RESUMO
Pancreatic tuberculosis and peripancreatic tuberculous lymphadenitis are rare conditions mainly affecting young women, and often occur in endemic areas and immunocompromised patients. The presentation of this condition could be similar to a malign neoplasm. However, coexistence of both pathologies is still very rare and just one case has been reported. A case of synchronism of peripancreatic tuberculous lymphadenitis and pancreatic adenocarcinoma in a 79-year-old woman is presented.
Assuntos
Adenocarcinoma/complicações , Pancreatopatias/complicações , Pancreatopatias/microbiologia , Neoplasias Pancreáticas/complicações , Tuberculose/complicações , Adenocarcinoma/patologia , Idoso , Feminino , Humanos , Pancreatopatias/patologia , Neoplasias Pancreáticas/patologia , Tuberculose/patologiaRESUMO
Biliary and pancreatic stents are effective tools in the management of obstructive jaundice (both malignant and benign), pancreatic pseudocyst drainage, and as treatment for biliary and pancreatic fistulae. Unfortunately, stents may become blocked and require replacement in a number of patients. In the present study a blocked stent from a patient with transpapillary drainage of pancreatic pseudocyst and another from a patient with obstructive jaundice resulting from cancer of the head of the pancreas associated with Mirizzi syndrome were characterized by electron microscopy. Stent blockage was diagnosed by a pressure test and stent cultures were performed. Electron microscopy of the blocked stents revealed the sludge to consist of microcolonies of bacteria mixed with amorphous material, and cultures of both stents were positive for Klebsiella sp and E. coli.
Assuntos
Biofilmes , Colestase/microbiologia , Escherichia coli/patogenicidade , Klebsiella/patogenicidade , Pancreatopatias/microbiologia , Stents , Adulto , Feminino , Humanos , Masculino , Microscopia EletrônicaRESUMO
Objetivo: Caracterizar, mediante pancreatografía dinámica, el origen, características, evolución clínica e imagenología de las colecciones secundarias (CS) a pancreatitis aguda, así como evaluar los resultados del tratamiento. Sede: Departamentos de Cirugía Gastrointestinal y Radiología del Hospital de Especialidades Siglo XXI del Centro Médico Nacional del IMSS, en México, D.F. Diseño: Estudio prospectivo, observacional, longitudinal. Análisis estadístico: Análisis univariado, análisis de varianza (Kruskal-Wallis), prueba de U de Mann-Whitney, t de Student, X², prueba exacta de Fisher. Valor significativo de p menor de 0.05. Pacientes y métodos: Durante un período de 36 meses, 216 pacientes con PA fueron admitidos en el Departamento de Cirugía Gastrointestinal. Se realizó PD en 175, excluímos 55 referimientos tardíos. Se analizaron los siguientes datos: Demografía, severidad, datos de la pancreatografía dinámica (número, lugar, tamaño, forma, densidad, necrosis y características asociadas), bacteriología, comunicación ductal, evoluación y tratamiento. Resultados: Un total de 82 (68 por ciento) desarrollaron una CS durante su evoluación: 16 con colección Líquida Aguda (CLA), 7 con Pseudoquiste Agudo (PsAg), 7 con Absceso Pancreático (Ab P) y 52 con Secuestro Pancreático (SP). No existieron diferencias demográficas. Las CLA fueron una reacción temprana exudativa, típicamente pequeña, múltiple, irregular, de densidad homogénea y baja, estéril, sin pared, necrosis o comunicación ductal. Todas presentaron regresión espontánea. Los PsAg fueron único, regulares, intrapancreáticos, relativamente grandres, con mayor densidad, pared gruesa no epitelizada, estériles y sin necrosis asociada. Se resolvieron con tratamiento médico dos, con drenajes percutáneo uno, con drenaje quirúrgico cutro; los operados fueron los de mayor tamaño, con densidad heterogénea y tuvieron mayor tiempo de estancia hospitalaria. Loas AbP fueron únicos, irregulares, de tamaño y distribución variable, con mayor densidad, con detritus y comunicacion ductal en forma ocasional e infección polimicrobiana siempre; con los PsAg, tuvieron el mayor inatervalo entre su inicio y el diagnóstico (casi 4 semanas), requirieron drenaje quirúrgico externo y presentaron la mayor estancia intrahospitalaria y morbilidad. Los SP constituyeron el grupo más ambigüo; tuvieron la mayor severidad y fueron los únicos con necrosis Asociada, múltiples, de localización y densidad variable, no de gran tamaño pero si muy irregulares (pared delgada en 10 por ciento); se realizó tratamiento conservador en 18 y quirúrgico en los restantes 34. Pueden progresar a la licuefacción total y desaparecer o complicarse y requerir cirugía, en especial cuando se infectan. Conslusión: El reconocer y clasificar, con la ayuda de la pancreatografía dinámica a cada una de las colecciones secundarias, como entidades diferentes de origen, evolución y pronóstico, nos permitirá unificar los criterios de diagnóstico y tomar medidas adecuadas en su tratamiento
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Pancreatopatias/microbiologia , Suco Pancreático , Morbidade , Pancreatite/etiologia , Pancreatite/fisiopatologia , Cisto Pancreático/fisiopatologia , Ultrassonografia/estatística & dados numéricosRESUMO
La pancreatitis aguda es una entidad frecuente en nuestro medio. La enfermedad biliar es la causa principal en el desencadenamiento de ella. La evolución de la pancreatitis aguda puede adquirir diferentes formas clínicas que se relacionan con el pronóstico. Se proponen factores pronósticos de la enfermedad tanto desde el punto de vista clínico, de laboratorio y de imagenología. Se analizan los tratamientos actuales y conductas terapéuticas
Assuntos
Humanos , Pancreatite/diagnóstico , Amilases/sangue , Diagnóstico Diferencial , Grupos Diagnósticos Relacionados , Pancreatopatias/microbiologia , Exame Físico/métodos , Infecção Hospitalar/diagnóstico , Lipase/sangue , Pancreatite/classificação , Pancreatite/complicações , Pancreatite/terapia , Pseudocisto Pancreático/diagnóstico , Testes de Função Pancreática/métodosRESUMO
A 49 year old "mapuche" male patient was operated on and tuberculosis of the gallbladder was found. Later on, he developed evidence of meningeal and pulmonary involvement and elevated pancreatic enzyme levels. In spite of appropriate anti-tuberculosis therapy, the patient died. Autopsy revealed multiorgan involvement with pancreatic tuberculosis and areas of steatonecrosis. Immune deficiency related to the previous cholecystectomy may have facilitated the severe dissemination of the disease observed in this patient.
Assuntos
Pancreatopatias/diagnóstico , Pancreatopatias/microbiologia , Tuberculose/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The structural proteins of infectious pancreatic necrosis virus (IPNV) have been analyzed. Two-dimensional gel electrophoresis showed that IPNV proteins are slightly acidic with apparent pIs ranging from 5.8 to 6.6. To identify the IPNV surface-located proteins, purified virus was labelled either with fluorescein isothiocyanate (FITC) or with Na 125I. After analysis by SDS-PAGE, only the major viral protein, VP2, was labelled by either procedure. The accessibility of VP2 to these reagents suggests that this protein is externally located. In addition, using Concanavalin A conjugated with FITC and IPNV labelling with 3H-mannose, evidence is present that VP2 contains carbohydrate residues.
Assuntos
Fluoresceína-5-Isotiocianato/análogos & derivados , Proteínas Estruturais Virais/análise , Vírus/análise , Animais , Capsídeo/análise , Proteínas do Capsídeo , Concanavalina A/análogos & derivados , Fluoresceínas , Glicosilação , Ponto Isoelétrico , Necrose , Pancreatopatias/microbiologia , Pancreatopatias/patologia , SalmonidaeRESUMO
Viral infections have been implicated in the induction of diabetes mellitus in man and laboratory animals. Since virus-specific immunofluorescence (FA) is detectable in hamster pancreas during the acute phase of Venezuelan encephalitis (VE), experiments were designed to correlate pathologic and virologic events with metabolic studies in VE-infected hamsters. Golden Syrian hamsters were inoculated s.c. in groups of four to 12 with 100,000 plaque-forming units (PFU) of the vaccine strain (TC-83) of VE or 1,000 PFU of the virulent Trinidad strain of VE. Ultrastructurally, during Trinidad infection, mature virions were associated with the cell surfaces and within pancreatic beta cells in contrast to absence of virus-related changes in TC-83-infected hamsters. Virus-specific-FA was noted in islet cells and acinar cells of Trinidad-infected hamsters. VE growth curves demonstrated viral replication in pancreas with both strains. Although ultrastructural and FA changes were much more prominent in Trinidad-infected hamsters in contrast to TC-83-infected hamsters during the first few days of illness, the rapid lethality of the Trinidad-infected group necessitated performing all metabolic studies in TC-83-strain-infected hamsters. Accordingly, for the metabolic studies, glucose tolerance tests (GTT) using 2 mg. or 5 gm./kg. glucose i.p. were performed in groups of hamsters acutely infected two days earlier with the TC-83 vaccine strain and in 24-day and 90-day convalescent hamsters after TC-83 vaccine strain. Samples were obtained for glucose and immunoreactive insulin (IRI) determinations. Glucose intolerance occurred in hamsters in each of the infected groups given 5 gm./kg. glucose except for the 90-day convalescent TC-83 group. Severely decreased IRI responses occurred in the 24-day and 90-day convalescent TC-83 hamsters following both 2- and 5-gm./kg. glucose. Pancreatic IRI content in 24-day convalescent TC-83 hamsters was within normal limits, suggesting a defect in IRI release from the beta cells at this stage of convalescence.