel preparation. METHODS: We performed an analytic, observational, cross-sectional and prospective study. We included all outpatients scheduled for colonoscopy in the Peruvian-Japanese Health Center between January and July 2012. We excluded patients with a complete or partial colonic resection. In patients with two or more colonoscopies during the study interval, only the first procedure was considered. Aronchick scale was used in assessment of bowel cleaning. The variables studied with relationship to bowel preparation were: age, sex, grade ofeducation, body mass index, time of examination, history (diabetes mellitus, stroke, cirrhosis, use of antidepressants/anxiolytics, number of bowel movements per week, abdominal surgery, personal history of previous colonoscopy, polyps and colon cancer, family history of colon cancer), received purgative, additional laxative, indication for colonoscopy and adverse effects of the preparation. Statistical analysis was made with SPSS v.160. For the categorical variables we used chi square test or Fisher exact test, whereas for continuous variables the Mann Whitney test was used. The variables significantly associated with suboptimal preparation in the univariated analysis were included in a multivariate analysis using logistic regression. RESULTS: We included 841 patients. The bowel preparation was suboptimal in 438 patients (52.1%). The univariate analysis showed that the factors related to suboptimal preparation were age (P = 0.023) and body mass index ≥ 30 kg/m2 (P = 0.021). The multivariate analysis confirmed that age ≥ 70 years old (P = 0.001) and body mass index ≥ 30 kg/m2 (P = 0.010) were the variables related to suboptimal bowel preparation. CONCLUSIONS: Age greater than 70 years old and obesity are factors related to suboptimal bowel preparation.

[Quality indicators for colonoscopy in the Peruvian Japanese Policlinic: linked factors]. / Indicadores de calidad en colonoscopía en el Policlínico Peruano Japonés: factores relacionados.

INTRODUCTION: Colonoscopy is the gold standard for the diagnosis of diseases of the colon and rectum and the primary prevention test for colon cancer. The main indicators of quality in colonoscopy are the rate of complete colonoscopy and the rate of detected adenomas. OBJECTIVES: We aimed to know the rates of cecal intubation and detection of adenomas and to identify factors related to these two quality indicators in colonoscopies performed in the Peruvian Japanese Policlinic during 2007. MATERIAL AND METHODS: A correlational cross-sectional and retrospective study was performed. Data were collected from the colonoscopies performed by 10 endoscopists in the Peruvian Japanese Policlinic during 2007. RESULTS: We included 843 colonoscopies. Cecal intubation was achieved in 801 patients (95%). The multivariate analysis found that cecal intubation was correlated with the type of sedation/analgesia and the quality of bowel preparation. At least one adenoma was detected in 168 colonoscopies (19.9%). Multivariate analysis found that age, colonic cleansing and time of withdrawal were factors significantly associated with the detection of adenomas. CONCLUSIONS: The quality of colonoscopy depends on several factors: bowel preparation, type of sedation/analgesia and time of withdrawal. These are the targets on which we can act to improve performance.

[PREGNANCY AND LIVER CIRRHOSIS: REPORT OF A CASE] / Cirrosis Hepática y Gestación:Reporte de un Caso.

Pregnancy in women with liver cirrhosis is unusual, because of the metabolic alterations that the liver disease produces.We report a case of a cirrhotic alcoholic patient who was pregnant twice. The first pregnancy was successful delivering a baby of 2,500g. On the second one, the patient died because of digestive hemorrahage caused esophageal varices the fetus also died.

[GASTRIC CANCER IN PATIENTS YOUNGER THAN FORTY YEARS OLD.HOSPITAL LOAYZA EXPERIENCE BETWEEN 1991 - 1998] / Cáncer Gástrico en pacientes menores de 40 a os, en el Hospital A. Loayza entre 1991 - 1998.

A retrospective study was performed on patients diagnosed of gastric cancer, younger than 40 years old, in the Hospital Arzobispo Loayza, from January 1991 to December 1998.We found 81 patients younger than 40 years old, with confirmed diagnosis of gastric adenocarcinoma; we reviewed the records of 59 patients.There were 44 (74.6%) women and 15 (25.4%) men. The mean age was 31.644 +- 5.437 years and the mean duration of symptoms was 13.189 months.The most common symptoms were: epigastric pain (89.8%), weight loss (86.4%), dyspepsia (64.4%),vomiting (64.4%) and nausea (62.7%). The most frequent physical findings were pallor (62.7%), epigastric tenderness (40.7%) and emaciation (37.3%). 57.8% of patients had hemoglobine levels of less than 11 gr/dl.The most frequent location of the neoplasm was the antrum (31.1%) followed by the body (27.3%).On endoscopy, we observed that the most frequent lesion was advanced gastric cancer, Borrmann III (48%), followed by Borrmann IV (27.3%). The predominant histologic type was undifferentiated adenocarcinoma.

[Sedation used during colonoscopies at the Peruvian-Japanese policlinic. Their relationship with quality indicators]. / Sedación Utilizada en las Colonoscopías en el Policlínico Peruano Japonés y su Relación con Indicadores de Calidad.

INTRODUCTION: The practice of sedation used during colonoscopy vary widely between countries, even gastroenterologists and endoscopy centers. Knowing the type of sedation used at present and its relationship to quality indicators of colonoscopy, will help improve the quality of it. OBJECTIVES: To determine the type of sedation used for colonoscopies in the Japanese Peruvian Polyclinic, and its relation to quality indicators in colonoscopy: cecal intubation rate and detection rate of adenomas MATERIAL AND METHODS: A retrospective cross-sectional correlational. Data were recorded colonoscopies performed in the Japanese Peruvian Polyclinic during 2007, which were conducted by 10 endoscopists RESULTS: We included 843 colonoscopies, of which 63.1% received moderate sedation, deep sedation, 36.7% and only 0.2% received no sedation. Moderate sedation was performed most commonly with the combination midazolam + meperidine, whereas deep sedation propofol used almost exclusively in combination with other agents. An anesthesiologist was present in 38.4% of the colonoscopies. Statistical analysis showed significant differences in cecal intubation rate when deep sedation was used: 96.1% compared to the moderate: 94.5% (p = 0.009). Equally significant difference in adenoma detection rate with deep sedation, 26.9%, compared with the moderate: 15.8% (p = 0.000). Immediate complications were reported in 9% of procedures was more common when deep sedation was used: 13.3% compared to the moderate: 6.4% (p = 0.003). CONCLUSIONS: The moderate sedation was the most common method of sedation used for colonoscopies in the Japanese Peruvian Polyclinic. Deep sedation was associated with higher rates of cecal intubation and adenoma detection, but also in more immediate complications. KEYWORDS: sedation, colonoscopy, colonoscopy quality.

[Role of the endoscopist in the detection of adenomatous polyps during colonoscopy]. / Papel del Endoscopista en la Detección de Pólipos Adenomatosos Durante la Colonoscopia.

INTRODUCTION: Age, gender and indication for the examination are known predictors of adenomatous polyp detection during colonoscopy. But no one knows the importance of the endoscopist in detection. OBJECTIVES: To determine the role of the endoscopist in detecting adenomatous polyps during colonoscopy MATERIAL AND METHODS: Is retrospective cross-sectional correlational study. Data were recorded colonoscopies performed in the Japanese Peruvian Polyclinic during 2007, which were conducted by 10 endoscopists RESULTS: A total of 843 colonoscopies. Statistical analysis showed significant differences between endoscopists regarding the detection rate of adenomatous polyps (p = 0.038). The range for the detection of at least 1 adenomatous polyp by colonoscopy was 14,6-30,0%. In patients over 50 years, there were also significant differences between endoscopists in detection rate of adenomatous polyps (p = 0.001). The range for the detection of at least 1 adenomatous polyp was 18,2-37,5% in that group.Also found that age and gender were powerful predictors of adenomatous polyps, both for the total cohort, and patients older than 50 years. Regarding the indication for colonoscopy, no significant difference between the categories, were found p = 0.288 CONCLUSION S: The endoscopist is as or more important than age, gender or indication for the examination, in predicting the detection of adenomatous polyps during colonoscopy.

[Optimal age for gastric cancer screening in patients with dyspepsia without alarm symptoms]. / Edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma.

OBJECTIVE: To determine the optimal age for screening endoscopy on patients with dyspepsia without alarm symptoms to avoid missing gastric cancer. METHODS: A Cross sectional study was performed (2001-2005). 285 cases of patients with dyspepsia and gastric cancer were found at Arzobispo Loayza National Hospital. Cumulative age frequencies and percentiles were used to determine the optimal age for screening endoscopy. Both groups, with and without alarm symptoms were compared using the chi-square test for categorical data. Continuous data was expressed as mean (SD) and was compared with the t- test. Significant values of p were specified as <0.05. RESULTS: A total of 32,388 upper endoscopic procedures in dyspeptic patients were performed and 285 cases of gastric cancer were diagnosed, 45 cases of them not featuring any alarm symptoms were found. There were no differences in cumulative frequency between the <35 and <40 years old, with a frequency of 0.29 and 0.20 per 1000 endoscopies, respectively. If the age of 40 had been taken as the optimal age for screening, 4 cases of gastric cancer (8.9%) would have been missed (one case per year approximately), one case would have been an early gastric cancer. The 5th percentile was 30.3 years old and the 10th was 39.4. If the age of 45 had been taken as the optimal age for screening, 6 (15%) cases of gastric cancer would have been missed and 12 (27%) cases if the age was 55 years old. There was no statistical difference between gender, age and duration of dyspepsia. On the other hand, relations between type of dyspepsia (ulcerative), type of lesion, position, histology and stage of gastric cancer for both groups were found. CONCLUSION: It's recommended that the optimal age for endoscopic screening for gastric cancer in dyspeptic patients without alarm symptoms for both genders, should be over 40 years old.

Sedación utilizada durante las colonoscopías en el policlínico peruano japonés y su relación con indicadores de calidad / Sedation used during colonoscopies at the peruvian-japanese policlinic: their relationship with quality indicators

INTRODUCCIÓN: Las prácticas de sedación utilizadas durante las colonoscopias varían ampliamente entre países, centros endoscópicos y aún gastroenterólogos. Conocer el tipo de sedación utilizada actualmente y su relación con indicadores de calidad en colonoscopía, ayudará a mejorar la calidad de la misma. OBJETIVOS: Conocer el tipo de sedación utilizada durante las colonoscopias en el Policlínico Peruano Japonés, y su relación con indicadores de calidad en colonoscopía: tasa de intubacióncecal y tasa de detección de adenomas. MATERIAL Y MÉTODOS: Estudio correlacional observacional transversal y retrospectivo. Se registraron los datos de las colonoscopías realizadas en el Policlínico Peruano Japonés durante el año 2007, las cuales fueron realizadas por 10 endoscopistas. RESULTADOS: Se incluyeron 843 colonoscopías, de las cuales el 63,1 por ciento recibió sedación moderada, el 36,7 por ciento sedación profunda y sólo el 0,2 por ciento no recibió sedación. La sedación moderada se llevó a cabo más comúnmente con la combinación midazolam + meperidina, en tanto que la sedación profunda utilizó casi exclusivamente propofol, en combinación con otro agentes. Un anestesiólogo estuvo presente en el 38,4% de las colonoscopias. El análisis estadístico mostró diferencias significativas en la tasa de intubación cecal cuandose usó sedación profunda: 96,1 por ciento respecto a la moderada: 94,5 por ciento (p=0,009). Igualmente hubo diferencias significativas en la tasa de detección de adenomas con la sedación profunda: 26,9 por ciento , respecto a la moderada: 15,8 por ciento (p=0,0001). Se reportaron complicaciones inmediatas en el 9 por ciento de procedimientos, siendo más comunes cuando se usó sedación profunda: 13,3 por ciento , respecto a la moderada: 6,4 por ciento (p=0,003)...

INTRODUCTION: The practice of sedation used during colonoscopy vary widely between countries, even gastroenterologists and endoscopy centers. Knowing the type of sedationused at present and its relationship to quality indicators of colonoscopy, will help improve the quality of it. OBJECTIVES: To determine the type of sedation used for colonoscopies in the Japanese Peruvian Polyclinic, and its relation to quality indicators in colonoscopy: cecal intubation rateand detection rate of adenomas. MATERIAL AND METHODS: A retrospective cross-sectional correlational. Data were recorded colonoscopies performed in the Japanese Peruvian Polyclinic during 2007, which were conducted by 10 endoscopists. RESULTS: We included 843 colonoscopies, of which 63.1 percent received moderate sedation, deep sedation, 36.7 percent and only 0.2 percent received no sedation. Moderate sedation was performed most commonly with the combination midazolam + meperidine, whereas deep sedation propofol used almost exclusively in combination with other agents. An anesthesiologist was present in 38.4 percent of the colonoscopies. Statistical analysis showed significant differences in cecal intubation rate when deep sedation was used: 96.1 percent compared to the moderate: 94.5 percent (p = 0.009). Equally significant difference in adenoma detection rate with deep sedation, 26.9 percent ,compared with the moderate: 15.8 percent (p = 0.000). Immediate complications were reported in 9 percent of procedures was more common when deep sedation was used: 13.3 percent compared to themoderate: 6.4 percent (p = 0.003). CONCLUSIONS: The moderate sedation was the most common method of sedation used for colonoscopies in the Japanese Peruvian Polyclinic. Deep sedation was associated with high errates of cecal intubation and adenoma detection, but also in more immediate complications.

[Hereditary hemochromatosis]. / Hemocromatosis hereditaria.

The case of a 43-year-old male is presented, with diagnosed diabetes mellitus,heart failure, skin pigmentation, hepatic cirhosis, and hereditary hemochromatosis confirmed by liver biopsy. The objective of this publication is to have hemochromatosis in mind as a differential diagnosis in a middle-aged patient with several pathologies and organs involved.

Papel del endoscopista en la detección de pólipos adenomatosos durante la colonoscopia / Role of the endoscopist in the detection of adenomatous polyps during colonoscopy

INTRODUCCIÓN: Edad, género e indicación para el examen son conocidos predictores de detección de pólipos adenomatosos durante colonoscopía. Pero no se conoce la importancia del endoscopista en dicha detección.OBJETIVOS: Determinar el papel del endoscopista en la detección de pólipos adenomatosos durante la colonoscopíaMATERIAL Y MÉTODOS: Estudio correlacional observacional transversal y retrospectivo. Se registraron los datos de las colonoscopías realizadas en el Policlínico Peruano Japonés durante el año 2007, las cuales fueron realizadas por 10 endoscopistas. RESULTADOS: Se incluyeron 843 colonoscopías. El análisis estadístico mostró diferencias significativas entre endoscopistas respecto a su tasa de detección de pólipos adenomatosos (p=0,038). El rango para la detección de al menos 1 pólipo adenomatosopor colonoscopía fue de 14,6-30,0 por ciento. En los pacientes mayores de 50 años, también hubo diferencias significativas entre endoscopistas en su tasa de detección de pólipos adenomatosos (p=0,001). El rango para la detección de al menos 1 pólipo adenomatoso fue de 18,2-37,5 por ciento en dicho grupo. Igualmente se determinó que la edad y el género fueron poderosos predictores de pólipos adenomatosos, tanto para la cohorte total, como para los pacientes mayores de 50 años. Respecto a la indicación para la colonoscopía, no se encontró diferencia significativa entre las categorías, con un p=0.288. CONCLUSIONES: El endoscopista es tan o más importante que la edad, género o indicación para el examen, en predecir la detección de pólipos adenomatosos durante la colonoscopia.

INTRODUCTION: Age, gender and indication for the examination are known predictors of adenomatous polyp detection during colonoscopy. But no one knows the importanceof the endoscopist in detection.OBJECTIVES: To determine the role of the endoscopist in detecting adenomatous polyps during colonoscopy. MATERIAL AND METHODS: Is retrospective cross-sectional correlational study. Datawere recorded colonoscopies performed in the Japanese Peruvian Polyclinic during 2007, which were conducted by 10 endoscopists. RESULTS: A total of 843 colonoscopies. Statistical analysis showed significant differencesbetween endoscopists regarding the detection rate of adenomatous polyps (p = 0.038). The range for the detection of at least 1 adenomatous polyp by colonoscopy was 14,6-30,0 percent.In patients over 50 years, there were also significant differences between endoscopists in detection rate of adenomatous polyps (p = 0.001). The range for the detection of atleast 1 adenomatous polyp was 18,2-37,5 percent in that group.Also found that age and gender were powerful predictors of adenomatous polyps, both for the total cohort, and patients older than 50 years. Regarding the indication for colonoscopy, no significant differencebetween the categories, were found p = 0.288. CONCLUSION S: The endoscopist is as or more important than age, gender or indication for the examination, in predicting the detection of adenomatous polyps during colonoscopy.

Edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma / Age optimal for endoscopic screening for gastric cancer in patients with dyspepsia symptoms without alarm

Objetivo: Determinar la edad óptima de despistaje de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma. MÉTODO: Estudio analítico, descriptivo y retrospectivo (2001-2005). Se analizó 285 casos de pacientes con dispepsia y cáncer gástrico en el Hospital Nacional Arzobispo Loayza, calculándose la frecuencia acumulativa por edad y grupo etáreo, así como también por estudio de percentiles, para determinar la edad óptima de despistaje endoscópico. Ambos grupos, con y sin signos de alarma fueron analizados con frecuencias relativas y absolutas, Chi-cuadrado y test de Student según la variable categórica o contínua respectivamente. Se consideró valores significativos de p<0.05. RESULTADOS: De 32,388 endoscopías realizadas en pacientes por motivo de dispepsia, se encontró 285 casos confirmados de cáncer gástrico, 45 de ellos sin signos de alarma. No hubo diferencia en la frecuencia acumulativa <35 y <40 años, con una pérdida de casos de cáncer gástrico de 0.29 y 0.30 por 1000 endoscopías, respectivamente. Al tomarse 40 años como edad óptima de despistaje, se perderían 4 casos (8.9 por ciento, aproximadamente 1 caso por año), de los cuales uno sería cáncer gástrico precoz. El percentil 5 fue 30.3 años y el 10 fue 39,4 años. Si se hubiera tomado una edad de 45 años se habrían perdido 6 casos (15 por ciento) y 12 (27 por ciento), si la edad se elevaba a 55 años. No hubo diferencia estadísticamente significativa entre el sexo, edad y duración de la dispepsia. Por el contrario, sí existió relación con el tipo de dispepsia (ulcerosa), tipo de lesión, localización, histología y el estadío del cáncer gástrico para ambos grupos. CONCLUSIÓN: Se recomienda que la edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma, sea a partir de los 40 años de edad para ambos sexos.

Objective: To determine the optimal age for screening endoscopy on patients withdyspepsia without alarm symptoms to avoid missing gastric cancer. Methods: A Cross sectional study was performed (2001-2005). 285 cases of patientswith dyspepsia and gastric cancer were found at Arzobispo Loayza National Hospital. Cumulative age frequencies and percentiles were used to determine the optimal age for screening endoscopy. Both groups, with and without alarm symptoms were comparedusing the chi-square test for categorical data. Continuous data was expressed as mean (SD) and was compared with the t- test. Significant values of p were specified as mayor 0.05. Results: A total of 32,388 upper endoscopic procedures in dyspeptic patients were performed and 285 cases of gastric cancer were diagnosed, 45 cases of them not featuring any alarm symptoms were found. There were no differences in cumulative frequency between the mayor 35 and mayor 40 years old, with a frequency of 0.29 and 0.20 per 1000 endoscopies, respectively. If the age of 40 had been taken as the optimal age for screening, 4 cases of gastric cancer (8.9 per cent) would have been missed (one case per year approximately),one case would have been an early gastric cancer. The 5th percentile was 30.3 years old and the 10th was 39.4. If the age of 45 had been taken as the optimal age for screening, 6 (15 per cent) cases of gastric cancer would have been missed and 12 (27 per cent) cases if the age was 55 years old. There was no statistical difference between gender, age and duration of dyspepsia. On the other hand, relations between type of dyspepsia (ulcerative), type of lesion, position, histology and stage of gastric cancer for both groups were found. Conclusion: It´s recommended that the optimal age for endoscopic screening for gastric cancer in dyspeptic patients without alarm symptoms for both genders, should be over 40 years old.

Cáncer gástrico incipiente: reporte de 40 casos / Early gastric cancer: report of 40 cases

Se revisan los aspectos clínicos y epidemiológicos de 40 pacientes con el diagnóstico de cáncer gástrico incipiente. Eran menores de 40 años un 27.5 por ciento y mayores de dicha edad, el 72.5 por ciento. Predominó el sexo femenino con 65 por ciento. Las lesiones ulceradas y deprimidas llegaron al 79 por ciento. La sintomatología clínica referida fue síndrome ulceroso en 42.5 por ciento y epigastralgia no característica en 35 por ciento; los síntomas duraron menos de 6 meses o entre 6 y 12 meses o entre 1 y 2 años, en cerca al 30 por ciento en cada grupo. Como antecedente, en 25 por ciento del total se encontró diagnóstico radiológico y/o endoscópico de úlcera péptica gástrica o de haber obtenido alivio con tratamiento antiulceroso

Pancreatitis aguda: aplicación de un nuevo sistema de estadiaje pronóstico / Acute pancreatitis: use of a new prognostic stage system

La pancreatitis aguda tiene una amplia gama de severidad siendo fundamental predecir los casos graves. En tal sentido, se han desarrollado múltiples sistemas de evaluación valiéndose de exámenes auxiliares. El objetivo del estudio fue aplicar el sistema clínico de estadiaje pronóstico de Rabeneck (basado en el examen físico y las condiciones comórbidas), clasificados en estadíos I, II y III. Se realizó un estudio retrospectivo en 51 pacientes admitidos al Hospital Arzobispo Loayza, de 1988 a 1994. Correspondieron al sexo femenino 42 (82.4%) y 9 (17.6%) al masculino. Edad promedio 40.3 años. La estancia hospitalaria varió de 3 a 41 días. Ecográficamente se encontró alteraciones del páncreas en 84.4% y litiasis vesicular en 57.7%. Las tasas de mortalidad según el sistema de Rabeneck fueron estadío I: O de 44 (0%); estadío II:1 de 4 (25%); estadío III: 2 de 3 (66.7%). Se concluye que el nuevo sistema de estadiaje pronóstico es de fácil aplicación, sencillo y no requiere datos de laboratorio, siendo útil para nuestra realidad.

The spectrum of clinical severity of acute pancreatitis varies widely, but the most important is to predict high risk patients, so that, a number of classification systems have been proposed with the main focus is on laboratory findings. The purpose of this paper was to validate the Rabeneck Clinical prognostic staging system (using clinical features and comorbid illness) which classified in three stages: I, II and III. We conducted a retrospective study in 51 patientes admitted to Hospital Arzobispo Loayza, from 1988 to 1994. 42 (82.4%) were female and 9 (17.6%) male. The average age was 40.3 years. The range hospital stay was 3 to 41 days. Ultrasonographycally we found some alterations in pancreas texture about 84.4% and galibladder stones in 57.7%. The mortality rates according to Rabeneck system were stage I: O of 44 (0%); stage II: 1 of 4 (25%); stage III 2 of 3 (66.7%) In conclusion the new prognostic staging system in easy to use, simple and require no additional laboratory test, so that utility to our institutional situation.

Cáncer gástrico en pacientes menores de 40 años, en el Hospital Arzobispo Loayza entre 1991 - 1998 / Gastric cancer in patients younger than forty years old. Hospital Loayza experience betwen 1991 - 1998

Se realizó un estudio retrospectivo entre los pacientes diagnosticados de cáncer gástrico, menores de 40 años, en el Hospital Nacional Arzobispo Loayza, en el período comprendido entre enero de 1991 y diciembre de 1998. Se encontró 81 pacientes, menores de 40 años, con diagnóstico confirmado histológicamente de adenocarcinoma gástrico, obteniéndose la historia clínica de 59 pacientes. El 74.6 por ciento (44) de pacientes era de sexo femenino y el 25.4 por ciento (15) de sexo masculino. La edad promedio fue de 31.644 mas 5.437 años de edad y el tiempo de enfermedad promedio fue 13.189 meses. Los síntomas más frecuentes fueron: dolor epigástrico (89.8 por ciento), pérdida de peso (86.4 por ciento), dispepsia (64.4 por ciento), vómitos (64.4 por ciento) y nauseas (62.7 por ciento). Los signos clínicos más frecuentes fueron: palidez (62.7 por ciento), dolor epigástrico a la palpación (40.7 por ciento) y adelgazamiento (37.3 por ciento). El 57.8 por ciento de pacientes tuvieron niveles de hemoglobina en rangos inferiores a lo normal. La localización más frecuente de la lesión gástrica fue el antro (31.1 por ciento), seguida por el cuerpo (27.3 por ciento). Endoscópicamente se observó que el tipo de lesión más frecuente fue la de cáncer gástrico avanzado, Borrmann III (48 por ciento), seguida por Borrmann tipo IV (27.3 por ciento). El 84 por ciento (68/81) de los pacientes presentaron diagnóstico histológico de adenocarcinoma gástrico indiferenciado.

Cáncer gástrico incipiente / Early gastric cancer

Se presenta un trabajo de revisión sobre cáncer gástrico incipiente, iniciándose con una recopilación de los hechos importantes que permitieron el avance en el diagnóstico y tratamiento. Se señala la definición y clasificación de la escuela Japonesa. Se revisan los trabajos importantes descritos en el Japón y otros países con los reportado en el Perú, señalándose la distribución por edad, la sintomatología clínica, las formas más frecuentes en el diagnóstico, las características diferenciales con otras lesiones y la proporción entre cáncer gástrico incipiente y avanzado, observándose que mientras en el Japón existe un incremento progresivo en los años sucesivos que llega a más del 50% de los casos; en Perú no hay un incremento significativo, a pesar de la difusión de conocimientos y mejor equipamiento. Se analizan los factores que retardan el diagnóstico y se expone una estrategia que posibilite el incremento del diagnóstico del cáncer gástrico incipiente en el que se propone la conducta a seguir con el paciente sintomático y en los que se diagnostica lesión elevada o erosiva ulcerativa y en los que se consideran dentro del grupo de riesgo.

This is a work of revision on Early Gastric Cancer, begins with a compilation of significant event that allowed advances in diagnostic and treatment. This paper presents the definition and classification of the Japanese School. The work makes a review of the most important studies made in Japan and other countries and compares them with Peruvian works, denoting the incidence by ages, the clinic symtomalogy, the most usual forms in diagnostic, the characteristic that makes the difference between cancer and other lesions, besides presents the proportion between early and advanced gastric cancer and observing that while in Japan exists a progressive increase in the following years over coming 50% of the cases, in Peru there is no a significant increase, in spite of the knowledge divulging and better equipment. The woks analyses the determining factors in diagnostic dalay and finally, this study presents a strategy that facilitates the early gastric cancer diagnostic, putting up for discussion a course of treatment to the symptomatic patient and besides the strategy must to diagnostic elevated or erosive ulcus lesion in the risk group patient.

Cirrosis hepática y gestación: reporte de un caso / Pregnancy and liver cirrhosis: report of a case

La gestación en mujeres cirróticas es inusual, por las alteraciones metabólicas queesta enfermedad produce. Presentamos el caso de una paciente con cirrosis alcohólica que tuvo dos embarazos. El primero fue a término con un recién nacido de 2,500 g; en el segundo, la paciente falleció por hemorragia digestiva por várices esofágicas; hubo óbito fetal.

pregnancy in women with liver cirrhosis is unusual, beca use of the metabolic alterations that the liver disease produces. We report a case of a cirrhotic alcoholic patient who was pregnant twice. The first pregnancy was successful delivering a baby of 2,500 g. On the second one, the patient died because of digestive hemorrahage caused esophageal varices the fetus also died.

Hemocromatosis hereditaria / Hereditary hemochromatosis

Se presenta el caso de un varón de 43 años, con diagnóstico de diabetes mellitus, insuficiencia cardiaca, pigmentación de piel, cirrosis hepática, y de hemocromatosis hereditaria confirmada por biopsia hepática. El objetivo de esta publicación es tener presente como diagnóstico diferencial a la hematocromatosis ante un paciente en la edad media de la vida con varias patologías y órganos involucrados.

Tuberculosis gastrica / Gastric tuberculosis

Presentamos cinco casos de pacientes admitidos al Hospital "Arzobispo Loayza", con cuadro clínico general y gastrointestinal alto (hemorragia digestiva alta, síndrome ulceroso, masa epigástrica o sub-oclusión intestinal con asctitis), que fueron evaluados clínicamente, radiológicamente, endoscópicamente, habiendo sido diagnosticados de cáncer gástrico linfoma, úlcera péptica, gastritis, lesiones sub-mucosas etc. Una de las pacientes falleció y en los otros casos se llegó a la intervención quirúrgica, se demostró tuberculosis gástrica en el estudio anatomopatológico en los cinco casos. El tipo mixto úlcero-hipertrófico de tuberculosis gástrica fue el más frecuentemente encontrado en nuestra serie (90%), uno de los cuales se acompañaba además de una gastritis granulomatosa. El otro caso fue catalogado como una tuberculosis gástrica tipo gastritis granulomatosa. Se concluye que en nuestro medio las lesiones de tuberculosis gástrica son de difícil diagnóstico, en la mayoria de los casos son tipo mixto úlcero-hipertrófico y que en toda lesión gástrica sub-mucosa, especialmente si es ulcerada, debe tenerse en cuenta el diagnóstico de tuberculosis gástrica

Famotidina en el tratamiento de la úlcera péptica / Famotidine in peptic duodenal ulcer treatment

Este estudio abierto, multicéntrico, estuvo destinado a evaluar la eficacia, tolerancia y seguridad del nuevo antagonista de los receptores H2, Famotidina, en el tratamiento de la úlcera péptica duodenal. Treinticuatro pacientes con úlcera péptica duodenal, demostrada endoscópicamente, recibieron una tableta de Famotidina, 40mg. noche, hasta por seis semanas. Se mantuvo el tratamiento hasta documentar cicatrización de la lesión, mediante endoscopía realizada a la segunda, cuarta y sexta semana. Un paciente fue excluído por desviación del protocolo. La curación acumulativa en los 33 pacientes evaluables fue de 48.5 por ciento, 91 por ciento y 97 por ciento a la segunda, cuarta y sexta semana de tratamiento, respectivamente. El 52 por ciento de los pacientes se tornó asintomático a las 72 horas y el 79 por ciento al finalizar la primera semana. La droga fue bien tolerada y no se registraron reacciones adversas clínicas, ni de laboratorio en los treinticuatro pacientes estudiados. Se concluye que Famotidina es eficaz y bien tolerada en el tratamiento de la mayoría de pacientes con úlcera péptica duodenal