Paediatric community-acquired septic shock: results from the REPEM network study.

UNLABELLED: INTRODUCTION AND PURPOSE OF THE STUDY: With this study we aimed to describe a "true world" picture of severe paediatric 'community-acquired' septic shock and establish the feasibility of a future prospective trial on early goal-directed therapy in children. During a 6-month to 1-year retrospective screening period in 16 emergency departments (ED) in 12 different countries, all children with severe sepsis and signs of decreased perfusion were included. RESULTS: A 270,461 paediatric ED consultations were screened, and 176 cases were identified. Significant comorbidity was present in 35.8 % of these cases. Intensive care admission was deemed necessary in 65.7 %, mechanical ventilation in 25.9 % and vasoactive medications in 42.9 %. The median amount of fluid given in the first 6 h was 30 ml/kg. The overall mortality in this sample was 4.5 %. Only 1.2 % of the survivors showed a substantial decrease in Paediatric Overall Performance Category (POPC). 'Severe' outcome (death or a decrease ≥2 in POPC) was significantly related (p < 0.01) to: any desaturation below 90 %, the amount of fluid given in the first 6 h, the need for and length of mechanical ventilation or vasoactive support, the use of dobutamine and a higher lactate or lower base excess but not to any variables of predisposition, infection or host response (as in the PIRO (Predisposition, Infection, Response, Organ dysfunction) concept). CONCLUSION: The outcome in our sample was very good. Many children received treatment early in their disease course, so avoiding subsequent intensive care. While certain variables predispose children to become septic and shocked, in our sample, only measures of organ dysfunction and concomitant treatment proved to be significantly related with outcome. We argue why future studies should rather be large multinational prospective observational trials and not necessarily randomised controlled trials.

Primary adenosquamous carcinoma of the rectum. Report of 4 cases and review of the literature.

OBJECTIVE: To review the experience of two referral centres in the management of an infrequent condition: primary adenosquamous carcinoma of the rectum, a rare disease. MATERIALS AND METHODS: Four cases of primary adenosquamous carcinomas of the rectum are reported with a review of the literature. No preoperative diagnosis of adenosquamous carcinoma was established. All tumours were located in the rectum. Two patients presented with liver metastasis. No preoperative therapies were indicated. All patients underwent surgery. RESULTS: Patients underwent anterior resections (n=2), recto-sigmoid resection (n=1) and abdomino-perineal excision (n=1). All resected specimens had positive lymph nodes and metastatic liver disease was confirmed in the two cases. No adjuvant therapy was carried out after surgery and patients died within 8 months after surgical treatment. CONCLUSIONS: Adenosquamous carcinoma of the rectum is a rare and aggressive tumour characterized by coexisting of malignant glandular and squamous components. Presentation is usually at an advanced stage. The tumour is aggressive and metastatic disease at the time of diagnosis is common. Surgery is the treatment of choice. Adjuvant therapy is difficult to evaluate prospectively due to the rarity of the condition. Survival is less than 50% than that for adenocarcinoma.

[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.

[Is there pancreatic regeneration? Morphological and functional certification after a corporocaudal splenopancreatectomy/]. / Existe la regeneración pancreática? Certificación morfológica y funcional luego de una esplenopancreatectomía corporocaudal.

INTRODUCTION: The process of pancreatic regeneration, well known and accepted, is less known than the hepatic and includes different mechanisms and factors. Pancreatic regeneration is better known in acute pancreatitis. After an extensive pancreatic necrosis, the morphological and functional regeneration is assessed by dynamic computed tomography associated with normalization of glycemia and the exocrine function. Different groups identified and evaluated experimentally and clinically the actions of multiple factors involved in the process of pancreatic regeneration. Even difficult to assess, pancreatic regeneration after partial pancreatectomy is well documented and of capital importance. CASE REPORT: A 57-year-old woman with discomfort in the upper-left abdominal quadrant. CT scans showed a tumor in the body and tail of the pancreas adherent to the spleen. Preoperative CA 19-9 was normal. She was operated on and the tumor resected en bloc with the spleen. Only the head of the pancreas was preserved. Intraoperative pathological examination of the specimen showed a mucinous cistoadenoma with no malignant degeneration. Postoperative course was uneventful and discharged at p.o. day 10, with ongoing diabetes. Four month later she presented pain in the upper-left quadrant with hyperamylasemia. CT scans showed a normal body and tail with an image of pseudocyst at the top of the pancreatic tail. One year after the initial surgery she remained asymptomatic, without diabetes and with no dietary restrictions. Further CT controls showed images of the entire regeneration of the body and tail of the pancreas. DISCUSSION: Several phenomena are well known and accepted to be associated with the regeneration of the pancreas. In 1965, Tiscornia et al demonstrated the restoration of the pancreatic exocrine function after 6 weeks of selective occlusion of the pancreatic duct. The authors proposed pancreatic regeneration as responsible of morphological, histological and functional changes observed in operated patients where the pancreatic duct was decompressed by an anastomosis to the small bowel and constitutes the rational basis for surgical treatment of chronic pancreatitis. Several humoral factors seems to be involved in pancreatic regeneration acting by a specific receptors-mechanisms, like Bombesin, Octeotride, FGF (Fibroblast Growth Factor) and TGF (Transforming Growth Factor). Friess et al demonstrated increased levels of TGF in acute pancreatitis and considered it to be responsible of the pancreatic regeneration. Waguri et al experimentally demonstrated a double mechanism involved in the regeneration of B-cells: cellular and humoral ways could vary according to different situations. Less evident are the mechanisms involved after surgical pancreatic resection. Kato et al demonstrated the importance of zinc after partial pancreatic resection in dogs. Up to now, there are no other associations experimentally nor in humans. Our case showed in several CT scans control the presence of a normal pancreatic body and tails after a splenopancreatectomy, with restoration of endocrine and exocrine functions. Probably, several mechanisms were involved in this case. Further investigations will elucidate the answered. CONCLUSIONS: Pancreatic regeneration was confirmed by CT scans images and also functionally after an extensive resection. Future similar findings could be of great clinical importance.

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)

Existe la regeneración pancreática? Certificación morfológica y funcional luego de una esplenopancreatectomía corporocaudal. / [Is there pancreatic regeneration? Morphological and functional certification after a corporocaudal splenopancreatectomy/]

INTRODUCTION: The process of pancreatic regeneration, well known and accepted, is less known than the hepatic and includes different mechanisms and factors. Pancreatic regeneration is better known in acute pancreatitis. After an extensive pancreatic necrosis, the morphological and functional regeneration is assessed by dynamic computed tomography associated with normalization of glycemia and the exocrine function. Different groups identified and evaluated experimentally and clinically the actions of multiple factors involved in the process of pancreatic regeneration. Even difficult to assess, pancreatic regeneration after partial pancreatectomy is well documented and of capital importance. CASE REPORT: A 57-year-old woman with discomfort in the upper-left abdominal quadrant. CT scans showed a tumor in the body and tail of the pancreas adherent to the spleen. Preoperative CA 19-9 was normal. She was operated on and the tumor resected en bloc with the spleen. Only the head of the pancreas was preserved. Intraoperative pathological examination of the specimen showed a mucinous cistoadenoma with no malignant degeneration. Postoperative course was uneventful and discharged at p.o. day 10, with ongoing diabetes. Four month later she presented pain in the upper-left quadrant with hyperamylasemia. CT scans showed a normal body and tail with an image of pseudocyst at the top of the pancreatic tail. One year after the initial surgery she remained asymptomatic, without diabetes and with no dietary restrictions. Further CT controls showed images of the entire regeneration of the body and tail of the pancreas. DISCUSSION: Several phenomena are well known and accepted to be associated with the regeneration of the pancreas. In 1965, Tiscornia et al demonstrated the restoration of the pancreatic exocrine function after 6 weeks of selective occlusion of the pancreatic duct. The authors proposed pancreatic regeneration as responsible of morphological, histological and functional changes observed in operated patients where the pancreatic duct was decompressed by an anastomosis to the small bowel and constitutes the rational basis for surgical treatment of chronic pancreatitis. Several humoral factors seems to be involved in pancreatic regeneration acting by a specific receptors-mechanisms, like Bombesin, Octeotride, FGF (Fibroblast Growth Factor) and TGF (Transforming Growth Factor). Friess et al demonstrated increased levels of TGF in acute pancreatitis and considered it to be responsible of the pancreatic regeneration. Waguri et al experimentally demonstrated a double mechanism involved in the regeneration of B-cells: cellular and humoral ways could vary according to different situations. Less evident are the mechanisms involved after surgical pancreatic resection. Kato et al demonstrated the importance of zinc after partial pancreatic resection in dogs. Up to now, there are no other associations experimentally nor in humans. Our case showed in several CT scans control the presence of a normal pancreatic body and tails after a splenopancreatectomy, with restoration of endocrine and exocrine functions. Probably, several mechanisms were involved in this case. Further investigations will elucidate the answered. CONCLUSIONS: Pancreatic regeneration was confirmed by CT scans images and also functionally after an extensive resection. Future similar findings could be of great clinical importance.

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.

[Malignant peritoneal mesothelioma. An infrequent cause of prolonged fever syndrome and leucocytosis in a young adult]. / Mesotelioma maligno de peritoneo. Causa infrecuente de síndrome febril prolongado y leucocitosis en un adulto joven.

Peritoneal mesothelioma is a rare neoplasia usually associated with exposure to asbestos. The incidence in the population not in contact with asbestos is of one per million per year. The disease is most common in males over the age of 40, with signs and symptoms of neoplasic disease together with abdominal pain and ascitis with or without a palpable abdominal mass. We report the case of a young male without a history of exposure to asbestos who presented with prolonged fever, leukocytosis and a septated peritoneal exudate. With a presumptive diagnosis of peritoneal tuberculosis, the patient received empirical antituberculosis treatment. Because the clinical picture persisted and microbiological studies remained negative, a second exploratory laparotomy was performed which demonstrated the presence of a malignant epithelial peritoneal mesothelioma.

Mesotelioma maligno de peritoneo. Causa infrecuente de síndrome febril prolongado y leucocitosis en un adulto joven. / [Malignant peritoneal mesothelioma. An infrequent cause of prolonged fever syndrome and leucocytosis in a young adult]

Peritoneal mesothelioma is a rare neoplasia usually associated with exposure to asbestos. The incidence in the population not in contact with asbestos is of one per million per year. The disease is most common in males over the age of 40, with signs and symptoms of neoplasic disease together with abdominal pain and ascitis with or without a palpable abdominal mass. We report the case of a young male without a history of exposure to asbestos who presented with prolonged fever, leukocytosis and a septated peritoneal exudate. With a presumptive diagnosis of peritoneal tuberculosis, the patient received empirical antituberculosis treatment. Because the clinical picture persisted and microbiological studies remained negative, a second exploratory laparotomy was performed which demonstrated the presence of a malignant epithelial peritoneal mesothelioma.

Pure pancreatic juice in humans: orange-lemon-juice-induced secretory effects. Comparative analysis with a regular meal, sorbitol, acidified peptone broth and secretin.

The secretory effect elicited by the ingestion of 100 ml of orange-lemon juice (O.-L.J.) was studied on pure pancreatic juice obtained from a catheter placed in the human Wirsung duct at surgery. These changes were compared with those evoked by a regular meal (R.M.), the ingestion of a Sorbitol solution (S.S.), the intragastric infusion of an acidified peptone broth (A.P.B.) and an i.v. single injection of secretin (Boots, 1.0 U/kg). The O.-L.J. induced purer pancreatic secretion response (flow, bicarbonate and enzyme output) than that triggered by the R.M., S.S. and A.P.B. The O.-L.J. evoked peak values, were observed earlier (60 min) than with a R.M. (90 min) ingestion. The 120-min-cumulative values confirmed these findings and disclosed that O.-L.J. elicits a rate of secretion and bicarbonate output closely similar to that of an i.v. secretin injection and amylase response greater than that evoked by this hormone. Thus, O.-L.J. ingestion proved to be an unexpected powerful stimulus of exocrine pancreatic secretion.

[Post-sectional antral peptic ulcer and antrofundic re-anastomosis in rats (manifestation of a probable antrofundic neuroendocrine center)]. / Ulcera péptica antral postsección y reanastomosis antrofúndica en la rata (puesta de manifiesto de un probable centro neuroendócrino antrofúndico).

The antrum-fundic section and re-anastomosis (AESR), liberates, in Wistar male rats, genuine antral peptic ulcers. They start within 20 days. They are progressive evolution, penetrating into all gastric walls. Between 7 and 8 months, they involve near organs (spleen, liver, pancreas) and produce a great inflammatory reaction of the peripancreatic ganglions. The antral peptic ulcer is induced if the gastric lesser curvature's nerves are sectioned and a concomitant pyloroplasty is done or not. The gastric hemisection, if anterior or posterior, break out the peptic ulcer only on the same side of the antrum-fundic interruption. In all this situations, except in cases of concomitant pyloroplasty, it is proved a pronounced and significantly increase of the gastric (g/kg), but not pancreatic index. In the AFSR series with nervous section on the lesser curvature and without pyloroplasty, the percentage of antral peptic ulcers in 56%. It is postulated the probably existence, at an antrum-fundic level, of a neuroendocrine center. Its nullification or disturbance by the section and re-anastomosis procedure could generate the antral ulcer and other histologic changes (increase of the "G" cells, hyperplasia of the parietal, ECL and "A like" cells) by one or various hypothetical ways: 1. Direct action, nullifying the normal blocking function of somatostative over the "G" cells and or parietal cells. 2. Disturbing or nullifying the motor pump effect of the gastric antrum, and on this way, enhancing the duodenum-gastric reflux with all know deleterious effects of the bile in the antrum particularly in an acid milieu. 3. Modifying, in the opposite direction, the sensitivity by one hand, of the "G" cells mass and by the other one, of the parietal, ECL and "A like" cells. The depression of the fundic sensitivity will induce the hyperplasia of the "G" cells, the hypersecretion of gastrin and, "a posteriori", all the secretory effects and trophic characteristic of it. 4. Disturbing the prostaglandins secretion, perhaps through a deficit of the nervous innervation, with the resulting epiphenomenon of a cytoprotection deficit mediated through the mucus and bicarbonate production. It is probably that the proposed physiopathogenic mechanism are associated and that the final result, the antral peptic ulcer is the consequence of an increase of the aggressive factors (acid, bile) and a concomitant depression of the defensive factors (cytoprotection), starting normally by the prostaglandins through the mucus and bicarbonate secretion.

Ulcera péptica antral postsección y reanastomosis antrofúndica en la rata (puesta de manifiesto de un probable centro neuroendócrino antrofúndico). / [Post-sectional antral peptic ulcer and antrofundic re-anastomosis in rats (manifestation of a probable antrofundic neuroendocrine center)]

The antrum-fundic section and re-anastomosis (AESR), liberates, in Wistar male rats, genuine antral peptic ulcers. They start within 20 days. They are progressive evolution, penetrating into all gastric walls. Between 7 and 8 months, they involve near organs (spleen, liver, pancreas) and produce a great inflammatory reaction of the peripancreatic ganglions. The antral peptic ulcer is induced if the gastric lesser curvatures nerves are sectioned and a concomitant pyloroplasty is done or not. The gastric hemisection, if anterior or posterior, break out the peptic ulcer only on the same side of the antrum-fundic interruption. In all this situations, except in cases of concomitant pyloroplasty, it is proved a pronounced and significantly increase of the gastric (g/kg), but not pancreatic index. In the AFSR series with nervous section on the lesser curvature and without pyloroplasty, the percentage of antral peptic ulcers in 56

. It is postulated the probably existence, at an antrum-fundic level, of a neuroendocrine center. Its nullification or disturbance by the section and re-anastomosis procedure could generate the antral ulcer and other histologic changes (increase of the [quot ]G[quot ] cells, hyperplasia of the parietal, ECL and [quot ]A like[quot ] cells) by one or various hypothetical ways: 1. Direct action, nullifying the normal blocking function of somatostative over the [quot ]G[quot ] cells and or parietal cells. 2. Disturbing or nullifying the motor pump effect of the gastric antrum, and on this way, enhancing the duodenum-gastric reflux with all know deleterious effects of the bile in the antrum particularly in an acid milieu. 3. Modifying, in the opposite direction, the sensitivity by one hand, of the [quot ]G[quot ] cells mass and by the other one, of the parietal, ECL and [quot ]A like[quot ] cells. The depression of the fundic sensitivity will induce the hyperplasia of the [quot ]G[quot ] cells, the hypersecretion of gastrin and, [quot ]a posteriori[quot ], all the secretory effects and trophic characteristic of it. 4. Disturbing the prostaglandins secretion, perhaps through a deficit of the nervous innervation, with the resulting epiphenomenon of a cytoprotection deficit mediated through the mucus and bicarbonate production. It is probably that the proposed physiopathogenic mechanism are associated and that the final result, the antral peptic ulcer is the consequence of an increase of the aggressive factors (acid, bile) and a concomitant depression of the defensive factors (cytoprotection), starting normally by the prostaglandins through the mucus and bicarbonate secretion.

[Hydroelactic and ecbolic of piprozoline on basal bile-pancreatic secretion in rats]. / Efectos hidreláticos v ecbólicos de la piprozolina sobre la secreción basal bilio-pancreática en la rata.

In male conscious rats provided with a new type of biliary-pancreatic fistula, the effects on basal bile-pancreatic secretion by piprozoline were analyzed when infused intraduodenally superimposed on a "plateau" reached by three previous collection periods of 30 minutes each. Different doses: 25, 50, 100 and 200 mg were evaluated at random during the first 48 hs. of fistula. The secretion evoked by the intraduodenal piprosoline's solvent, propilenglicol, was used as a control reference. The analysis of the percentage secretory changes elicited by piprozoline in respect to the "plateau" put in evidence that this agent exerts a preferential hydrelatic influence namely due to a significant increase in volume. The smallest dose, 25 mg/kg induces a peak volume increase of 30%. The higher dose, 100 and 200 mg/kg give origin to a higher and more sustained response, with peak values of around 70%. Protein and lipase output are also stimulated, but due to a high inter-animal variability the percentage changes are in the borderline of a significant level. It is postulated that piprozoline exerts its influences on basal bile-pancreatic secretion through a stimulation of the hepatic and pancreatic acinar cells and of both hepatic and pancreatic ductal systems. The main mediator of these changes trig by piprozoline would be peptides of the secretin family and duodeno-hepatic and duodeno-pancreatic reflexes. Further clarification through tests in either atropinized or vagotomyzed animals is suggested.

[Malignant tumors of extrahepatic bile ducts]. / Tumores malignos de los conductos biliares extrahepáticos.

In connection with increased incidence of extrahepatic bile duct cancer, clinicalpathological characteristics, treatment and prognosis of this particular tumor are revised on the basis of data obtained from patients series observed by the authors and from those of the reference.

Tumores malignos de los conductos biliares extrahepaticos. / Malign tumors of extrahepatic bile ducts

A proposito de la incidencia creciente del cancer de la via biliar extrahepatica se revisan las caracteristicas clinicopatologicas, el tratamiento y el pronostico de este particular tumor en base a los datos obtenidos de la serie de pacientes de los autores y a las referidas en la bibliografia