[Dynamic high-contrast computed tomography in the diagnosis of pancreatic necrosis]. / Tomografía computada dinámica de alto contraste en el diagnóstico de necrosis pancreática.

UNLABELLED: This work intended to find out whether dynamic high-contrast computed axial tomography (CAT scan) in effective and more useful than conventional computed tomography for the diagnosis of pancreatic necrosis in patients with severe acute pancreatitis. BACKGROUND: Although many methods have been used to predict the severity and extent of pancreatic necrosis, few studies have assessed computed tomography. METHODS: Longitudinal, prospective and comparative study was performed on consecutive patients with severe acute pancreatitis in which dynamic high-contrast computed tomography and conventional computed tomography were carried out. RESULTS: In pancreatic necrosis, pancreatic densities were lower. Necrosis by itself was also associated with higher severity scores, but not with a higher mortality rate. However, mortality rates were influenced by the extent of pancreatic necrosis. Sensitivity of 100%, specificity of 68%, positive predictive and negative predictive values of 100 and 42% were achieved. STATISTICS: Densities of TCNL and TCAC were analyzed using student's t test of independent samples. The correlation of the aorta/pancreas index and the presence of necrosis was analyzed using a linear correlation test. CONCLUSIONS: The authors conclude that dynamic high-contrast computed tomography is more effective than conventional computed tomography in diagnosing pancreatic necrosis. Moreover, the diagnosis of pancreatic necrosis and its extent makes it possible to formulate a prognosis as to severity of the disease.

[Pancreatic abscess. Extraperitoneal drainage]. / Absceso pancreático, drenaje por vía extraperitoneal.

The pancreatic abscess occurs in two to six per cent of patients with acute pancreatitis and in 40 to 50 per cent of whom develop the severe form of the disease. The postoperative morbidity rate is 85 to 90 per cent and the mortality rate is 30 to 50 per cent due to persistence or recurrence of infection. The anatomical location and dissemination of the pancreatic abscess allows an extraperitoneal approach. Twelve patients with pancreatic abscess are reported. Seven males and five females, with an average age of 36 years. Fever, abdominal pain, cutaneous hypersensitivity and palpable abdominal mass were the most frequent clinical signs. Most of them developed multiple organic failure, leukocytosis, hyperglycemia, increasing L.D.H. and alkaline phosphatase levels. The CAT scan was most useful to localize the abscess. About 83 per cent of patients had been operated on previously. The extraperitoneal surgical approach was anterior in 10 patients and posterior in two patients. Ten patients developed complications that resolved with conservative measures. Two patients (17%) died. Extraperitoneal drainage is a valid alternative to prevent peritoneal contamination and some other serious postoperative complications in the management of pancreatic abscess.

Colangitis aguda supurada. / Acute suppurative cholangitis

Se analizo retrospectivamente la experiencia del Hospital de Especialidades del Centro Medico La Raza con veinticuatro pacientes con colangitis obstructiva supurada aguda tratados de Abril de 1979 a Agosto de 1981. El 84% de los casos tenia etiologia benigna; embargo, la morbilidad fue de 38% y, aunque la mortalidad de toda la serie fue de 8%, en los casos con septicemia fue de 29%. Se encontro que el caracter supurativo de la colangitis no necesariamente se anuncia con un cuadro clinico tipico, que la presencia de pus en la via biliar y la diseminacion de la infeccion dependen del tiempo de evolucion y que si bien el tratamiento medico preoperatorio mejora el pronostico, cuando las condiciones clinicas del enfermo permiten instituirlo, el tratamiento definitivo es el drenaje del coledoco y no debe soslayarse mas alla del lapso indispensable para hacer el diagnostico de la enfermeda