[Pseudo acute pancreatitis: a syndrome mimicked by a multiple parasitic duodenitis. Analysis of 7 case]. / Pseudo-Pancreatitis Aguda Edematosa: síndrome mimetizado por una duodenitis parasitaria múltiple. Análisis de 7 casos.

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%); 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.

Pseudo-Pancreatitis Aguda Edematosa: síndrome mimetizado por una duodenitis parasitaria múltiple. Análisis 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

); 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.

Effects of sex and age on pancreatic secretion.

The secretory response of the exocrine pancreas to an intravenous bolus of secretin (1.0 U/kg) was studied in healthy men and women below and above 45 years of age. We studied the secretory pattern, i.e., electrolyte and enzyme secretion in 8 sequential, 10-min collections and cumulative values for each parameter. Within the male group, no significant changes were observed, except for higher amylase and lipase secretions in the older subjects. On the other hand, females over 45 yr old had secretory patterns that showed a decline of flow and of bicarbonate concentration and output. No significant secretory differences were observed in the groups of younger males and females. When the over-45 groups of men and women were compared, the women exhibited a significant decrease in bicarbonate concentration and output. Moreover, this group of women had a cumulative 80-min output of bicarbonate and lipase significantly below these parameters in the men. Possible mechanisms are discussed.

[Trophic and functional changes of the pancreas induced by chronic truncal vagotomy]. / Cambios tróficos y funcionales del páncrease, inducidos por la vaguectomía troncular crónica.

The effects of chronic truncal vagotomy on the pancreatic gland was studied in male adult Wistar rats. Two to three months after parasympathetic decentralization, the gland weight was found to be significantly increased by nearly 100%. This trophic effect is mainly due to the proliferation of young acinar cells. Concomitantly, there is a decrease of the ductular mass and of the Langerhans islets. Choline acetylase activity was decreased by about 35% to 40% in the vagotomized pancreas. Further, enzyme concentration was found to be greater in the head than in the body and tail of the gland, thus suggesting a higher nerve density of vagal cholinergic fibers in the former than in the latter. Basal pancreatic secretion of the decentralized gland showed a significant increase in the flow rate with no significant changes in both bicarbonate concentration and output. Protein concentration was significantly reduced at 60 minutes; protein output remained unchanged. The most remarkable finding was the fall in both lipase concentration and output (60-70%) when compared with control values. These findings may be related to clinical manifestations after long-term vagotomy.

Cambios tróficos y funcionales del páncrease, inducidos por la vaguectomía troncular crónica. / [Trophic and functional changes of the pancreas induced by chronic truncal vagotomy]

The effects of chronic truncal vagotomy on the pancreatic gland was studied in male adult Wistar rats. Two to three months after parasympathetic decentralization, the gland weight was found to be significantly increased by nearly 100

. This trophic effect is mainly due to the proliferation of young acinar cells. Concomitantly, there is a decrease of the ductular mass and of the Langerhans islets. Choline acetylase activity was decreased by about 35

to 40

in the vagotomized pancreas. Further, enzyme concentration was found to be greater in the head than in the body and tail of the gland, thus suggesting a higher nerve density of vagal cholinergic fibers in the former than in the latter. Basal pancreatic secretion of the decentralized gland showed a significant increase in the flow rate with no significant changes in both bicarbonate concentration and output. Protein concentration was significantly reduced at 60 minutes; protein output remained unchanged. The most remarkable finding was the fall in both lipase concentration and output (60-70

) when compared with control values. These findings may be related to clinical manifestations after long-term vagotomy.