RESUMO
Interleukin-(IL-) 12 has been recently suggested to participate during development of insulin resistance in obese mice. Nevertheless, serum IL-12 levels have not been accurately determined in overweight and obese humans. We thus studied serum concentrations of IL-12 in Mexican adult individuals, examining their relationship with low-grade inflammation and obesity-related parameters. A total of 147 healthy individuals, 43 normal weight, 61 overweight, and 43 obese subjects participated in the study. Circulating levels of IL-12, tumor necrosis factor-alpha (TNF- α ), leptin, insulin, glucose, total cholesterol, and triglyceride were measured after overnight fasting in all of the study subjects. Waist circumference and body fat percentage were recorded for all the participants. Serum IL-12 was significantly higher in overweight and obese individuals than in normal weight controls. Besides being strongly related with body mass index (r = 0.5154), serum IL-12 exhibited a significant relationship with abdominal obesity (r = 0.4481), body fat percentage (r = 0.5625), serum glucose (r = 0.3158), triglyceride (r = 0.3714), and TNF- α (r = 0.4717). Thus, serum levels of IL-12 are increased in overweight and obese individuals and show a strong relationship with markers of low-grade inflammation and obesity in the Mexican adult population. Further research is needed to understand the role of IL-12 in developing obesity-associated alterations in humans.
Assuntos
Inflamação/sangue , Interleucina-12/sangue , Obesidade/sangue , Adulto , Feminino , Humanos , Insulina/sangue , Leptina/sangue , Masculino , Triglicerídeos/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto JovemRESUMO
Sex steroid hormones (estrogens, progestagens and androgens) have been associated with healthy and neoplastic pancreatic biology, although the precise significance of the findings has not been well established. Receptors for the three different types of SSH are expressed in normal and tumoral pancreatic tissue with varying profiles related to cell origin (exocrine or endocrine), to type of neoplasm, and probably even to tumoral behavior. The activity of specific enzymes involved in the synthesis and transformation of SSH are increased in some neoplastic pancreatic tissues, which may influence the circulating concentrations of these hormones, such as the low serum testosterone:dihydrotestosterone ratio described in male patients with pancreatic carcinoma. Different patterns of age and gender-related incidence and growth of neoplasms have been identified. Experimental studies have shown that pancreatic carcinogenesis is promoted or inhibited by SSH. At present, the data supporting hormonal manipulation for the treatment of these tumors are non-conclusive. Normal and tumoral pancreatic tissues may be regarded as a target for SSH and an additional site of biosynthesis. The influence of these hormones on physiological activities is not well known but should be further explored. The study of SSH in pancreatic neoplasms will provide clues about its origin, development, tumoral behavior, prognosis and more specific hormonal therapy. We review here the evidence favoring the role of SSH and their possible clinical implications in pancreatic function.
Assuntos
Androgênios/fisiologia , Estrogênios/fisiologia , Pâncreas/fisiologia , Progestinas/fisiologia , Humanos , Neoplasias Pancreáticas/etiologiaRESUMO
BACKGROUND: Pancreatic insufficiency may appear secondary to several intestinal disorders. It may contribute to malabsorption in tropical sprue (TS). METHODS: The exocrine pancreatic function was evaluated with the indirect pancreolauryl test (PT) in 56 patients with TS. The PT results were analyzed and correlated with serum albumin levels, degree of intestinal atrophy, and steatorrhea. RESULTS: Abnormally low values were found in 36 (64.2%) cases. A significant relationship was not observed between PT and hypoalbuminemia. Patients with more severe damage by intestinal biopsy tended to have lower PT values. No relationship was found between pancreatic insufficiency and steatorrhea (expressed as g/24 h), but patients with pancreatic insufficiency had increased stool fat concentrations (expressed as percentage of wet stool weight). All patients responded favorably to treatment with folic acid and tetracycline. Fifteen patients with abnormal initial PT values underwent a repeat PT after a 6-week therapy; all of them showed normalization of PT values. CONCLUSIONS: The abnormal exocrine pancreatic function found with an indirect test in patients with TS is probably secondary to a low pancreatic hormonal stimulation due to intestinal damage, as occurs in celiac sprue. These abnormalities are reversible after specific treatment for TS.
Assuntos
Pâncreas/fisiologia , Pancreatopatias/etiologia , Espru Tropical/complicações , Adolescente , Adulto , Idoso , Albuminas/análise , Atrofia , Biópsia , Doença Celíaca/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Pancreatopatias/fisiopatologia , Índice de Gravidade de DoençaAssuntos
Proteínas de Transporte , Doença de Crohn/genética , Peptídeos e Proteínas de Sinalização Intracelular , Proteínas/genética , Cromossomos Humanos Par 16/genética , Análise Mutacional de DNA , Exposição Ambiental , Predisposição Genética para Doença , Humanos , Lipopolissacarídeos/metabolismo , Macrófagos/metabolismo , Monócitos/metabolismo , Proteína Adaptadora de Sinalização NOD2 , Estrutura Terciária de Proteína , Proteínas/fisiologiaRESUMO
BACKGROUND: Cyclosporine (CsA) use has been associated to the development of cholelithiasis in transplant recipients. We herein explored the role of time under CsA on this association in asymptomatic adult kidney transplant recipients (KTR). METHODS: A cross-sectional study was conducted in 140 KTR with variable post-transplant follow-up (PTFU), and without history of symptomatic biliary disease. Upper abdominal ultrasound was performed in all patients. According to the immunosuppressive schedule, patients were classified in three groups: Azathioprine + prednisone (group 1, n = 37), azathioprine + prednisone < 24 months CsA (group 2, n = 58), or azathioprine + prednisone > or = 24 months CsA (group 3, n = 45). Age at time of ultrasound performance, gender, PTFU, chronic viral liver disease, parity, oral contraceptives, serum lipids, diabetes and body mass index were analyzed concomitantly. RESULTS: Median age was 38, 31, and 36 years in groups 1, 2, and 3, respectively. The male:female ratio in the same groups was 1.5:1, 1:1, and 2:1. Mean PTFU was 130, 48, and 53 months, respectively (p = 0.0001). Gallstones were found in three (8%) group 1 KTR, in nine (16%) group 2 KTR, and in 10 (22%) group 3 KTR (p = 0.214). Adjusting for PTFU, the association between length of CsA and prevalence of lithiasis was significantly stronger among those with longer use of CsA (odds ratio = 6.1, p = 0.046). No significant differences were found among groups in the other variables. CONCLUSIONS: KTR receiving CsA for more than two years show increased prevalence of gallstones.
Assuntos
Colelitíase/induzido quimicamente , Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Rim , Azatioprina/uso terapêutico , Bile/metabolismo , Colelitíase/diagnóstico por imagem , Colelitíase/epidemiologia , Comorbidade , Fatores de Confusão Epidemiológicos , Anticoncepcionais Orais/efeitos adversos , Estudos Transversais , Ciclosporina/administração & dosagem , Ciclosporina/farmacocinética , Ciclosporina/uso terapêutico , Diabetes Mellitus/epidemiologia , Quimioterapia Combinada , Seguimentos , Rejeição de Enxerto/prevenção & controle , Hepatite Viral Humana/epidemiologia , Humanos , Hiperlipidemias/epidemiologia , Imunossupressores/administração & dosagem , Imunossupressores/farmacocinética , Imunossupressores/uso terapêutico , México/epidemiologia , Obesidade/epidemiologia , Paridade , Prednisona/uso terapêutico , Prevalência , Fatores de Tempo , UltrassonografiaRESUMO
BACKGROUND: CA 19-9 is used for diagnosis of gastrointestinal neoplasia, mainly pancreatic and biliary cancer. False positive results have been described in cholestasis. OBJECTIVE: To establish the clinical value of CA 19-9 in the diagnosis of pancreatic and biliary cancer in patients with and without cholestasis. METHODS: Five hundred forty-eight medical records of patients with serum CA 19-9 determination performed from May-1996 to June-1998 were reviewed. Cases were grouped by final diagnosis; malignancy was established by histology or clinical and radiological characteristics. ROC curves were used to calculate ideal cut-off values (ICV) for the test. Cholestasis was defined as bilirrubinemia above 3 mg/dL. RESULTS: Thirty percent of serum determinations were done in patients with non-pancreatic and non-hepatobiliary benign diseases (only 1.3% with values > or = 100 U/mL). CA 19-9 levels were higher in pancreatic and hepatobiliary malignancy compared to benign diseases of the same origin, as well as in pancreatic cancer when compared with hepatobiliary cancer. ICV for differentiation of malignant hepatobiliary diseases was set around 100 U/mL, with increased specificity when compared with the usual cut-off value (37 U/mL). Cholestasis increased the values of the antigen in malignant and benign diseases and modified the efficacy of the test by increasing sensitivity while decreasing specificity. The ICV for determining resectability in pancreatic tumors was 224 U/mL. CONCLUSIONS: CA 19-9 is a valuable test for diagnosis of malignant pancreato-hepatobiliary disease. Given that cholestasis modifies the operational characteristics of the test, a cut-off value has to be tailored for each patient depending on the clinical setting, so to maintain the usefulness of the marker.
Assuntos
Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/diagnóstico , Biomarcadores Tumorais/análise , Antígeno CA-19-9/análise , Colestase/complicações , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Early detection of severe acute pancreatitis could represent a formidable task for the clinician with limited resources. We have previously proposed a series of parameters that can identify patients with severe acute pancreatitis. The aim of this prospective study was to compare Ranson criteria with those previously described by the authors (INNSZ criteria) in 78 patients with acute pancreatitis. Sensitivity, specificity, positive and negative predictive values and accuracy were similar in both scores. We found a good correlation (r = 0.65, p < 0.001) and agreement (z = 5.0, Kappa 0.69, p < 0.001) between Ranson and INNSZ criteria. Our results allow us to propose INNSZ severity criteria as an easy and inexpensive alternative in the evaluation of patients with acute pancreatitis.
Assuntos
Pancreatite/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Sensibilidade e EspecificidadeAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Doenças do Colo/induzido quimicamente , Fístula Gástrica/induzido quimicamente , Fístula Intestinal/induzido quimicamente , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Aspirina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Úlcera Gástrica/induzido quimicamenteRESUMO
The International Agency for Research on Cancer (IARC) of the WHO has recognized a cause-effect relationship between Helicobacter pylori (Hp) infection and gastric cancer of such magnitude that the presence of this infection increases the risk of gastric cancer approximately four times. Gastric cancer is currently the second cause of mortality due to malignant neoplasms in Mexico City. This article explores the association between Hp infection and gastric cancer incidence through an epidemiological study including 109 gastric cancer patients and 177 hospital controls in Mexico City. The study estimates that, in the population studied, Hp infection was present in 87.2% of the cases, compared with 82.5% of the controls. The odds ratio of having gastric cancer if infected with Hp was 1.44 IC95% 0.7-2.8. In addition, it was calculated that with eradication of Hp infection in the general population, gastric cancer incidence would decrease by at least 26.6%. An improvement of the actual sanitary conditions along with the development of an effective vaccine for Hp infection and the existence of increasingly effective treatments to eradicate the bacteria are the necessary next step for populational prevention and control of gastric cancer.
Assuntos
Adenocarcinoma/epidemiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Neoplasias Gástricas/epidemiologia , Adenocarcinoma/etiologia , Adenocarcinoma/prevenção & controle , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Interpretação Estatística de Dados , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/prevenção & controle , Humanos , Japão/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/prevenção & controleRESUMO
OBJECTIVE: To analyze characteristics of patients with endocrine tumors of the pancreas seen between 1960 and 1992 at the Instituto Nacional de la Nutrición. MATERIAL & METHODS: The clinical records of 38 patients with endocrine tumors of the pancreas were reviewed. Overall characteristics, diagnostic studies, intraoperative findings, treatment and outcome were analyzed. The archival histological specimens were revised and immunohistochemical stainings were performed in the non-functioning tumors. RESULTS: Twenty patients had hyperinsulinism, 10 non-functioning tumors, and eight a Zollinger-Ellison syndrome. The mean age of patients with hyperinsulinism was 38 years (8 males and 12 females); 18 were sporadic and two associated with MEN I syndrome. In 16 patients an insulinoma was removed: (6 in the head, 5 in the body, 5 in the tail of the pancreas). A cure was documented in 14 patients with sporadic tumors but not in the two cases associated with MEN I; 15 tumors were benign. Three patients with the Zollinger-Ellison syndrome were males and five females with a mean age of 41 years. Seven tumors were sporadic and one associated with the MEN I syndrome; 70% were located in the gastrinoma triangle. Local excision was performed in five and gastrectomy in three. The cure rate was 60% and malignancy was documented in 40%. Two males and eight females with a mean age of 30 years had non-functioning tumors (9 sporadic and one associated to MEN I). There was a positive immunohistochemistry in 60% of the tumors; 90% were malignant and the cure rate was 10%. CONCLUSIONS: Insulinoma is the most common endocrine tumor of the pancreas in our hospital. The cure rate for insulinomas, gastrinomas and non-functioning tumors was 90%, 60% and 10% and malignancy was documented in 5%, 40% and 90% respectively.
Assuntos
Gastrinoma , Insulinoma , Neoplasias Pancreáticas , Adulto , Feminino , Gastrinoma/complicações , Gastrinoma/diagnóstico , Gastrinoma/epidemiologia , Gastrinoma/terapia , Hospitais , Humanos , Hiperinsulinismo/epidemiologia , Hiperinsulinismo/etiologia , Insulinoma/complicações , Insulinoma/diagnóstico , Insulinoma/epidemiologia , Insulinoma/terapia , Masculino , México , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/terapia , Estudos RetrospectivosRESUMO
OBJECTIVE: To analyze clinical characteristics, diagnostic methods, intraoperative findings, morbidity & mortality and outcome of a series of patients with ampullary adenocarcinoma. DESIGN: Retrospective analysis. SETTING: Tertiary-care medical center. PATIENTS: Thirty four consecutive patients who underwent radical resection between 1960 and 1992. RESULTS: The most frequent findings were jaundice (91%), weight loss (44%) and palpable gallbladder (42%). Thirty-three patients (97%) underwent Whipple resection and one total pancreatectomy (3%). The postoperative mortality was 15%. Overall survival at 1, 5, 10 and 14 years was 67, 36, 25 and 17% respectively. Fourteen patients died of tumor recurrence developed more than five years after the resection. CONCLUSION: Radical resection for ampullary carcinoma remains the procedure of first choice in these patients.
Assuntos
Adenocarcinoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Pancreaticoduodenectomia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adulto , Idoso , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Pancreaticoduodenectomia/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Doença de Chagas/transmissão , Infecções por HIV/transmissão , Hepatite Viral Humana/transmissão , Malária/transmissão , Reação Transfusional , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Adulto , Bancos de Sangue , Doadores de Sangue , Doença de Chagas/prevenção & controle , Criança , Pré-Escolar , Feminino , Órgãos Governamentais , Infecções por HIV/prevenção & controle , Hepatite B/prevenção & controle , Hepatite B/transmissão , Hepatite C/prevenção & controle , Hepatite C/transmissão , Hepatite Viral Humana/prevenção & controle , Humanos , Malária/prevenção & controle , Masculino , MéxicoRESUMO
OBJECTIVE: To review the experience of the previous and present status of post-transfusional hepatitis (PTH) and to describe the landmarks events that have modified its incidence and the new alternative measures that effectively lead to the eradication of PTH. DISCUSSION: In the development of PTH participate factors from the donor and receptor, number of units administered and the type of blood products transfused. During the 60s, prevalence rates of the disease was reported as high as 65% at present it appears to be under 2%. The facts markedly related to the fall in PTH prevalence are the recognition of real frequency of the disease in the transfused subjects; the exclusion of commercial blood donors; the discovery of the Hepatitis B virus; the recognition of an additional human hepatitis agents and the development of specific and non-specific assays for their identification; the recognition of AIDS transmission and the self exclusion of donors having experienced high-risk sexual or addictive behaviour. Coupled with the development of the prevention strategies as inactivation of viruses or immunoprophylaxis, and programmes that avoided the use of homologous blood such as autologous transfusion, drugs and blood substitutes.
Assuntos
Hepatite B/etiologia , Hepatite C/etiologia , Reação Transfusional , Saúde Global , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Humanos , Incidência , México/epidemiologia , PrevalênciaRESUMO
In order to determine the reference values of serum beta-carotene and its usefulness in the diagnosis of steatorrhea, 140 healthy subjects and 120 patients with suspected malabsorption syndrome were studied. The reference values, established in terms of the percentiles 2.5 and 97.5, were 85-270 micrograms/dL for men and 112-385 micrograms/dL for women. The beta-carotene diagnostic usefulness was determined by comparison with stool fat levels. According to ROC curves, steatorrhea was diagnosed at beta-carotene values of less than 89 micrograms/dL and 103 micrograms/dL for men and women respectively with a 78% sensitivity, 82% specificity, 76% positive and 84% negative predictive values and 80% accuracy. The steatorrhea prevalence (stool fat > 5 g/day) in our patients was 42%. Due to the implicit technical difficulties of the stool fat determinations and the results of this study, we propose the serum quantification of beta-carotene as an useful screening test in patients with chronic diarrhea and malabsorption syndromes.