ABSTRACT
The investigation performed in 18 diarrheid and 24 spastic patients showed adrenal glands hyperactivity in the former and hypoactivity in the latter. The central noradrenergic system was unresponsive to glucose in both groups: probably due to glucose-insulin failure to rise in diarrheics, whereas a hyperactive parasympathetic system may have been resposible in spactics. Diarrheics had the lowest sigmoidal tone with rectal hyperactivity and the highest plasma catecholamines + cortisol + glucose + insulin values. Spastic patients, in turn, had the highest sigmoidal tone and the lowest catecholamine values. Plasma glucose, insulin, platelet serotocin and sigmoidal tone rose in spactics, after glucose ingestion, but failed to do so in diarrheics. Further, in spactic patients, sigmoidal tone correlated positively with platelet serotonin and negatively with noradrenaline. The clonidine test showed hyperresponsivenes of growth hormone, cortisol and diastolic blood pressure in diarrheics, compared to a normal response in spastics, alpha-adrenergic antagonists suppressed diarrhea and renal hiperactivity. Alpha adrenergic agonists (wich also deplete plattelet-and myentericplexa serotonin) reduced signoidal tone to zero, increased rectal activity and provoked diarrhea. These findings suggest that peripheral sympathetic activity (prevalent in diarrheics) and hyperparasympathetic activity (prevalent in spactics) trigger these physiological disorders by respectively suppressing and reinforcing the serotonin-plexa level functioning
Subject(s)
Humans , Male , Female , Colonic Diseases, Functional/classification , Colonic Diseases, Functional/diagnosis , Colon/abnormalities , Diarrhea/diagnosis , Glucose/analogs & derivatives , Insulin/administration & dosage , Serotonin/administration & dosageABSTRACT
La Infundibulotomía o colédoco-duodenostomía endoscópica es una laternativa a la anastomosis bilio-digestiva quirúrgica por obstrucción del ducto-biliar común en casos con cálculo impactado en la ampolla de Vater en los cuales ocasionalmente la esfinterotomía endoscópica por el orificio natural se dificulta. Además se describe su indicación como método de tratamiento paliativo en pacientes ancianos y/o alto riesgo quirúrgico con obstrucción maligna de la porción distal del ducto biliar común