RESUMO
The hemoglobin S is a consequence of the substitution of valine for glutamic acid at position 6 of beta globin chain. The problem arises when some individuals with Hb S is moved to the mountains and exposed to hypoxia. The decrease in oxygen saturation distorts the red blood cell with HbS-shaped crescent (sickle cell). Sickle cell (rigid and fragile) tends to adhere to the other red blood cells, generating a series of intravascular alterations that can lead to tissue ischemia or infarction. The spleen by type of movement and lack of lateral communications between the branches of the splenic artery was the most susceptible to sickle cell crisis. Splenic infarction at altitude corresponding to different circumstances can evolve in three stages: a) Acute (focal, uncomplicated), b) massive attack (more than 50% of parenchyma) and c) spontaneous rupture.Early diagnosis is crucial, allowing the quick and timely introduction of various measures, including adequate hydration and oxygenation continues until its evacuation to lower altitude locations. These measures would reduce the phenomenon of sickle and some patients may overcome this acute trance without major complications. The delay in diagnosis leads to action that can exacerbate tissue hypoxia and cause ischemia or infarction of various organs. A large population of black and mixed race of African descent living in the Peruvian coast, 10% and 2% respectively have hemoglobin S; Caucasian subjects with Mediterranean ancestry this hemoglobin also can carry. It is therefore essential to disseminate within the clinicians working in regions of high status and to thus prevent potentially fatal complications in patients with Hb S; is also essential to promote preventive measures for individuals with African or Mediterranean ancestry know their sickle cell status before traveling to places above 2,500 m.
Assuntos
Altitude , Anemia Falciforme/complicações , Hipóxia/complicações , Infarto do Baço/etiologia , Anemia Falciforme/genética , Humanos , Infarto do Baço/diagnóstico , Infarto do Baço/prevenção & controle , Infarto do Baço/terapiaRESUMO
La hemoglobinopatía S es un desorden hereditario resultado de una mutación en el gen beta-S que se expresa con la sustitución de un aminoácido en la cadena beta de globina. El problema se presenta cuando algún sujeto con hemoglobinopatía S se expone a la hipoxia de altura. La disminución de la saturación de oxígeno forma polímeros de Hb S que deforman al glóbulo rojo en forma de ômedia lunaõ (célula falciforme o drepanocito). Las células falciformes (rigidas y frágiles) tienden a adherirse a otros glóbulos rojos incrementando la viscosidad y estásis sanguínea, generando oclusión vascular e infarto en los tejidos. El bazo por su tipo de circulación es un órgano susceptible de la crisis falciforme. El infarto esplénico en la altura -en correspondencia a diferentes circunstancias- puede evolucionar en tres etapas: a) Infarto agudo (focal, no complicado), b) infarto masivo (compromiso de mas del 50% del parénquima) y c) infarto con disrupción capsular. El diagnóstico precoz es fundamental, permite la instauración oportuna de diversas medidas, especialmente una adecuada hidratación, oxigenación y rápida evacuación a localidades de menor altitud. Con estas medidas se atenua el fenómeno falciforme y algunos pacientes pueden superar este trance sin mayores complicaciones. El retardo diagnostico conlleva a tomar medidas que incluso pueden exacerbar la hipoxia tisular. Importantes poblaciones de raza negra y mestiza con ancestro africano viven en la costa peruana, 10% y 2% respectivamente tienen hemoglobinopatía S; sujetos de raza blanca con ancestro mediterráneo también pueden portar esta hemoglobina. Es indispensable difundir el conocimiento de esta entidad para que la tengan presente los médicos que laboran en regiones de altura; asimismo es primordial impulsar medidas preventivas para que los individuos con ancestro africano o mediterráneo conozcan su estatus sickle cell antes de viajar a lugares por encima de 2.500 m.
The hemoglobin S is a consequence of the substitution of valine for glutamic acid at position 6 of beta globin chain. The problem arises when some individuals with Hb S is moved to the mountains and exposed to hypoxia. The decrease in oxygen saturation distorts the red blood cell with HbS-shaped crescent (sickle cell). Sickle cell (rigid and fragile) tends to adhere to the other red blood cells, generating a series of intravascular alterations that can lead to tissue ischemia or infarction. The spleen by type of movement and lack of lateral communications between the branches of the splenic artery was the most susceptible to sickle cell crisis. Splenic infarction at altitude corresponding to different circumstances can evolve in three stages: a) Acute (focal, uncomplicated), b) massive attack (more than 50% of parenchyma) and c) spontaneous rupture. Early diagnosis is crucial, allowing the quick and timely introduction of various measures, including adequate hydration and oxygenation continues until its evacuation to lower altitude locations. These measures would reduce the phenomenon of sickle and some patients may overcome this acute trance without major complications. The delay in diagnosis leads to action that can exacerbate tissue hypoxia and cause ischemia or infarction of various organs. A large population of black and mixed race of African descent living in the Peruvian coast, 10% and 2% respectively have hemoglobin S; Caucasian subjects with Mediterranean ancestry this hemoglobin also can carry. It is therefore essential to disseminate within the clinicians working in regions of high status and to thus prevent potentially fatal complications in patients with Hb S; is also essential to promote preventive measures for individuals with African or Mediterranean ancestry know their sickle cell status before traveling to places above 2,500 m.
Assuntos
Humanos , Altitude , Hemoglobina Falciforme , Hemoglobinopatias , Infarto do Baço , PeruRESUMO
INTRODUCTION: Gastrointestinal Stromal Tumors (GIST) are lesions which origin from Intersticial Cells of Cajal that may be asymptomatic or cause complications like digestive bleeding or malignant transformation. AIM: To determine the clinical, endoscopic and histological profile, as well as the main demographic features of patients with GIST in Hospital Edgardo Rebagliati (Lima-Perú) from January 2002 to December 2004. METHODS: Descriptive, transversal and retrospective study in which we reviewed clinical and anatomopathological archives from 34 patients with GIST during the above mentioned period. The collected data were placed on a sheet of recollection. RESULTS: There was male predominance (58.82%).The most affected age group was 71-80 years old (26.47%). The average age was 64.7 years old. The most frequent clinical presentation was abdominal pain (47.06%) followed by melena (44.12%). Diagnosis was made by endoscopic method in 58.82%. The main histological type was spindle (47.06%). There was high risk of malignancy in 50% and the most often involved site was stomach (61.77%). Endoscopicall the characteristic image was a submucosal tumor with ulceration, the average size was 6.44 cm. There was significant statistical relation (p<0.05) between endoscopic method and melena. CONCLUSION: Patients with GIST in HNERM are mostly men, older than 60 years that come with abdominal pain and melena, being endoscopy the best method to diagnose if patients present melena. Predominating histology was fusiform.
Assuntos
Tumores do Estroma Gastrointestinal , Dor Abdominal/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Distribuição Binomial , Endoscopia Gastrointestinal , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/epidemiologia , Tumores do Estroma Gastrointestinal/patologia , Hospitais , Humanos , Masculino , Melena/etiologia , Pessoa de Meia-Idade , Peru/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Estômago/patologiaRESUMO
La hemorragia gastrointestinal es una entidad clínica frecuente y la principal emergencia gastroenterológica . Desde 1994, la Unidad de hemorragia Digestiva del Hospital Rebagliati ha adquirido gran experiencia en este campo. El 83 por ciento de las hemorragias son altas y 17 por ciento bajas, 63 por ciento son varones y 37 por ciento mujeres, 66 por ciento son mayores de 60 años. Las principales causas de hemorragia digestiva alta son: úlcera duodenal (24,5 por ciento), úlcera gástrica (19,8 por ciento) y várices esófagogástricas (15 por ciento). La principal causa de hemorragia digestiva baja es enfermedad diverticular colónica. La mortalidad es una unidad especializada como la nuestra es sólo 3 por ciento y entre los principales factores tenemos: volumen de sangrado, hepatopatía crónica (cirrosis), presencia de hematemesis.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hemorragia GastrointestinalRESUMO
La gastritis hemorrágica por radiación es una entidad rara. Nosotros presentamos un caso, en un paciente varón de 75 años, admitido por melena recurrente y anemia, a quien se le aplicó previamente radioterapia adyuvante por un hipernefroma. Este paciente requirió la transfusión de 10 unidades de paquete globular. La endoscopía inicial mostró múltiples telangiectasias difusas en antro con sangrado activo espontáneo, tratadas exitosamente con varias sesiones de probeta caliente.
The hemorrhagic radiation gastritis is rare. We describe a case, a 75-year-old man admitted for recurrent melena and progressive anemia, with history of adjuvant radiotherapy of hipernefroma. He required the transfusion with 10 units of packed red blood cells. The initial endoscopy revealed multiple telangiectasias spreading in the antrum, with active spontaneous bleeding, successfully treated with some sessions of heater probe.