[Early carbohydrate metabolism dysfunction in chronic pancreatitis. Relation with the exocrine pancreatic function]. / Disfunción temprana del metabolismo hidrocarbonado en la pancreatitis crónica. Relación con la función exocrina pancreática.

BACKGROUND: The relationship between endocrine and exocrine dysfunction in chronic pancreatitis (CP) is controversial. Our goals were to evaluate the disturbances of carbohydrate metabolism in relation to the degree of exocrine insufficiency, to compare the usefulness of oral glucose tolerance test (OGTT) versus fasting blood glucose and to investigate the degree of exocrine and endocrine dysfunction according to the duration of CP. PATIENTS AND METHOD: 73 patients with CP were studied. Pancreas exocrine and endocrine status was evaluated by secretin-CCK test (SCT), fecal fat analysis and OGTT. RESULTS: Out of 8 patients with normal SCT, 4 had an abnormal glucose metabolism with diabetes in 2 of them. Out of 50 patients with moderate exocrine insufficiency, there was an abnormal fecal fat excretion in 20%, an endocrine dysfunction in 54% and diabetes in 40%. All patients with severe dysfunction of the exocrine pancreas were diabetics. The OGTT test demonstrated that 42% of patients with normal fasting blood glucose had an abnormal glucose metabolism. Mean evolution time of CP was shorter in patients with endocrine dysfunction than in those with steatorrhea. CONCLUSIONS: As far as functional exocrine status is concerned, in chronic pancreatitis there is a higher proportion of patients with glucose metabolism dysfunction than with abnormal fecal fat excretion. Carbohydrate metabolism dysfunction can be demonstrated by OGTT in a large proportion of patients with normal fasting blood glucose. In patients with CP, hydrocarbonate dysfunction seems to develop earlier than abnormal fecal fat excretion.

Hemoperitoneo por rotura de aneurisma de la arteria esplénica / Hemoperitoneum due to ruptured aneurysm of the splenic artery

Objetivo. Presentar 3 casos de hemoperitoneo secundario a rotura de aneurismas de la arteria esplénica (AAE) atendidos en el Servicio de Cirugía del Hospital Clínico Universitario de Valencia. Evaluar la rentabilidad de las exploraciones complementarias en relación a los hallazgos operatorios y el curso postoperatorio. Pacientes y métodos. Han sido intervenidos quirúrgicamente 3 pacientes (edad media de 48 años; r: 3161 años) por rotura de AAE. La manifestación clínica inicial fue dolor en hipocondrio izquierdo de aparición súbita, con signos de shock hipovolémico posteriormente (hipotensión, palidez y sudación).Resultados. Entre los estudios complementarios, tanto la hemoglobina como el hematócrito fueron normales en 2 de los 3 casos al ingreso. La ecografía abdominal, realizada en dos de los casos, evidenció un líquido libre intraabdominal determinando la etiología en uno de ellos. En 2 casos, el diagnóstico etiológico se confirmó mediante TC abdominal. La detección de hemorragia en la transcavidad de los epiplones es indicativo de rotura del aneurisma y signo de alarma previo al establecimiento del hemoperitoneo ("fenómeno de la doble rotura"). Sólo en uno de los casos se realizó una arteriografía que confirmó el diagnóstico pero que no logró ser terapéutica. En los tres pacientes se practicó aneurismectomía con esplenectomía, asociando pancreatectomía caudal en 2 de los casos, sin mortalidad postoperatoria. Conclusiones. El shock hipovolémico de etiología incierta es una forma frecuente de presentación de los AAE. En pacientes hemodinámicamente estables la TC es el método diagnóstico de elección e identifica precozmente las complicaciones hemorrágicas de los AAE y permite establecer una indicación de laparotomía urgente. El tratamiento de elección es la aneurismectomía, con esplenectomía y pancreatectomía, si técnicamente se precisa, según la localización del aneurisma (AU)

Neumoperitoneos no quirúrgicos: una difícil decisión terapéutica / Nonsurgical pneumoperitoneum: a difficult therapeutic decision

La presencia de neumoperitoneo por perforación visceral conlleva en la mayoría de casos la realización de una laparotomía diagnóstico-terapéutica. A continuación se presentan cuatro casos de neumoperitoneos "no quirúrgicos", tres de los cuales fueron manejados de forma expectante al no detectar por exploraciones radiológicas la presencia de perforación. Se discute la etiopatogenia del neumoperitoneo y los criterios de tratamiento no quirúrgico de aquellos pacientes ventilados artificialmente y con neumoperitoneos secundarios a traumatismos abdominales cerrados y iatrogénicos postendoscopia (AU)

[Pancreatic transplantation. Experience at the University of Barcelona]. / Trasplate de páncreas. Experiencia de la Universidad de Barcelona.

OBJECTIVES: To present the experience of the University of Barcelona with simultaneous transplantation of the kidney and pancreas. METHODS: From February, 1983 to September, 1995, we have performed 112 simultaneous kidney and pancreas transplants at the University of Barcelona. Significant changes were made in 1989 relative to the surgical technique, immunosuppression and diagnosis of rejection, consequently the patients have been divided into two groups for analysis: patients treated from 1983 to 1988 (period A) and patients treated from 1989 to 1995 (period B). In both groups we analyzed patient and graft survival, morbidity, effects of SKP transplantation on glucose metabolism, diabetic complications and quality of life. RESULTS: Patient, kidney and pancreas survival rates were 62.50%, 52.94% and 23.52%, respectively for period A and 86.88%, 82.40% and 71.65% for period B. The metabolic study performed in patients with pancreas functioning for more than one year showed glucose and glycosylated hemoglobin values similar to those of the normal population, although the baseline insulin values were higher (24 +/- 15vs 12 +/- 1 mv/l, p 0.01). The course of retinopathy and visual acuity was better in patients with functioning kidney and pancreas than in the control group. Some aspects of quality of life, such as overall perception of health and physical activity were better in patients with functioning kidney and pancreas than in the control group. CONCLUSION: The results of simultaneous kidney and pancreas transplantation have improved significantly in recent years and it is currently the best therapeutic option for patients with type 1 diabetes and end-stage renal disease.