[Dynamic pancreatography: the diagnosis of pancreatic necrosis and the identification of the risk factors of severity]. / Pancreatografía dinámica: diagnóstico de necrosis pancreática e identificación de factores de riesgo de gravedad.

BACKGROUND: Dynamic pancreatography (DP) can establish the development of tissue damage and demonstrate pancreatic necrosis (PN). OBJECTIVE: To prospectively evaluate the usefulness of DP in patients with acute pancreatitis (AP), analyzing its capabilities for determining the incidence of necrosis, and as a prognostic predictor. MATERIAL AND METHODS: All patients with AP seen at our department during 4 years were included. All patients were scheduled to DP. Findings were classified in five groups: I, interstitial AP; II, secondary fluid collections; III, peripancreatic necrosis; IV, pancreatic necrosis < 50% and pancreatic necrosis > 50%. Also included for analysis were: demographic variables, etiology, APACHE-II score, and Ranson's signs; when infection was suspected, cultures were done. PD and operative findings were correlated to calculate sensibility (S), specificity (Sp), positive and negative predictive values (PPV, NPV), and the diagnostic accuracy (DA) of the test. Correlation between severity/mortality and morphologic alterations according to the classified group were also performed. RESULTS: 244 patients. Biliary associated pancreatitis in 47% and alcohol induced in 37%. DP in 207 patients showed, 34 patients in group I; 36 in group II, 67 in group III, 47 and 60 in groups IV and V, respectively. Secondary pancreatic infection was present in 48%. One hundred seventy-two patients underwent surgery; the surgical indication was to interrupt the pathogenesis of complications in 52%. DP correlated with the prognostic signs and APACHE-II score as predictors of complications with an overall (S) of 93%, (Sp) 98%, (PPV) 91%, (NPV) 98%, and (DA) 97%. Greater scores values are all directly proportional with PD necrosis findings (P < 0.05). There was not PD related morbidity. CONCLUSIONS: We found correlation between PD classification and prognostic factors. Morphologic alterations were accurately identified. PD as preoperative work-up allows surgeons design operative strategies and as is useful follow-up of the patients after necrosectomy.

[Squamous cell carcinoma of the liver]. / Carcinoma escamoso primario de hígado.

A case of primary squamous cell carcinoma of the liver in a 38-year-old male patient is informed. We could only find 13 cases reported in the literature, all of them in male patients; in the Mexican literature this histologic type of hepatic neoplasia has not been reported. The prognosis of these lesions are extremely poor, and no case has survived over six months.

[Treatment of bile duct calculi with extracorporeal lithotripsy]. / Tratamiento de los cálculos de los conductos biliares con litotripsia extracorpórea.

Currently there are several non-surgical procedures on biliary duct stones treatment; one of them is extracorporeal shock-waves lithotripsy (ESWL), which has advantages over the others. It is safe, effective and non invasive method, that does not need direct contact with the stone and has low morbidity. We treated 10 patients with ESWL generated by a piezoelectric system with ultrasonic localization. The stones were fragmented in 80% of the patients and eventually the concrements were eliminated in 63%. The complications were one case of hemobilia and another of pancreatitis.

[Hepatico-jejunal anastomosis without sutures with permanent access to the anastomosis]. / Anastomosis hepático yeyunal sin suturas con acceso permanente de la anastomosis.

A simple and rapid surgical technique for the treatment of bile duct strictures is described, is a nonsuture technique that permits a safe long term control of the anastomosis, is an hepatico-jejunostomy without sutures, a Roux in Y loop is anchored to the hepatic bilium with a transhepatic Levin F14-16 tube. When the Levin tube is retired a nylon thread is left in place for future use. Has been used with exit in 15 cases two of them presented biliar fistula that was easily treated with sucction at the ends of the catheter.

[Ultrasound-guided percutaneous plugged biopsy of the liver in patients with coagulation disorders. Preliminary report]. / Biopsia hepática percutánea con taponamiento guiada por ultrasonido en pacientes con coagulación alterada. Informe preliminar.

The histopathological study is very useful to establish a correct diagnosis in hepatic diseases, nevertheless conventional percutaneous liver biopsy is contraindicated in patients with abnormal coagulation. For this reason, some other alternatives have been looked for. The purpose of this study was to evaluate the safety and effectivity of gelfoam plugged liver biopsy, like alternative of the conventional biopsy in patients with impaired coagulation. The procedure was done in fourteen patients with prothrombin time longer than twelve seconds over the control and platelet count until 20,000/mm3. Besides that, we used real time ultrasound to guide the biopsy, in order to improve the safety and effectivity of this technique. All were successful, and there were no serious complications. This technique is a good alternative in patients with liver disease and impaired coagulation, in whom the histological diagnosis is essential.

Sindrome de Zollinger y Ellison. / Zollinger and Ellison syndrome

El sindrome de Zollinger-Ellison es una enfermedad que en las personas que la padecen se manifiesta por presencia de ulcera peptica incurable, acompanada ademas, de hipersecrecion e hiperacidez gastrica.Es causada por la presencia de un tumor que se origina en el sistema neuroendocrino difuso, especificamente a partir de las celulas no beta de los islotes pancreaticos, que produce gastrina, hormona que normalmente se encuentra en el antro gastrico en una proporcion de casi 90 por ciento, y de la que hasta la fecha se han identificado cuatro componentes. La presente revision analiza algunos conceptos primordiales en relacion con la gastrina necesarios a nuestro juicio, para entender el problema. Enseguida aborda los aspectos clinicos, bioquimicos, radiograficos, histologicos y ultraestructurales indispensables para establecer el diagnostico preciso y por onde, el tratamiento adecuado

[Pancreatic changes in patients with liver cirrhosis caused by alcoholism]. / Alteraciones pancreáticas en los pacientes con cirrosis hepática por alcoholismo.

Alcoholism in frequently associated to inflammatory lesions of the pancreas. The changes involved have been duly depicted in necropsis studies. In this paper we have evaluated the association of pancreatic changes in patients undergoing hepatic cirrhosis due to alcoholism by means of endoscopic pancreatography. Forty four patients were studied by endoscopic pancreatography, 25 males and 19 females. Their ages varied between 22 and 81 year old. Three groups were formed; the first one by 19 patients with hepatic cirrhosis due alcoholism; the second group by 7 patients with hepatic cirrhosis in whom no alcoholic antecedents could be ascertained; the third group was formed by 18 non alcoholic, non cirrhotic individuals. Pancreatography was performed by means of a JF-B3 duodenoscope. In 12 out of 19 patients with alcoholic hepatic cirrhosis, the pancreatography showed changes such as irregularities in the ducts, sacular formations, retarded emptying with partial filling, shortening and stenosis of the ducts, changes usually present in patients with chronic pancreatitis. Both in groups II and III no pathologic changes were found in pancreatography. From the radiologic standpoint alone one cannot eestablish the diagnosis of chronic pancreatitis, although we consider that the usefulness of the pancreatography is that of making quite apparent the above said alterations in the alcoholic cirrhotics patients and stablish the adequate therapeutic conduct.