Hidratación con Ringer Lactato combinado con diclofenaco rectal en la prevención de pancreatitis poscolangiopancreatografía retrógrada endoscópica / Hydration with Lactated Ringer's solution combined with rectal diclofenac in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography

OBJETIVO: Se aconsejan diferentes medidas para disminuir la pancreatitis poscolangiopancreatografía retrógrada endoscópica (PPCPRE). Efectuamos un estudio en pacientes con CPRE tratados con diclofenaco rectal o Ringer Lactato o bien ambas intervenciones para valorar si existe una disminución en el número de PPCPRE. MATERIAL Y MÉTODOS: Estudio de cohortes mixto con 1.896 pacientes desde 2009 hasta 2018. Hasta junio de 2012 sin tratamiento (grupo i). Posteriormente 100mg de diclofenaco rectal (grupo ii). Desde 2016 Ringer Lactato 200ml/h durante el procedimiento y 4h después del mismo, además 500ml en 30min cuando se canuló el páncreas (grupo iii). Desde 2017 Ringer Lactato más diclofenaco (grupo iv). Hubo 725 pacientes en el grupo i, 530, 227 y 414 pacientes en grupos ii,iii y IV. Se han recogido factores predisponentes a PPCPRE y los casos de PPCPRE que fue definida por criterios de consenso. RESULTADOS: Hubo 65 PPCPRE (3,4%); 2,9; 3,4; 3,1 y 4,3% en los grupos i, ii,iii y IV respectivamente (p = 0,640). En el grupo I hubo un 4,2% de PPCPRE en papilas naïve y un 4; 4,9% y 6,3% en los grupos ii,iii y IV respectivamente (p = 0,585). La gravedad de PPCPRE y los efectos adversos fueron similares en los grupos. El 38,4% eran pacientes de alto riesgo. Tampoco hubo diferencias de PPCPRE en este grupo (p = 0,501). CONCLUSIÓN: En este trabajo no se ha obtenido beneficio con diclofenaco más hidratación en la disminución del número y gravedad de la PPCPRE. Tampoco con las otras medidas profilácticas

OBJECTIVE: Different measures are recommended to reduce pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). We conducted a study in patients with ERCP treated with rectal diclofenac or lactated Ringer's solution, or both interventions, to assess whether there is a decrease in the number of cases of post-ERCP pancreatitis. MATERIAL AND METHODS: A mixed cohort study involving 1,896 patients from 2009 to 2018. Up to June 2012 without treatment (Group I). Subsequently, 100mg of rectal diclofenac (Group II). Since 2016, lactated Ringer's solution 200ml/hour during the procedure and 4hours after it, in addition to 500ml over 30minutes when the pancreas was cannulated (Group III). Since 2017, lactated Ringer's solution plus Diclofenac (Group IV). There were 725 patients in group I, and 530, 227 and 414 patients in groups II, III and IV, respectively. Factors predisposing to post-ERCP pancreatitis and post-ERCP pancreatitis cases that were defined by consensus criteria have been collected. RESULTS: There were 65 cases of post-ERCP pancreatitis (3.4%); 2.9%, 3.4%, 3.1% and 4.3% in groups I, II, III and IV, respectively (P=.640). In group I, there was 4.2% of post-ERCP pancreatitis in naïve papillae and 4%, 4.9% and 6.3% in groups II, III and IV, respectively (P=.585). The severity of post-ERCP pancreatitis and adverse effects were similar in all groups. 38.4% were high-risk patients. There were also no differences in post-ERCP pancreatitis in this group (P=.501). CONCLUSION: In this work, no benefit was obtained with diclofenac plus hydration in reducing the number and severity of cases of post-ERCP pancreatitis nor with the other prophylactic measures

Vasculopatía colágena cutánea: una causa infrecuente de telangiectasias generalizadas / Cutaneous collagenous vasculopathy: A rare cause of generalized cutaneous telangiectasia

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Glycogenic hepatopathy in young adults: a case series

Glycogenic hepatopathy is a rare and underecognized complication in long-standing poorly controlled type 1 diabetes mellitus patients. This is a distinct entity from other causes of hepatomegaly and elevated liver enzymes in diabetics, such as nonalcoholic fatty liver disease. Glycogenic hepatopathy is characterized by the combination of poorly controlled diabetes, acute liver injury with marked elevation in serum aminotransferases, and the characteristic histological features on liver biopsy. It is important to distinguish this entity as it has the potential for resolution following improved glycemic control. In this report, we describe four cases of adult patients presenting elevated serum transaminases and hepatomegaly with a history of poorly controlled type I diabetes mellitus. One of the patients had also elevated amylase and lipase in the serum, without clinical or imagiologic evidence of acute pancreatitis. Liver biopsy was performed in all patients and revealed glycogenic hepatopathy. Clinician’s awareness of glycogenic hepatopathy should prevent diagnostic delay or misdiagnosis and will provide better insight and management for this condition (AU)

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Pseudoquiste pancreático de localización intrahepática / Intrahepatic pancreatic pseudocyst: A case report

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Valoración y tratamiento de la pancreatitis aguda. Documento de posicionamiento de la Societat Catalana de Digestologia, Societat Catalana de Cirurgia y Societat Catalana de Pàncrees / Assessment and treatment of acute pancreatitis. Position document of the Catalan Society of Gastroenterology, Catalan Society of Surgery and Catalan Society of the Pancreas

La pancreatitis aguda (PA) tiene una incidencia creciente y es una de las enfermedades gastrointestinales que con más frecuencia requiere hospitalización. Numerosas evidencias científicas en los últimos años han comportado modificaciones importantes del tratamiento médico y quirúrgico de la PA. Los nuevos conocimientos sobre la fisiopatología de la enfermedad nos indican que la gravedad de la PA viene marcada por la repercusión sistémica que ocasiona (fallo orgánico), sobre todo si es persistente, y también por las complicaciones locales que se pueden desarrollar (colecciones líquidas o necrosis), especialmente si se infectan. El tratamiento ha de ser personalizado y la actuación dependerá de la situación clínica, la localización de la necrosis y el momento evolutivo en que se encuentre el paciente

The incidence of acute pancreatitis (AP) is increasing. AP is one of the gastrointestinal diseases that most frequently requires hospital admission in affected individuals. In the last few years, considerable scientific evidence has led to substantial changes in the medical and surgical treatment of this disease. New knowledge of the physiopathology of AP indicates that its severity is influenced by its systemic effects (organ failure), especially if the disease is persistent, and also by local complications (fluid collections or necrosis), especially if these become infected. Treatment should be personalized and depends on the patient's clinical status, the location of the necrosis, and disease stage

Screening, isolation, and characterization of glycosyl-hydrolase-producing fungi from desert halophyte plants

Fungal strains naturally occurring on the wood and leaves of the salt-excreting desert tree Tamarix were isolated and characterized for their ability to produce cellulose- and starch- degrading enzymes. Of the 100 isolates, six fungal species were identified by ITS1 sequence analysis. No significant differences were observed among taxa isolated from wood samples of different Tamarix species, while highly salt-tolerant forms related to the genus Scopulariopsis (an anamorphic ascomycete) occurred only on the phylloplane of T. aphylla. All strains had cellulase and amylase activities, but the production of these enzymes was highest in strain D, a Schizophyllum-commune- related form. This strain, when grown on pretreated Tamarix biomass, produced an enzymatic complex containing levels of filter paperase (414 ± 16 IU/ml) that were higher than those of other S. commune strains. The enzyme complex was used to hydrolyze different lignocellulosic substrates, resulting in a saccharification rate of pretreated milk thistle (73.5 ± 1.2 %) that was only 10 % lower than that obtained with commercial cellulases. Our results support the use of Tamarix biomass as a useful source of cellulolytic and amylolytic fungi and as a good feedstock for the economical production of commercially relevant cellulases and amylases (AU)

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Pancreatitis aguda en la infancia / Acute pancreatitis in children

Introducción. La pancreatitis aguda en la infancia ha presentado un incremento en su incidencia. El 80% de los casos es leve y no requiere cirugía. Su etiología es diversa, destacándose los casos secundarios a traumatismos, infecciones, anomalías estructurales y medicamentos. El objetivo del presente estudio fue determinar la distribución etiológica, las características clínicas y los resultados de los casos de pancreatitis aguda en los niños tratados en nuestro centro. Materiales y métodos. Se efectuó una revisión retrospectiva de los casos de pancreatitis aguda en pacientes menores de 16 años atendidos en nuestro hospital entre los años 1998 a 2010. Resultados. Se presentaron 24 casos de pancreatitis aguda durante un período de 12 años. La edad media fue de 8,75 años. El síntoma principal fue dolor abdominal, seguido de vómitos y distensión abdominal. El valor medio de amilasa al inicio del episodio fue de 1.565 UI/L. Una paciente presentó pancreatitis aguda con normoamilasemia. El 79,2% de los casos tuvieron hallazgos ecográficos compatibles con pancreatitis aguda y seis casos requirieron intervención quirúrgica. El porcentaje de complicaciones pancreáticas fue del 20,8%. La distribución etiológica fue múltiple, siendo la idiopática la más común, seguida de secundaria a colangiopancreatografía, a malformaciones congénitas y de origen medicamentoso. No hubo mortalidad atribuible a la pancreatitis aguda. Conclusiones. La pancreatitis aguda en la infancia presenta una etiología muy variada. Algunos casos pueden debutar con normoamilasemia, situación en la que la determinación de la lipasa sérica es fundamental. Se requieren estudios prospectivos para evaluar la distribución etiológica y la incidencia de la pancreatitis aguda en la infancia (AU)

Introduction. Lately, there has been an increase in incidence of acute pancreatitis in childhood. Fortunately, 80% of cases are mild and do not require surgical approach. Several etiologic factors have been implicated, such as infections, trauma, congenital anomalies, drugs, biliary diseases. The aim of this study was to assess etiology, clinical features and outcomes of children with acute pancreatitis treated at our center. Materials and methods. A retrospective chart review of our cases of acute pancreatitis in patients younger than 16 years old was performed. Results. 24 cases of acute pancreatitis were found from 1998 to 2010. Mean age was 8.75 years. There were 7 boys and 17 girls. The main clinical manifestations were abdominal pain, vomiting and abdominal distention. Mean amylase level was 1565 UI/L. There was one patient with normal serum amylase levels. Serum lipase was required in two patients (239 UI/L and 5,980 UI/L). Ultrasound showed pancreatic lesion in 79.2% of cases. Severe pancreatitis was presented in two cases, due to renal failure and pancreatic necrosis. Surgery was performed in 6 cases (3 cholecystectomies, 1 choledocal cyst resection, 1 percutaneous pseudocyst drainage and 1 necrosectomy) Pancreatic complications were found in 20.8% of cases (4 pseudocysts y 1 pancretic necrosis) Several causes were found: idiophatic, secondary to ERCP, congenital anomalies, drugs, infections, biliary disease and trauma. Mean hospital stay was 25.65 days. There were no deaths due to acute pancreatitis. Conclusions. There are several causes of acute pancreatitis in children. Some cases may present normoamilasemia, situation, in which serum lipase and clinical and radiological criteria are pivotal. Prospective studies evaluating etiological factors and incidence are required (AU)

Pancreatitis aguda: nuestra experiencia / Acute pancreatitis: our experience

Introducción: La pancreatitis aguda es un cuadro de dolor abdominal poco frecuente en la infancia. Nuestro objetivo es describir las características de los pacientes ingresados entre1988 y 2008 en un hospital terciario con este diagnóstico. Métodos: Estudio observacional retrospectivo por revisión de historias clínicas. Se recogen datos epidemiológicos, etiológicos, clínicos, de laboratorio, radiológicos, de manejo terapéutico y evolución clínica. Resultados: Incluimos 27 pacientes (un 66% varones), con una media de edad de 7,2 años (rango: 6 meses-16 años). El52% presenta enfermedades crónicas relevantes. El mecanismo etiológico más frecuente fue el estructural (37%), aunque hubo otros agentes causales, como ingesta de fármacos, infecciones, shock e inmunodeficiencias. Un 26% de los casos fueron catalogados como idiopáticos. El síntoma guía en todos los pacientes estables fue el dolor abdominal, de localización y características variables, acompañado de vómitos (55%), fiebre(33%), anorexia (19%) y otros síntomas relacionados con el agente causal. En todos se observó un aumento de las enzimas pancreáticas. La prueba de imagen más realizada fue la ecografía (patológica en un 74% de los casos), y el aumento del tamaño de la glándula fue el hallazgo más común. En el 89%de los pacientes el tratamiento fue médico, con dieta absoluta durante una mediana de 48 horas. Dos pacientes precisaron la realización de una colangiopancreatografía retrógrada endoscópica para el tratamiento de una coledocolitiasis. La duración media del ingreso fue de 9 días, y el 40% de los casos evolucionó favorablemente. Tres pacientes evolucionaron hacia pancreatitis crónica y 6 fallecieron por causas extradigestivas. Conclusiones: La pancreatitis aguda es una entidad poco frecuente en la edad pediátrica, con una amplia variedad de factores etiológicos que condicionan un pronóstico muy heterogéneo(AU)

Introduction: Acute pancreatitis is an unusual disorder in childhood that commonly onsets with sudden abdominal pain. Our goal is to describe the features of the patients diagnosed of acute pancreatitis between 1988 and 2008 who were admitted to our hospital. Methods: Retrospective observational study by review of medical records. We collected data referred to epidemiology, aetiology, clinical symptoms, analytical (amylase, lipase) and radiological findings, medical treatment administered and outcome. Results: We included 27 patients (66% males), with a mean age of 7.2 years (range: 6 months-16 years). 52% of them suffered from chronic diseases. The most common cause was a structural anomaly (37%). Other aetiologies included: drugs, infections, shock and immunodeficiencies. 26% of cases were catalogued as idiopatic. The presenting symptom in non-critical patients was abdominal pain, in different areas and with diverse features, associated with vomiting (55%), fever (33%),anorexia (19%) and other symptoms related to the a etiological agent. Pancreatic enzyme levels were elevated in all patients. The most widely used radiological test was ecography (abnormalin 74%), being the most common image the enlargement of the gland. 89% of patients were managed conservatively with complete bowel rest during a median of 48 hours. ERCP was indicated in 2 patients to treat coledocolitiasis. Median hospital stay was 9 days, with favourable outcome in 40% of patients. Recurrence was described in 3 patients and 6 died because of non-digestive causes. Conclusions: Acute pancreatitis is an unusual disease in childhood with a great variety of aetiological factors that determine different prognosis(AU)

Pancreatitis aguda con normoamilasemia / Acute pancreatitis with normal amylase levels

Aunque la pancreatitis aguda en la infancia suele cursar con niveles altos de amilasa, en ciertas situaciones puede aparecer con valores normales. Presentamos el caso clínico de una paciente que ingresó con un cuadro inespecífico de fiebre, irritabilidad y somnolencia, en el que el diagnóstico de pancreatitis fue un hallazgo intraoperatorio. Los niveles de amilasa sérica eran normales, pero las cifras de lipasa estaban elevadas. A partir de este caso, revisamos la bibliografía sobre la elevación de los niveles de amilasa y lipasa en el contexto de la PA en la edad pediátrica(AU)

Acute pancreatitis (AP) in childhood is used to present with high levels of amylase, although in certain situations it usually occurs with normal values. We present the case of a patient who was admitted with anon specific symptom of fever, irritability and drowsiness, whose diagnosis of pancreatitis was an intraoperative finding. Serum amylase levels were normal, remaining high, however, levels of lipase. From this case, we reviewed the literature of the elevation of amylase ad lipase levels in the context of AP in pediatric age(AU)

Screening Brazilian Macrophomina phaseolina isolates for alkaline lipases and other extracellular hydrolases

Macrophomina phaseolina, phylum Ascomycota, is a phytopathogenic fungus distributed worldwide in hot dry areas. There are few studies on its secreted lipases and none on its colony radial growth rate, an indicator of fungal ability to use nutrients for growth, on media other than potato-dextrose agar. In this study, 13 M. phaseolina isolates collected in different Brazilian regions were screened for fast-growth and the production of hydrolases of industrial interest, especially alkaline lipases. Hydrolase detection and growth rate determination were done on citric pectin, gelatin, casein, soluble starch, and olive oil as substrates. Ten isolates were found to be active on all substrates tested. The most commonly detected enzymes were pectinases, amylases, and lipases. The growth rate on pectin was significantly higher (P < 0.05), while the growth rates on the different media identified CMM 2105, CMM 1091, and PEL as the fastest-growing isolates. The lipase activity of four isolates grown on olive oil was followed for 4 days by measuring the activity in the cultivation broth. The specific lipolytic activity of isolate PEL was significantly higher at 96 h (130 mU mg protein(-1)). The broth was active at 37 °C, pH 8, indicating the potential utility of the lipases of this isolate in mild alkaline detergents. There was a strong and positive correlation (0.86) between radial growth rate and specific lipolytic activity (AU)

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Bacterial isolates from the bryozoan Membranipora membranacea: influence of culture media on isolation and antimicrobial activity

From specimens of the bryozoan Membranipora membranacea collected in the Baltic Sea, bacteria were isolated on four different media, which significantly increased the diversity of the isolated groups. All isolates were classified according to 16S rRNA gene sequence analysis and tested for antimicrobial properties using a panel of five indicator strains and six different media. Each medium featured a unique set of isolated phylotypes, and a phylogenetically diverse collection of isolates was obtained. A total of 96 isolates were assigned to 49 phylotypes and 29 genera. Only one-third of the members of these genera had been isolated previously from comparable sources. The isolates were affiliated with Alpha- and Gammaproteobacteria, Bacilli, and Actinobacteria. A comparable large portion of up to 22 isolates, i.e., 15 phylotypes, probably represent new species. Likewise, 47 isolates (approximately 50%) displayed antibiotic activities, mostly against grampositive indicator strains. Of the active strains, 63.8 % had antibiotic traits only on one or two of the growth media, whereas only 12.7 % inhibited growth on five or all six media. The application of six different media for antimicrobial testing resulted in twice the number of positive hits as obtained with only a single medium. The use of different media for the isolation of bacteria as well as the variation of media considered suitable for the production of antibiotic substances significantly enhanced both the number of isolates obtained and the proportion of antibiotic active cultures. Thus the approach described herein offers an improved strategy in the search for new antibiotic compounds (AU)

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Macroamilasemia en pediatría / Macroamylasaemia in paediatrics

La macroamilasemia es una entidad que debe sospecharse ante cualquier paciente que presente concentraciones elevadas de amilasa plasmática sin datos clínicos ni de investigaciones complementarias que demuestren la existencia de una afección pancreática o parotídea. Se caracteriza por la elevación de amilasa plasmática debido a macrocomplejos circulantes de alto peso molecular, formados por una molécula de amilasa unida generalmente a una inmunoglobulina. En ausencia de enfermedad renal, una hiperamilasemia sin aumento de amilasuria orienta hacia este diagnóstico, que se confirma al identificar a los componentes de la macromolécula. Es una entidad infrecuente en pediatría. Se ha descrito como un hallazgo casual asociado a dolor abdominal y a enfermedad celíaca. Se presentan 2 casos pediátricos de macroamilasemia, así como las pruebas necesarias para su diagnóstico. El conocimiento de esta anomalía bioquímica permite distinguirla de otras situaciones que cursan con elevación de amilasa, con el fin de evitar exploraciones complementarias y tratamientos invasivos innecesarios (AU)

Macroamylasaemia should be considered in any patient with high plasma amylase, no clinical signs and negative additional investigations for pancreatic or parotid diseases. It is characterised by an increase in serum amylase due to circulating high molecular mass macrocomplexes, most often formed due the binding of the amylase to an immunoglobulin. With a normal renal function, a hyper-amylasaemia without an increase in urine amylase suggests the diagnosis, and is confirmed by identifying the macromolecular components. It is an uncommon entity in paediatrics. It has been described as a casual finding associated to abdominal pain and to celiac disease. We report two paediatric cases of macroamylasaemia, and a review of the tests needed for its diagnosis. The better understanding of this biochemical anomaly allows us to differentiate it from other situations associated to hiperamylasaemia, in order to avoid additional invasive explorations and unnecessary treatments (AU)

Macroamilasemia en pediatría / Macroamylasemia in paediatrics

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Macroglobulinemia de Waldenström asociada a lesiones cutáneas y crioglobulinemia tipo I / Waldenström macroglobulinemia associated with cutaneous lesions and type I cryoglobulinemia

La macroglobulinemia de Waldenström (MW) es una discrasia sanguínea caracterizada por la proliferación monoclonal de células linfoplasmocitarias en la médula ósea, ganglios linfáticos y bazo. Estos pacientes tienen niveles elevados en suero y depósito en tejidos de la inmunoglobulina (Ig) M, de tipo monoclonal, producida por estas células aberrantes. Presentamos el caso de un paciente afecto de MW, con lesiones cutáneas debidas al depósito de cadenas ligeras Kappa de IgM y con manifestaciones clínicas secundarias a la crioglobulinemia tipo I que el paciente tenía asociada. Discutimos los distintos proceso patológicos cutáneos provocados por la IgM en la MW (AU)

Waldenström macroglobulinemia is a blood dyscrasia characterized by monoclonal proliferation of Bcells in the bone marrow, lymph nodes, and spleen. Patients with this disease show elevated serum levels and tissue deposition of monoclonal immunoglobulin (Ig) M produced by these aberrant cells. We present the case of a patient with Waldenström macroglobulinemia who suffered cutaneous lesions resulting from deposition of k light chains of IgM and clinical manifestations secondary to associated type I cryoglobulinemia. We discuss the different pathological cutaneous processes caused by IgM in Waldenström macroglobulinemia (AU)

Seudoquiste pancreático en dos pacientes menores de 24 meses / Pancreatic pseudocysts in two patients under 24 months of age

El seudoquiste pancreático se produce como consecuencia de un proceso inflamatorio y/o traumático; su contenido es estéril y rico en enzimas pancreáticas. Habitualmente, debe sospecharse ante una elevación persistente de la amilasa, puesto que suele ser asintomático, salvo complicaciones. El 40-50% de los seudoquistes se resuelven espontáneamente, y deben drenarse los mayores de 6 cm y/o que persistan más de seis semanas, dado el riesgo de complicaciones. Presentamos los casos de dos pacientes menores de 24 meses con seudoquistes pancreáticos secundarios a pancreatitis agudas: el primero con una evolución típica y el segundo con una elevación aislada de la lipasa

Pancreatic pseudocysts are produced as a result of an inflammatory process or trauma, and contain a sterile, amylase-rich fluid. They should be suspected in the case of persistently increased amylase levels, as they are asymptomatic unless complications develop. Pseudocysts resolve spontaneously in 40%- 50% of cases. Those measuring more than 6 cm and/or persisting for more than 6 weeks are at high risk for the development of further complications and therefore require drainage. We describe two cases of pancreatic pseudocysts secondary to acute pancreatitis in two patients under 24 months of age. The first one exhibited the typical course, whereas, in the second one, an isolated increase in lipase was detected

Lipasa y amilasa total y sus isoenzimas como marcadores de daño pancreático en pacientes tratados con fármacos antiepilépticos / No disponible

Objetivo: El estudio de la lipasa y amilasa total y sus isoenzimasen suero como indicadores bioquímicos de daño pancreáticoen pacientes tratados con ácido valproico y con otros fármacosantiepilépticos inductores enzimáticos.Método: Se determinaron las actividades séricas de lipasa yamilasa total y sus isoenzimas en 41 pacientes tratados con ácidovalproico en monoterapia, 50 pacientes tratados en mono/politerapiacon fenitoína, fenobarbital y carbamazepina y 30 controlesclínicamente sanos.Resultados: En el primer grupo de pacientes no se encontróuna diferencia clínicamente significativa en relación al grupo controlpara ninguna de las actividades enzimáticas; sin embargo, enel grupo tratado con fármacos antiepilépticos inductores seencontró una diferencia clínicamente significativa para la lipasa yamilasa de tipo pancreático. En este grupo de pacientes, en2 casos (4%) la actividad de amilasa pancreática estaba claramenteaumentada con niveles que sugerían la existencia de un dañopancreático. La amilasa total presentó una deficiente especificidadcomo marcador bioquímico de daño pancreático en los pacientesestudiados, correspondiendo la mayor actividad encontrada a uncaso con aumento de la isoenzima de tipo salivar. Por su parte lalipasa parece presentar una menor sensibilidad.Conclusiones: En pacientes tratados con fármacos antiepilépticosla determinación de la isoenzima de tipo pancreático de laamilasa podría ser de interés aun en ausencia de signos clínicos depancreatitis aguda

Objective: The study of the serum lipase and total amylaseand its isoenzymes as biochemical markers of pancreatic injury inpatients treated with valproic acid and other enzyme-inducingantiepileptic drugs.Method: The serum activities of lipase and total amylase andits isoenzymes were determined in 41 patients treated inmonotherapy with valproic acid, 50 patients in mono/polytherapywith phenytoin, phenobarbital and carbamazepine, and 30healthy controls.Results: In the first group of patients a clinically significantdifference in relation to the control group was not obtained forany of the enzyme activities studied; however, in the group ofpatients treated with enzyme-inducing antiepileptic drugs clinicallysignificant differences were obtained for lipase and pancreaticamylase. In this group of patients, the activity of pancreaticamylase was clearly increased in two cases (4%), suggestingthe existence of a pancreatic damage. In the patients studied,the total amylase showed a poor specificity as a biochemicalmarker for pancreatic injury, and the greater serum activityobserved in one case corresponds to an increase of the salivarisoenzyme. The sensitivity of the lipase is smaller than amylasepancreatic isoenzyme.Conclusions: In patients treated with antiepileptic drugs, thedetermination of the pancreatic isoenzyme of amylase would be ofinterest even in absence of clinical signs for acute pancreatitis

Importancia de la determinación de la amilasa pleural en los pacientes con derrame neoplásico / Utility of amylase levels in malignant pleural effusions

Fundamento y objetivo: Analizar la utilidad diagnóstica y el significado de la determinación de la amilasa pleural (APL) y su cociente pleuroplasmático (CPP) en los derrames neoplásicos. Pacientes y método: Se ha realizado un estudio prospectivo y comparativo de la APL y su CPP según las características de los pacientes y el derrame en 295 derrames neoplásicos y 673 no neoplásicos. Resultados: Hubo un total de 103 casos con APL mayor de 100 U/l (11%) y 268 un CPP mayor de 1 (28%), de los que 53 (18%) y 109 (37%), respectivamente, correspondieron a derrames neoplásicos. La APL y el CPP aumentaron en los derrames neoplásicos, en los de origen pulmonar, en la citología o la biopsia pleural diagnóstica y en los adenocarcinoma. La regresión multivariante demostró una asociación de la APL con la citología o la biopsia positiva y un derrame masivo. Los derrames neoplásicos de origen pulmonar en estadio IV presentaron un aumento de APL o CPP. Conclusiones: La APL y su CPP no fueron útiles en el diagnóstico o cribado de un derrame pleural para descartar el origen neoplásico. El aumento de la APL o su CPP se asoció a una citología o una biopsia pleural diagnóstica; un derrame masivo y el origen pulmonar, a una enfermedad más avanzada

Background and objective: To analyze the utility of the measurement of pleural amylase levels (AL) and pleural fluid/serum amylase ratio (AR) in malignant pleural effusions. Patients and method: Prospective and comparative study of AL and its AR in relation to the patient and pleural fluid characteristics in 295 malignant effusions and 673 nonmalignant. Results: There were 103 patients with AL greater than 100 U/l (11%) and 268 with AR greater than 1 (28%): 53 (18%) and 109 (37%) in malignant effusions respectively. Patients with malignant effusions had higher AL and AR, especially when tumour origin was lung cancer, had positive pleural citology or biopsy and showed an adenocarcinoma. Multivariate regression analysis revealed a significant difference in the changes in AL associated with positive pleural citology or biopsy and massive pleural effusion. The malignant effusions had higher AL in lung cancer of stage IV. Conclusions: AL and AR should not be routinely measured to exclude a malignant effusion. A high AL or AR was related to positive pleural citology or biopsy, a massive pleural effusion and lung cancer with an advanced disease

Fracaso renal agudo como presentación de pancreatitis aguda hemorrágica con amilasa normal / Acute renal failure secondary to haemorrahagic acute pancreatitis with normal serum amylase levels

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Efecto de la administración de indometacina rectal sobre los niveles séricos de amilasa posteriores a colangiopancreatografía retrógrada endoscópica y su impacto en la aparición de episodios de pancreatitis secundaria / Effect of the rectal administration of indomethacin on amylase serum levels after endoscopic retrograde cholangiopancreatography, and its impact on the development of secondary pancreatitis episodes

Introducción: hiperamilasemia y pancreatitis aguda representan las complicaciones mayores más frecuentes posteriores a colangiopancreatografía retrógrada endoscópica (CPRE), apareciendo en 1-30% de los casos. Objetivo: determinar la incidencia de hiperamilasemia y pancreatitis posterior a CPRE y evaluar la utilidad de indometacina rectal para la prevención de estos. Material y métodos: ensayo clínico controlado. Durante un periodo de 12 meses se incluyeron 150 pacientes. Estos fueron divididos en grupo de estudio (n = 75), a quienes se administró indometacina rectal 100 mg 2 horas previas al procedimiento, y control (n = 75) que recibió glicerina. Dos horas posteriores a la CPRE se determinó el nivel de amilasa sérica y se clasificaron en: 0 = 600 UI/l. Los episodios de pancreatitis clínica se cuantificaron y clasificaron de acuerdo a los criterios de Ranson. Resultados: distribución por género: 100 mujeres y 50 hombres. Edad media: 55,37 ± 18,0 para el grupo de estudio y 51,1 ± 17,0 para el control. El diagnóstico de patología benigna se presentó en 56 (74,7%) casos del grupo de estudio y 59 (78,7%) del control. Posterior al procedimiento, 13 (17,3%) pacientes del grupo experimental y 28 (37,3%) del control desarrollaron hiperamilasemia (p 600 UI/l en 3 pacientes del grupo de estudio y 10 del control (p = 0,001). Se detectó pancreatitis leve en 5,3% de los pacientes del grupo de estudio y 16% del control (p < 0,05). No hubo mortalidad ni eventos adversos. Conclusiones: indometacina rectal previo a CPRE disminuye el riesgo de hiperamilasemia y pancreatitis. La indometacina es accesible, de bajo costo con mínimos o nulos efectos secundarios

Background: hyperamylasemia and acute pancreatitis represent the most frequent major complication after endoscopic retrograde cholangiopancreatography (ERCP), developing in 1-30% of cases. Objective: to determine the incidence of hyperamylasemia and acute pancreatitis after ERCP, and to assess the utility of rectal indomethacin to prevent these events. Material and methods: a randomized clinical trial. During a 12-month period 150 patients were included. They were divided up into a study group (n = 75), where 100 mg of rectal indomethacin were administered 2 hours prior to the procedure, and a control group (n = 75), which received rectal glycerin. Two hours after ERCP serum amylase levels were measured and classified as follows: 0 = 600 IU/L. Clinical pancreatitis episodes were quantified and classified according to Ranson’s criteria. Results: gender distribution: 100 women and 50 men. Mean age: 55.37 ± 18.0 for the study group, and 51.1 ± 17.0 for the control group. A diagnosis of benign pathology was present in 56 (74.7%) cases in the study group, and 59 (78.7%) controls. After ERCP 13 (17.3%) patients in the study group and 28 (37.3%) in the control group developed hyperamylasemia (p 600 IU/L was found in 3 patients in the study group, and in 10 in the control group (p = 0.001). Mild pancreatitis was detected in 4 (5.3%) patients in the study group, and in 12 (16%) patients in the control group (p = 0.034). There were no deaths or adverse drug reactions. Conclusions: rectal indomethacin before ERCP decreases the risk of hyperamylasemia and pancreatitis. Indomethacine is a feasible, low-cost drug with minimal or nil side effects