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OBJETIVOS: El objetivo de este estudio es identificar los factores que se asocian a la tuberculosis enteroperitoneal en pacientes del Hospital Nacional Dos de Mayo en el periodo 2008-2015. METODOLOGÍA: Se diseñó un estudio no experimental, descriptivo observacional de tipo retrospectivo. El estudio se realizó en el Hospital Nacional Dos De Mayo, Lima-Perú. Se incluyeron un total de 108 pacientes con diagnóstico de tuberculosis enteroperitoneal hospitalizados en el periodo 2008-2015. Se estudiaron las variables edad, sexo, lugar de procedencia, coinfección con VIH y tuberculosis de localización pulmonar. Se utilizó el programa SPSS versión 23.0 para describir las variables y establecer la asociación entre las mismas. RESULTADOS: El grupo etario más frecuente hallado fue de los 18-40 años, representando un 71.3% del total de casos. La edad media de presentación fue de 33.75 ± 13.44 años. El género masculino representó un 71.3% del total de pacientes vs el sexo femenino que representó solo el 28.69%. Los distritos de procedencia donde hubo mayor registro de casos fueron: Cercado de Lima (18.5%), La Victoria (14.8%), San Juan de Lurigancho (12%), San Juan de Miraflores (5.6%), El Agustino (4.6%). La coninfección con VIH fue observada en un 34.25% de todos los pacientes y la tuberculosis de localización pulmonar fue observada en un 21.3% de los casos. CONCLUSIONES: El lugar de procedencia y la tuberculosis de localización pulmonar tuvieron una asociación estadísticamente signficativa con la TBC enteroperitoneal, p(=0.023), p(=0.017) respectivamente. El grupo etáreo de 18-40 años, el género masculino y la coinfección con vih obtuvieron un registro importante de casos en nuestros pacientes con TBC enteroperitoneal, sin embargo no alcanzaron una asociación estadísticamente significativa en comparación a otros estudios.

No description available.

Se registraron 167 episodios de hemorragia digestiva alta (HDA) en el Instituto Especializado de Salud del Niño, de los cuales se incluyeron 136 episodios desde enero del 2000 a diciembre del 2004. Se realizó un estudio descriptivo retrospectivo. El objetivo general fue describir las características epidemiológicas, etiológicas, clínicas y de manejo de la Hemorragia Digestiva Alta. La prevalencia hospitalaria fue de 0.24 por 1000 atenciones/año. El mayor número de casos se presentó en varones (50.7%). El 94.1% se hospitalizó por emergencia, el servicios donde fueron hospitalizados con mayor frecuencia fue en gastroenterología (41.9%). El sangrado se inició en 96% fuera del hospital, los signos más frecuentes de presentación fueron la hematemesis y la melena. El 41.2% utilizó por lo menos un medicamento antes del sangrado, los antecedentes patológicos más frecuentes fueron los respiratorios y los gastrointestinales. El método de diagnóstico principal fue la endoscopía el cual se realizó en 61.3% de los casos. Las tres causas más frecuentes de diagnóstico fueron la gastritis en el 25.7%, seguido de las várices esofágicas en 18.4% y la úlcera duodenal 11.8%, no se estableció el diagnóstico en 13.2%. En 96.3% se usó tratamiento médico y solo en el 3.7% requirió manejo quirúrgico. En el 95.58% (130) se reportó mejoría del HDA y 6 pacientes fallecieron (4.42%). En conclusión se puede decir que la HDA es una enfermedad poco frecuente y se recomienda realizar un estudio prospectivo controlado para determinar mejor algunas variables epidemiológicas y clínicas, que ayudarían al mejor conocimiento de esta patología gastrointestinal.

Durante el estudio de la profesión médica se encuentra entidades nosograficas como la enfermedad de Crohn o Enteritis Regional que, por poseer características propias, producen en el estudiante mayor atención. La enfermedad de Crohn, llamada asi en consideración a su descubridor, es una enfermedad es una enfermedad granulomatosa que afecta preferentemente al segmento terminal del ileon habiéndose denominado por esta razón primitivamente como “ Ileitis regional” (13) pero en vista de su variable localización se ha optado en la actualidad por llamarlo “Enteritis Regional”.

Com o objetivo de estudar a viabilidade de implantação e a sobrevivência além da ação dos lactobacilos no trato intestinal de humanos adultos, foram realizados dois tipos de tratamento, com duração de 45 dias ininterruptos. Os indivíduos foram divididos em dois grupos designados grupo A e grupo B. O grupo A consumiu iogurte natural e o grupo B consumiu iogurte natural e leite "in natura" tipo C. Para avaliar a ação dos lactobacilos sobre a flora intestinal e sua permanência no trato digestivo, foram efetuadas análises microbiológicas periódicas das fezes dos indivíduos. Os resultados obtidos permitem concluir que os lactobacilos podem permanecer no intestino mesmo após a interrupção da ingestão de iogurte, embora em números inferiores aos encontrados durante o período experimental, e que somente com ingestão diária desse produto será possível sua persistência exercendo efeito controlador sobre a flora intestinal. / With the objective of studying the possibility of the implantation and subsequent survival - as well as the action - of lactobacilli in the adult human intestinal tract, two types of treatment were administered during 45 uninterrupted days. The individual were divided into two groups, designated as group A and group B. Group A consumed natural yogurt, while group B consumed natural yogurt plus ordinary milk (called type C, in Brazil). In order to evaluate the effect of the lactobacilli on the intestinal flora and the permanence of such in the digestive tract, microbiological analyses were effected upon the feces of the same individuals. The results obtained permit to conclud that the lactobacilli may remain in the intestine even after interrupting the yogurt intake, though in smaller numbers than previously encontered during the experimental period, and that only with the daily intake of the said product is any permanence made possible, as well as the exercise of any controlling effect upon the intestinal flora.

Introduction: Houghton and colleagues (2004) demonstrated bone marrow derived cells (BMDCs) to be the origin of epithelial cells in pre-invasive and malignant gastric tumours in Helicobacter felis infected mice. However, this has yet to be replicated in any other experimental scenario. Methods: To clarify the significance of Houghton’s observation we examined four mouse models of gastrointestinal tumourigenesis: the Tff1-/- mouse model of inflammatory gastric adenocarcinoma, the ApcMin/+ and Apc1322T mouse models of familial adenomatous polyposis, and the Il10-/- mouse model of colitis-associated colorectal adenocarcinoma, employing sex-mismatched bone marrow (BM) transplantation (male BM to female recipients) followed by the identification of BMDCs in tissues using Y-chromosome in situ hybridisation (ISH) detection and immunohistochemical phenotyping of cells. To investigate the mechanism for BMDC recruitment into tissues, osteopontin (Opn) mRNA isotopic ISH was employed. Results: In four mouse models there was not a single instance of a gastric gland or intestinal crypt with a patch of clonal Y-chromosome positive (Y+) cells. Y+ cells in the epithelium were very rare and were mostly positive for several markers of immune cells. In contrast, Y+ cells were frequently observed in the stroma. Quantification of BMD-myofibroblasts demonstrated increased recruitment into larger Apc1322T mouse tumours and desmoplastic reaction sites in Tff1-/- mouse tumours, but not into inflamed non-fibrotic tissues. Similarly, Opn mRNA expression was unaffected by inflammation but increased with tumour burden and in desmoplastic reaction sites. In the desmoplastic reaction sites of Tff1-/- mouse tumours, increased osteopontin mRNA expression correlated with increased BMD-myofibroblasts, therefore suggesting some chemoattraction was occurring. Conclusions: In four mouse models of gastrointestinal tumourigenesis BMDCs were not a source of reparative, pre-cancerous, or malignant epithelial cells. Analysis of BM contribution in the stroma demonstrated that BMD-myofibroblast engraftment is driven by increased tumour burden and fibrosis. In addition, the increased presence of BMD-myofibroblasts at desmoplastic reaction sites of Tff1-/- mouse tumours correlated with increased Opn mRNA expression, indicating that osteopontin may act as chemoattractant in desmoplasia.

Bibliography: leaves 206-251. The motor and sensory interactions between nutrients and proximal gut in humans are not well understood, despite the pivotal importance of these interactions on appetite, absorption and thus, nutrition. In part, this lack of knowledge results from technical difficulties in studying motor function in the human gut. In particular, the inability to continuously measure intraluminal flow with any degree of temporal resolution, has impeded progress in this field. The studies described in this thesis focus on nutrient-gut interactions, and also on the development of novel methodologies aimed at advancing the understanding and interpretation of the relationships between intraluminal pressures and flows.

Gastric emptying, and small intestinal glucose exposure and absorption, are potentially important determinants of postprandial blood glucose homeostasis and energy intake. The studies presented in this thesis were designed to provide novel insights into the interrelationships of upper gastrointestinal function with glycaemia and appetite in both health and type 2 diabetes. The issues which were addressed relate in particular to : ( i ) the physiology, regulation and measurement of gastric and small intestinal motility, ( ii ) the relationships between small intestinal glucose exposure, incretin hormone release, antropyloroduodenal motility and appetite, and ( iii ) the impact of gastric and small intestinal motility on glycaemia. The study reported in chapter 4 evaluated the effect of variations in small intestinal glucose delivery on blood glucose, plasma insulin, and incretin hormone ( GLP - 1 and GIP ) concentrations in healthy subjects. While initially rapid, and subsequently slower, duodenal glucose delivery potentiated incretin and insulin responses when compared to constant delivery of an identical glucose load, the overall glycaemic excursion was not improved. These observations add to the rationale for the use of dietary and pharmacological strategies designed to reduce postprandial glycaemic excursions in health and type 2 diabetes by slowing gastric emptying, rather than initially accelerating it. Fat is a potent inhibitor of gastric emptying. In chapter 5, the acute effect of slowing gastric emptying by fat, on postprandial glycaemia in type 2 diabetes, has been evaluated. Ingestion of a small amount of olive oil, as a 'preload' 30 min before a carbohydrate meal, was shown to markedly slow gastric emptying, affect intragastric meal distribution, delay the postprandial rises in blood glucose, plasma insulin, and GIP, and stimulate GLP - 1. In contrast, the effects of including the same amount of oil within the meal, on gastric emptying, as well as glycaemic and incretin responses, were relatively modest. As blood glucose levels had not returned to baseline by 210 min ( the end of each experiment ), effects on the overall glycaemic ( or insulinaemic ) response could not be determined ; this represents a priority for future studies. The energy content of a meal is a major determinant of its rate of gastric emptying. The study reported in chapter 6 demonstrated that the substitution of an artificial sweetener ( "diet" mixer ) for sucrose ( "regular" mixer ) in a mixed alcoholic beverage has a major impact on the rate of gastric emptying and alcohol absorption in healthy adults. A low calorie alcohol - containing drink ( made with "diet" mixer ) emptied from the stomach much more rapidly and resulted in higher blood alcohol concentrations when compared with a relatively high calorie alcoholic drink ( made with "regular" mixer ). These observations highlight the need for community awareness of factors, other than the alcohol content of a beverage, which should be taken into account in considering safe levels of consumption and the potential for inebriation. Upper gastrointestinal motor function and incretin hormone ( GLP - 1 and GIP ) secretion are known to be major determinants of postprandial glycaemia and insulinaemia, however, the impact of small intestinal flow events on glucose absorption and incretin release has not been evaluated. In the study reported in chapter 7, intraduodenal pressures and impedance signals were recorded simultaneously in healthy humans, while glucose was infused into the duodenum in the presence and absence of the anticholinergic drug, hyoscine butylbromide. The frequency of duodenal flow events ( evaluated by impedance ) was suppressed by hyoscine much more than that of duodenal pressure waves, or propagated pressure wave sequences ( evaluated by manometry ). Blood glucose and plasma 3 - OMG concentrations ( the latter provide an index of glucose absorption ) were lower during hyoscine than saline. Plasma insulin, GLP - 1, and GIP concentrations were initially lower during hyoscine. The disparity between impedance measurements and manometry in detecting alterations in flow during hyoscine infusion was marked and, accordingly, supports the potential utility of small intestinal impedance monitoring to evaluate alterations in gastrointestinal transit in various disease states. The observations also indicate that the frequency of small intestinal flow events is a determinant of both glucose absorption and incretin release. Intraduodenal administration of the local anaesthetic, benzocaine, has been shown to attenuate the release of cholecystokinin ( CCK ) by small intestinal lipid, and the perceptions of fullness, discomfort, and nausea induced by gastric distension during small intestinal lipid infusion, implying that local neural mechanisms may regulate CCK release in response to intraduodenal nutrients. In chapter 8, the effects of intraduodenal administration of benzocaine on : ( i ) blood glucose, incretin hormone and insulin concentrations ( ii ) antropyloroduodenal motility, and ( iii ) gut sensations and appetite, in response to an intraduodenal glucose infusion, were evaluated in healthy subjects. Benzocaine attenuated the perceptions of abdominal bloating and nausea, but had no effect on antro - pyloro duodenal motility, blood glucose concentrations, or incretin responses. These observations indicate that the induction of sensations by small intestinal glucose is mediated by local neural pathways. GLP - 1 is released from L - cells whose density is greatest in the distal jejunum and ileum, GIP predominantly from duodenal K cells, and cholecystokinin ( CCK ) from I cells, which appear confined to the duodenum and jejunum. The study reported in chapter 9 evaluated the effects of infusion of glucose into different gut regions ( mid - jejunal vs duodenal ) on incretin hormones, CCK, appetite and energy intake in healthy subjects. There was no difference in the incretin responses between infusion at the two sites ( 85 cm apart ), however the stimulation of CCK and suppression of hunger and energy intake, were greater with the duodenal compared to the jejunal infusion. These observations indicate that the site of small intestinal glucose exposure is a determinant of CCK release and appetite. Both glucose and fat are known to be potent stimuli for incretin secretion, but the effect of protein is uncertain. Protein may also stimulate insulin secretion directly via absorption of amino acids. In the study reported in chapter 10, gastric emptying, and the blood glucose, insulin and incretin responses, alter a 300 mL drink containing 50 g glucose, 25 g protein, or both 50 g glucose and 25 g protein, were evaluated in healthy subjects. This study established that the addition of protein to an oral glucose load improved the glycaemic response, predominantly by slowing gastric emptying. However, protein also stimulated incretin and insulin secretion. These observations have implications for the use of protein in the dietary management of type 2 diabetes. The relationship between glycaemia, incretin hormones, appetite suppression and modulation of antropyloroduodenal motility with duodenal glucose delivery is poorly defined. In chapter 11, the effects of intraduodenal glucose infusions at different caloric rates ( of 1 kcal / min, 2 kcal / min and 4 kcal / min, or control ( saline ) ) on antropyloroduodenal motility, plasma GLP - 1, GIP and CCK, appetite and energy intake have been evaluated in healthy subjects. While there was a rise in blood glucose in response to all the intraduodenal glucose loads, there was no significant difference in the response to infusions at 2 kcal / min and 4 kcal / min. An initial, transient, small rise in GLP - 1 was evident, in response to all glucose loads, but a sustained and progressive rise only occurred with the 4 kcal / min infusion. In contrast, a load - dependent stimulation of GIP occurred in response to all glucose infusions. The stimulation of CCK was much greater in response to the 4 kcal / min infusion. While antral pressures were suppressed by all rates of glucose infusion, the stimulation of basal pyloric pressure was load - dependent. Energy intake was suppressed only by the 4 kcal / min infusion. This may potentially reflect the substantially greater stimulation of CCK, consistent with the observations reported in chapter 9. This study establishes that there is a substantial discordance in the acute effects of small intestinal glucose on glycaemia, incretin hormones, CCK, motility and appetite. It is planned to perform measurements of plasma insulin on the stored samples - these results were, unfortunately, not available at the time of the submission of this thesis and are critical to the overall interpretation of the data. / Thesis (Ph.D.)--University of Adelaide, School of Medicine, Discipline of Medicine, 2007.

Thesis (M. Phil.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.