Prevalence, phenotype and medication for the pediatric inflammatory bowel disease population of a state in Southeastern Brazil.

BACKGROUND: Inflammatory bowel disease (IBD) can lead to social and economic impacts worldwide. In Brazil, where its adult prevalence is increasing, the epidemiology of the pediatric population is not well known, although there is a documented increase in pediatric IBD incidence worldwide. Brazil has continental dimensions, and Espírito Santo is a state of southeastern Brazil, the region with the highest demographic densities and is the economically most important in the country. AIM: To assess the prevalence, incidence, phenotype and medications in a Southeastern Brazilian pediatric population. METHODS: Data were retrieved from the Public Medication-Dispensing System of the Department of Health in Espírito Santo state from documentation required to have access to highly expensive medication from August 1, 2012 to July 31, 2014. There were 1048 registered patients with IBD of all ages, and of these patients, the cases ≤ 17 years were selected. The data were obtained through the analysis of administrative requests for these medications and included medical reports, endoscopy exams, histopathology and imaging tests, which followed the Clinical Protocols and Therapeutic Guidelines of the Brazilian Government. Only confirmed cases of IBD were included in the study. RESULTS: There were 55 pediatric patients/1048 registered patients (5.34%), with Crohn's disease (CD) representing 30/55 (55%), ulcerative colitis (UC) 24/55 (43.6%) and 1 unclassified IBD, a significant difference from adult patients (P = 0.004). The prevalence of IBD in pediatric patients was 5.02 cases/100.000 inhabitants; the incidence in 2014 was 1.36 cases/100.000 inhabitants. The mean age at diagnosis was 12.2 years (± 4.2). There were 7 children diagnosed up to 6 years old, 7 between 7 to 10 years old and 41 between 11 and ≤ 17 years old. There was no difference in the distribution of UC and CD between these age categories (P = 0.743). There was no difference in gender distribution in relation to adults. Children and adolescents with UC had a predominance of pancolitis, unlike adults (P = 0.001), and used aminosalicylates and immunomodulators for their treatment. Pediatric patients with CD did not present a difference in disease location but had a higher frequency of fistulizing behavior (P = 0.03) and perianal disease phenotype (P = 0.007) than adult patients. Patients with CD used more immunomodulators and biological therapy. Treatment with biological therapy was more frequently used in pediatric patients than in adults (P < 0.001). CONCLUSION: Although the data from this study demonstrate that incidence and prevalence rates are low in southeastern Brazil, these data demonstrate the severity of IBD in pediatric patients, with the need for early diagnosis and therapy, avoiding serious damage.

Evaluation of the use of blood in surgeries as a tool to change patterns for requesting blood product reserves.

OBJECTIVES: Thirty to sixty percent of prepared blood products are not transfused. Blood reserves for surgeries lead to many unused blood products, which increases hospital costs. The aim of this study is to identify the request and use profiles of blood products for elective surgeries in different surgical specialties, the influence of surgery time and demographic, clinical, and laboratory variables on the number of red blood cells (RBCs) used and to calculate the rate of transfused patients (RTP) and cross-matched and transfused (C/T) RBCs. METHODS: Observational and prospective studies. Sociodemographic, clinical and quantitative data on the request and use of blood products were collected. The influence of the data on the use of RBCs was examined by binary logistic regression. Chi-square, one-way ANOVA and Kruskal-Wallis tests were utilized to compare the data among the specialties. RESULTS: In total, 822 procedures were included. Most of the requested blood products were not used, even 24 hours postoperatively. Of the 2,483 RBC units, 314 were transfused, leaving 87.6% unused; however, cardiac, digestive tract, vascular, gynecologic, urologic and thoracic surgery procedures transfused 50%, 25%, 16.5%, 11%, 9.5% and 8.1% of requested RBCs, respectively. The factors that influenced the transfusions were age, time of surgery and cardiac surgeries. The RTP was >10% in 22 surgical types and <1% in 24 surgical types, and 88% of samples presented a C/T ratio >2.5. CONCLUSION: The RTP and C/T ratios can guide RBC requests in the preoperative period. Knowing the standard of use of blood products and developing protocols enables the optimization of reserves, reduction of costs and improvement of care.

Evaluation of the use of blood in surgeries as a tool to change patterns for requesting blood product reserves

OBJECTIVES: Thirty to sixty percent of prepared blood products are not transfused. Blood reserves for surgeries lead to many unused blood products, which increases hospital costs. The aim of this study is to identify the request and use profiles of blood products for elective surgeries in different surgical specialties, the influence of surgery time and demographic, clinical, and laboratory variables on the number of red blood cells (RBCs) used and to calculate the rate of transfused patients (RTP) and cross-matched and transfused (C/T) RBCs. METHODS: Observational and prospective studies. Sociodemographic, clinical and quantitative data on the request and use of blood products were collected. The influence of the data on the use of RBCs was examined by binary logistic regression. Chi-square, one-way ANOVA and Kruskal-Wallis tests were utilized to compare the data among the specialties. RESULTS: In total, 822 procedures were included. Most of the requested blood products were not used, even 24 hours postoperatively. Of the 2,483 RBC units, 314 were transfused, leaving 87.6% unused; however, cardiac, digestive tract, vascular, gynecologic, urologic and thoracic surgery procedures transfused 50%, 25%, 16.5%, 11%, 9.5% and 8.1% of requested RBCs, respectively. The factors that influenced the transfusions were age, time of surgery and cardiac surgeries. The RTP was >10% in 22 surgical types and <1% in 24 surgical types, and 88% of samples presented a C/T ratio >2.5. CONCLUSION: The RTP and C/T ratios can guide RBC requests in the preoperative period. Knowing the standard of use of blood products and developing protocols enables the optimization of reserves, reduction of costs and improvement of care.

The prevalence and phenotype in Brazilian patients with inflammatory bowel disease.

BACKGROUND: The epidemiology of inflammatory bowel disease (IBD) varies in different countries. This study aimed to assess phenotype, medications, prevalence and incidence of IBD in the State of Espírito Santo, Brazil. METHODS: Patients with IBD who utilized the Public Medication-Dispensing System of the Department of Health of Espírito Santo, between August 2012 and July 2014. Of 1484 active patients, 1048 were analyzed, which included patients of all ages. RESULTS: The prevalence of IBD was 38.2 per 100,000 inhabitants, with ulcerative colitis (UC) being 24.1 per 100,000 and Crohn's disease (CD), 14.1 per 100,000. The incidence of IBD was 7.7 per 100,000 inhabitants/year (UC - 5.3/100,000 inhabitants/year and CD - 2.4/100,000 inhabitants/year). Out of the 1048 patients analyzed, 669 had UC (63.84%), 357 had CD (34.06%), and 22 had unclassified inflammatory bowel disease (UIBD; 2.10%). There were 48/1048 (4.5%) pediatric patients (16 years of age or younger). On the UC phenotype (n = 654), we observed left-sided colitis in 247 (37.7%), pancolitis in 209 (31.9%), and proctitis in 198 patients (30.2%). Pancolitis was more frequent in pediatric patients (p = 0.007). CD showed a homogeneous distribution between ileitis (L1), colitis (L2), and ileocolitis (L3). Regarding the CD behavior (n = 352) observed the inflammatory type (B1) in 176 (50%); fistulizing (B3) in 75 (21.2%), isolated type (B3) in 29 (8.2%), and perianal fistulizing type (B3p) in 46 (13.1%). Biologic therapies were used in 154/357 (43.3%). CONCLUSION: The prevalence of the IBD in the state of Espírito Santo, Brazil was higher than in two other brazilian studies. There was high utilization of biologic therapies in patients with CD.

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo.

INTRODUCTION: Few studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil. METHODS: We reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging. RESULTS: HCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases. CONCLUSIONS: These results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection.

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo

Introduction Few studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil. Methods We reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging. Results HCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases. Conclusions These results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection. .

Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espírito Santo.

OBJECTIVES: To report the etiology of liver cirrhosis cases diagnosed at the University Hospital in Vitoria, Espirito Santo, Brazil. METHODS: The medical charts of patients with liver cirrhosis who presented to the University Hospital in Vitoria were reviewed. Chronic alcoholism and the presence of hepatitis B or C infections (HBV and HCV, respectively) were pursued in all cases. RESULTS: The sample consisted of 1,516 cases (male:female ratio 3.5:1, aged 53.2 ± 12.6 years). The following main etiological factors were observed: chronic alcoholism alone (39.7%), chronic alcoholism in association with HBV or HCV (16.1 %), HCV alone (14.5%) and in association with alcoholism (8.6%) (total, 23.1 %), and HBV alone (13.1%) and in association with alcoholism (7.5%, total 20.6%). The remaining etiologies included cryptogenic cases (9.8%) and other causes (6.0%). The mean patient age was lower and the male-to-female ratio was higher in the cirrhosis cases that were associated with alcoholism or HBV compared with other causes. Intravenous drug abuse and a history of surgery or blood transfusion were significantly associated with HCV infection. Hepatocellular carcinoma was present at the time of diagnosis in 15.4% of cases. Chronic alcoholism associated with HCV infection was significantly associated (p<0.001) with reduced age (at the time of cirrhosis diagnosis) and increased prevalence of hepatocellular carcinoma (p = 0.052). CONCLUSION: Alcoholism, HCV and HBV are the main factors associated with liver cirrhosis in the state of Espirito Santo. Chronic alcoholism associated with HCV infection reduced the age of patients at the time of liver cirrhosis diagnosis.

Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espfrito Santo

OBJECTIVES: To report the etiology of liver cirrhosis cases diagnosed at the University Hospital in Vitoria, Espirito Santo, Brazil. METHODS: The medical charts of patients with liver cirrhosis who presented to the University Hospital in Vitoria were reviewed. Chronic alcoholism and the presence of hepatitis B or C infections (HBV and HCV, respectively) were pursued in all cases. RESULTS: The sample consisted of 1,516 cases (male:female ratio 3.5:1, aged 53.2±12.6 years). The following main etiological factors were observed: chronic alcoholism alone (39.7%), chronic alcoholism in association with HBV or HCV (16.1 %), HCV alone (14.5%) and in association with alcoholism (8.6%) (total, 23.1 %), and HBV alone (13.1%) and in association with alcoholism (7.5%, total 20.6%). The remaining etiologies included cryptogenic cases (9.8%) and other causes (6.0%). The mean patient age was lower and the male-to-female ratio was higher in the cirrhosis cases that were associated with alcoholism or HBV compared with other causes. Intravenous drug abuse and a history of surgery or blood transfusion were significantly associated with HCV infection. Hepatocellular carcinoma was present at the time of diagnosis in 15.4% of cases. Chronic alcoholism associated with HCV infection was significantly associated (p<0.001) with reduced age (at the time of cirrhosis diagnosis) and increased prevalence of hepatocellular carcinoma (p = 0.052). CONCLUSION: Alcoholism, HCV and HBV are the main factors associated with liver cirrhosis in the state of Espirito Santo. Chronic alcoholism associated with HCV infection reduced the age of patients at the time of liver cirrhosis diagnosis.

Cognitive components of frontal lobe function in alcoholics classified according to Lesch's typology.

AIMS: This study examined the frontal lobe cognitive function and the mental state among patients with different types of alcohol dependence according to Lesch's typology. METHODS: The frontal assessment battery (FAB) and the mini-mental status examination (MMSE) were given to 170 patients with alcoholism from a Brazilian outpatient service classified by Lesch's typology and to 40 non-alcoholic controls matched for age, gender, socio-demographic characteristics and education. RESULTS: Of the alcoholic sample, 21.2% were classified as Type I, 29.4% as Type II, 28.8% as Type III and 20.6% as Type IV. Alcoholics showed significantly lower overall scores on the MMSE and the FAB as compared to non-alcoholic subjects. Type IV alcoholics had lower MMSE and FAB overall scores as compared to non-alcoholic controls and also to all other types of alcoholic subjects. However, Type II and III subjects with alcoholism also had lower overall FAB scores, but not overall MMSE scores, as compared to non-alcoholic controls. The FAB subsets of motor programming, sensitivity to interference and inhibitory control were significantly reduced in Types II, III and IV alcoholics as compared to non-alcoholic subjects, but only motor programming remained impaired in Type IV alcoholics with preserved mental function. CONCLUSIONS: Executive dysfunctions in alcohol dependence seem to vary depending upon the type of alcoholism. Therefore, the determination of clinical type of alcohol dependence by applying Lesch's typology, along with brief mental state and frontal function examinations, is of clinical relevance in the examination of alcoholics and provides significant clues for more directed forms of alcohol dependence treatment.

Tipologia de Lesch em alcoolistas no Brasil / Lesch's Typology in Brazilian alcoholic patients

OBJETIVOS: Alcoolismo é uma doença heterogênea, com apresentações clínicas, resultados terapêuticos e recaídas variáveis, indicando vulnerabilidades biológicas diferentes. A Tipologia de Lesch distingue quatro categorias de alcoolismo: Tipo I - graves sintomas de abstinência; Tipo II - álcool como solução para conflitos; Tipo III - álcool para "tratamento" de desordens psiquiátricas; Tipo IV - alterações neurológicas antes do uso de álcool. Este estudo verificou a aplicabilidade de uma classificação do tipo clínico de alcoolismo pela Tipologia de Lesch em um ambulatório público brasileiro de atendimento especializado de alta demanda. MÉTODO: Estudo seccional descritivo, que classificou pacientes do ambulatório de alcoolismo do Hospital Universitário da Universidade Federal do Espírito Santo de acordo com a Tipologia de Lesch. RESULTADOS: A diferenciação pela Tipologia de Lesch foi facilmente conduzida em um serviço ambulatorial público de alta demanda. De 170 pacientes, 21,2 por cento foram classificados como Tipo I; 29,4 por cento, Tipo II; 28,8 por cento, Tipo III e 20,6 por cento, Tipo IV. Embora os diferentes tipos de alcoolismo tenham diferentes apresentações clínicas, o padrão de ingestão alcoólica, idade da primeira ingestão e tempo de abstinência não diferiram entre os tipos de alcoolismo. CONCLUSÃO: A distinção do tipo clínico de alcoolismo de acordo com a Tipologia de Lesch foi considerada aplicável em um ambulatório público brasileiro de grande demanda, sendo os dados encontrados semelhantes aos relatados em estudos realizados em diferentes países. A aplicação dessa classificação poderá definir mudanças nas estratégias de enfrentamento individualizadas do alcoolismo, sendo, entretanto, necessários estudos de seguimento para avaliar os resultados terapêuticos das mesmas.

OBJECTIVE: Alcohol dependence is a heterogeneous disease with a clear variability in clinical, therapeutic results and relapses, indicating different biological vulnerability. Lesch et al (1988) distinguished four categories of alcohol dependence: Type I - severe symptoms of abstinence; Type II - alcohol as a solution for conflicts; Type III - alcohol as self-medication for psychiatric symptoms; Type IV - history of neurological lesions preceding the development of alcohol dependence. This study examined the applicability of a classification of the clinical type of alcoholism according to Lesch's Typology in a high demanding Brazilian public outpatient service for alcohol dependence. METHOD: Alcoholics from a Brazilian public outpatient service for treatment of alcoholism of the School of Medicine of the Federal University of Espírito Santo were classified into categories according to Lesch's Typology. RESULTS: Differentiation by Lesch's Typology was easily conducted in a high demanding public outpatient service. Of 170 alcoholics, 21.2 percent were classified as Type I; 29.4 percent, Type II; 28.8 percent, Type III; 20.6 percent, Type IV. Although different types of alcoholism have different clinical presentations, patients showed similar pattern of alcohol intake, age for the first use of alcohol and withdrawal. CONCLUSION: Distinguishing clinical types of alcohol dependence according to Lesch's Typology was considered applicable in a high demanding Brazilian public outpatient service, in which the results were similar to those reported in studies realized in other countries. The application of this classification may provide significant changes in strategies for individualized approaches that may be of a great importance in the treatment of alcohol dependence. However, the therapeutic results of these changes will need to be evaluated in follow-up studies.

Pancreatite aguda grave: resultados do tratamento cirúrgico em 68 pacientes / Severe acute pancreatitis: results of surgical treatment in 68 patients

OBJETIVO: Analisar os resultados do tratamento cirúrgico das formas necrosantes, ou graves, da pancreatite aguda e da forma crônica agudizada. MÉTODO: Foi preenchido um protocolo, de modo consecutivo e prospectivo, de 68 pacientes operados por pancreatite aguda grave e crônica agudizada, no período de 1982 a 2000. Os pacientes foram classificados em três categorias: 1. Pancreatite aguda biliar; 2. Pancreatite aguda de causa indeterminada; 3. Pancreatite crônica agudizada. RESULTADOS: As indicações para o tratamento cirúrgico foram: diagnóstico incerto (32,3 por cento); necrose infectada (60,3 por cento) e para necrosectomia (7,4 por cento). As operações realizadas foram: desbridamento de necrose infectada(70,6 por cento); operações sobre as vias biliares (20,6 por cento) e desbridamento de grandes necroses (7,4 por cento). Os óbitos hospitalares incidentes, por categoria foram: 1. Pancreatite aguda biliar (33,3 por cento); 2. Pancreatite aguda indeterminada (45,0 por cento); 3. Pancreatite crônica agudizada (37,0 por cento). A média de óbitos foi de 38,2 por cento. Vinte e cinco pacientes foram reoperados, uma ou várias vezes, e nestes a mortalidade foi de 40,0 por cento. Os abscessos foram responsáveis por 52,0 por cento dos óbitos e as outras complicações que resultaram em óbitos, sempre evoluiram para infecção. CONCLUSÕES: Ocorreu um alto índice de operações por diagnóstico incerto. Esta indicação deve se restringir aos casos onde não seja possível o diagnóstico diferencial com certas causas de abdome agudo. As indicações para tratar precocemente a litíase biliar devem ser evitadas ou reduzidas a situações específicas. As reoperações são freqüentemente indicadas nesses pacientes e a infecção foi a principal causa de morte.

BACKGROUND: To evaluate the results of surgical treatment of acute necrotizing pancreatitis, as well as its necrotizing alcoholic form. METHODS: Patients were analyzed according to a prospective protocol. Surgery was performed on 68 patients due to necrotizing acute pancreatitis and acutized chronic pancreatitis from years 1982 to 2000. Patients were grouped into three categories: 1) Biliary acute pancreatitis; 2) Acute pancreatitis of unknown etiology; 3) Necrotizing alcoholic pancreatitis. RESULTS: Patients had the following clinical indications for laparotomy: 1) Uncertain diagnosis (32.3 percent); 2) Infected necrosis (60.3 percent); 3) Necrosectomy (7.4 percent). The surgical findings were: Infected necrosis (70.6 percent); biliary complicatios (20.6 percent) and large necrosis 1(7.4 percent). Global hospital mortality was 38.2 percent. Individual categories showed a mortality of 33.3 percent (biliary acute pancreatitis), 45.0 percent (undetermined acute pancreatitis) and 37.0 percent (necrotizing alcoholic pancreatitis). Reoperations were indicated once or more times in 25 patients, and among these, the mortality was 40 percent. Abscesses were the main cause of death (52.0 percent), and all the other complications that resulted in death invariably evolved to infection. CONCLUSIONS: The indications of early surgical treatment for gallbladder stones, as well as when the diagnosis is not clear, should be reduced to very specific circumstances. Reoperations are common in these patients and infection was the main immediate cause of death.

Pancreatite crônica: resultados do tratamento cirúrgico em 74 pacientes / Results of the surgical management of 74 patients with Chronic pancreatitis

OBJETIVO: Analisar as indicações, técnicas e resultados do tratamento cirúrgico de 74 pacientes operados por complicações da pancreatite crônica. MÉTODO: Foram pacientes consecutivos, estudados prospectivamente pelo preenchimento de um protocolo individual, no período de 1971 a 2000. Foram realizadas cirurgias de derivação e ressecção. O acompanhamento foi feito pelo agendamento de consultas no ambulatório, por convocação por cartas e telefonemas. RESULTADOS: Dos 270 pacientes com pancreatite crônica, acompanhados pelo Serviço, 74 (27,4 por cento) foram operados. Destes 74 pacientes, 97,7 por cento eram do sexo masculino e a idade variou de 15 a 63 anos, com média de 39,4 anos para alcoolistas e 33,1 para aqueles com outras etiologias. O alcoolismo foi a causa da doença em 68 pacientes (90,5 por cento) e os outros casos estiveram relacionados a hiperparatiroidismo(1), pancreatite hereditária (1), fibrose retroperitoneal (1) e em três casos a etiologia não foi definida. As seguintes causas únicas ou associadas definiram a indicação cirúrgica:1. dor em 44,6 por cento dos pacientes; 2. compressão de vias biliares em 28,4 por cento; 3. pseudocistos em 12,2 por cento; 4. fístulas internas em 10,8 por cento. Cinqüenta pacientes (67,5 por cento) foram submetidos a operações de derivação e 24 (32,5 por cento) a cirurgias de ressecção. Oito pacientes derivados (16,0 por cento) complicaram, ocorrendo três óbitos; dez ressecados (41,6 por cento) complicaram, com cinco óbitos. Os óbitos estiveram relacionados a abscessos, às deiscências e às hemorragias cirúrgicas. CONCLUSÕES: As cirurgias de derivação mostraram-se mais seguras e as complicações que evoluíram com infecção foram as mais graves e ocorreram com mais freqüência nas ressecções.

BACKGROUND: To evaluate the indications, methods and results of the surgical treatment of 74 patients operated on for chronic pancreatitis complications. METHOD: Consecutive patients' charts were studied prospectively, during the years of 1971 to 2000. Surgery was indicated for pain, billiary tract stricture, pseudocysts, pancreatic ascitis and pancreaticopleural fistulas. Pancreaticojejunal anastomosis, billiary tract derivations and resections were performed. Follow-up was achieved through ambulatorial appointments or by mail and telephone calls. RESULTS: Of 270 patients listed with chronic pancreatitis, 74 (27.4 percent) were operated on. 97.7 percent of them were males. Patients varied in age from 15 to 63 years old, with an average of 39.4 years for alchoolists and 33.1years for those with pancreatitis of other etiologies. The disease was caused by alchool in 68 patients (90.5 percent). The other causes were: hyperparathyroidism (1), hereditary pancratitis (1), retroperitoneal fibrosis(1) and in three patients the etiology was unknown. Indications for surgery were: 1. Pain in 44.6 percent of the patients; 2. Billiary tract stricture (28.4 percent); 3.Pseudocysts (12.2 percent); 4. Pancreatic ascitis and pancreaticopleural fistulas (10.8 percent). Derivations were performed in 50 patients (67.5 percent), and resections in 24 (32.5 percent). Complications ocurred in eight patients with five hospital deaths related to abscesses, suture leaking and surgical bleeding. CONCLUSIONS: There was less morbidity and mortality for derivations and than after resections.