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G Robles-Díaz

Publications and source records attributed to G Robles-Díaz.

At least 37 records · Page 2Linked to original sources
PubMed1985

Nutritional data and etiology of chronic pancreatitis in Mexico.

Alcoholism and malnutrition have been implicated commonly in the etiology of chronic pancreatitis (CP). The geographical distribution and clinical and nutritional features differ between the alcoholic and tropical forms of CP. This work presents the etiology and nutritional characteristics of CP in Mexico, a country in which both alcoholism and childhood malnutrition are common. Two well-defined groups of patients have been identified: an alcoholic group composed mainly of males with a mean age at clinical onset of 41 years and a high dietary intake of fat, protein, carbohydrates, and calories; and a nonalcoholic group with a female preponderance, a mean age at onset of 23 years, and a higher intake of protein than controls. We conclude that alcoholic chronic pancreatitis in Mexico is similar to that reported in other temperate countries. Although the nonalcoholic group resembles that observed in tropical countries in many ways, our patients are not malnourished, further questioning the role of childhood malnutrition in the pathogenesis of this type of chronic pancreatitis.

Adolescent↗
PubMedDate not supplied

Asymptomatic gallstones and duration of cyclosporine use in kidney transplant recipients.

BACKGROUND: Cyclosporine (CsA) use has been associated to the development of cholelithiasis in transplant recipients. We herein explored the role of time under CsA on this association in asymptomatic adult kidney transplant recipients (KTR). METHODS: A cross-sectional study was conducted in 140 KTR with variable post-transplant follow-up (PTFU), and without history of symptomatic biliary disease. Upper abdominal ultrasound was performed in all patients. According to the immunosuppressive schedule, patients were classified in three groups: Azathioprine + prednisone (group 1, n = 37), azathioprine + prednisone < 24 months CsA (group 2, n = 58), or azathioprine + prednisone > or = 24 months CsA (group 3, n = 45). Age at time of ultrasound performance, gender, PTFU, chronic viral liver disease, parity, oral contraceptives, serum lipids, diabetes and body mass index were analyzed concomitantly. RESULTS: Median age was 38, 31, and 36 years in groups 1, 2, and 3, respectively. The male:female ratio in the same groups was 1.5:1, 1:1, and 2:1. Mean PTFU was 130, 48, and 53 months, respectively (p = 0.0001). Gallstones were found in three (8%) group 1 KTR, in nine (16%) group 2 KTR, and in 10 (22%) group 3 KTR (p = 0.214). Adjusting for PTFU, the association between length of CsA and prevalence of lithiasis was significantly stronger among those with longer use of CsA (odds ratio = 6.1, p = 0.046). No significant differences were found among groups in the other variables. CONCLUSIONS: KTR receiving CsA for more than two years show increased prevalence of gallstones.

Azathioprine↗
PubMedDate not supplied

[Does cholestasis change the clinical usefulness of CA 19-9 in pacreatobiliary cancer?].

BACKGROUND: CA 19-9 is used for diagnosis of gastrointestinal neoplasia, mainly pancreatic and biliary cancer. False positive results have been described in cholestasis. OBJECTIVE: To establish the clinical value of CA 19-9 in the diagnosis of pancreatic and biliary cancer in patients with and without cholestasis. METHODS: Five hundred forty-eight medical records of patients with serum CA 19-9 determination performed from May-1996 to June-1998 were reviewed. Cases were grouped by final diagnosis; malignancy was established by histology or clinical and radiological characteristics. ROC curves were used to calculate ideal cut-off values (ICV) for the test. Cholestasis was defined as bilirrubinemia above 3 mg/dL. RESULTS: Thirty percent of serum determinations were done in patients with non-pancreatic and non-hepatobiliary benign diseases (only 1.3% with values > or = 100 U/mL). CA 19-9 levels were higher in pancreatic and hepatobiliary malignancy compared to benign diseases of the same origin, as well as in pancreatic cancer when compared with hepatobiliary cancer. ICV for differentiation of malignant hepatobiliary diseases was set around 100 U/mL, with increased specificity when compared with the usual cut-off value (37 U/mL). Cholestasis increased the values of the antigen in malignant and benign diseases and modified the efficacy of the test by increasing sensitivity while decreasing specificity. The ICV for determining resectability in pancreatic tumors was 224 U/mL. CONCLUSIONS: CA 19-9 is a valuable test for diagnosis of malignant pancreato-hepatobiliary disease. Given that cholestasis modifies the operational characteristics of the test, a cut-off value has to be tailored for each patient depending on the clinical setting, so to maintain the usefulness of the marker.

Adolescent↗
PubMedDate not supplied

[Dissolution of pancreatic calcifications with oral citrates in a woman with chronic idiopathic pancreatitis].

Pain control is one of the most important objectives in the medical treatment of patients with chronic calcifying pancreatitis (CCP). It is generally accepted that pain in CCP is secondary to the obstruction of the pancreatic duct by calcifications, protein plugs and stenotic areas. Experimental studies have shown that calculi and protein plugs are soluble in citrates. We report here the case of a young non alcoholic woman with idiopathic CCP who after a pancreatojejunostomy developed again pain and pancreatic calcifications which were dissolved with oral citrates. The case confirms previous observations and illustrates the potential use of citrates in subjects with CCP.

Abdominal Pain↗
PubMedDate not supplied

[Pancreatic phlegmon: a potentially fatal form of acute pancreatitis].

AIM: To report the clinical characteristics of a group of patients with pancreatic phlegmon (PF) seen at the Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City. MATERIAL AND METHODS: We reviewed all the cases of acute pancreatitis hospitalized from January 1981 to December 1989. The diagnosis of pancreatic phlegmon was established when the CT scan showed a solid mass in the pancreas and peripancreatic region with more than 20 Hounsfield units without liquid collections or a fibrous capsule. We analyzed clinical, biochemical, and radiological data. RESULTS: Acute pancreatitis was diagnosed in 132 patients. In 14 a pancreatic phlegmon was observed (10.6%). Twelve were men; the mean age was 44.7 years. In six cases acute pancreatitis was secondary to alcohol abuse and in four to gallstones. Abdominal pain was present in all patients. Ten had leucocitosis and seven fever and/or jaundice. An abdominal mass was detected in three cases. The severity of pancreatitis was graded according to our institutional criteria as mild (0-2 signs) or severe (3-5 signs). In 10 patients AP was graded as mild: no mortality was observed in this group but three presented complications (two liquid collections and one an abscess). The four patients with severe pancreatitis presented complications and three died (one abscess, two multiorgan failure). Five patients were operated on. In three an abscess was drained. CONCLUSIONS: Pancreatic phlegmon is a potentially severe form of AP. All patients who died presented, in addition to PF, clinical criteria of severe pancreatitis.

Acute Disease↗
PubMedDate not supplied

[4 cases of annular pancreas at the Instituto Nacional de la Nutrición Salvador Zubirán].

Annular pancreas (AP) is a rare congenital anomaly due to malrotation of the pancreatic ventral yolk. Although it has been described in young and middle age adults it predominates in children. Its clinical picture is that of duodenal obstruction or acute pancreatitis episodes. In this paper we report four cases of AP that were seen at the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. Three were females and three were less than twenty years old. In one case the diagnosis was established at birth and the operation done in another hospital. In another patient a diagnosis of pyloric hypertrophy was made and a pyloroplasty was performed. This young man was admitted in our hospital because of abdominal pain and hyperamylasemia. An eighty four year old woman was seen due to abdominal pain, nausea and vomit. In all cases the diagnosis of AP was carried out with radiological studies and confirmed by laparotomy. Surgical procedures consisted of duodenal-duodenal anastomosis in two, sphincteroplasty in one, and gastrojejunoanastomosis in the other. Two patients are asymptomatic, one died in the postoperative period, and one was lost for follow up. These four cases represent all the experience of our institute and correspond to one case in 36,735 admissions.

Abdominal Pain↗
PubMedDate not supplied

[Sphincteroplasty of the minor papilla in a female patient with pancreas divisum].

We report the case of a 30 year old woman with recurrent episodes of acute pancreatitis secondary to pancreas divisum. The diagnosis was established 18 years after the initiation of her symptomatology. She denied a family history of pancreatic disease and had no risk factors in her personal history. Diagnosis was confirmed by endoscopic retrograde cholangiopancreatography. She was surgically treated by means of a sphincteroplasty of the minor papillae with excellent results. After three years of follow-up, the patient remains asymptomatic.

Acute Disease↗