Enzimas pancreáticas: revisión y análisis de sus acciones atenuantes sobre la secreción ácida gástrica, el dolor pancreático, el colon irritable y trastornos digestivos múltiples / Pancreatic Enzymes: useful therapeutical agents to a wider spectrum of functional digestive disorders. Revision and analysis

Las enzimas pancreáticas constituyen agentes terapéuticos de utilidad clínica dentro de un espectro mucho más amplio del que se acepta habitualmente. En este trabajo se trata de demostrar que ejercen una influencia benéfica en un variado grupo de entidades... y que la asociación de una mejora en el mecanismo del proceso digestivo, especialmente de los carbohidratos, y el consecutivo alivio de los fenómenos dispépticos fermentativos, ello en conjunción con una atenuación de la hipersensibilidad del sistema nervioso aferente, cambio muy ligado a una depresión liberadora sobre la CCK, explican el valor terapéutico innegable que poseen los fermentos pancreáticos en el enfoque terapéutico del colon irritable

Pancreatitis experimental en el opossum. Rol de la esplacnicectomía previa en la respuesta inflamatoria / Experimental pancreatitis in opossum. Rol of the previus splanicectomy in inflamatory response

BACKGROUND: The role of the Autonomous Nervous System in the immunologic and inflammatory response is still an issue of discussion. Furthermore, the physiopathologic mechanisms involved are still unknown. Acute pancreatitis (AP) does not escape this disconcert. In fact, like in every severe acute inflammatory process, its discontrol could be responsible of the high morbidity and mortality rates. OBJECTIVE: To assess to which degree bilateral splanchnicectomy changes the course of acute inflammatory response in AP. METHOD: Prospective research. RESULTS: The following parameters were evaluated: red blood cell count, white blood cell count, calcium, glucemia, urea, aminase, lypase and liver enzymes. Macroscopy and microscopy views of the pancreas were also obtained. The leucocitary response was abolished, and the calcium levels dropped to a lesser degree. CONCLUSIONS: Bilateral splanchnicectomy prior to unchaining AP had a beneficial effect, Its mechanism of action could have been through the disconnection of the respective reflex arches

Pseudo-Pancreatitis Aguda Edematosa: sindrome mimetizado por una duodenitis parasitaria multiple. Analisis de 7 casos / Pseudo acute pancreatitis: a syndrome mimicked by a multiple parasitic duodenitis. Analysis of 7 case

INTRODUCTION: The aim of this presentation was to analyze a clinical syndrome characterized by repeated episodes of upper abdominal pain, markedly increased levels of both total amylase and lipase, but with normal values of pancreatic isoamylase. Besides, with the lack of morphologic changes of the pancreatic gland, either by ultrasound, abdominal tomography, or Nuclear Magnetic Resonance. MATERIAL, METHODS AND RESULTS: Five female and two male patients, with an average age of 51 +/- 3 were studied. All had been diagnosed as having acute edematous pancreatitis (ranson score < 3). Laboratory tests had disclosed eosinophilia (5-30 percent); total amylasemia (1547 +/- 398 UA/l); lipasemia (857 +/- 499 UBL/L); normal pancreatic isoamylase (72 +/- 18 UA/L). Upper endoscopy showed nonspecific signs of duodenitis sometimes with duodenal erosions. Collection studies, pre and post Sorbitol, disclosed an unexpected multiple parasitic infestation, e.g.: giardias, ascaris, amoeba, hymenolepis nana. This finding was always suggestively associated with abundant sludge (bilirrubinate cholesterol and oxalate crystals). All patients, after having been submitted to the appropriate antiparasitic medication, were rapidly relieved of their symptoms and remained free of episodes of abdominal pain. CONCLUSIONS: When the fact that all our patients had normal pancreatic isoamylase levels and lack of any morphologic distortion of the pancreatic parenchyma is associated to the notion that total amylase and lipase may have as a source the gastrointestinal mucosa, it appears as a logical inference that the clinical syndrome here discussed is indeed primarily a reflection of an extrapancreatic disease, essentially of parasitic duodenitis.

Pancreatitis aguda experimental en el opossum. Rol de la vagotomía troncular previa en la respuesta inflamatoria / Acute experimental pancreatitis in the opossum. The role of prior truncular vagotomy on the inflammatory response

Antecedentes: Las Pancreatitis Agudas (PA) son causa frecuente de consulta en los Servicios de Emergencias. Tanto sus etiopatogenias como la respuesta inflamatoria desencadenada son ejes de controversia, a la luz del desconocimiento actual de muchos de estos aspectos. La influencia del Sistema Nervioso Autónomo dentro de la respuesta a la inflamación es actualmente discutida. Objetivo: Demostrar el efecto de la vagotomía troncular previa sobre la PA por distensión duodenal en el opossum sudamericano. Lugar de aplicación: Instituto de Neurociencias (INEUCI-CONICET-UBA) y Sección Cirugía Experimental del Servicio de Cirugía General del hospital Churruca-Visca. Diseño: Estudio prospectivo randomizado. Población: Opossum sudamericanos de ambos os sexos divididos en cuatro grupos; Grupo control: (7 animales) se les ocasionó PA. Grupo A: (7 animales) se les realizó vagotomía troncular y piloroplastía siete días antes de ocasionar PA. Grupo B: (7 animales) se les realizó vagotomía troncular y piloroplastía 30 días antes de ocasionar PA. Grupo C: (7 animales) se les ocasionó PA después de 45 días de realizarles una vagotomía troncular y piloroplastía. Métodos: Se les realizó PA por distensión de la segunda porción del duodeno, por el insuflado de una sonda Foley frente a la papila. A todos los animales se les determinó Hto, G. Blancos, Calcio, Transaminasas, LDH, CPK, Amilasemia, Lipasemia, Colesterol, Urea en estado basal, a las 2 horas de desencadenada la PA y a las 4 horas de producida la afección. A todos los animales se les realizó estudio anatomopatológico con microscopía óptica del páncreas, hígado, pulmón y riñon. Resultados: Los datos de laboratorio más significativos fueron la interrupción vagal no altera el recuento leucocitario en relación a los grupos control; tanto la amilasa como la lipasa y la LDH, presentan un incremento pos distensión. No existen modificaciones de consideración con el hematocrito, la calcemia, la urea y el colesterol. Conclusiones: El método de desencadenamiento es original. Existe para los autores una subvaloración de la participación del Sistema Nervioso Autónomo en el proceso inflamatorio agudo pancreático. No existe relación entre el tiempo transcurrido de la vagotomía troncular en relación a las lesiones posteriores. La vagotomía troncular no aparenta modificar las lesiones desencadenada por este modelo experimental. En este grupo de animales, en relación a...

Existe la regeneración pancreática? Certificación morfológica y funcional luego de una esplenopancreatectomía corporocaudal / There is pancreatic regeneration? Morphological and functional certification after a corporocaudal splenopancreatectomy

INTRODUCTION: The process of pancreatic regeneration, well known and accepted, is less known than the hepatic and includes different mechanisms and factors. Pancreatic regeneration is better known in acute pancreatitis. After an extensive pancreatic necrosis, the morphological and functional regeneration is assessed by dynamic computed tomography associated with normalization of glycemia and the exocrine function. Different groups identified and evaluated experimentally and clinically the actions of multiple factors involved in the process of pancreatic regeneration. Even difficult to assess, pancreatic regeneration after partial pancreatectomy is well documented and of capital importance. CASE REPORT: A 57-year-old woman with discomfort in the upper-left abdominal quadrant. CT scans showed a tumor in the body and tail of the pancreas adherent to the spleen. Preoperative CA 19-9 was normal. She was operated on and the tumor resected en bloc with the spleen. Only the head of the pancreas was preserved. Intraoperative pathological examination of the specimen showed a mucinous cistoadenoma with no malignant degeneration. Postoperative course was uneventful and discharged at p.o. day 10, with ongoing diabetes. Four month later she presented pain in the upper-left quadrant with hyperamylasemia. CT scans showed a normal body and tail with an image of pseudocyst at the top of the pancreatic tail. One year after the initial surgery she remained asymptomatic, without diabetes and with no dietary restrictions. Further CT controls showed images of the entire regeneration of the body and tail of the pancreas...

Pancreatitis aguda biliar: una revisión eteiopatogénica y evolutiva de 148 casos / Biliary acute pancreatitis: an etiopathology and evolution review of 148 cases

BACKGROUND: A retrospective analysis of de etiologic factors and fisiopathogenic mechanisms underlyng an acute biliar pancreatitis episode put in evidence the complexity of the attempt to acquire a clear understanding of the entity. In this presentation the authors try to re-examine the main factors involved in the triggering of the disease. Beasides the clasic theories and their own approach to the management of an acute pancreatic inflammation episode are discussed. AIMS: The main purpose of this endeavor was to identify and discuss the etiopahogenic machanisms that were prevalent in a series of 148 patients observed and trated in a 10 years period. Besides, another distinctive aim was to analyze their evolution and somehow to try to assess their probable prognosis. PLACE OF APPLICATION: Close comunity. POPULATION: The whole group of patients that were admitted with the diagnosis of acute pancreatitis in the time period comprised between 1987-1997. METHODS: The acute pancreatitis subgroups and their respective number of patient included were the following: BILIARY ACUTE PANCREATITIS 140 CASES POST ERCP 8 CASES CONCLUSIONS: As a result of the present reviewing endeaveur several observations deserve to be pointed out: a. The pancreatic gland undoubtedly is a neuroendocrine organ, that is subjeted to complex neural and hormonal influence. b. Undeniably, the involvement of the autonomic nervous system in the physiopathogenic mechanism of acute pancreatitis has been surprisingly disregarded. c. The biliary acute pancreatitis variant is the most frequent. What we consider a simplification is to accept the Opie's postulation without taking into account the intermediate steps, centered on autonomic reflexes, that ultimately lead to the acute inflammatory lesions. d. Although without an absolute proof, it is undeniable that "stress" is a primary etiologie in some cases of acute pancreatitis. e. We favor the idea that the pancreon's functional status influences on the extension and intensity degree of the acute pancreatic inflammatory lesions.

Pancreatitis agudas de etiologías poco frecuentes: una aproximación fisiopatogénica / Acute pancreatitis of uncommon etiology: a physiopathologic approach

Los autores presentan 73 casos de pancreatitis agudas (P.A.) de causas poco frecuentes. Ellas fueron divididas en ingestión copiosa, displémicas, postcolangioretrógrada endoscópica, postoperatorias, tercer trimestre de embarazo, puerperio inmediato, parotídica, por stress e idiopáticas, medicamentosa y por trauma. Se evalúan las teorías etiopatogénicas probables haciendo hincapié en la importancia del Sistema Nervioso Autónomo (S.N.A.) como responsables de las lesiones glandulares. El estado funcional del páncreas, previo al ataque agudo, es uno de los factores predisponentes de mayor envergadura. La mortalidad de la serie fue de 7 casos (9.58 por ciento) siendo las postoperatorias (50 por ciento) y las dislipémicas (16.6 por ciento) las de mayor índice de mortalidad.

Influence of pirenzepine on colonic serotonin changes induced by short chaim fatty acid

En este trabajo hemos la influencia de un ácido graso de cadena corta (acetato) sobre el número de células enterocromafines (EC) conteniendo serotonina (5HT) a dos diferentes pH (pH 6.9, estímulo absortivo y pH 2.9 estímulo secretor) infundido durante una hora en el colon. El número de células EC disminuye significativament con una solución infundida a pH 2.9, especialmente en el ciego. La acción de la pirencepina en prevenir esta reducción demuestra que el mecanismo se efectúa parcialmente a través de receptores colinérgicos. Por parte, se observa una disminución de la liberación de 5HT, a través de un mecanismo colinérgico, como lo indica la inhibición observada con la droga antimuscarínica

Correlacion entre funcion y estructura pancreatica. Evaluacion del test de secretina y la colangiopancreatografia retrograda. / Correlation of pancreatic function and structure. Evaluation of secretin test and retrograde cholangiopancreatography

Se ha efectuado, en 25 pacientes, un analisis de correlacion entre el test de Secretina y la pancreatografia retrograda. El valor predictivo de normalidad o de alteracion patologica de la glandula brindado por la exploracion funcional del pancreon mediante el test de secretina es confirmado en esta evaluacion comparativa. Esto justifica que este examen sea utilizado como un primer medio de "rastreo" en el estudio de las diferentes pancreatopatias