[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.

[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.