Pancreatitis autoinmune. A propósito de un caso / Autoimmune pancreatitis. Related to a case

La pancreatitis autoinmune es una reciente entidad a tener en cuenta en el diagnóstico diferencial de pancreatits crónica-masa pancreática. La presencia de estenosis difusa e irregular del Wirsung, junto con niveles elevados de IgG4, presencia de determinados autoanticuerpos e infiltración linfoplasmocitaria de páncreas son la clave del diagnóstico. La sospecha diagnóstica precoz y la colaboración multidisciplinar es vital en estos casos, ya que puede evitar cirugía innecesaria, puesto que el diagnóstico diferencial se establece con entidades entre las que se encuentra cáncer de páncreas, pancreatitis crónica, cirrosis biliar primaria o colangitis esclerosante primaria. Además, la pancreatitis autoinmune tiene excelente respuesta a tratamiento esteroideo, con resolución completa de parámetros clínicos, analíticos y radiológicos, como ocurría en nuestro paciente. Debido al escaso número de casos descritos en la Literatura, sería necesario la elaboración de estudios con seguimiento largo plazo para conocer pronóstico y frecuencia de asociación a otras patologías

Autoimmune pancreatitis is an entity that has recently been included in the differential diagnosis of chronic pancreatitis-pancreatic mass. The presence of diffuse, irregular Wirsung’s duct stenosis, together with high levels of IgG4, the existence of certain autoantibodies and lymphoplasmacytic infiltration of the pancreas are key factors in the diagnosis. An early diagnostic suspicion and multidisciplinary collaboration are vital in these cases to avoid unnecessary surgery as the differential diagnosis is established with such entities as pancreas cancer, chronic pancreatitis, primary biliary cirrhosis or primary sclerosing cholangitis. Autoimmune pancreatitis has an excellent response to steroid therapy, with complete resolution of clinical, analytical and radiological parameters, as occurred in our patient. The very few cases reported sofar suggest the need for the elaboration of long-term follow-up studies to determine the prognosis and frequency of its association with other diseases

[Autoimmune pancreatitis. Related to a case]. / Pancreatitis autoinmune. A propósito de un caso.

Autoimmune pancreatitis is an entity that has recently been included in the differential diagnosis of chronic pancreatitis-pancreatic mass. The presence of diffuse, irregular Wirsung's duct stenosis, together with high levels of IgG4, the existence of certain autoantibodies and lymphoplasmacytic infiltration of the pancreas are key factors in the diagnosis. An early diagnostic suspicion and multidisciplinary collaboration are vital in these cases to avoid unnecessary surgery as the differential diagnosis is established with such entities as pancreas cancer, chronic pancreatitis, primary biliary cirrhosis or primary sclerosing cholangitis. Autoimmune pancreatitis has an excellent response to steroid therapy, with complete resolution of clinical, analytical and radiological parameters, as occurred in our patient. The very few cases reported so far suggest the need for the elaboration of long-term follow-up studies to determine the prognosis and frequency of its association with other diseases.

Study of factors related to quality of life in patients with locally advanced rectal cancer.

OBJECTIVES: Given the increasing concern about the physical, psychological, and social welfare of patients surgically treated for rectal cancer, we designed a study of the factors influencing quality of life in these patients. EXPERIMENTAL DESIGN: We prospectively analyzed factors related to quality of life in a cohort of patients using the Nottingham Health Profile and the EORTC questionnaire (QLQ-CR 38). PATIENTS: A total of 116 patients with locally advanced rectal cancer surgically treated in our hospital from 1994 to 1999. RESULTS: Quality of life scores for the various factors studied showed that quality of life was worse in women, in patients with tumors in the middle third of the rectum, and in patients undergoing low anterior resection. CONCLUSIONS: Factors influencing quality of life in patients surgically treated for locally advanced rectal cancer included sex, tumor site, and surgical technique. Since only this latter factor is modifiable, we suggest that the surgical technique be individualized in persons with mid-lower and lower-third tumors of the rectum, bearing in mind that quality of life in amputated patients is, in many respects, better than that of patients with preserved sphincters.

Reingeniería de empresa en el hospital. Aplicación en el Hospital Civil de Málaga - C.H. Carlos Haya / Company re-engineering in the hospital. Application in the Civil Hospital of Málaga - C.H. Carlos Haya

Se presenta en este trabajo un análisis de la reestructuración de un centro hospitalario, el Hospital Civil del Complejo Hospitalario Carlos Haya de Málaga, abarcando el período 1996-2000, en el que se ha utilizado el concepto y el método de la reingeniería de empresas aplicándola a un medio hospitalario. El método utilizado ha sido descriptivo aunque sin embargo para la realización del cambio se han utilizado modelos prospectivos en los que han participado los autores (AU)

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Síndrome de Peutz-Jeghers. Presentación de un caso con degeneración maligna metacrónica de pólipos adenomatosos y hamartomatosos / Peutz-Jeghers syndrome: report of a case involving metachronous malignant degeneration of hamartomatous adenomatous polyps

El síndrome de Peutz-Jeghers (SPJ) es una enfermedad hereditaria de etiología desconocida que se caracteriza por la presencia de pólipos hamartomatosos en el tracto gastrointestinal asociados a depósito mucocutáneo de melanina. La frecuencia de malignidad gastrointestinal en este síndrome se estima entre el 2 y el 3 por ciento. Presentamos el caso de un paciente varón de 44 años con SPJ que presentó, de forma secuencial y con 4 años de metacronía, dos episodios de oclusión aguda del intestino delgado que requirieron cirugía y se debieron, respectivamente, a degeneración maligna de varios pólipos adenomatosos en primera instancia y uno hamartomatoso en la segunda crisis. Discutimos la presencia de forma concomitante de pólipos adenomatosos y hamartomatosos en un paciente con SPJ, con la particularidad de que ha existido degeneración asociada con ambos subtipos histológicos de pólipos; se plantea, igualmente, la problemática de establecer una secuencia adenoma-hamartoma-cáncer o bien de considerar la degeneración maligna independiente de pólipos adenomatosos y hamartomatosos (AU)

[Analysis of surgery of gastroesophageal reflux by laparotomy and laparoscopy approach]. / Análisis de la cirugía del reflujo gastroesofágico por vía laparotómica y laparoscópica.

UNLABELLED: The development of the laparoscopic surgery has allowed its use in the treatment of gastroesophageal reflux. PATIENTS AND METHODS: We have reviewed the results and follow-up of 30 patients treated with open procedure (group A) and 30 patients with laparoscopic surgery (group B). The most frequent indication for surgery was failure of medical therapy and the Nissen fundoplication was the method most commonly used. RESULTS: The average surgical time was shorter in group A (66 minutes) than in group B (140 minutes). Intraoperative complications were: in group A, 2 patients with splenic injury; in group B, 3 patients required conversion to the open procedure (pneumothorax, gastric perforation, technical problems) and 1 patient with pneumothorax which didn't require conversion. Postoperative morbidity and mortality occurred in 20% (26% group A, 13% group B); the most common complications were: respiratory (4 patients), gas bloat syndrome (2 patients) and esophageal perforation (1 patient). At follow-up we observed complete heartburn relief in 95%, 4 patients in group A had mild dysphagia, 3 patients with recurrent hiatal hernia (2 in group A and 1 in group B) and 2 patients required reintervention in group A (intestinal occlusion caused by adherence and laparotomic hernia). Mortality occurred in a patient with esophageal perforation in group B. CONCLUSIONS: Treatment for gastroesophageal reflux is feasible with similar effectiveness with open and laparoscopic procedures. The results are advantageous with the laparoscopic procedure relative to postoperative morbidity and follow-up.

[Diagnostic and therapeutic assessment of liver trauma]. / Valoración diagnóstica y terapéutica de los traumatismos hepáticos.

We have observed an increase in the frequency of hepatic trauma. They are very severe (44% of our group in IV-V stage), right hepatic lobe is the most frequently injured (22 patients), are associated with several lesions and in 20% of patients radical proceedings (parenchymal resection) were needed. A high incidence of associated lesions (24 patients), mainly thoracic and cranio-encephalic, have been observed. Therefore we have to improve the vital support measures, both in the accident place and in their transport, as quick and safe as possible, to hospital. We have at present better diagnostic and management methods to evaluate these patients: abdominal puncture, echography and abdominal CT. The echography in emergencies is the examination of choice in severe abdominal trauma and laparatomy is an urgent procedure in uncertain cases. Most of the hepatic traumatisms were treated by conservative surgical procedures (suture, hemostasis and abdominal drainage in 25 patients), but at times hepatic resection was needed (6 patients). The main aim is this surgery is the hemorrhage control, which determines mortality and prompt reoperation. That happened in two cases. Respiratory problems, infection with sepsis, renal failure, biliary fistulas, upper digestive tract hemorrhages and hemobilia, are complications most frequently observed in our patients. The vital support measures (respiratory, cardiovascular, nutritional, neurologic, etc.) improve the clinical evolution. In our patients the mortality rate was 12%. This rate is very similar to the one reported by other authors.