Factors affecting prosthetic rehabilitation outcomes in amputees of age 60 years and over.

This retrospective, observational study was designed to investigate factors affecting successful prosthetic ambulation in elderly amputees aged > or = 60 years. The study included 64 unilateral transfemoral or hip disarticulation amputees. Patients who were able to walk > or = 100 m with prosthesis were classified as successful and those who could walk < 100 m as failures. Age, comorbidities, cause of amputation, ability to stand on one leg, patient's motivation for walking and maximum oxygen uptake as a proportion of predicted maximum oxygen uptake (%VO(2max)) during an exercise load test were examined as indicators of physical fitness. Significant differences were noted between the two groups in the number of comorbidities, ability to stand on one leg, patient's motivation for walking and mean %VO(2max). A low number of comorbidities, the ability to stand on one leg, motivation for walking and adequate physical fitness allowing an exercise intensity of > or = 50% VO(2max) were considered to be predictive factors for successful prosthetic rehabilitation.

Enzimas pancreáticas: revisión y análisis de sus acciones atenuantes sobre la secreción ácida gástrica, el dolor pancreático, el colon irritable y trastornos digestivos múltiples / Pancreatic Enzymes: useful therapeutical agents to a wider spectrum of functional digestive disorders. Revision and analysis

Las enzimas pancreáticas constituyen agentes terapéuticos de utilidad clínica dentro de un espectro mucho más amplio del que se acepta habitualmente. En este trabajo se trata de demostrar que ejercen una influencia benéfica en un variado grupo de entidades... y que la asociación de una mejora en el mecanismo del proceso digestivo, especialmente de los carbohidratos, y el consecutivo alivio de los fenómenos dispépticos fermentativos, ello en conjunción con una atenuación de la hipersensibilidad del sistema nervioso aferente, cambio muy ligado a una depresión liberadora sobre la CCK, explican el valor terapéutico innegable que poseen los fermentos pancreáticos en el enfoque terapéutico del colon irritable

Enzimas pancreáticas: revisión y análisis de sus acciones atenuantes sobre la secreción ácida gástrica, el dolor pancreático, el colon irritable y trastornos digestivos múltiples / Pancreatic Enzymes: useful therapeutical agents to a wider spectrum of functional digestive disorders. Revision and analysis

Las enzimas pancreáticas constituyen agentes terapéuticos de utilidad clínica dentro de un espectro mucho más amplio del que se acepta habitualmente. En este trabajo se trata de demostrar que ejercen una influencia benéfica en un variado grupo de entidades... y que la asociación de una mejora en el mecanismo del proceso digestivo, especialmente de los carbohidratos, y el consecutivo alivio de los fenómenos dispépticos fermentativos, ello en conjunción con una atenuación de la hipersensibilidad del sistema nervioso aferente, cambio muy ligado a una depresión liberadora sobre la CCK, explican el valor terapéutico innegable que poseen los fermentos pancreáticos en el enfoque terapéutico del colon irritable

[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.

[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)]. / Sistema nervioso autónomo y páncreas. (Análisis de la influencia de diversos tipos de denervación autonómica en los fenómenos de regeneracón glandular y en las de las interacciones del Eje Endocrino-Exocrino).

The present tests, in male Wistar rats, 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, a drop of glucose (G), without changes of insulin (I). At autopsy, 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% 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 splachicectomy (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. In acute interruptions (24 h) of the autonomic nervous innervation of the PG: CG, V, P. V-D, the depression in the BBPS is highly significant, more than 40%. From these three sets of experiments it is concluded that: Firstly, CG increases the regenerative and functional capacity of both the exocrine pancreas. This is distinctively evident when the secretory mass is reduced like in the Pt. 95% series of animals. CG probably exerts its effects suppressing the releasing of some negative reins: adrenergic, pepdidergic (galanin). Secondly, CG evokes modifications of the normal Islet-pancreon inter-relationships. The rising of A and the drop of L in blood elicited by this type of autonomic nervous interruption probably reflects an increased release of I by the Langerhans islet. Thirdly, CG, the same as V. CG + V and P.V-D, but not Spl, depress the intrapancreatic cholinergic tone. This might by at the basis of the depression of L excretion in the BB-PS. The reversion to C Through the coupling of chronic alcohol intoxication to the autonomic decentralized PG would be a reflection of an increased sensitivity to ethanol of the intrapancreatic ganglionic neurons. The augmented acetylcholine release at the nerve terminal would lead to a high intrapancreatic cholinergic tone that, in the end, might be at the basis of the reversal changes induced in the autonomic decentralized PG by the chronic ethanol intoxication.

Sistema nervioso autónomo y páncreas. (Análisis de la influencia de diversos tipos de denervación autonómica en los fenómenos de regeneracón glandular y en las de las interacciones 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 rats, 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, a drop of glucose (G), without changes of insulin (I). At autopsy, 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

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 splachicectomy (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. In acute interruptions (24 h) of the autonomic nervous innervation of the PG: CG, V, P. V-D, the depression in the BBPS is highly significant, more than 40

. From these three sets of experiments it is concluded that: Firstly, CG increases the regenerative and functional capacity of both the exocrine pancreas. This is distinctively evident when the secretory mass is reduced like in the Pt. 95

series of animals. CG probably exerts its effects suppressing the releasing of some negative reins: adrenergic, pepdidergic (galanin). Secondly, CG evokes modifications of the normal Islet-pancreon inter-relationships. The rising of A and the drop of L in blood elicited by this type of autonomic nervous interruption probably reflects an increased release of I by the Langerhans islet. Thirdly, CG, the same as V. CG + V and P.V-D, but not Spl, depress the intrapancreatic cholinergic tone. This might by at the basis of the depression of L excretion in the BB-PS. The reversion to C Through the coupling of chronic alcohol intoxication to the autonomic decentralized PG would be a reflection of an increased sensitivity to ethanol of the intrapancreatic ganglionic neurons. The augmented acetylcholine release at the nerve terminal would lead to a high intrapancreatic cholinergic tone that, in the end, might be at the basis of the reversal changes induced in the autonomic decentralized PG by the chronic ethanol intoxication.

Reduced injury and scar in acute myocardial infarctions treated with human growth hormone.

Repair processes of cells submitted to an injury may exhibit an indirect identifying feature of its activity, based on the amount of connective tissue that could be traced with special stains and morphometry. Hydroxyproline concentration in tissue is also an index with which the presence and amount of repair mechanisms can be assessed. They may be quantitated appropriately in correlation with the end products of collagen, which represent the amount of cicatricial tissue. In order to correlate the size of the scar in myocardial infarcts with the amount of connective tissue, a determination of hydroxyproline levels after 30 days of acute experimental infarctions was performed in 3 groups of rats: 10 received a single dose of 2I U of human growth hormone (HGH) per week for 4 weeks, in a bolus injection immediately after the infarction was surgically induced; 10 received the same dose as above in daily injections during a week. Finally, another group of 10 animals which did not receive an active treatment served as controls. All animals were sacrificed at the end of a month. A morphometric study with Van Gieson stain was performed. Hydroxyproline levels were determined. Hydroxyproline levels were considerably lower in hGH-treated rats (T) compared to control (C) rats: 3.30 ug/mg +/- 0.1 vs. 4.10 +/- 0.29 (p < 0.05). Morphometry: T.: 5.23 +/- 2.45 vs. C.: 4.22 +/- 2.15 of the left ventricular wall. Three aneurysms were found in C group versus 1 in T. Human growth hormone administered to a group of rats with myocardial infarction showed obvious dose--effects consisting of a significant diminution of scar tissue in treated rats with a proportional fall in the hydroxyproline levels.

Ulex europeus agglutinin I binding pattern during chemical carcinogenesis in the rat gastrointestinal tract.

BACKGROUND: Fluorescein isothiocyanate-Ulex europeus agglutinin I stain (UEA1) was postulated as a prominent histochemical marker for premalignant mucosa in dimethylhydrazine (DMH)-treated animals. UEA1 (evaluated by two scanning methods) and high iron diamine Alcian blue (HIDAB) stain were used in attempt to detect premalignant colonic mucosa in this animal model. The authors also examined the influence of the duodenal medium on colonic segments transposed to the upper gastrointestinal tract. METHODS: Rats were placed into three groups: those with interposed intestine, those receiving the sham operation, and controls. Half of the animals received DMH, and surviving rats were killed at 2, 4, and 8 months. RESULTS: The authors found no differences in tumor development in the transposed and nontransposed colons of animals treated with DMH. Several transposed segments of animals without carcinogen induction showed dysplastic areas. These findings suggest a trophic role of certain duodenal factors in the epithelial kinetics of the transposed colons. The authors did not find HIDAB stain useful in the identification of premalignant colonic mucosa. The quantitative evaluation method of UEA1 binding was more reliable. Fifteen percent of all the colon specimens of animals without chemical induction were stained with UEA1 with this form of evaluation. Positive staining of the interposed colon samples was the most important factor for these findings. CONCLUSIONS: In this animal model, UEA1 staining is a potentially useful marker of premalignant mucosa, particularly when the nontransposed distal colon of animals treated with DMH is considered.

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

Pirenzepine has been widely used for the treatment of gastric and duodenal ulcer. In this work we have proved that this drug could prevent the inflammatory reaction induced in the colon with an intraluminal stimuli as the acetic acid. These data suggest the cholinergic participation in the inflammatory colonic response.

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

Pirenzepine has been widely used for the treatment of gastric and duodenal ulcer. In this work we have proved that this drug could prevent the inflammatory reaction induced in the colon with an intraluminal stimuli as the acetic acid. These data suggest the cholinergic participation in the inflammatory colonic response.

Does secretin influence rat colonic absorption and secretion?

In rats, a secretin (Jorpes) intravenous infusion superimposed on an intracolonic sodium acetate perfusion elicits, with respect to control values, a significant depression of Na+ absorption (0.16 mEq./h-0.00 mEq./h.) and mucus secretion (230-40 mg.). When the hormone is superimposed upon an intracolonic infusion of acetic acid, mucus secretion is also significantly inhibited (790-340 mg.). The influence of secretin on organic anion movement was pH related. At pH values of 7.0, absorption was unchanged (0.34--0.33 mEq./h.), at pH values of 2.9, absorption was significantly reduced (0.67-0.41 mEq./h). The secretin impairment of colonic mucus secretion could influence the transport of watersoluble (Na+) and lipid soluble (acetic acid) substances, probably through changes at the "unstirred layer" level.