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.

Global Health↗

PubMedDate not supplied

[The clinical laboratory in the study of pancreatitis].

The useful laboratory tests in the pancreatitis study are revised. A short description of the procedures, its sensibility and specificity, availability and indication is made. In acute pancreatitis the different enzymatic determinations in serum and urine that are used to establish the illness diagnosis and prognosis are described and also, the results of other substances assays like some acute phase reactants that can be useful as prognostic factors. In chronic pancreatitis the different levels in which pancreatic insufficiency can be studied are described as well as the test that can be done in each case. The complexity, specificity and sensibility of direct tests is analyzed. Nevertheless functional exploration methods that constitute a useful alternative as pancreolaurly, PABA or the recently proposed plasmatic amino acids and marked triglicerids with C13 are also mentioned. The clinical laboratory in the diagnosis of pancreatitis is complementary to the image methods and it is considered indispensable to perform at least two precise methods and it is considered indispensable to perform at least two precise methods of enzymatic determination in serum and an indirect test or another non invasive test that should be validated in each group for the study of gastroenterologic patients.

Acute Disease↗

PubMedDate not supplied

[Diagnostic utility of serum beta-carotenes in intestinal malabsorption syndrome].

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.

Adolescent↗

PubMedDate not supplied

[The in-vitro digestive availability of lipase and trypsin in pancreatic supplements under different degrees of acidity].

We evaluated the in vitro disintegration time and the remanent digestive activity of eight pancreatic supplements under pH conditions similar to the gastrointestinal tract. They were incubated for 45 min at various pH levels (1, 3 or 6) and continued thereafter at pH 6, for another 135 min. The activities of lipase and trypsin were evaluated titrimetrically every 15 min. At pH 6, the products without an enteric coat and Creon, showed the shortest disintegration times; under acidic conditions, those times were longer in all the enteric coated products. At constant pH 6, lipase activity was greater in Creon, Pankreon and Cotazym-B; trypsin activity was greater in Nutrizym-C, Onoton and Cotazym-B. After acidic pH exposure enzyme bioavailability was decreased in all the products. Disintegration times and acid inactivation of enzymes, should be considered when prescribing PS.

Biological Availability↗

PubMedDate not supplied

[Pancreatoduodenectomy in the treatment of carcinoma of Vater's ampulla].

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.

Adenocarcinoma↗

PubMedDate not supplied

[Endocrine tumors of the pancreas at a Mexican institution].

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.

Adult↗

PubMedDate not supplied

[Identification of the patient with acute severe pancreatitis. A prospective, comparative study of the Ranson and the Salvador Zubirán National Institute of Nutrition criteria].

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.

Acute Disease↗