Pancreatic transplantation with duodenoduodenostomy drainage: technique, normal radiological appearance and complications.

Pancreas transplantation is considered the curative treatment for severe type 1 diabetes mellitus in selected cases. Since the first procedure in 1966, surgical techniques have been improved. The current trend among most medical centers, as well as at our Institution, is enteric drainage and systemic venous or portal anastomosis. The aim of this pictorial essay is to describe the main imaging features of pancreatic transplantation with duodenoduodenostomy drainage.

Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors / Sintomas de ansiedade social em alcoolistas em tratamento ambulatorial: prevalência, gravidade e preditores

ABSTRACT Objectives High rates of comorbidity between social anxiety disorder (SAD) and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods A cross-sectional study with 53 adults who were in treatment for alcohol dependence at a Brazilian public university outpatient service. Assessment instruments Social Phobia Inventory (SPIN), Short Alcohol Dependence Data and Beck Depression Inventory. Bivariate analyses between the categorical outcome (Probable SAD: SPIN ≥ 19) and explanatory variables were conducted. Correlates of SPIN total and subscales scores (dimensional outcomes) were also investigated. Results The diagnosis and treatment of alcohol dependence occurred, on average, 30 years after the onset of alcohol use and 39.6% of the 53 patients (37 men and 16 women) reported alleviation of social anxiety symptoms with alcohol use. Twenty-four (45.3%) patients presented probable SAD. These patients differed from non-SAD alcohol-dependent individuals by having lower income and higher frequency of depression, suicidal ideation, suicide plans and attempts. The SPIN subscales mostly associated with suicidal behaviors were social inadequacy and social inferiority. Conclusions SAD symptoms are common among help-seeking alcohol-dependent individuals and should be directly investigated and treated, since depression and suicidality are associated with this comorbidity. Prospective studies are needed to assess the impact of SAD treatment on the clinical course of alcohol dependence.

RESUMO Objetivos Altas taxas de comorbidade têm sido descritas entre o transtorno de ansiedade social (TAS) e os transtornos por uso de álcool, mas os preditores dessa comorbidade são pouco conhecidos, e a maioria dos estudos envolve pacientes com diagnóstico primário de TAS. Os objetivos foram estimar a prevalência e a gravidade de sintomas de TAS em pacientes dependentes de álcool e investigar fatores sociodemográficos e clínicos associados à comorbidade com TAS, incluindo risco de suicídio. Métodos Estudo transversal com 53 adultos em tratamento ambulatorial para dependência de álcool num hospital público universitário brasileiro. Instrumentos de avaliação: Social Phobia Inventory (SPIN), Short Alcohol Dependence Data e Beck Depression Inventory. Foram conduzidas análises bivariadas entre o desfecho categorial (provável TAS: SPIN ≥ 19) e as variáveis explanatórias. Correlatos dos escores total e das subescalas da SPIN (desfechos dimensionais) também foram investigados. Resultados O diagnóstico e o tratamento da dependência de álcool ocorreram em média 30 anos após o início do uso de álcool, e 39,6% dos 53 pacientes (37 homens e 16 mulheres) relataram alívio dos sintomas de ansiedade social com o uso de álcool. Vinte e quatro (45,3%) pacientes apresentaram provável TAS. Esses pacientes diferiram dos alcoolistas sem TAS, por terem menor renda, maior frequência de depressão, ideação suicida, planos e tentativas de suicídio. As subescalas da SPIN que mais se associaram com comportamentos suicidas foram inadequação social e inferioridade social. Conclusões Sintomas de TAS são comuns em alcoolistas em tratamento e devem ser diretamente investigados e tratados, já que depressão e suicidalidade associam-se com essa comorbidade. Estudos prospectivos são necessários para investigar o impacto do tratamento do TAS no curso clínico da dependência de álcool.

Obsessive-compulsive symptoms among alcoholics in outpatient treatment: Prevalence, severity and correlates.

The literature on symptoms of obsessive-compulsive disorder (OCD) in alcoholic patients is scarce and such symptoms can go unnoticed, worsening the prognosis of alcoholism. The objectives were to estimate the prevalence and severity of obsessive-compulsive symptoms in alcoholics undergoing outpatient treatment and to assess sociodemographic and clinical correlates, including suicidal behaviors. The instruments used in this cross-sectional study were the Obsessive-Compulsive Inventory - Revised (OCI-R), the Short Alcohol Dependence Data and the Beck Depression Inventory. After descriptive analyses, bivariate analyses between the categorical ("probable OCD": OCI-R≥27) and dimensional (OCI-R total and subscales scores) outcomes and all explanatory variables were conducted. Eleven (20.4%) of the 54 alcoholic patients (37 men and 17 women) presented "probable OCD", which was associated with lower income, more severe dependence, depression, lifetime suicidal thoughts and plans and suicide attempts. OCI-R severity (mean 16.0) was associated with the same predictors and with psychiatric hospitalization. Suicidal behaviors were mainly associated with the Obsession, Hoarding and Washing subscales. It is essential to investigate and treat OCD symptoms in alcoholics, as they are associated with greater severity of dependence, depression and suicidal behaviors. Longitudinal studies are required to assess the impact of OCD treatment on the clinical course of alcoholism.