Pancreatitis y pancreatopatía crónica: evaluación fisiopatogénica, clínica y funcional: (basada en 1.300 casos en más de tres décadas en el Hospital de Clínicas de Bs. As.) / Chronic pancreatitis and chronic pancreatopathy: physiopathogenic, clinical and funcitonal evaluation. experience with 1,300 cases during three decades

Siguiendo a una experiencia de 33 años, de orden clínico y funcional (test de secretina), se intenta, por una parte, precisar los conceptos de pancreatitis crónica (PC) y de pancretopatía crónica (Pt.p.Cr.). Por otra, de consignar los índices de incidencia y de sus peculiaridades clínicas de expresión. El término de PC se propone cuando: "Las alteraciones estructurales del páncreas, con las eventuales modificaciones de los órganos y elementos anatómicos que con él se vinculan, y/o el déficit funcional de su componente exocrino ("pancreón") constituyen la fuente de la expresión clínica que predomina, de manera ostensible, en el complejo sindromático que exhibe el paciente en evaluación". Se estima como no ajustada a la realidad la noción clásica que considera a la PC como una afección de curso progresivo inexorable. Se enfatiza, por el contrario, la noción de que la PC cuando es adecuadamente tratada puede detener su evolución e, incluso, mostrar evidencias clínico-funcionales de su capacidad regenerativa. La denominación de pancreatopatía crónica (Pt.p.Cr.) es propuesta para aquellas condiciones en las que: "Los signos y/o síntomas originados por eventuales alteraciones anátomos-estructurales del páncreas y/o por modificaciones funcionales de su componenete secretorio exocrino se hallan disimuladamente inmersos dentro de un complejo sindromático que tiene génesis extra-pancreonal". De los 1.300 tests de secretina efectuados, 100 fueron dedicados a perfilar la respuesta secretoria exocrina normal. Y ello tanto en el hombre como en la mujer, discriminando, además, en ambos sexos, los resultados obtenidos por encima y por debajo de una edad crítica límite trazada a los 45 años. En 368 casos, la evaluación conjunta clínica-funcional permitió incluir a los pacientes dentro de la categoría de las PC. Dentro de esta entidad nosológica, se hizo el distingo entre la PC calcificante (alcohólica e idiopática), la autoinmune y la obstructiva. Como PC alchólica fueron.

Following a clinical evaluation and an exocrine pancreatic secretion exploration with the secretin test for more than three decades, we have tried to delineate the concepts of chronic pancreatitis (CP) and chronic pancreatopathy (Chr. Ptp). Besides, the rate of incidence of these two clinical entities in the Clinicas Hospital of Bs. As. was analyzed and discussed. The term CP was accepted when: "The anatomo-structural changes of the pancreatic gland and/or the exocrine functional component impairment constitute the patient's dominant clinical expresion". It is considered as erroneous and misleading the assumption that considers CP as a disease of an inexorable progressive course. On the contrary, the authors empehasize their conviction, based on experimental and clinical experiences, that CP is susceptible, when appropriately treated, of stopping its evolution and even disclose clinical-functional imporovements testifyng the inherent regenerative capacity of the gland. In contrast to the above, the denomination of Chr.Ptp. should be restricted when: "The signs and/or symptoms induced by the anatomo-structural changes of the pancretic gland and/or the functional derangement of the exocrine component remain disguised in the clinical syndrome of other diseases". Out of the 1,300 secretin tests performed, 100 were done on healthy controls. This study allowed establishing the normal statistical values of the different parameters. Besides, of showing the differences between men and women, especially above the critical age of 45. This clinical-functional evaluation allowed classifying 368 cases as CP. The folowing sub-groups were delineated: Calcifyiung "CP" (alcoholic, 240 cases and idiopathic, 119 cases); autoimmune CP (n=7) and Obstructive "CP" (n=11). In the Chr.Ptp. entity were classified 171 cases. As it is implied in the definition, this type of chronic inflammation of the pancreatic gland remained immersed in other disease entities.

[Biochemical profile of the pancreatic function: pancreolauril and oral glucose tolerance tests]. / Evaluación bioquímica de la función pancreática: Pruebas del pancreolauril y de la tolerancia a la glucosa oral.

BACKGROUND: The pancreas is a mixed gland that takes part in the digestion of nutrients and in the homeostasis ofglycemia. Chronic pancreopathy is the cause of secretory insufficiency, characterized by an inflammatory process that leads to fibrosis of the pancreas, with a progressive loss of both exocrine and endocrine functions of the gland. OBJECTIVE: To study both the exocrine and endocrine pancreatic relationship in patients with pancreatopathies and other non-pancreatic digestive alterations, by means of serum pancreolauril (sPL) and oral glucose tolerance tests (OGTT). Glycemia and insulin, basal and at 30, 60 and 120 minutes; amylase and lipase; and the HOMA index (homeostatic model) were determined in serum. MATERIAL AND METHODS: Thirty-two patients were evaluated: normal OGTT (n=11, control group) and pathologic OGTT (n=21). From the latter group, a subgroup (n=11) with a diagnosis of chronic pancreatitis (CP) was studied. RESULTS: Patients with pathologic OGTT in relation with normal OGTT presented a significant increase of glycemia at the four periods of time and of insulin at 120 minutes (P < 0.05), and a significant decrease of sPL (P < 0.05). In patients with CP, men were more than women, and all of them presented a pathologic OGTT and the sPL was significantly lower (P < 0.001). CONCLUSION: By the biochemical tests used, pancreas functionality corresponds with a close relationship between exocrine and endocrine pancreas. Thus, we suggest the use of the sPL test as a helpful tool for the diagnosis of CP.

Lipasa: una enzima singular por sus interacciones neuro-hormonales. (Revisión y análisis experimental y clínico) / Lipase: a particular enzyme because of its neuro-hormonal interactions

Un objetivo de esta presentación es el de analizar las peculiaridades distintivas de la enzima lipasa proveniente de diferentes fuentes: gástrica (LG), intestinal (LI)hepática (LH), lipoproteica (LLP), pero, en especial, aquella de la pancreática (LP), sobre todo en lo relativo a sus interacciones neuro-hormonales.

Lipasa: una enzima singular por sus interacciones neuro-hormonales. (Revisión y análisis experimental y clínico) / Lipase: a particular enzyme because of its neuro-hormonal interactions

Un objetivo de esta presentación es el de analizar las peculiaridades distintivas de la enzima lipasa proveniente de diferentes fuentes: gástrica (LG), intestinal (LI)hepática (LH), lipoproteica (LLP), pero, en especial, aquella de la pancreática (LP), sobre todo en lo relativo a sus interacciones neuro-hormonales.(AU)

Pseudo-Pancreatitis Aguda Edematosa: sindrome mimetizado por una duodenitis parasitaria multiple. Analisis 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 percent); 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: sindrome mimetizado por una duodenitis parasitaria multiple. Analisis 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 percent); 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. (Au)

Sistema nervioso autónomo y páncreas. (Análise da influencia de diversos tipos de denervación outonómica en los fenómenos de regeneración glandular y en las de las interaciones del eje endocrino-exocrino / Autonomic nervous system and pancreas. (Analysis of the influence of different types of autonomic denervation in glandular regeneration phenomena and the interactions of the exocrine-endocrine-Axis)

The present tests, in male Wistar rsts, center around the trophic and functional changes of the pancreatic gland (R G), both exocrine and endocrine, induced by different types of autonomic nervous interruptions. First Group of Tests: Following one year celiac ganglionectomy (CG), nonpancreatectomized (Non-Pt) rats showed, basally, in blood, adrop of glucose (G), without changes of insulin (I). At autpsy, the CG animals showed an increase of the pancreatic we weight, of the total protein, of the RNA but not DNA. In the Pt. 95 per cent rats, superimposing CG triggered, on the one hand, a drop to control values of the raised G blood levels, and on the other, a rise of I Besides, in feces, a rising of chymotrypsin concentration. At autopsy, in the PG, an increase of total protein and of RNA. Second Group of Tests: CG, after 6 months, induced, in blood, both basally and a 2 h glucose tolerance test, significant opposite enzyme activities changes in respect to C. Indeed, as amylase (A) was increased, that of lipase (L) was depressed. When alcohol feeding (AF) was superimposed to CG rats, a reversal of the L values was observed. The latter reached levels significantly higher those of the C. In in-vitro tests, the isolated islets of CG disclosed to release more I to the bath medium than those of the C animals. Third Group of Tests: Analyzing, in conscious animal, the L excretory changes in the basal bile pancreatic secretion (BB-PS) induced by chronic (2 months interruption of the autonomic nervous innervation of the PG, it was found that CG, truncal vagotomy (V), the association of CG + V, peri-Vaterian duodenotomy (PV-D), but not bilateral splachnicectomy (Spl), inhibit, significantly the L output. It was also shown that superimosing AF to the V or CG + V animals reverted to C values the I depressed levels...

Sistema nervioso autónomo y páncreas. (Análise da influencia de diversos tipos de denervación outonómica en los fenómenos de regeneración glandular y en las de las interaciones del eje endocrino-exocrino / Autonomic nervous system and pancreas. (Analysis of the influence of different types of autonomic denervation in glandular regeneration phenomena and the interactions of the exocrine-endocrine-Axis)

The present tests, in male Wistar rsts, center around the trophic and functional changes of the pancreatic gland (R G), both exocrine and endocrine, induced by different types of autonomic nervous interruptions. First Group of Tests: Following one year celiac ganglionectomy (CG), nonpancreatectomized (Non-Pt) rats showed, basally, in blood, adrop of glucose (G), without changes of insulin (I). At autpsy, the CG animals showed an increase of the pancreatic we weight, of the total protein, of the RNA but not DNA. In the Pt. 95 per cent rats, superimposing CG triggered, on the one hand, a drop to control values of the raised G blood levels, and on the other, a rise of I Besides, in feces, a rising of chymotrypsin concentration. At autopsy, in the PG, an increase of total protein and of RNA. Second Group of Tests: CG, after 6 months, induced, in blood, both basally and a 2 h glucose tolerance test, significant opposite enzyme activities changes in respect to C. Indeed, as amylase (A) was increased, that of lipase (L) was depressed. When alcohol feeding (AF) was superimposed to CG rats, a reversal of the L values was observed. The latter reached levels significantly higher those of the C. In in-vitro tests, the isolated islets of CG disclosed to release more I to the bath medium than those of the C animals. Third Group of Tests: Analyzing, in conscious animal, the L excretory changes in the basal bile pancreatic secretion (BB-PS) induced by chronic (2 months interruption of the autonomic nervous innervation of the PG, it was found that CG, truncal vagotomy (V), the association of CG + V, peri-Vaterian duodenotomy (PV-D), but not bilateral splachnicectomy (Spl), inhibit, significantly the L output. It was also shown that superimosing AF to the V or CG + V animals reverted to C values the I depressed levels...(AU)

Pirenzepine as anti-inflammatory drug in a model of experimental colitis in rat

La pirenzepina se ha utilizado ampliamente en el tratamiento de la úlcera gástrica y duodenal. En este trabajo hemos probado que esta droga puede prevenir la acción inflamatoria inducida en el colon con un estímulo intraluminal como el ácido acético. Estos datos sugieren una participación colinérgica en la respuesta inflamatoria del colon

Pirenzepine as anti-inflammatory drug in a model of experimental colitis in rat

La pirenzepina se ha utilizado ampliamente en el tratamiento de la úlcera gástrica y duodenal. En este trabajo hemos probado que esta droga puede prevenir la acción inflamatoria inducida en el colon con un estímulo intraluminal como el ácido acético. Estos datos sugieren una participación colinérgica en la respuesta inflamatoria del colon (AU)