RESUMO
The aim of this study was to analyze the gallbladder motor function in chronic pancreatitis (CP) patients. Gallbladder emptying was evaluated in 11 patients, without and with addition of pancreatic extract and in ten controls. The results were compared and analyzed statistically. The ejection fraction (EF) of the gallbladder (GB) at 30, 45 and 60 minutes were calculated by using Tc-99m DISIDA scintigraphy. The EF of GB at 60 minutes was significantly higher in the controls when compared to patients, although the results between patients were similar without and with addition of pancreatic extract. The results suggest that the delay in the GB emptying does not depend on the eventual alteration in the intestinal phase of the vesicular stimulation, but it probably results from a mechanic factor, which depends on the chronic pathological process located in the head of the pancreas.
Assuntos
Calcinose/fisiopatologia , Esvaziamento da Vesícula Biliar/fisiologia , Vesícula Biliar/diagnóstico por imagem , Pancreatite/fisiopatologia , Compostos Radiofarmacêuticos , Disofenina Tecnécio Tc 99m , Adulto , Índice de Massa Corporal , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Pancreáticos , Cintilografia , Fatores de TempoRESUMO
Chronic Pancreatitis (CP) presents distinctive characteristics in different geographical areas. With the purpose of evaluating the clinical characteristics, particularly in relation to the frequency and etiopathogeny of the complications in São Paulo, in comparison to other centers, 545 patients with this disease were analyzed, retrospectively, 493 (90.5%) of these patients were males and 52 (9.5%) females, with ages ranging from 8 to 88 (38.2 +/- 9.3 years). The diagnosis of CP was based on criteria previously adopted by the Pancreas Group of Gastroenterology Studies of the Medical School of São Paulo. The principal etiologic factors were represented by: chronic alcoholism in 509 of the 545 patients (93.4%), hereditary factors in four (0.7%), malnutrition in three (0.5%), metabolic alterations in three (0.5%) and obstruction to the pancreatic flow in two patients (0.3%). In 24 (4.4%) of the 545 patients, the etiologic factor could not be established, due to the idiopathic nature of the disease. Of the 509/545 patients (93.4%) presenting chronic ethylism, alcoholic consumption was characterized by: a) mean age alcoholic consumption was initiated: 19.5 +/- 6.5 years; b) mean daily alcoholic consumption in grams of pure ethanol: 358.6 +/- 282.0 g/d; c) mean time of alcoholic consumption: 19.8 +/- 8.8 years, and d) mean age of the appearance of clinical symptoms: 34.9 +/- 9.8 years. The clinical complications were always investigated in accordance with the pre-established protocol; the principal complications observed were represented by: gastrointestinal compression (3.3%), jaundice (24%), cysts (35.9%), cavity effusions (13.3%), pancreatic necrosis (4.7%), abscesses (3.6%), digestive hemorrhage of pancreatic origin (2.3%) and fistulae (1.1%). The incidence of these complications, particularly cysts, cavity effusions and pancreatic necrosis, was greater in the patients studied than in those observed in other regions, probably due to the presence of more intense and frequent anatomopathologic lesions found in these patients, possibly resulting from the greater consumption of alcohol compared to patients with this disease in other centers. The etiopathogenic mechanisms for the complications were individually analyzed and interpreted.
Assuntos
Pancreatite/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Aiming at establishing the prevalence of peptic ulcer in chronic alcoholic pancreatitis and an eventual correlation with gastric acid secretion and endoscopic and histopathologic alterations as well as the presence of Helicobacter pylori in the gastroduodenal mucosa, thirty patients with chronic alcoholic pancreatitis (Group I) and ten control subjects (Group II) were prospectively studied. After upper gastrointestinal endoscopy was performed. Group I was subdivided according to the lack (Subgroup Ia) or a presence (Subgroup Ib) of peptic ulcer. The prevalence of peptic ulcer in these patients was 23.33% clearly higher than that reported in the general population. Baseline and stimulated acid secretion as well as baseline gastrinemia among the subgroups and groups were similar. There was no statistically significant difference in the other parameters evaluated. Due to the increased prevalence of asymptomatic peptic ulcer in patients with chronic alcoholic pancreatitis. Upper gastrointestinal endoscopy is suggested as a diagnosis routine and follow-up of this group of patients.
Assuntos
Ácido Gástrico/metabolismo , Infecções por Helicobacter/microbiologia , Pancreatite Alcoólica/complicações , Pancreatite Alcoólica/epidemiologia , Adulto , Endoscopia Gastrointestinal , Feminino , Mucosa Gástrica/metabolismo , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Helicobacter pylori/isolamento & purificação , Humanos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/microbiologia , Prevalência , Estudos ProspectivosRESUMO
Abnormalities of microcirculation are thought to have an important role in the pathogenesis of severe acute pancreatitis (SAP) and in the associated multiple organic failure. We studied changes in capillary permeability during experimental SAP in rats. Necrotizing acute pancreatitis was induced by retrograde injection of sodium taurocholate in pancreatic ducts in rats (n = 30). The animals were distributed in three groups in which the spaces of compartmental distribution as well as the tissue distribution of labeled tracers were evaluated with the use of erythrocytes and albumin tagged with radioactive chromium, apart from determining the volume of total body water. All the studies were carried out four hours after the induction of acute pancreatitis and the administration of radioactive tracers.
Assuntos
Permeabilidade Capilar , Pancreatite/fisiopatologia , Doença Aguda , Animais , Masculino , Pancreatite/induzido quimicamente , Pancreatite/patologia , Ratos , Ratos Wistar , Índice de Gravidade de Doença , Ácido TaurocólicoRESUMO
This report describes one case of primary non-Hodgkin lymphoma of the extrahepatic biliary tree. The main symptom was obstructive jaundice. Cholangiography demonstrated stricture of the bile duct which resembled the appearance of cholangiocarcinoma. The surgical approach allowed complete ressection. The histopathological analyses showed a centrocitic-centroblastic follicular non-Hodgkin lymphoma. She underwent chemotherapy, developed severe bone marrow hypoplasia, but 48 months after surgery, the patient is doing well.
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ducto Hepático Comum , Tumor de Klatskin/diagnóstico , Linfoma não Hodgkin/diagnóstico , Adulto , Neoplasias dos Ductos Biliares/cirurgia , Feminino , Ducto Hepático Comum/cirurgia , Humanos , Linfoma não Hodgkin/cirurgiaRESUMO
In Brazil, the incidence of IPF due to alcohol-induced CP seems to be higher than in other countries. The authors analysed some general, epidemiologic, laboratory and radiologic features in 98 patients with CP, all of them alcoholics, divided in two groups: 49 patients without IPF (I) and 49 patients with IPF (II). The authors first analysed the following parameters in each group and then comparatively in both groups: age, sex, race, smokers and daily consumption of cigarettes, daily consumption of alcoholic beverages, years of alcohol consumption, and mortality. The authors concluded that pancreatic fistula plays in effusions the main role, secondary to cysts disruption or necrosis of the main pancreatic duct.
Assuntos
Cisto Pancreático/complicações , Fístula Pancreática/complicações , Pancreatite/complicações , Adulto , Fatores Etários , Alcoolismo/complicações , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Cisto Pancreático/epidemiologia , Ductos Pancreáticos/patologia , Fístula Pancreática/epidemiologia , Pancreatite/epidemiologia , Fatores Sexuais , Fatores de TempoRESUMO
We observed 797 consecutive cases of chronic pancreatitis from 1963 to 1987 in the cities of Belo Horizonte and São Paulo. Alcoholism was the main etiological agent, responsible for 714 cases (89.6%). Chronic calcifying pancreatitis from different etiologies, alcohol, idiopathic, nutritional, and familial, was the most important form of chronic pancreatitis, with 786 cases (98.6%). Only three cases of chronic obstructive pancreatitis were diagnosed. Eight cases of chronic pancreatitis, anatomicopathologically studied, have not showed the typical pancreatic changes of either chronic calcifying pancreatitis or of obstructive pancreatitis and were impossible to classify according to the 1984 Marseilles' classification.
Assuntos
Pancreatite/epidemiologia , Alcoolismo/complicações , Brasil , Calcinose/etiologia , Doença Crônica , Feminino , Humanos , Masculino , Fenômenos Fisiológicos da Nutrição , Pancreatite/etiologiaRESUMO
The etiology of chronic pancreatitis was investigated in 407 patients: 381 (93.6%) had a history of heavy alcoholic ingestion (average = 295.3 +/- 171.3 g of ethanol) during a time of 19.2 +/- 8.0 years: five patients (1.0%) had familial background of pancreatitis, two (0.5%) had the obstructive form, and two (0.5%) presented history of malnutrition. In 18 patients (4.4%) it was not possible to determine the etiology. Patients with the alcoholic form started the alcohol abuse at the age of 19.4 +/- 6.0 years. A careful dietetic inquiry showed that patients with chronic pancreatitis lived on a diet which was significantly richer in protein than that of patients of the control group (p less than 0.01). Attention is called to the high incidence of chronic alcohol abuse in patients with chronic pancreatitis.