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Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as 3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN 1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

Resumen Introduccion La enfermedad COVID-19 se ha convertido en una prioridad para nuestro sistema sanitario. Los MIR de Endocrinologia y Nutricion (MIR-EyN) se han integrado en los equipos COVID-19. Se ha disenado este estudio con el objetivo de analizar el impacto a nivel formativo, laboral y en la salud de los MIR-EyN. Material y metodos Estudio observacional transversal tipo encuesta via web, dirigida a los MIR-EyN socios de la SEEN, realizado en noviembre de 2020. Se han analizado: variables demograficas, tamano del hospital de formacion en numero de camas, alteracion de las rotaciones, integracion en equipos COVID-19, participacion en teleconsulta, actividad cientifica e impacto sobre la salud fisica y emocional. Resultados Se han obtenido 87 respuestas (27% de los MIR-EyN); 67,8% mujeres, edad media 28,1 ± 1,8 anos, 60% MIR-EyN 4.o ano. El 84% ha participado en equipos COVID-19 y el 93% en las consultas telematicas de su servicio. La mayoria ha visto interrumpidas sus rotaciones. El 97,7% ha participado en reuniones cientificas o congresos virtuales y un tercio de ellos ha colaborado en trabajos cientificos sobre la COVID-19 en relacion con la Endocrinologia y Nutricion. La pandemia ha afectado a su estado de animo mucho o bastante (75,8%) y opinan que ha impactado de forma negativa a su formacion (73,8%). Conclusiones La pandemia por SARS-CoV-2 ha comprometido la formacion, la actividad laboral y la salud de los MIR-EyN. Se han integrado tanto en equipos COVID-19 como en la actividad reestructurada de sus servicios. Sin embargo, han conseguido mantener la formacion en formato virtual y participado en trabajos cientificos.

Background: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. Objective: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. Methods: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. Results: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. Conclusion: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.

Background & aims: Intestinal failure (IF) is defined from a requirement or intravenous supplementation due to failing capacity to absorb nutrients and fluids. Acute IF is an acute, potentially reversible form of IF. We aimed to identify the prevalence, underlying causes and outcomes of acute IF.Methods: This point-of-prevalence study included all adult patients hospitalized in acute care hospitals and receiving parenteral nutrition (PN) on a study day. The reason for PN and the mechanism of IF (if present) were documented by local investigators and reviewed by an expert panel.Results: Twenty-three hospitals (19 university, 4 regional) with a total capacity of 16,356 acute care beds and 1237 intensive care unit (ICU) beds participated in this study. On the study day, 338 patients received PN (21 patients/1000 acute care beds) and 206 (13/1000) were categorized as acute IF. The categorization of reason for PN was revised in 64 cases (18.9% of total) in consensus between the expert panel and investigators. Hospital mortality of all study patients was 21.5%; the median hospital stay was 36 days. Patients with acute IF had a hospital mortality of 20.5% and median hospital stay of 38 days (P > 0.05 for both outcomes). Disordered gut motility (e.g. ileus) was the most common mechanism of acute IF, and 71.5% of patients with acute IF had undergone abdominal surgery. Duration of PN of >= 42 days was identified as being the best cut-off predicting hospital mortality within 90 days. PN >= 42 days, age, sepsis and ICU admission were independently associated with 90-day hospital mortality.Conclusions: Around 2% of adult patients in acute care hospitals received PN, 60% of them due to acute IF. High 90-day hospital mortality and long hospital stay were observed in patients receiving PN, whereas presence of acute IF did not additionally influence these outcomes. Duration of PN was associated with increased 90-day hospital mortality. (C) 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Contains fulltext : 244566.pdf (Publisher’s version ) (Closed access) BACKGROUND AND AIMS: The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. METHODS: The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as 3 L/day. RESULTS: In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused ≥5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. CONCLUSIONS: SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.

Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.The median adherence to ERAS was 68.2% (IQR 59.1%-81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P 0.01) were independently associated with greater adherence. Case volume (-2.38% per 4 cases weekly, 95%CI -3.03 to -1.74, P 0.01) and number of anesthesia providers (-1.19% per 10 providers, 95%CI +2.23 to -8.18%, P 0.01) were negatively associated with adherence.Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.

espanolAntecedentes y objetivos: el ultimo gran estudio multicentrico sobre desnutricion relacionada con la enfermedad (DRE) en Espana (el estudio PREDyCES) mostro una prevalencia de desnutricion del 23,7 % segun la herramienta Nutritional Risk Screening (NRS-2002). El principal objetivo del estudio SeDREno fue evaluar la prevalencia de la desnutricion hospitalaria al ingreso segun los criterios GLIM diez anos despues. Metodos: estudio transversal, observacional, multicentrico, segun la practica clinica estandar, realizado en 17 hospitales durante un periodo de cinco a siete dias. Los pacientes fueron evaluados inicialmente con la herramienta de deteccion universal de desnutricion (MUST) y luego con los criterios GLIM para el diagnostico de DRE y la clasificacion de la gravedad. Resultados: se evaluaron 2185 pacientes, con un 54,8 % de varones, una edad media de 67,1 (17,0) anos (50,2 % ≥ 70 anos). Se observo desnutricion en el 29,7 % de los pacientes segun los criterios GLIM (12,5 % grave, 17,2 % moderada). Entre los pacientes ≥ 70 anos se observo desnutricion en el 34,8 %. Las condiciones clinicas asociadas significativamente con una mayor prevalencia de desnutricion fueron la disfagia (47,6 %), el deterioro cognitivo (43,4 %), el cancer (39,1 %), las enfermedades gastrointestinales (37,7 %), la diabetes (34,8 %) y la patologia cardiovascular (33,4 %). El analisis multivariante revelo que el sexo, el IMC, la diabetes, el cancer, los trastornos gastrointestinales y la polimedicacion eran los principales factores independientes asociados a la DRE. La desnutricion se asocio a un aumento de la duracion de la estancia hospitalaria y la muerte (p Conclusiones: la DRE en pacientes ingresados ha aumentado en Espana en los ultimos 10 anos en paralelo con el aumento del envejecimiento de la poblacion. En el estudio SeDREno, casi uno de cada tres pacientes esta desnutrido. La evaluacion sistematica del estado nutricional permite la deteccion e implementacion precoces de intervenciones nutricionales para lograr un mejor resultado clinico. EnglishBackground & aims: the last large multicenter study on disease-related malnutrition (DRM) in Spain (the PREDyCES study) showed a 23.7 % prevalence of malnutrition, according to the Nutritional Risk Screening (NRS-2002) tool. The main objective of the SeDREno study was to assess the prevalence of hospital malnutrition upon admission, according to GLIM criteria, ten years later. Methods: a cross-sectional, observational, multicenter study in standard clinical practice, conducted in 17 hospitals during a period of five to seven days. Patients were initially screened using the Malnutrition Universal Screening Tool (MUST), and then assessed using the GLIM criteria for diagnosis and severity grading. Results: a total of 2,185 patients, 54.8 % males, mean age 67.1 (17.0) years (50.2 % aged ≥ 70 years), were evaluated. Malnutrition was observed in 29.7 % of patients according to GLIM criteria (12.5 % severe, 17.2 % moderate). In patients ≥ 70 years malnutrition was observed in 34.8 %. The clinical conditions significantly associated with a higher prevalence of malnutrition were dysphagia (47.6 %), cognitive impairment (43.4 %), cancer (39.1 %), gastrointestinal disease (37.7 %), diabetes (34.8 %), and cardiovascular disease (33.4 %). The multivariate analysis revealed that gender, BMI, diabetes, cancer, gastrointestinal disorders, and polypharmacy were the main independent factors associated with DRM. Malnutrition was associated with an increase in length of hospital stay and death (p Conclusions: DRM in admitted patients has increased in Spain in the last 10 years paralleling ageing of the population. In the SeDREno study almost one in three patients are malnourished. A systematic assessment of nutritional status allows early detection and implementation of nutritional interventions to achieve a better clinical outcome.

Aim: To communicate home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe. com) for the year 2018. Material and methods: Descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2018 to December 31st, 2018. Results: There were 278 patients from 45 Spanish hospitals (54.7% women), 23 children and 255 adults, which represent a prevalence rate of 5.95 patients/million inhabitants/year 2018. The most frequent diagnosis in adults was “palliative cancer” (22.0%), followed by “others”. In children it was Hirschsprung’s disease together with necrotizing enterocolitis, with four cases (17.4%). The first indication was short bowel syndrome in both children (60.9%) and adults (35.7%). The most frequently used type of catheter was tunneled in both children (81.0%) and adults (41.1%). Ending 75 episodes, the most frequent cause was death (52.0%) and change to oral feeding (33.3%). Conclusions: The number of centers and collaborating professionals in the registry of patients receiving HPN remains stable, as well as the main indications and reasons for termination of HPN., Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadyasenpe. com) del año 2018. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE del 1 de enero al 31 de diciembre de 2018. Resultados: se registraron 278 pacientes (54,7% mujeres), 23 niños y 255 adultos, procedentes de 45 hospitales españoles, lo que representa una tasa de prevalencia de 5,95 pacientes/millón de habitantes/año 2018. El diagnóstico más frecuente en adultos fue “oncológico paliativo” (22,0%), seguido de “otros”. En niños fue la enfermedad de Hirschsprung junto con la enterocolitis necrotizante, con cuatro casos (17,4%). El primer motivo de indicación fue síndrome de intestino corto tanto en niños (60,9%) como en adultos (35,7%). El tipo de catéter más utilizado fue el tunelizado tanto en niños (81,0%) como en adultos (41,1%). Finalizaron 75 episodios, la causa más frecuente fue el fallecimiento (52,0%) y el paso a vía oral (33,3%). Conclusiones: el número de centros y profesionales colaboradores en el registro de pacientes que reciben NPD se mantiene estable, así como las principales indicaciones y los motivos de finalización de la NPD.

In recent years, there has been growing interest in diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) as an important mainstay in the treatment of irritable bowel syndrome (IBS). This model of diet was developed by a multidisciplinary team from the Monash University in Melbourne and became well-known after the publication of a study in 2008 showing that dietary FODMAPs acted as causing factors in patients with IBS. Since then there have been several randomized controlled trials which, although with small sample sizes, have again shown the benefits of this dietary pattern.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality., This work was supported by Instituto de Salud Carlos III (ISCIII, co-funded by Fondo Europeo de Desarrollo Regional [FEDER], European Union [EU], Una manera de hacer Europa), Ministerio de Ciencia, Innovacion y Universidades, Gobierno de Espana (PI15/01034), and Sociedad Andaluza de Endocrinologia Diabetes y Nutrition (SAEDYN) 2016 research project. Centro de Investigacion Biomedica en Red (CIBERDEM) is an initiative of the Instituto de Salud Carlos III.

BACKGROUND & AIMS: The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements.METHODS: ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need.RESULTS: Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume.CONCLUSIONS: Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.

Fundamento. La prevalencia de obesidad en Espana en los ultimos anos muestra un incremento alarmante. El fracaso repetido de las pautas de alimentacion equilibrada, actividad fisica, educacion nutricional y farmacoterapia han conducido a la necesidad de utilizar la cirugia bariatrica tanto para el mantenimiento de la perdida ponderal a largo plazo, como para la resolucion de las co-morbilidades asociadas. En el presente trabajo se pretende analizar los resultados iniciales de la puesta en marcha del programa de cirugia bariatrica laparoscopica en Navarra obtenidos en un grupo de pacientes obesos con indicacion quirurgica e intervenidos mediante el bypass gastrico laparoscopico (BPGYR). Material y metodos. Desde enero de 2010 hasta diciembre de 2011 se realizaron 47 BPGYR por via laparoscopica en la Clinica Universidad de Navarra procedentes todos ellos de la Comunidad Foral de Navarra y evaluados previa y posteriormente en el Complejo hospitalario de Navarra. De ellos, se han seleccionado para este trabajo los primeros 19 casos por presentar al menos un ano de seguimiento. Resultados . El porcentaje de exceso de IMC perdido (PEIMCP) fue del 65,47%, con una disminucion del porcentaje de peso total de 31,68%. Las cifras de glucosa, acido urico, tension arterial y metabolismo lipidico al ano de la intervencion presentaron un descenso progresivo muy significativo, No se presentaron complicaciones importantes medicas ni quirurgicas. Conclusiones. El bypass gastrico por laparoscopia es un tecnica eficaz para el tratamiento a largo plazo de la obesidad morbida, con escaso numero de complicaciones, excelente perdida de peso y curacion o mejora de las co-morbilidades asociadas en estos pacientes.

Hypophysitis are a group of inflammatory lesions affecting the pituitary gland and pituitary stalk. These lesions should be included in the differential diagnosis of sellar masses. There are three types of primary hypophysitis: lymphocytic, granulomatous and xanthomatous. Lymphocytic hypophysitis is the most frequent form of chronic pituitary inflammation and is believed to have an autoimmune origin. This form characteristically affects women during the peripartum, with diverse types of pituitary deficiency, especially ACTH deficiency, and frequently there are other associated autoimmune processes. Lymphocytic hypophysitis can affect the anterior pituitary only, the infundibular stalk and posterior lobe of the pituitary (infundibuloneurohypophysitis), or the entire pituitary (panhypophysitis). Clinically, lymphocytic hypophysitis can manifest with compression symptoms, hypopituitarism, diabetes insipidus or hyperprolactinemia. The imaging technique of choice is magnetic resonance imaging, which helps to characterize the sellar lesion. Treatment includes replacement of the functional pituitary deficiency and the use of corticosteroids, generally at high doses. Surgical treatment is reserved for patients unresponsive to conservative therapy. Granulomatous hypophysitis can be of known etiology, whether infectious (currently highly infrequent) or non-infectious (ruptured Rathke's cyst, etc.). Granulomatous hypophysitis of unknown etiology is manifested by the presence of idiopathic granulomas. Xanthomatous hypophysitis is characterized by a histiocytic infiltrate with cystic characteristics on imaging. Secondary hypophysitis is due to pituitary inflammation caused by surrounding lesions or can form part of systemic diseases.

During pregnancy, the body undergoes a major adaptation process as a result of the interaction between mother, placenta and fetus. Major anatomical and histological changes are produced in the pituitary, with an increase of up to 40% in the size of the gland. There are wide variations in the function of the hypothalamus-pituitary-thyroid axis that effect iodine balance, the overall activity of the gland, as well as transport of thyroid hormones in plasma and peripheral metabolism of thyroid hormones. The incidence of goiter and thyroid nodules increases throughout pregnancy. The management of differentiated thyroid carcinoma should be individually tailored according to tumoral type and pregnancy stage. Given the effects of hypothyroidism on fetal development, both the diagnosis and appropriate therapeutic management of thyroid hypofunction are essential. The most important modification to the hypothalamus-pituitary-adrenal axis during pregnancy is the rise in serum cortisol levels due to an increase in cortisol-binding proteins. Although Cushing's syndrome during pregnancy is infrequent, both diagnosis and treatment of this disorder are especially difficult. Adrenal insufficiency during pregnancy does not substantially differ from that occurring outside pregnancy. However, postpartum pituitary necrosis (Sheehan's syndrome) is a well-known complication that occurs after delivery and, together with lymphocytic hypophysitis, constitutes the most frequent cause of adrenal insufficiency. The management of prolactinoma during pregnancy requires suppression of dopaminergic agonists and their reintroduction if there is tumoral growth. Notable among the neuropituitary disorders that can occur throughout pregnancy is diabetes insipidus, which occurs as a consequence of increased vasopressinase activity.

In recent years, there has been growing interest in diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) as an important mainstay in the treatment of irritable bowel syndrome (IBS). This model of diet was developed by a multidisciplinary team from the Monash University in Melbourne and became well-known after the publication of a study in 2008 showing that dietary FODMAPs acted as causing factors in patients with IBS. Since then there have been several randomized controlled trials which, although with small sample sizes, have again shown the benefits of this dietary pattern.

Purpose: A new technique for stem cells intrapancreatic autotransplantation in rats. Basic Procedures: Section of a femoral diaphysis and aspirations of the bone marrow in both femoral segments were performed. A Kirschner needle was placed into the femur. Cells were isolated in Ficoll gradients and preserved at 4–68C. The second day, cells were injected, via aortic celiac trunk, into the pancreas of the same rat. Results: Femoral surgery were well tolerated. Intrapancreatic homing of the injected cells was suggested with methylene blue injection that stained the pancreas, and proved by labeled cells in pancreas sections. Cell counts after Ficoll isolation were 1 10 6 6 2 10 5 ES. Conclusions: A technique is described for stem cell autotransplantation in rats. First we obtain autologous bone marrow-derived stem cells. Second, we inject the cells in the pancreas of the donor rat. This approach can be applied to experimental diabetes and other pancreatic processes. V V C 2006 Wiley-Liss, Inc. Microsurgery 26:539–542, 2006.

Refeeding syndrome is a complex clinical picture that encompass all those alterations that can occur as a consequence of the nutritional support (oral, enteral or parenteral) in malnourished patients. Refeeding syndrome is classically characterized by neurological alterations, respiratory symptoms, cardiac arrhythmias and heart failure few days after beginning of refeeding, with life-threatening outcome. Its pathogenesis includes alterations in the corporal fluids, and in some electrolytes, minerals and vitamins. In this article a review of refeeding syndrome pathogenesis and clinical manifestations is carried out, with a final series of recommendations for lowering the risk of this syndrome and for facilitate the early diagnosis and the treatment.

El termino diabetes mellitus postrasplante (DMPT) se refiere a la aparicion de diabetes mellitus en individuos que han sido previamente sometidos a trasplante de organos, fenomeno que se ha observado a medida que las tasas de supervivencia de los receptores de trasplante se prolongan, gracias a la mejora en las tecnicas de trasplante y la introduccion de nuevos medicamentos inmunodepresores. De entrada surgen dos planteamientos: a) la posibilidad de que estos pacientes podrian haber desarrollado diabetes aunque no hubiesen sido trasplantados 1 , y b) la relacion causal con los medicamentos empleados durante y despues del trasplante. Aunque siempre influiran la predisposicion individual y la historia familiar de cada paciente, en muchos casos existe evidencia clinica y experimental de que los inmunodepresores pueden ser la causa del incremento del riesgo de padecer diabetes postrasplante 2 . El numero de pacientes que sobreviven mas de 10 anos al trasplante de organos es cada vez mayor, y el desarrollo de diabetes mellitus en ellos puede ocasionar morbimortalidad debido a complicaciones micro y macrovasculares

Resumen El objetivo de esta nota clinica, es resaltar la eficiencia diagnostica de la gammagrafia 123 I-Metayodobencilguanidina ( 123 I-MIBG) en el diagnostico inicial y seguimiento del carcinoma medular de tiroides (CMT) dentro del MEN2. Material y metodos Se expone el caso de un paciente, que durante la realizacion de estudio gammagrafico con 123 I-MIBG para el diagnostico de feocromocitoma, se halla de forma casual un CMT. Previa a la realizacion de la prueba, se procedio al bloqueo de la captacion de la glandula tiroides mediante la administracion de Lugol. Se llevo a cabo estudio gammagrafico, realizando inyeccion i.v. de 10 mCi de 123 I-MIBG. Resultados Se detecto captacion patologica del radiofarmaco sobre glandula suprarrenal derecha y, como hallazgo casual, sobre glandula tiroidea, confirmandose posteriormente la existencia de CMT en este paciente, llegando al diagnostico de sindrome poliglandular tipo MEN2A. Conclusiones Nuestra experiencia, ponen de manifiesto el valor de la gammagrafia con 123 I-MIBG en el diagnostico y localizacion del CMT. Asi mismo, esta indicada en pacientes en los que se sospeche la existencia de MEN, pudiendo llegar al diagnostico de este tipo de sindromes, mediante la realizacion de una unica prueba.