[Aortic pseudoaneurysm as a complication of oesophageal perforation caused by a fish bone]. / Seudoaneurisma de aorta como complicación de una perforación esofágica por una espina de pescado.

We describe the case of a 41 year-old female patient with acute thoracic and epigastric pain associated with dysphagia. Due to the acute onset and the intensity of symptoms an urgent gastroscopy was requested. This was delayed and only performed when further serious complications appeared. This showed an oesophageal perforation due to ingestion of a fish bone, and an aortic pseudoaneurysm. Early determination of the cause and the extraction of fish bone would have avoided the subsequent worsening and long term stay in the hospital. Special tests limitations often delay diagnosis with severe consequences for the patients.

Seudoaneurisma de aorta como complicación de una perforación esofágica por una espina de pescado / Aortic pseudoaneurysm as a complication of oesophageal perforation caused by a fish bone

Se presenta el caso de una mujer de 41 años con dolor torácico y epigástrico agudo asociado a disfagia. Por el inicio agudo y la intensidad de los síntomas solicitamos que le realizaran una gastroscopia de forma urgente, aunque se retrasó y solo fue realizada cuando se presentaron complicaciones graves. El resultado fue una perforación esofágica debida a la ingestión de una espina de pescado y un seudoaneurisma de aorta. La rápida determinación de la causa y la extracción de la espina hubieran evitado las posteriores complicaciones y la prolongada estancia hospitalaria. Las limitaciones en las pruebas complementarias a menudo retrasan el diagnóstico con importantes consecuencias para los pacientes(AU)

We describe the case of a 41 year-old female patient with acute thoracic and epigastric pain associated with dysphagia. Due to the acute onset and the intensity of symptoms an urgent gastroscopy was requested. This was delayed and only performed when further serious complications appeared. This showed an oesophageal perforation due to ingestion of a fish bone, and an aortic pseudoaneurysm. Early determination of the cause and the extraction of fish bone would have avoided the subsequent worsening and long term stay in the hospital. Special tests limitations often delay diagnosis with severe consequences for the patients(AU)

The Epidemiology of parasuicide in Canary Islands

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Objective: To analyze the epidemiology of parasuicide in Canary Islands. Methods: Emergency Department reports at every Hospitals and clinical data of all Mental Health Units were revised in Tenerife (1992-1996) and in Gran Canaria (1994-1996). Data about age, sex, address, educational level, marital status, job situation, time and methods used for committing parasuicide and previous parasuicide events were collected. Results: In Tenerife Island the annual average was 355 parasuicides among which 24.9% of the episodes were repeaters. The average crude rate was 70.99 cases per 100.000 inhabitants and the standardized rate was 61.81. In Gran Canaria Island the annual average was 634 and 21.3% were repeaters. The average crude rate was 120.23 per 100.000 and the standardized rate was 103.7 per 100.000. The age group 15-34 years, showed the higher rate values. Women presented higher rates as compared to men in all age categories. Conclusion: These findings are in agreement with those of the WHO-EURO Multicentre Project on Parasuicide. We found in Tenerife the lowest parasuicide rate values published in Europe (AU)

Occurrence of somatostatin and insulin immunoreactivities in the stomach of sea bass (Dicentrarchus labrax L.): light and electron microscopic studies.

Somatostatin (SST)- and insulin (INS)-immunoreactive (ir) cells were identified in the gut of sea bass (Dicentrarchus labrax) by immunofluorescence double staining and peroxidase-antiperoxidase (PAP) techniques for light microscopy and by immunogold method for electron microscopy using antisera to mammalian and fish peptides. SST-14 and SST-25 immunoreactivities coexisted in cells mainly located among the mucous neck cells of the gastric glands. Preabsorption controls showed that some SST-25- and, possibly, some SST-14-like peptides appeared in these cells. Immunoreactivity to fish INS, but not to mammalian INS (mINS) or insulin-like growth factor I (mIGF-I), was observed in all the SST-ir cells. The preabsorption controls suggest a cross-reaction of the fish INS antisera with SST-containing or type I cells. These cells displayed ovoid or round secretory granules with fibrous, medium electron-dense or homogeneous osmiophilic materials. Some gastric cells (type II) with round secretory granules of variable electron density, which were gold immunolabeled with bonito INS but not with mINS, mIGF-I, or SST antisera, were also found. INS-related peptide in type II cells of the sea bass stomach is suggested.

Somatostatin 14- and somatostatin 25-like peptides in pancreatic endocrine cells of Sparus aurata (teleost): a light and electron microscopic immunocytochemical study.

An immunocytochemical investigation demonstrates the presence of somatostatin (SST) 14- and salmon somatostatin (sSST) 25-like peptides in two populations of somatostatin (D) cells in the islets of gilthead sea bream (Sparus aurata). Both cell types were identified by their differing immunoreactivities to the somatostatin antisera used. D1 cells in the islet periphery between glucagon cells showed sSST 25-like immunoreactivity and contained large moderate to low electron-dense granules. D2 cells, present only in the central region of the islets between insulin cells, were immunoreactive to the SST 14 antisera and had smaller electron-dense granules. In S. aurata, as in other teleosts, preprosomatostatin I and II are probably synthesized and processed to SST 14- and sSST 25-like peptides, respectively, in different D cell types.

Pancreatic endocrine cells in sea bass (Dicentrarchus labrax L.) I. Immunocytochemical characterization of glucagon- and PP-related peptides.

PP-, PYY-, and glucagon-immunoreactive cells were immunocytochemically identified in the pancreatic islets of Dicentrarchus labrax (sea bass). PYY cells also reacted with anti-PP serum. The specificity control showed that preabsorption of PP antiserum by PYY peptide abolished the immunostaining, while the reaction did not change when the PYY antiserum was preabsorbed by PP. These results suggested the existence of a PP/PYY molecule in the sea bass islets. The islet distribution of PP/PYY-immunoreactive cells differed markedly. Thus, in the principal islet and some intermediate islets few PP/PYY-immunoreactive cells are present (type I islets), whereas in the smaller and some intermediate ones they are numerous (type II islets). Adjacent sections stained by peroxidase-antiperoxidase (PAP) technique and individual sections stained by immunofluorescence double staining showed the coexistence of glucagon and PP/PYY-like immunoreactivities. Both islet types contained cells with PP/PYY coexisting with glucagon peptide, while cells showing solely glucagon immunoreactivity were found in type I islets only.

Pancreatic endocrine cells in sea bass (Dicentrarchus labrax L.) II. Immunocytochemical study of insulin and somatostatin peptides.

Insulin (INS)- and somatostatin (SST)-immunoreactive cells were demonstrated by light immunocytochemistry in the endocrine pancreas of sea bass (Dicentrarchus labrax). INS-immunoreactive cells were identified using bovine/porcine, bonito, and salmon (s) INS antisera; the immunostaining was abolished when each antiserum was preabsorbed with its respective peptide but not with unrelated peptides. These cells also reacted with mammal (m) SST-28 (4-14) antiserum. The immunoreaction did not change when this antiserum was preabsorbed by bovine INS. INS-immunoreactive cells were located in the central part of the endocrine areas of the principal, intermediate, and small islets. Two SST-immunoreactive cell types (D1 and D2) were revealed. D1 cells, immunoreactive to SST 14 (562) and sSST-25 antisera, were located next to the glucagon-immunoreactive cells in the peripheral part of the endocrine areas. D2 cells, immunoreactive to SST-14 (562), SST-14 (566), and mSST-28 (4-14) antisera, were found in apposition to the INS-immunoreactive cells. The specificity controls showed that D1 cells expressed sSST-25-like peptides, while D2 cells might contain SST-14 and/or mSST-28-like peptides. The close topographic association between the different SST-immunoreactive cells and both glucagon- and insulin-immunoreactive cells might indicate the existence of a specific paracrine regulation of each endocrine cell type in the sea bass endocrine pancreas.

Identification of two somatostatin-immunoreactive cell types in the principal islet of Sparus auratus L. (Teleostei) by immunogold staining.

Two types of somatostatin (SST 14)-immunoreactive cells are identified by immunogold staining in the Lowicryl-embedded principal islet of Sparus auratus: D1 cells, having large moderate to low electron dense granules, located between A cells in the islet periphery and D2 cells, containing smaller electron-dense granules, present between B cells in the central region of the islet. Although SST 28-like immunoreactivity was not observed in D cells of S. auratus, the presence of SST 14 and a SST 22-,25-, or 28-like sequence in D2 and D1 cells, respectively, is discussed. A third SST 14-immunoreactive cell, found in the islet periphery, showed immunoreactive D1- and unreactive A-like granules. This cell type, which has a pyknotic-like nucleus and a dark appearance in osmicated Epon-embedded tissue, is supposed to be the product of fusion of D1 and A cells.

Immunocytochemical and ultrastructural characterization of coexistence of pancreatic polypeptide and glucagon-like immunoreactivity in the pancreatic endocrine cells of Sparus auratus L. (Teleostei).

Coexistence of pancreatic polypeptide (PP)- and glucagon-like immunoreactivity was demonstrated in the pancreatic endocrine cells of the teleost fish Sparus auratus. An immunofluorescence double-staining method revealed coexistence of glucagon- and PP-like immunoreactivity in endocrine cells of small and intermediate islets. In contrast to small islets, the intermediate ones also contained a variable number of glucagon-immunoreactive cells next to cells having both immunoreactivities. Coexistence of both immunoreactivities could not be observed in endocrine cells of the principal islet, whereas many cells containing glucagon and a few cells containing PP immunoreactivity were found. By an immunogold double-staining method the precise ultrastructural location of each immunoreactivity could be demonstrated. Again, cells containing glucagon- and/or PP-like immunoreactivity were found. Although, only two different types of granules were observed, four distinct cell types could be distinguished. Based on this granule morphology two cell types showing coexistence were found: one cell type, only present in the small islets, showing a different distribution of glucagon and PP immunoreactivity within the granules (predominantly in the center and periphery, respectively) and another cell type with larger granule cores, present in small as well as intermediate islets, having a mixed distribution of both immunoreactivities.

A comparative immunocytochemical study of the gastro-entero-pancreatic (GEP) endocrine system in a stomachless and a stomach-containing teleost.

The gastro-entero-pancreatic (GEP) endocrine system of a stomach-containing and of a stomachless teleost, Sparus auratus and Barbus conchonius, respectively, are studied immunocytochemically using different antisera against mammalian hormones. Insulin-, glucagon-, somatostatin-, and pancreatic polypeptide (PP)-immunoreactive cells are identified in the endocrine pancreas of both species. Only the distribution of PP-immunoreactive cells differed strongly; in the principal islet of both fishes, few PP-immunoreactive cells are present, whereas in the smaller ones many of them are observed in S. auratus and none in B. conchonius. In the digestive tract of S. auratus 10 endocrine cell types can be distinguished: neurotensin-, secretin-, serotonin-, somatostatin-, and two types of substance P-immunoreactive cells exclusively in the stomach, and C-t-gastrin/CCK-, glucagon-, Met-enkephalin-, PP-, and only one type of substance P-immunoreactive cells in the intestinal epithelium. With the exception of substance P-immunoreactive cells, the other four intestinal endocrine cells, as well as an unspecific immunoreactive cell, can also be found in B. conchonius. Coexistence of glucagon- and PP-like immunoreactivity is observed in the pancreas of S. auratus and in the gut of B. conchonius. Pancreatic and gut endocrine cells showing only PP- or glucagon-like immunoreactivity are found, too.

Coexistence of pancreatic polypeptide (PP)-and glucagon-immunoreactivity in pancreatic endocrine cells of mouse.

Immunocytochemical double staining techniques were used to study PP- and glucagon-like-immunoreactivity in pancreatic endocrine cells of mouse. An antiserum against FMRFamide appeared to react with all PP-immunoreactive endocrine cells. With fluorescence microscopy most PP/FMRFamide-immunoreactive cells also showed glucagon-immunoreactivity, but cells containing only PP- or glucagon-like substances were found as well. The proportion of cells containing PP-, glucagon, and both immunoreactivities varied strongly from islet to islet in all parts of the pancreas. Using an electron microscopical immunogold double staining procedure on Lowicryl-embedded pancreas, PP/FMRFamide- and glucagon-immunoreactivity appeared to be present in the majority of endocrine A cells; both immunoreactivities were randomly distributed within the granules of these cells. Cells containing only PP/FMRFamide- or glucagon-immunoreactivity were also found. Glucagon- and a faint FMRFamide-immunoreactivity was also observed in osmicated epon-embedded tissue. Independent of their immunoreactivity all positive cells showed the same round electron dense secretory granules.

An immunocytochemical and ultrastructural study of the endocrine pancreas of Sparus auratus L. (Teleostei).

The pancreatic endocrine cells of Sparus auratus (gilthead sea bream) are concentrated in two or three principal islets, or Brockmann bodies, and numerous smaller islets embedded in the exocrine tissue. Insulin-, glucagon-, somatostatin-, and pancreatic polypeptide (PP)-immunoreactive cells were identified in all pancreatic islets of S. auratus using an indirect immunocytochemical (PAP) method. Insulin-immunoreactive cells were found in the central region of the islets. Glucagon-immunoreactive cells could be seen at the periphery of the islets and isolated in the exocrine tissue surrounding the large principal islet. Somatostatin-immunoreactive cells were distributed throughout the islets. PP-immunoreactive cells were clustered, in a limited shallow section, being found in no other part of the large principal islet whereas, in the smaller islets, these cells were more numerous and found in the whole peripheral area. Four cell types were identified in the pancreatic islets of S. auratus by electron microscopy. A,B,D and PP cells were characterized by the shape, size, and electron density of their respective secretory granules.

An immunocytochemical and ultrastructural study of the endocrine pancreas of Pseudemys scripta elegans (Chelonia).

Immunocytochemical and ultrastructural methods have shown four cell types in the endocrine pancreas of the turtle Pseudemys scripta elegans: insulin-, glucagon-, somatostatin-, and pancreatic polypeptide-immunoreactive cells. Each endocrine cell type was distributed differently in the duodenal or splenic regions of the turtle pancreas. Round or fusiform insulin- and glucagon-containing cells could be seen as single scattered cells which were more numerous in the duodenal regions, and the cell groups becoming progressively smaller from splenic to duodenal region. Round or fusiform somatostatin cells with thick processes and spindly pancreatic polypeptide cells with long protrusions were less numerous the nearer they were to the splenic regions; they were isolated in the duodenal zone. Insulin cells were surrounded by somatostatin cells and an outer layer of glucagon cells around the cell groups could be seen. Insulin cells were characterized by their round secretory granules which contained a polygonal, irregular or rod-shaped dense core. They also contained numerous clustered mitochondria, large multivesicular bodies, and cilium. Glucagon cells, joined by desmosomes to adjacent ones, had numerous filamentous mitochondria with longitudinal cristae and round electron-dense secretory granules with closely applied membrane. Somatostatin cells contained two kinds of secretory granules, some of which showed an electron-dense core, while others had moderately electron-dense floccular material. PP cells were characterized by round secretory granules, smaller than those of other cell types, and a large euchromatinic nucleus. Lysosomes, microtubules, bundles of microfilaments, a well-developed Golgi apparatus, and scarce rough endoplasmic reticulum were present in the cytoplasm of all these endocrine cell types.