[Ornidazole in the treatment of liver dysfunction associated to long-term parenteral nutrition]. / Ornidazol como tratamiento de la hepatotoxicidad asociada a la nutrición parenteral total prolongada.

AIM: to reduction the TPN-related hepatic toxicity with an anaerobicidal therapy (ornidazole in our case). PATIENT: a 24-year-old male surgically treated for intestinal occlusion. He had been treated with abdominal radiotherapy for rabdomyosarcoma of embryonic urogenital sinus when he was five months old. It was found a great abdominal radiotherapy sequelae and occluded and perforated small-bowel loop that was resected. Postoperative time developed pelvic abscess and reoperation was performed. Severe intraabdominal inflammatory-adhesive process was noticed which included all the intestinal loops with multiple perforations. Attempts to release this situation was unsuccessful and several anastomoses, with some loop exclusions and a diverting loop jejunostomy were performed. In postoperative period he developed an enterocutaneous fistula and TPN was initiated. Higher and higher hepatic marker values were detected suggesting a progressive hepatotoxicity. METHODS: anaerobicidal agent (ornidazole) and cyclic total parenteral nutrition as a therapy design were prescribed. RESULTS: there were satisfactory showing a reduction in hepatic marker values (72.5% fall in alanine aminotransferase). CONCLUSIONS: bearing in mind that some theories suggest that total parenteral nutrition may cause atrophic changes in the gut mucosa so giving rise to bacterial translocation, this anaerobicidal treatment designed could be assumed effective for attenuating TPN-related liver damage.

[Clinical usefulness of the determination of the lipase/elastase ratio and of the polymorphonuclear elastase in the hospital admission of the patient with acute pancreatitis]. / Utilidad clínica de la determinación del cociente lipasa/elastasa y de la elastasa polimorfonuclear en la admisión hospitalaria del paciente con pancreatitis aguda.

OBJECTIVE: The clinical usefulness of the determination of polymorphonuclear elastase in serum, in patients with acute pancreatitis as a predictive value of severity. MATERIAL AND METHODS: A prospective study was made of 60 patients who at admission in the hospital showed high rates not only of lipase but also of polymorphonuclear elastase. High rates of this enzyme have been statistically related with the severity of pancreatitis. This severity is expressed by multifactorial Glasgow prognostic factors and by Ranson's CT degree. The predictive value in the evolution of the disease has been related to the need for surgery and related to the number of hospitalization days in non-operated patients. All these factors have been analysed taking into account such variables as age, sex, and biliary origin of the acute pancreatitis. RESULTS: Our study shows no statistically significant correlation between high polymorphonuclear (pmn) elastase serum levels in patients with acute pancreatitis (AP) and their evolution (as evaluated by means of clinical signs and CT images). In other words, determination of high pmn elastase serum levels has no predictive value to indicate the degree of severity in AP. Finally, we have found no clinical use in the lipase/ amylase ratio, neither as a predictive value in the evolution of our AP patients nor as a diagnostic tool to aid in the distinction among AP of biliary origin and AP due to other causes. CONCLUSION: The severity of acute pancreatitis must be evaluated according to clinical parameters and CAT scan imaging.