Valor de la tomografia computada en el diagnostico y seguimiento de las pancreatitis agudas graves. / Value of the computed tomography in the diagnosis and follow-up of severe acute pancreatitis

Se estudio la evolutividad de 10 pancreatitis agudas graves mediante la tomografia computada, realizada cada 7 a 10 dias, correlacionables con la evolucion clinica (semiologia abdominal, curva termica, recuento de leucocitos y hemocultivos) y el estudio de amilasa total, isoamilasa P y ACCR. Mediante el estudio tomografico se diagnosticaron 1 necrosis cefalica, 1 necrosis corporocaudal, 1 necrosis difusa, 1 pseudoquiste del pancreas y 2 abscesos del pancreas, todos ellos confirmados por la cirugia. En 3 pacientes, a pesar de la evolucion clinica desfavorable, el estudio tomografico permitio detectar pequenos focos de necrosis en cuerpo y cola sin constituir una zona manifiesta de secuestro, por lo que no se operaron, siendo su evolucion favorable. Se considera la utilidad de este metodo en el seguimiento de las pancreatitis agudas graves, que sin ser de por si excluyente en la indicacion quirurgica, la union con la evolucion clinica proporciona fundamentos solidos para el manejo de las distintas contingencias que pueden surgir en el curso de esta enfermedad

[Prophylaxis of acute gastroduodenal lesions in critically ill patients]. / Profilaxis de las lesiones agudas gastroduodenales en pacientes críticos.

There were 220 patients studied, of which 44 were considered "critical" according to pre-established factors. In all of them, intra-gastrical pH in serious forms was detected, establishing that 45% of the "non-critical" patients had a pH factor less than 4. In these 61 patients and in the 44 "critical" patients a gastric alkalinization was sought, using between 1.2 and 2.4 grams of cimetidina daily, to which alkalines were added when necessary. Nine percent of the critical patients (4 of 44) had H.D.A., while 11 of 33 (33%) of the critically ill from a previous series that had not been treated had pronounced gastro-intestinal bleeding lesions (p less than 0.01.) The potential difference of gastric mucous in critical patients was measured likewise, being significantly less (means = 17.37 +/- 1.13) than in the non-critical patients (means = 30.2 +/- 1.13) (p less than 0.005). The use of cimetidina as an inhibitor of gastric secretion in a dosage of 1.2 grams was effective in 73% of the non-critical patients and in only 29% of the critical patients. Despite an increase in the dosage up to 2.4 grams in 9% of the critical and 22% of the non-critical patients, it was necessary to add alkalines. This lack of response shows a correlation between the amount of risk factors (3 of 10 patients had 3 factors) and the existence of hepatitic insufficiency (5 out of 16 patients and 5 out of 26 of sepsis).