Ansa pancreática: desafio no diagnóstico etiológico em paciente jovem com pancreatite grave / Ansa pancreatica: etiological diagnosis challenge in a young patient with severe pancreatitis

A ansa pancreática é uma variação anatômica rara dos ductos pancreáticos. Consiste numa comunicação entre o ducto pancreático principal (Wirsung) e o ducto pancreático acessório (Santorini). Recentemente, estudos têm demonstrado estar essa variação anatômica implicada como fator predisponente e significativamente associada a episódios recorrentes de pancreatite aguda. A pancreatite é uma entidade clínica pouco frequente na infância. Diferente dos adultos, as causas mais comuns incluem infecções virais, por ascaris, medicamentosas, traumas e anomalias estruturais. O objetivo deste estudo foi relatar um caso de pancreatite aguda grave não alcoólica e não biliar, em um paciente jovem de 15 anos, em cuja propedêutica imagenológica evidenciou-se alça, comunicando com os ductos pancreáticos ventral e dorsal, compatível com ansa pancreática.

Ansa pancreatica is a rare anatomical variation of the pancreatic ducts. It consists of communication between the main pancreatic duct (Wirsung) and the accessory pancreatic duct (Santorini). Recently, studies have shown that this anatomical variation is implicated as a predisposing factor and significantly associated with recurrent episodes of acute pancreatitis. Pancreatitis is a rare clinical entity in childhood. Different from that in the adults, the most common causes include viral and ascaris infections, drugs, traumas, and structural abnormalities. The objective of this study was to report a case of a severe non-alcoholic and non-biliary acute pancreatitis in a 15-year-old patient, whose propedeutic imaging showed a loop communicating with the ventral and dorsal pancreatic ducts, consistent with ansa pancreatica.

Analysis of influencing factors of severity in acute pancreatitis using big data mining

SUMMARY OBJECTIVES To evaluate the epidemiological characteristics of acute pancreatitis (AP) and explore potential relationships between these factors and severity. METHODOLOGY Data-sets of 5,659 patients with AP from health statistics and the Information Center of Jiangsu province, between 2014 and 2016, were analyzed. A self-organizing map (SOM) neural network was used for data clustering. RESULTS Biliary acute pancreatitis (BAP) (86.7%) was the most frequent etiological factor. A total of 804 (14.2%) patients had severe acute pancreatitis (SAP). The mean age of patients was 53.7 + 17.3 (range 12~94y). Most of the AP patients were married (75.4%); 6% of mild /moderately severe AP (MAP/MASP) patients were unmarried, which was less than SAP patients (P=0.016). AP patients with blood type AB in the general population (8.8%) was significantly lower than that of AP cases (13.9%) (P=0.019) and SAP cases(18.7%) (P=0.007). The number of AP patients in southern Jiangsu was much higher than that in northern Jiangsu province, especially in Nanjing (1229, 21.7%). The proportion of acute alcoholic pancreatitis (AAP) in the north of Jiangsu (Xuzhou 18.4%) was much higher than that in southern Jiangsu (Suzhou 2.6%). The whole sample was divided into five classes by SOM neural network. If BAP patients were male, old, divorced, and blood type AB or B, they were more likely to develop SAP. Middle-age, unmarried or divorced male patients with blood type B/AB who suffered from HAP or AAP were also more likely to develop SAP. CONCLUSIONS The number of unmarried patients with MAP/MASP was smaller than that of SAP. Blood types AB and B were more frequent in AP, especially in SAP. The differences between southern Jiangsu and northern Jiangsu, in number of AP patients and the proportion of AAP, were significant. In class I and class IV, the ratio of SAP was much higher than in other classes and the whole sample.

Pancreatitis autoinmune tipo 1: reporte de caso / Autoimmune pancreatitis type 1: a case report

La pancreatitis autoinmune tipo 1 es una enfermedad de baja prevalencia siendo más frecuente en varones, se encuentra incluida dentro de las enfermedades relacionadas a IgG4. Esta patología puede debutar como un síndrome colestásico y el diagnóstico se realiza según los criterios del consenso internacional para pancreatitis autoinmune (ICDC) que incluye una imagen típica, serología, compromiso de otros órganos, histología y respuesta al tratamiento con corticoides. Presentamos el caso de una mujer de 52 años con antecedente de artritis reumatoide sin tratamiento que acude con tiempo de enfermedad de 2 meses caracterizado por dolor abdominal en hipocondrio derecho de moderada intensidad asociado a ictericia, coluria, hipocolia, xeroftalmia, xerostomía y pérdida de peso de 3 kg. Al examen físico se evidencia ictericia, hipertrofia simétrica de glándulas submandibulares, leve dolor en epigastrio. En los exámenes auxiliares existe patrón colestásico con hiperbilirrubinemia a predominio directo. En los estudios de imágenes se evidencia colédoco dilatado, con aumento difuso del volumen del páncreas con captación tardía de contraste. En el estudio inmunológico se evidenció IgG4 en 610 u/L y ANA 1/640. Se inició tratamiento con corticoides con respuesta clínica y de laboratorio favorable. En conclusión, se debe sospechar de pancreatitis autoinmune ante un cuadro de dolor abdominal y colestasis extrahepática con imágenes sugestivas de páncreas inflamatorio, en el que se deben complementar los criterios ICDC para confirmar el diagnóstico

Autoimmune pancreatitis type 1 (AIP) is the pancreatic manifestation of IgG4-related disease. The most frequent presentation of AIP is with obstructive jaundice. For definite diagnosis of type 1 Autoimmune pancreatitis international consensus diagnosis criteria (ICDC) for AIP are used. ICDC criteria include pancreatic parenchymal imaging, ductal imaging, serology, other organ involvement, histology, and response to steroid. We report a 52-years-old woman with rheumatoid arthritis without treatment presented with two months of abdominal pain in up-right quadrant with moderate intensity. She also presented jaundice, acholia, xerophtalmia, xerostomia, and a weight loss of 5 pounds. On examination jaundice, symmetrically enlarged submandibular glands, and epigastric pain was observed. On laboratory, a cholestasis pattern and conjugated bilirubin predominance was found. CT Abdominal, CMR revealed a dilated common bile duct with a diffuse pancreatic enlargement with delayed enhancement. Immunological studies show a IgG4 610 u/l and ANA 1/640. The patient responds to steroid clinically and in the laboratorial values. In conclusion, autoimmune pancreatitis type 1 should be suspected in case of an obstructive jaundice with a pancreatic inflammatory image, and complete ICDC criteria for a definite diagnosis

Severe hypoproteinemia as a harbinger of Ménétrier's disease in autoimmune pancreatitis / Hipoproteinemia grave como indicador de doença de Ménétrier na pancreatite autoimune

Summary Ménétrier's disease is an extremely rare disease of unknown etiology causing gastric mucosal hypertrophy and protein-losing gastropathy. Rare cases of this condition have been reported in patients with autoimmune diseases. However, to the best of our knowledge, Ménétrier's disease associated with autoimmune pancreatitis (AIP) has never been reported. We described a case of severe hypoproteinemia as a harbinger of Ménétrier's disease associated with AIP. The patient was successfully treated with octreotide and high-protein diet, which led to symptomatic remission and significant improvement in serum levels of albumin and recovery of the nutritional status. Thus, in AIP patients presenting with severe and persistent hypoproteinemia without apparent cause, clinicians need to consider Ménétrier's disease in the differential diagnosis. In this setting, endoscopic evaluation with histological examination of gastric biopsy material, including a full-thickness mucosal biopsy of involved mucosa, may be helpful in promptly establishing the diagnosis and allowing appropriate and timely therapy.

Resumo A doença de Ménétrier é uma condição extremamente rara, de etiologia desconhecida, caracterizada por hipertrofia da mucosa gástrica e gastropatia perdedora de proteína. Casos raros dessa patologia têm sido relatados em pacientes com doenças autoimunes. Até o momento, desconhecemos qualquer relato dessa doença associada à pancreatite autoimune (PAI). Descrevemos um caso de hipoproteinemia grave como indicador de doença de Ménétrier associada à PAI. O paciente foi tratado de forma satisfatória com octreotide e dieta hiperproteica, alcançando remissão sintomática, melhora significativa das concentrações de albumina e recuperação do estado nutricional. Portanto, em pacientes com PAI e hipoproteinemia grave e persistente, deve-se considerar a doença de Ménétrier como um diagnóstico diferencial. Nesses casos, a avaliação endoscópica com biópsia gástrica, incluindo biópsia de toda a espessura da mucosa, pode ser útil no estabelecimento do diagnóstico e do pronto início da terapêutica.

Therapeutic effects of ellagic acid on L-arginin induced acute pancreatitis

ABSTRACT PURPOSE: To investigate the therapeutic effects of ellagic acid on L-arginin ınduced acute pancreatitis in rats. METHODS: Thirty-two were split into four groups. Group 1 (control) rats were performed only laparotomy, no drugs were administered. Group 2 (control+EA) rats were administered 85mg/kg EA orally. Rats were sacrificed by cardiac puncture 24 hours after the administration. Group3 (AP) 24 hours after intraperitoneal L-arginine administration, rats were sacrificed by cardiac puncture. Group 4 (EA)-(AP): 85mg/kg EA was administered orally after the L-arginine administration. 24 hours later, rats were sacrificed by cardiac puncture. Serum TNF-α, IL-1β, IL-6, total oxidative status (TOS), total antioxidant capacity (TAC), amylase levels were determined in all groups. RESULTS: Group 3 (AP) rats showed significantly raised TOS level as compared to Group1 (control) rats (p<0.001). Following the EA therapy, a decrease in TOS was observed in Group 4 (AP+EA). TAC levels were significantly raised in the Group 4 (AP+EA) compared to the Group 3 (AP) (p=0.003). Group 3 (AP) showed significantly increased TNF-α, IL-1β and IL-6 serum levels as compared to Group 4 (AP+EA). Histopathological changes were supported our result. CONCLUSION: The healing effects of ellagic acid on inflammatory and oxidative stress were confirmed by histopathological and biochemical evaluations of the pancreatic tissue.

Ulcerative Colitis and Immunoglobulin G4

BACKGROUND/AIMS: Ulcerative colitis (UC) is sometimes associated with autoimmune pancreatitis (AIP). Infiltration of immunoglobulin G4 (IgG4)-positive plasma cells is sometimes detected in the colonic mucosa of AIP or UC patients. This study aimed to clarify the relation between UC and IgG4. METHODS: Associations with UC were reviewed in 85 AIP patients. IgG4 immunostaining was performed on biopsy specimens from the colonic mucosa of 14 AIP and 32 UC patients. RESULTS: UC was confirmed in two cases (type 1 AIP, n=1; suspected type 2 AIP, n=1). Abundant infiltration of IgG4-positive plasma cells in the colonic mucosa was detected in the case of suspected type 2 AIP with UC and two cases of type 1 AIP without colitis. Abundant infiltration of IgG4-positive plasma cells was detected in 10 UC cases (IgG4-present, 31%). Although 72% of IgG4-absent UC patients showed mild disease activity, 70% of IgG4-present patients showed moderate to severe disease activity (p<0.05). CONCLUSIONS: UC is sometimes associated with AIP, but it seems that UC is not a manifestation of IgG4-related disease. Infiltration of IgG4-positive plasma cells is sometimes detectable in the colonic mucosa of UC patients and is associated with disease activity.

A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis

BACKGROUND/AIMS: The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously. METHODS: Fifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC). RESULTS: The accuracy of BISAP (> or = 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (> or = 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT. CONCLUSIONS: BISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

Ação do tacrolimus na pancreatite aguda experimental induzida pela arginina / Action of tacrolimus in arginine induced experimental acute pancreatitis

OBJETIVO: verificar se o tacrolimus administrado em ratos, em vigência de pancreatite induzida pela L-Arginina, interfere nos níveis séricos da amilase e glicose e no padrão histológico do parênquima pancreático. MÉTODOS: quarenta ratos Wistar foram distribuídos em quatro grupos com 10 ratos cada. Grupo controle (C), grupo tacrolimus (T), grupo pancreatite (P) e grupo pancreatite-tacrolimus (PT). Foram avaliados os níveis séricos de amilase, glicose e tacrolimus e feitas avaliações histológicas do pâncreas, A indução de pancreatite foi feita pela inoculação de L-Arginina na dose de 500mg/100g de peso corporal por via intraperitoneal e o tratamento com tacrolimus na dose de 1ìg/kg por via subcutânea durante quatro dias. RESULTADOS: a amilasemia estava mais elevada (p=0,0000) nos grupos PT, T e P do que no grupo controle. A média do grupo PT foi maior (p=0,0009) que a do grupo T, mas não diferiu (p=0,6802) da média do grupo P. Entre os grupos P e T não houve diferença (p=0,2568). Não houve diferença nas médias de glicemia entre os grupos (p=0,4920) e os níveis séricos de tacrolimus foram similares nos grupos PT e T (p=0,7112). Não ocorreram alterações histológicas nos grupos T e C e não ocorreu hemorragia no pâncreas dos ratos dos grupos P e PT. No grupo P, em 30 por cento não se observou edema, em 20 por cento observou-se a forma leve e em 50 por cento, a moderada; quanto à infiltração inflamatória, em 80 por cento moderada e em 20 por cento não ocorreu, e a atrofia do parênquima foi de 60 por cento moderada e 40 por cento acentuada. No grupo PT, houve ocorrência de edema, infiltração inflamatória e atrofia do pâncreas em todos os ratos. CONCLUSÃO: o tratamento pelo tacrolimus induziu aumento nos níveis séricos de amilase em ratos normais, não alterou a glicemia nem o padrão histológico do parênquima pancreático. Na vigência de pancreatite induzida pela L-Arginina o tacrolimus induziu edema, infiltração inflamatória e atrofia com maior gravidade no parênquima pancreático.

OBJECTIVE: To determine whether tacrolimus administered to rats, in the presence of pancreatitis induced by L-Arginine, interferes with the serum levels of amylase and glucose and the histological pattern of the pancreatic parenchyma. METHODS: Forty Wistar rats were divided into four groups with 10 rats each: control group (C), tacrolimus group (T), pancreatitis group (P) and pancreatitis-tacrolimus group (PT). We evaluated serum levels of amylase, glucose, and tacrolimus and made histological assessments of the pancreas. Induction of pancreatitis was made by inoculation of L-Arginine at a dose of 500mg/100g body weight intraperitoneally, and tacrolimus treatment at a dose of 1ìg/kg subcutaneously for four days. RESULTS: Serum amylase was higher (p = 0.0000) in groups PT, P and T than in the control group. The PT group mean was higher (p = 0.0009) than in the T group, but did not differ (p = 0.6802) from the average of the P group. There was no difference between groups P and T (p = 0.2568). Neither in mean blood glucose between the groups (p = 0.4920); serum levels of tacrolimus were similar in PT and T groups (p = 0.7112). There were no histological changes in groups T and C and no hemorrhage in the pancreas of rats in groups P and PT. In group P, there was no edema in 30 percent, mild edema in 20 percent and in 50 percent, moderate; as for inflammatory infiltration, it was moderate in 80 percent and absent in 20 percent, and atrophy of the parenchyma was moderate in 60 percent and severe in 40 percent. In the PT group, there was edema, inflammatory infiltration or atrophy in the pancreas in all rats. CONCLUSION: Treatment with Tacrolimus induced an increase in serum amylase in normal mice, but did not affect blood glucose or the histological pattern of the pancreatic parenchyma. In the presence of pancreatitis induced by L-Arginine tacrolimus induced edema, inflammatory infiltration and more severe atrophy in the pancreatic parenchyma.

A case of lupus-associated pancreatitis in Jamaica / Un caso de pancreatitis asociada con lupus en Jamaica

Pancreatitis complicating a diagnosis of systemic lupus erythematosus (SLE) is rarely reported in the literature and there are no known published cases thus far in the Caribbean. A 50-year old female diagnosed with SLE and discoid lupus erythematosus (DLE) since 1990, presented in February, 2009, to the University Hospital of the West Indies (UHWI), Kingston, Jamaica, with symptoms suggestive of lupus pancreatitis. Serum amylase level was 2341 IU/L and serum lipase was 203 IU/L. Pancreatitis has a 3-8% rate of occurrence in adult patients with SLE. Aetiology and management of this entity remains controversial in these cases, but one must bear the diagnosis in mind, when faced with a SLE patient presenting with abdominal pain, vomiting and diarrhoea.

La pancreatitis que complica el diagnóstico del lupus eritematoso sistémico (LES), raramente se reporta en la literatura, y hasta hoy no se conoce de caso alguno publicado en el Caribe. Una mujer de 50 años de edad, a quien se le diagnosticara lupus eritematoso sistémico (LES), y lupus eritematoso discoide (LED) desde 1990, acudió en febrero de 2009 al Hospital Universitario de West Indies, Kingston, Jamaica, con síntomas que sugerían una pancreatitis por lupus. El nivel de amilasa sérica fue 2341 IU/L y el de lipasa sérica fue 203 IU/L. La pancreatitis tiene una tasa de ocurrencia de 3-8% en pacientes adultos con LES. La etiología y el tratamiento de esta entidad siguen siendo controversiales en estos casos, pero se debe tener presente el diagnóstico frente a pacientes de SLE que presenten dolor abdominal, vómito y diarrea.

Determinación de proteína C reactiva como predictor de severidaden pancreatitis aguda / Predictive value of PCR for severity, complications and hospital mortality of acute pancreatitis

INTRODUCCION: La proteína C reactiva (PCR) es un examen simple y de bajo costo que según la literatura tiene buena asociación para la evaluación pronóstica en Pancreatitis Aguda (PA). OBJETIVO: Determinar valor pronóstico de PCR para severidad, presencia de complicaciones y mortalidad intrahospitalaria de PA. MATERIAL Y METODO: Estudio de cohorte retrospectiva de pacientes adultos ingresados al Hospital Dr. Gustavo Fricke, Viña del Mar durante el año 2007. Se identificaron características generales, etiología, score de Balthazar, PCR, complicaciones y mortalidad. Se utilizó test de Mann Whitney para comparación de medianas y curvas ROC. RESULTADOS: Se incluyeron 59 pacientes, siendo el 54,23 por ciento hombres. La mediana de edad fue 51 años. La etiología biliar se observó en 57,62 por ciento. La mediana de hospitalización fueron 12 días. El 40,67 por ciento presentó complicaciones, siendo más frecuente la necrosis pancreática (20,33 por ciento). El nivel de PCR mostró diferencias significativas entre pacientes con y sin gravedad imagenológica (33,5mg/dL vs 15,9mg/dL, p=0,0009), complicaciones intrahospitalarias (40mg/dL vs 15,9mg/dL, p<0,0001) y mortalidad intrahospitalaria (66mg/dL vs 22mg/dL, p=0,0061). El área bajo la curva ROC fue de 0,75; 0,84 y 0,91 respectivamente, todos estadísticamente significativos. La sensibilidad, especificidad, likelihood ratio (LR) positivo, LR negativo para gravedad imagenológica con un punto de corte de 13,14mg/dL fue 88 por ciento, 54 por ciento, 1,83 y 0,28 respectivamente. Para predecir mortalidad con un valor de 32,76mg/dL, estos fueron 100 por ciento, 71 por ciento, 3,43 y 0 respectivamente. DISCUSION. Un valor de PCR de 40mg/dL es buen marcador pronóstico de complicaciones intrahospitalarias. Niveles aumentados tienen alta sensibilidad para predecir gravedad imagenológica y mortalidad intrahospitalaria.

INTRODUCTION: C-reactive protein (CRP) is a simple and low price test with good association in acute pancreatitis (AP) prognosis evaluation. OBJECTIVE: To determine predictive value of PCR for severity, complications and hospital mortality of AP. MATERIAL AND METHODS: Retrospective cohort study of adult patients admitted to Dr. Gustavo Fricke Hospital, Viña del Mar in 2007. General characteristics, etiology, Balthazar score, CRP, and mortality rates were identified. Mann Whitney U test for comparison of medians and ROC curves were used for the analysis. RESULTS: 59 patients were included, 54.23 percent were males. The median age was 51 years. The biliary etiology was observed in 57.62 percent. The average hospitalization period was 12days. Complications were observed in 40.67 percent, being pancreatic necrosis the most frequent one (20.33 percent). The CRP level showed significant differences between patients with and without imaging severity (33.5 mg/dL vs 15.9 mg/dL, p=0.0009), hospital complications (40mg/dL vs 15.9mg/dL, p<0,0001) and hospital mortality (66mg/dL vs 22mg/dL, p=0.0061). The area under the ROC curve was 0.75, 0.84 and 0.91 respectively, all statistically significant. The sensitivity, specificity, positive likelihood ratio (LR), negative LR gravity imaging with a cut off of 13.14 mg/dL was 88 percent, 54 percent, 1.83 and 0.28 respectively. To predict mortality with a value of 32.76 mg/dL, they were 100 percent, 71 percent, 3.43 and 0 respectively. DISCUSSION: The 40mg/dL CRP value is a good prognostic marker of hospital complications. Increased level has high sensitivity to predict imaging severity and hospital mortality.

Acute pancreatitis in viral infections, with possible progression to chronic pancreatitis.

Isolated cases and small series of acute pancreatitis complicating viral infections have been reported. However, data on the natural history of such patients are sparse. We report a series of five patients of acute pancreatitis complicating diverse viral infections. During follow-up ranging from 6 to 36 months, two of these five patients developed evidence of chronic pancreatitis.

Serum and tissue glycoconjugates, digoxin and magnesium levels in chronic calcific pancreatitis.

BACKGROUND: Endogenous or exogenous digoxin can lead to membrane Na+,K+-ATPase inhibition and hypomagnesemia. Low magnesium levels can lead to increased glycosaminoglycans (GAG) concentration in many organs. Aim: To measure the serum levels of pancreatic GAG and glycoproteins, two major components of the extracellular matrix, in patients with chronic calcific pancreatitis (CCP). Serum levels of magnesium and digoxin were also assessed. METHODS: Patients with CCP and age- and sex-matched healthy control subjects (15 each) were studied. Serum GAG, Mg and digoxin levels were measured. RBC membrane Na+,K+-ATPase activity was also assessed. Pancreatic tissue obtained at autopsy from seven patients with CCP and sex- and age-matched healthy subjects who had died in accidents were also tested for GAG and glycoproteins. RESULTS: Total GAG levels were significantly increased in the serum and pancreas of patients with CCP. This was associated with lower serum Mg levels, increased serum digoxin levels and decreased RBC membrane Na+,K+-ATPase activity. CONCLUSION: Exogenous or endogenous digoxin-induced hypomagnesemia and the consequent altered glycoconjugate metabolism may be important in the pathogenesis of CCP.

Plasma gastrin levels in alcoholic and idiopathic chronic pancreatitis patients free from helicobacter pylori infection

Previous studies on gastrin levels in chronic pancreatitis [CP] patients have given conflicting results. These studies did not take into consideration the influence of Helicobacter pylori [H. pylori] infection on gastrin release. Also, there is no previous study that compared alcoholic CP patients to patients with idiopathic pancreatitis. Our aim was to measure basal and postprandial plasma gastrin levels in all CP patients, including subgroups of alcoholic, idiopathic, severe and mild CP patients, and compare them with healthy subjects after the eradication of H. pylori infection. Patients and Basal and postprandial gastrin levels were measured in 30 patients with CP [10 patients with alcoholic and 20 patients with idiopathic CP] and in 25 healthy subjects. A significant increase in basal gastrin levels was found only in a subgroup of alcoholic CP [P<0.05] in comparison to healthy subjects. A significant increase in postprandial plasma gastrin levels [P<0.01] was found in all chronic pancreatitis compared to healthy subjects. In the absence of H. pylori infection, plasma gastrin levels were significantly higher in chronic pancreatitis patients than in healthy subjects. Chronic alcoholism, however, does not appear to be the only factor responsible for the increased plasma gastrin levels in these patients

Estudo da celularidade do parenquima pulmonar distal em ratos pelo metodo do lavado bronco-alveolar na pancreatite aguda / A study of the distal pulmonary cells obtained by broncho alveolar lavage in rats with acute pancreatitis

Alteracoes celulares do lavado bronco-alveolar (LBA) em ratos com pancreatite aguda necro-hemorragica (PANH) foram estudadas nos tempos de duas e oito horas apos indicao de PANH por injecao de solucao de acido taurocolico a 2,5 por cento no ducto hepatico. Grupo controle-dez ratos, Grupo PANH-nove ratos (2hs) Grupo PANH (8hs)-oito ratos. A comparacao entre os grupos mostrou aumento significativo no numero de Macrofagos/ml, segmentados/ml e linfocitos/ml no LBA (p<0,05). Assim os autores concluem que a PANH aumenta o numero de celulas inflamatorias principalmente dos neutrofilos segmentados no LBA de ratos o que e compativel com uma pneumopatia inflamatoria aguda

Modifications of tissue blood flow in acute pancreatitis

I.Acute pancreatitis (AP) was induced by ductal injection of 2.5% sodium taurocholate saline solution. Plasma and red blood cell (RBC) volume and visceral organ blood flow were evaluated by a radioisotopic method (51Cr tracers) in 45 adult male Wistar rats (22 submitted to AP and 23 controls) 4 h after AP induction. 51Cr-albumin was used to measure plasma volume and 51Cr-RBC was used to measure RBC volume. II.Changes in tissue hematocrit reflect alterations in tissue blood flow, since reduction in blood flow increases microvascular erythrocyte sequestration. To evaluate the tissue blood flow, we introduce a "tissuehematocrit index" calculated relating 51Cr-RBC and 51Cr-albumin specific activities measured in visceral organ biopsies. Application of this index to the control and AP groups showed a decrease in blood flow in all visceral organs of the AP group which was reflected by an increase in tissue hematocrit index (2.5-fold for kidneys, 2-fold for pancreas and lungs, 1.6-fold for liver, and 1.2-fold for spleen). III.As expected there was an increase in blood hematocrit and a decrease in plasma volume in the AP group, but there were no significant alterations in RBC volume. However, an unequal decrease in blood flow in various tissues such as kidneys, lungs, pancreas and liver was detected in the AP group. IV.This approach provides an easy and simple way to evaluate possible therapeutic protocols for the treatment of acute panreatitis by measuring effects on visceral blood flow and plasma and blood volumes

Influência do regime alimentar na evoluçäo tardia da pancreatite aguda. Estudo experimental em ratos / Influence of diet composition on the evolution of acute pancreatitis. Experimental study in rats

Com a finalidade de estudar o efeito de regimes dietéticos diversos sobre a recuperaçäo das funçöes do pâncreas exócrino pós pancreatite aguda (PA), dois lotes de ratos submetidos, durante três semanas, a dietas isoprotéicas, diferindo apenas no teor de gordura (normo e hiperlipídica), foram distribuídos em grupos controles e com pancreatite aguda moderada, induzida com taurocolato de sódio a 1%. Amostras de sangue para dosagem de amilase sérica e fragmentos de tecido pancreático, para determinaçäo de enzimas triptolíticos, amilase, proenzimas e nucleotídeos foram colhidos nos grupos controles e nos com pancreatite após um, quatro, sete e 15 dias da induçäo da doença. Os resultados foram comparados estatisticamente por ANOVA, entre grupoos sob o mesmo regime alimentar e pelo teste "t" de Student, entre grupos correspondentes, sob regimes alimentares diversos (p <0.05). Os autores verificaram que, nas condiçöes experimentais utilizadas, a pancreatite agravou-se progressivamente até o quarto dia pós-PA, independentemente do regime alimentar prévio. A recuperaçäo funcional no órgäo manifestou-se a partir do sétimo dia pelo aumento de RNA/DNA, mas foi incompleta durante o período deste estudo. No décimo quinto dia pós-PA, ocorreu a normalizaçäo de parâmetros histopatológicos e bioquímicos, para os grupos com ambas as dietas. Os autores concluíram que, nas condiçöes experimentais deste estudo, o agravamento da doença, traduzido pela capacidade de síntese do pâncreas exócrino, foi progressivo até o quarto dia e independeu do teor de gordura na dieta

Tratamiento quirurgico precoz de la pancreatitis aguda ligada a enfermedad del tracto biliar / Early surgical treatment of acute pancreatitis linked with biliary tract disease

Presentacion de 43 pacientes, que sirven como base para revisar los factores etiologicos de la pancreatitis aguda y el mecanismo de asociacion con afeccion del tracto biliar, diagnostico, tratamiento (eminentemente quirurgico) y resultados