[Pseudo acute pancreatitis: a syndrome mimicked by a multiple parasitic duodenitis. Analysis of 7 case]

INTRODUCTION

The aim of this presentation was to analyze a clinical syndrome characterized by repeated episodes of upper abdominal pain, markedly increased levels of both total amylase and lipase, but with normal values of pancreatic isoamylase. Besides, with the lack of morphologic changes of the pancreatic gland, either by ultrasound, abdominal tomography, or Nuclear Magnetic Resonance.

MATERIAL, METHODS AND RESULTS

Five female and two male patients, with an average age of 51 +/- 3 were studied. All had been diagnosed as having acute edematous pancreatitis (ranson score < 3). Laboratory tests had disclosed eosinophilia (5-30%); total amylasemia (1547 +/- 398 UA/l); lipasemia (857 +/- 499 UBL/L); normal pancreatic isoamylase (72 +/- 18 UA/L). Upper endoscopy showed nonspecific signs of duodenitis sometimes with duodenal erosions. Collection studies, pre and post Sorbitol, disclosed an unexpected multiple parasitic infestation, e.g.: giardias, ascaris, amoeba, hymenolepis nana. This finding was always suggestively associated with abundant sludge (bilirrubinate cholesterol and oxalate crystals). All patients, after having been submitted to the appropriate antiparasitic medication, were rapidly relieved of their symptoms and remained free of episodes of abdominal pain.

CONCLUSIONS

When the fact that all our patients had normal pancreatic isoamylase levels and lack of any morphologic distortion of the pancreatic parenchyma is associated to the notion that total amylase and lipase may have as a source the gastrointestinal mucosa, it appears as a logical inference that the clinical syndrome here discussed is indeed primarily a reflection of an extrapancreatic disease, essentially of parasitic duodenitis.

Prolonged bleeding time in experimental cirrhosis: role of nitric oxide

BACKGROUND/AIMS

Nitric oxide is a powerful in vitro inhibitor of platelet adhesion and aggregation. Our aim was to investigate whether the in vivo inhibition of nitric oxide release shortens bleeding time, in rats with cirrhosis induced by chronic bile duct ligation.

METHODS

Mean arterial pressure and bleeding time were measured under basal conditions and 5, 15 and 30 min after administration of vehicle (0.9% saline) or an inhibitor of nitric oxide synthesis, Nw-nitro-L-arginine (5 mg/kg, iv). Mean arterial pressure was measured with an intra-arterial catheter and bleeding time with a standardized Simplate device.

RESULTS

Cirrhotic rats showed a lower mean arterial pressure (116+/-4 mmHg) and a prolonged bleeding time (177+/-40 s) compared to control animals (133+/-6 mmHg and 95+/-12 s, respectively, p<0.01). In cirrhotic rats, Nw-nitro-L-arginine significantly increased mean arterial pressure (from 116+/-5 to 141+/-11 mmHg, p<0.05) and completely normalized bleeding time (from 170+/-39 to 103+/-21 s, p<0.05) 15 min after administration. Pretreatment with L-arginine (300 mg/kg, iv) prevented the hemodynamic and hemostatic changes induced by Nw-nitro-L-arginine. A trend to normalize platelet adhesion was observed in cirrhotic rats after the inhibition of nitric oxide production. In control animals, Nw-nitro-L-arginine increased mean arterial pressure, while no effect on bleeding time was observed.

CONCLUSIONS

These findings support the concept that nitric oxide may be a mediator in the bleeding time abnormalities associated with experimental cirrhosis.