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3.
Eur. j. anat ; 24(1): 1-7, ene. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-186059

RESUMO

The aim of this study is to demonstrate that the denervation of the pancreas may affect the enteric neuronal plexus, which controls both the endocrine and exocrine parts of the pancreas. By using the light microscope, the histological changes of the islets of Langerhans and the pancreatic acini in the rat pancreas were studied two and three weeks after sympathectomy and truncal vagotomy. More-over, measurements of the changes infasting blood glucose levels and glucose tolerance tests in the control and experimental animals were recorded. Atrophic changes and degeneration of the pancreatic acinar cells and islets of Langerhans cells were observed after both sympathectomy and vagotomy. Biochemical measurements of fasting blood, and the glucose tolerance tests after sympathectomy and vagotomy were increased significantly, which is consistent with the histological results. The results of this study explain that the exocrine and endocrine parts of the pancreas are dependent on both sympathetic and parasympathetic innervation via the enteric plexuses of the rat pancreas. These results establish a firm correlation between the autonomic innervation and the enteric plexus, which controls the function of the endocrine and exocrine parts of the pancreas


No disponible


Assuntos
Animais , Ratos , Pâncreas/anatomia & histologia , Pâncreas/diagnóstico por imagem , Microscopia/métodos , Microscopia/veterinária , Denervação/veterinária , Simpatectomia/métodos , Simpatectomia/veterinária , Vagotomia Troncular/métodos , Vagotomia Troncular/veterinária , Ilhotas Pancreáticas/anatomia & histologia
6.
Cir. Esp. (Ed. impr.) ; 97(9): 501-509, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187626

RESUMO

Introducción: La mortalidad postoperatoria asociada a la duodenopancreatectomía (DP) en centros de alto volumen es inferior al 5%, sin embargo, las tasas de morbilidad oscilan entre el 45% y el 60%. Estudios recientes muestran una menor incidencia de complicaciones y fístula pancreática postoperatoria (POPF) con el uso de la pancreaticogastrostomía (PG). El objetivo de nuestro estudio es evaluar la incidencia y los factores predictivos de las complicaciones: POPF, hemorragia pospancreatectomía y retraso del vaciamiento gástrico según los criterios de las clasificaciones ISGPS y Clavien-Dindo. Material y métodos: Estudio prospectivo observacional en el que se incluyeron todos los pacientes sometidos a DP entre 2008 y 2016. La PG fue la técnica de elección en la reconstrucción de la DP. Resultados. Doscientos cuarenta y nueve pacientes se sometieron a cirugía con la intención de realizar una DP. La viabilidad de PG fue del 90,5%. Ciento seis (53%) pacientes tuvieron complicaciones, 36 (18%) fueron graves (grado Clavien-Dindo ≥ III). La mortalidad a 90 días fue del 4%. El retraso del vaciamiento gástrico fue la complicación más frecuente (22,5%), seguida de la hemorragia pospancreatectomía (21%). La tasa clínica de POPF fue del 15% (6% grado Clavien-Dindo ≥ III). Los principales factores de riesgo asociados a las complicaciones fueron la edad > 70 años (1,9 [1-3,55]), el sexo masculino (1,89 [1; 3,6]) y la textura blanda del páncreas (3,38 [1,5; 7,37]). Conclusiones: En nuestra experiencia la factibilidad de la PG fue del 90,5%. Los principales factores de riesgo asociados a las complicaciones fueron la edad > 70 años, el sexo masculino y la textura blanda del páncreas. La textura blanda del páncreas también está asociada al desarrollo y la gravedad de la POPF


Background: Postoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications. Methods: A prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction. Results: Two hundred forty-nine patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥ III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥ III). The primary risk factors associated with complications were age > 70 years (1.9 [1-3.55]), being male (1.89 [1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]). Conclusions: In this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications were age > 70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Gastrostomia/mortalidade , Pâncreas/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Incidência , Morbidade , Pâncreas/patologia , Complicações Pós-Operatórias/mortalidade , Hemorragia Pós-Operatória/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Estudos de Viabilidade
9.
Rev. esp. enferm. dig ; 111(6): 471-480, jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-190083

RESUMO

Background and aim: the incidence of acute pancreatitis is rising across the world, thus further increasing the burden on healthcare services. Approximately 10% of patients with acute pancreatitis will develop infected necrotizing pancreatitis (INP), which is the leading cause of high mortality in the late phase. There is currently no consensus with regard to the use of endoscopic or minimally invasive surgery as the first-line therapy of choice for INP. However, more clinical research with regard to the superiority of an endoscopic approach has been recently published. Therefore, we conducted a systematic review and meta-analysis to determine which of the two treatments leads to a better prognosis. Methods: four databases (Medline, SINOMED, EMBASE and Cochrane Library) were searched for eligible studies from 1980 to 2018, comparing endoscopic and minimally invasive surgery for INP. Results: two randomized controlled trials (RCTs) and seven clinical cohort studies were included. After the analysis of data amenable to polling, significant advantages were found in favor of the endoscopic approach in terms of pancreatic fistulas (OR = 0.10, 95% CI 0.04-0.30, p < 0.001) and the length of hospital stay (weighted mean difference [WMD] = -24.72, 95% CI = -33.87 to -15.57, p < 0.001). No marked differences were found in terms of mortality, multiple organ failure, intra-abdominal bleeding, enterocutaneous fistula, recurrence of pseudocysts, and length of stay (LOS) in the Intensive Care Unit (ICU), endocrine insufficiency and exocrine insufficiency. Conclusion: compared with minimally invasive surgery, an endoscopic approach evidently improved short-term outcomes for infected necrotizing pancreatitis, including pancreatic fistula and the length of hospital stay. Furthermore, relevant multicenter RCTs are eager to validate these findings


No disponible


Assuntos
Humanos , Pancreatite Necrosante Aguda/cirurgia , Endoscopia Gastrointestinal/métodos , Pâncreas/microbiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento , Infecções/cirurgia
10.
Cir. Esp. (Ed. impr.) ; 97(5): 254-260, mayo 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187271

RESUMO

Introducción: Las características técnicas, humanas, científicas y asistenciales de las Unidades que atienden una patología compleja son poco estudiadas y conocidas. Métodos: Estudio descriptivo multiinstitucional (encuesta) desarrollado conjuntamente por la sección Hepatobiliopancreática de la Asociación Española de Cirujanos y el capítulo español de la IHPBA (Asociación Internacional Hepatopancreatobiliar) sobre las características de las Unidades donde se realiza cirugía pancreática en España. Resultados: Se enviaron 82 encuestas. Respondieron 69 centros (84%) pertenecientes a 16 comunidades autónomas. La suma de habitantes de las áreas propias fue 23.183.262. El número medio de camas por hospital fue 673. La Unidad que realiza la cirugía pancreática es la Unidad de Cirugía Hepatobiliopancreática o Cirugía HPB y Trasplante Hepático en 56 hospitales (77%). El número medio de cirujanos es 4,5 por Unidad. Cincuenta y cinco Unidades (80%) carecen de anestesistas específicos. El número de pancreatectomías realizadas durante 2017 en los centros encuestados fue 1.315 duodenopancreatectomías cefálicas (DPC), 566 pancreatectomías distales (PD) y 178 duodenopancreatectomías totales (DPT). La media por centro fueron 19,1 DPC, 8,2 PD y 2,6 DPT. La DPC más habitual se realiza mediante abordaje clásico, con pancreatoyeyunostomía, montaje en un asa, con gastroyeyunostomía antecólica y 2 drenajes. Solo 7 Unidades efectúan la DPC por laparoscopia y solamente 13 Unidades no realizan PD laparoscópica. Conclusiones: Esta encuesta proporciona información actualizada del trabajo asistencial y científico de un gran porcentaje de las Unidades donde se realiza cirugía pancreática en España, y además puede servir de punto de partida a trabajos multicéntricos prospectivos


Introduction: The technical, human, scientific and treatment characteristics of the Units that manage complex pathologies have not been studied in depth. Methods: Multi-institutional descriptive study (survey) developed jointly by the Hepatobiliary-Pancreatic Division of the Spanish Association of Surgeons and the Spanish Chapter of the IHPBA (International Hepatopancreatobiliary Association) on the characteristics of the Units where pancreatic surgery is performed in Spain. Results: 82 surveys were sent. 69 medical centers responded (84%), belonging to 16 autonomous regions of Spain. The total population of these regions was 23,183,262 (50% of the Spanish population). The average number of beds per hospital was 673. The unit that performs pancreatic surgery is a Hepatobiliary-Pancreatic Surgery Unit or HPB and Liver Transplant Surgery Unit in 56 hospitals (77%). The average number of surgeons is 4.5 per Unit. Fifty-five Units (80%) lack specific anesthetists. The number of pancreatectomies performed during 2017 at the hospitals surveyed was 1,315 pancreaticoduodenectomies (PD), 566 distal pancreatectomies (DP) and 178 total pancreaticoduodenectomies (TPD). The mean per hospital was 19.1 PD, 8.2 DP and 2.6 TPD. PD was usually performed using a classic approach, with pancreatojejunostomy, single-loop technique, antecolic gastrojejunostomy and using two drain tubes. Only 7 Units performed PD laparoscopically and only 13 units did not perform laparoscopic DP. Conclusions: This survey provides updated information about the majority of the Units where pancreatic surgery is performed in Spain and could also serve as a starting point for prospective multicenter studies


Assuntos
Humanos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Pâncreas/cirurgia , Pancreatopatias/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Unidades Hospitalares/organização & administração , Unidades Hospitalares/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Espanha
13.
Eur. j. anat ; 23(2): 141-144, mar. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-182425

RESUMO

The gastrointestinal tract is more susceptible to the development of diverticula. Duodenum, next to colon is the common site for diverticula. This case reports the presence of a single extramural diverticulum at the junction of a horizontal and the ascending part of the duodenum in an adult female cadaver during a routine dissection procedure. Suspensory ligament of duodenum containing suspensory muscle of duodenum was found attached to the basal aspect of the diverticulum. Though most of the duodenal diverticula are asymptomatic, awareness of its presence play a major role in treating the complications


No disponible


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Divertículo , Duodeno/anatomia & histologia , Ligamentos/anatomia & histologia , Cadáver , Pâncreas/anatomia & histologia , Doenças Raras , Duodeno/patologia , Músculos/anatomia & histologia , Dissecação/educação , Dissecação/métodos , Abdome/anatomia & histologia
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