Is carbohydrates-deficient transferrin the best test of the alcoholic etiology in acute pancreatitis?

AIM: To demonstrate if carbohydrates deficient transferrin (CDT) is the best marker to detect an excessive alcohol consumption as a cause of acute pancreatitis. MATERIAL AND METHODS: Prospective study of 60 patients consecutively admitted in our hospital. Acute pancreatitis were classified according to their different etiologies, alcoholic (11), probably alcoholic (4), biliary (25) and others (20). In all cases, we have compared CDT with classical quemical markers of alcohol abuse such as mean corpuscular volumen (MCV), gamma-glutamyltransferase (GGT) and aspartateaminotransferase (AST). Statistic correlations were done between the quantity of alcohol consumed and CDT, GGT, AST and MCV variables. RESULTS: Correlation between CDT and MCV with the excessive alcohol consumption was statistically significant. The acute pancreatitis caused by alcohol and the suspicious alcoholic group had a average CDT higher than the rest of the groups (p < 0.05). Taking a cut point with a CDT value of 20, the diagnosis capacity of the test to detect the alcoholic etiology was 82 and 92% of specificity. Taking a cut point with a MCV value higher than 95, sensibility was 67% and specificity was 82%. CONCLUSION: In our experience, the most efficient marker of the alcoholic etiology in acute pancreatitis was CDT.

¿La transferrina deficiente en carbohidratos es el mejor test de la etiología alcohólica en la pancreatitis aguda? / Is carbohydrates-deficient transferrin the best test of the alcoholic etiology in acute pancreatitis?

Objetivo: demostrar si el test de la transferrina deficiente en carbohidratos (CDT) es la mejor prueba para detectar la ingesta excesiva de alcohol como causa de la pancreatitis aguda. Material y métodos: estudio prospectivo de 60 pacientes con pancreatitis aguda ingresados consecutivamente en nuestro hospital. Las pancreatitis agudas se clasificaron según las diferentes etiologías en alcohólicas (11), probablemente alcohólicas (4), biliares (25), y otras (20). Comparamos en todos los casos la CDT con los marcadores bioquímicos clásicos de la toma excesiva de alcohol como son el volumen corpuscular medio (VCM), gammaglutamil-transpeptidasa (GGT) y aspartato-aminotransferasa (AST).Se realizaron las correlaciones estadísticas entre la cantidad de alcohol consumida y las variables CDT, GGT, AST y VCM.Resultados: la correlación entre la CDT y el VCM con la toma excesiva de alcohol fue estadísticamente significativa.Las pancreatitis agudas por el alcohol y el grupo de sospecha alcohólica tuvieron una CDT media mayor que los demás grupos (p<0,05). Tomando como punto de corte un valor de CDT de 20, la capacidad diagnóstica de la prueba para detectar la etiología alcohólica fue del 82 por ciento y 92 por ciento de especificidad. Tomando como punto de corte un VCM mayor de 95 la sensibilidad fue de un 67 por ciento y la especificidad de un 82 por ciento. Conclusión: en nuestra experiencia, el marcador más eficiente de la etiología alcohólica en las pancreatitis agudas fue la CDT (AU)

Acute pancreatitis: evaluation of the prognostic criteria of the latest Balthazar tomographic classification.

The use of prognostic criteria to detect potentially acute pancreatitis can allow us to select patients most in need of special attention. Of the many possible criteria, we used Ranson's clinical analytic criteria and Balthazar's tomographic criteria, and compared them to the latest criteria of Balthazar, in which pancreatic necrosis figures as the principal prognostic factor. Tomographic evaluation of pancreatic necrosis was shown to be the best prognostic marker in acute pancreatitis, with the greatest sensitivity and specificity of all methods used with one-hundred consecutive patients admitted with acute pancreatitis.

[Pseudotumoral hepatic tuberculosis]. / Tuberculosis hepática pseudotumoral.

In the absence of active pulmonary disease, hepatic focal tuberculosis is a rare form of tuberculosis. We present a case of pseudotumoral hepatic tuberculosis in a 44-year-old man; diagnosis is difficult because of its radiological similarity with primary or metastatic hepatic cancer. Percutaneous biopsy with US or CT guidance offers a good diagnostic alternative to laparoscopy. Histology examination revealed a tuberculoid granulomatous lesion. The disease has a good response to tuberculostatic treatment.

[An ischiorectal abscess due to Actinomyces]. / Absceso isquio-rectal por Actinomyces.

Actinomycosis is a chronic granulomatous inflammatory disease, with fistulization tendency, caused by Actinomyces. The clinical observation in presented of a patient with intermittent fever of three weeks duration, associated to pain and functional impotence of the right hip, observing with CT Scan an ischium-rectal abscess. After spontaneous fistulization, Actinomyces israelii was isolated in the biopsy sample by culture in anaerobic medium, confirming the diagnosis by anatomo-pathology. The patient was treated with intravenous penicillin for six weeks, followed by six months of oral treatment with which the symptoms disappeared and the radiological images normalized. Bone infection ranges between 1 and 15% of total actinomycosis.

[Acute pancreatitis caused by salazopyrine. An unusual association]. / Pancreatitis aguda por salazopirina. Una asociación excepcional.

A 28 year old patient with a moderate attack of ulcerative colitis was treated with sulfasalazine. Ten days after, the patient was admitted with clinical and laboratory symptoms of acute pancreatitis (serum amylase 631 u., serum lipase 1080 u. urine amylase, 910 u.). Upon recovery, sulfasalazine was reintroduced at lower dosage (2 Gm/day), and the patient repeated the clinical and biological picture of acute pancreatitis (serum amylase of 710 and lipase 1010 u.) CAT scan showed pancreatic edema and ultrasonography demonstrated a normal gallbladder. The symptoms and laboratory abnormalities disappeared in three days after stopping sulfasalazine. The patient has been followed-up for one year without recurrence of pancreatitis on maintenance treatment with 1.5 Gm 5-Aminosalicylic acid.

[Crohn's disease associated with Berger's disease. A rare complication]. / Enfermedad de Crohn asociada a enfermedad de Berger. Una rara asociación.

We report the case of a male patient with Crohn's disease associated with IgA nephropathy. He was treated surgically for the intestinal disorder and then with corticoids and sulfasalazine. Six years after treatment the patient was asymptomatic. As the intestinal situation improved there was concomitant normalization of urinary sediment, maintaining renal function. The fact that the digestive mucosa is one of the body's major sources of secretory IgA may account for the existence of a common for Crohn's disease and certain forms of IgA nephropathy.

Nodular regenerative hyperplasia and focal nodular hyperplasia of the liver associated with severe cholestasis. Report of a case with autopsy findings.

Nodular regenerative hyperplasia of the liver was found at liver biopsy and at autopsy in a 61-year-old woman with severe cholestasis. Increased bilirubin levels persisted over a follow-up period of 4 years. Microscopic findings included hyperplastic hepatocytic nodules, interlobular bile duct lesions, fibrous medial and intimal thickening of small arterial branches and portal veins, and recanalization of a thrombus in a major portal branch related to an area of focal nodular hyperplasia of the liver. Bile duct and small vessel changes were prominent in the present case. Their role as contributing factors to the development of nodular regenerative hyperplasia of the liver is discussed.