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G Robles-Díaz

Publications and source records attributed to G Robles-Díaz.

At least 19 recordsLinked to original sources
PubMed2006

Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis.

BACKGROUND/AIMS: Obesity is considered a risk factor in patients with acute pancreatitis. However, the relationship between obesity and mortality in this disease has not been confirmed definitively even in a previous meta-analysis. Since the publication of our previous meta-analysis, one study has been reported about the prognostic value of obesity in acute pancreatitis. We have performed a new meta-analysis to confirm the relationship between obesity and the outcome of acute pancreatitis. DATA SOURCES: A MEDLINE search using 'pancreatitis', 'obesity' and 'body mass index' as search terms. REVIEW METHODS: Clinical studies which investigated the prognostic value of obesity in acute pancreatitis with the following criteria: (a) inclusion of mild and severe acute pancreatitis; (b) use of body mass index (BMI) as the measure of obesity; (c) definition of obesity as BMI >or=30 kg/m(2); (d) definition of severity of acute pancreatitis according to the criteria established in the Atlanta Symposium. Five studies including patients with mild and severe acute pancreatitis and obesity measured by BMI were analyzed. The end points of the meta-analysis were the severity of acute pancreatitis, local complications, systemic complications and mortality. Pooled odds ratio (OR) and confidence intervals (CI) were calculated according to the Mantel-Haenszel method, and heterogeneity was assessed by the multiplicative inverse variance method. RESULTS: Seven hundred and thirty-nine patients were included. There was no heterogeneity for the variables severity, systemic complications, local complications and mortality among the included studies. Severe acute pancreatitis was significantly more frequent in obese patients (OR 2.9, 95% CI 1.8-4.6). Furthermore, those patients developed significantly more systemic (OR 2.3, 95% CI 1.4-3.8) and especially local complications (OR 3.8, 95% CI 2.4-6.6). In this new analysis, mortality was also higher in obese patients (OR 2.1, 95% CI 1.0-4.8). CONCLUSION: Obesity is not only a risk factor for the development of local and systemic complications in acute pancreatitis: it also increases the mortality of this disease.

Acute Disease↗
PubMed2004

Laparoscopic drainage of pancreatic pseudocysts.

BACKGROUND: Laparoscopic drainage of pancreatic pseudocysts (PPs) has been used in selected cases. The aim of this study is to analyze our results with the laparoscopic technique and to compare them with those of a cohort of patients treated by open surgery during the same time period. PATIENTS AND METHODS: Ten patients underwent laparoscopic drainage of PPs during a 7-year period [laparoscopic group (LG)]. The type of drainage was chosen according to the size and location of the PP. Demography, surgical details, results, and complications were analyzed and contrasted with those of 6 patients who underwent open drainage [open group (OG)]. RESULTS: All patients presented with mature PPs developed after a documented episode of acute pancreatitis. Mean age of the LG was 42 years (six males and four females). In the OG, mean age was 36 years (five males and one female). Etiology of the pancreatitis was alcoholic in eight patients, biliary in five, toxic in two, and associated with systemic lupus erythematous in one. Laparoscopic procedures included Roux-en-Y cystojejunostomy in four patients, extraluminal cystogastrostomy in four, and intraluminal cystogastrostomy in two. There were no conversions. In the OG, cystogastrostomy was performed in three patients and Roux-en-Y cystojejunostomy in three. One patient in the LG developed upper gastrointestinal bleeding the day after surgery that resolved uneventfully, one patient presented a postoperative abscess that required open drainage, and one patient presented a residual pseudocyst that was treated by endoscopy. Morbidity in the OG included a small bowel obstruction secondary to an internal hernia that required reoperation, pneumonia, and a residual pseudocyst that was treated conservatively in one patient each. At a median follow-up of 22 months (range, 1-72) all patients were asymptomatic with no evidence of recurrent disease by computed tomography scan. CONCLUSION: Laparoscopic drainage of PPs is feasible, safe, and effective. Results are similar to those obtained using the open technique.

Adolescent↗
PubMed2004

Is obesity a risk factor in acute pancreatitis? A meta-analysis.

BACKGROUND/AIMS: Obesity has been associated with a worse prognosis in acute pancreatitis. According to some authors, obesity favours the development of local complications, while according to other reports obese patients presented more frequently systemic complications. Few studies find a relationship between obesity and mortality in acute pancreatitis. We conducted a meta-analysis of several reports that evaluate the relationship between obesity and the outcome of acute pancreatitis in order to assess its prognostic role in this disease. METHODS: A MEDLINE search was conducted from 1965 to December 2002 with search terms including obesity, body mass index (BMI) and pancreatitis. A total of 12 reports were identified. Of these, only four studies included patients with mild and severe acute pancreatitis and measured obesity by BMI. The end points of the meta-analysis were the severity of acute pancreatitis, local complications, systemic complications and mortality. Obesity was defined when BMI was > or =30 kg/m2. Pooled odds ratio (OR) and confidence intervals (CI) were calculated according to the Mantel-Haenszel method, and heterogeneity was assessed by the multiplicative inverse variance method. RESULTS: A total of 607 patients were evaluated. There was no heterogeneity for the variables severity, systemic complications, local complications and mortality among the included studies. Severe AP was significantly more frequent in obese patients (OR 2.6, 95% CI 1.5-4.6). Furthermore, those patients developed significantly more systemic (OR 2.0, 95% CI 1.1-4.6) and local complications (OR 4.3, 95% CI 2.4-7.9). Mortality in obese patients was only slightly higher (OR 1.3, 95% CI 0.5-3.6). CONCLUSION: Obesity is a prognostic factor favouring the development of systemic and local complications in this disease. Therefore, it should be used routinely as part of the initial assessment of the severity of a case of acute pancreatitis.

Acute Disease↗
PubMed2001

Exocrine pancreatic insufficiency in tropical sprue.

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.

Adolescent↗
PubMed2000

Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis.

HYPOTHESIS: A worse clinical outcome might be expected in patients with acute pancreatitis (AP) who receive intravenous contrast medium for a nondynamic contrast-enhanced computed tomographic (CECT) study early during hospital admission. DESIGN: Cohort analytic study. SETTING: Tertiary care center. PATIENTS: Of 126 patients with mild AP, 52 patients underwent CECT to establish AP diagnosis (group 1), and the remaining 74 did not (group 2). MAIN OUTCOME MEASURES: Survival and development of local or systemic complications during the hospital stay. Potential confounders were demographic, clinical, and biochemical data, as well as therapeutic measures. The Atlanta classification was used to define local and systemic complications. RESULTS: Mean age, etiology of AP, prognostic score on admission, and pharmacologic treatment were similar between groups. Local and systemic complications were more frequently observed in patients who underwent CECT (odds ratio, 11.4; 95% confidence interval, 2.0-64.8; P =.008). Six patients, all in group 1, developed a pancreatic abscess (odds ratio, 20.8; P =.004). In 5 of them, a second CECT showed more severe AP changes. The association between CECT and abscess development was more apparent in patients with a body mass index of 25 or more and/or nasogastric suction. Six patients in group 1 and 1 in group 2 had systemic complications (odds ratio, 9. 5; P =.01). There were no deaths. CONCLUSIONS: The observed increased incidence of local and systemic complications in patients with mild AP who undergo CECT, particularly in those with a body mass index of 25 or more, suggests a potentially harmful effect of intravenous contrast medium. Until this issue is clarified, it seems reasonable to restrict the use of dynamic CECT to patients with severe AP, protracted clinical course, or suspected local septic complication.

Acute Disease↗
PubMed1998

Papillary-cystic neoplasm of the pancreas. A sex-steroid dependent tumor.

CONCLUSION: The rate of growth of a papillary-cystic tumor of the pancreas seemed to be enhanced by the concurrence of pregnancy. Progesterone receptors in the tumor were demonstrated by immunohistochemistry and by molecular biology methods. BACKGROUND: Papillary cystic tumor of the pancreas is extremely rare, occurring predominantly young females. Owing to the low frequency of the tumor, there is scarce information about the conditions that promote tumor growth. METHODS: In this report, we present the temporal association between very rapid growth of a papillary-cystic neoplasm and pregnancy. Clinicopathological, immunohistochemical, and molecular biology analyses were performed. RESULTS: A 21-yr-old woman was admitted because of recurrent epigastric abdominal pain associated with episodes of nausea and vomiting, and a history of an abdominal tumor of about 50 mm near the head of the pancreas, detected by ultrasound. On admission the patient had a flat, nontender abdomen without palpable masses. Laboratory analysis including hematologic and hepatic tests were strictly normal; only CA 19-9 (42 U/mL, normal 37 U/mL) was above normal values. One week after admission, an abdominal computerized axial tomography (CAT) scan revealed an 81.6-mm cystic mass localized in the head of the pancreas, and 1 wk later, in a laparotomy, a papillary-cystic neoplasm of 120 mm, limited to the head of the pancreas, was found. Three months later, in a routine follow-up visit, an 18-wk pregnancy was clinically diagnosed and confirmed by ultrasound exploration. The pregnancy continued without complications, and a normal male infant (3.7 kg) was born at 39 wk of gestation, by vaginal delivery. Eighteen months after tumor resection, the patient was asymptomatic and her child was in good health. We propose that progesterone affects tumor growth.

Adult↗
PubMed1998

Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis.

OBJECTIVE: In this study we evaluate the association between obesity and complication development in patients with a first-attack acute pancreatitis (AP), and investigate the influence of comorbid factors on this association. METHODS: Medical records of 150 patients with AP were reviewed. General data, AP etiology, admission AP prognostic criteria, and occurrence of complications were recorded. Patients were classified according to body mass index (BMI) as obese (BMI > 25 kg/m2) and nonobese (BMI < or = 25 kg/m2). RESULTS: Prevalence of obesity was 57%. Thirty-eight percent of the obese patients developed complications as compared with 21% of the nonobese (RR=1.74; 95% CI, 1-2.9). The risk for severe AP increased according to the degree of obesity. Pancreatic and peripancreatic necrosis was more common in obese patients (17.6% vs 6%), as was the incidence of infectious complications. The risk for severe AP was highest in obese patients with either alcoholic (RR=5.3; 95% CI, 1.2-23) or biliary etiology (RR=5.2, 95% CI, 1-26). CONCLUSION: Obesity may predispose to a complicated course of AP, especially if it is secondary to alcohol or gallstones. Further studies are needed to establish the precise prognostic value of obesity in AP, as well as the pathogenic mechanisms involved in the process.

Acute Disease↗
PubMed1997

Pain relief in chronic pancreatitis by pancreatico-jejunostomy. An institutional experience.

Effective pain control in chronic pancreatitis can be accomplished by pancreatic resection or decompression. Pancreatico-jejunostomy (PJ) has been reported to be effective for relieving pain in 70-80% of cases. The present study analyzes the authors' long-term results with PJ in the treatment of pancreatic pain. From 1963 to 1993, 49 patients with chronic pancreatitis underwent PJ for uncontrollable pain. General and radiologic characteristics, intraoperative findings and outcome were analyzed. Mean age was 35 +/- 13 years, 34 were male and 15 female. Alcoholic etiology was documented in 23 patients. Multiple pancreatic calcifications were found in 33 patients. Pancreatic biopsy confirmed chronic pancreatitis in all patients. There was one operative mortality, 12 minor, and 4 major complications. In a mean follow-up of 6.5 years, 98% of the total group was found to be free of pain. Pancreatic function remained stable in most patients. PJ is an excellent procedure for pain control that allows stable pancreatic function.

Adult↗
PubMed1995

Androgen receptor in the rat pancreas: genetic expression and steroid regulation.

Androgens influence the incidence and prevalence of pancreatic cancer in humans and animal models. To our knowledge there has been molecular demonstration of the presence of neither the androgen receptor (AR) nor transcripts of the AR gene. Reverse-transcription polymerase chain reaction (RT-PCR)-Southern blotting was employed for molecular detection and measurement of the androgen receptor messenger ribonucleic acid (AR mRNA) in pancreas. Total RNA obtained from pancreas, prostate, seminal vesicles, and testes of neonatal and adult male and female rats, as well as castrated males substituted with testosterone cyclopentylate, was analyzed by Northern blot technique. Positive hybridization to AR cDNA was obtained in all tissues assayed but not in the pancreas. However, a clear AR 32P cDNA hybridization signal was obtained in pancreatic tissues after cDNA synthesis using RT-PCR-Southern blotting. The levels of the AR transcripts obtained by RT-PCR in the various pancreatic samples were as follows: adult females and neonatal animals > castrated adult males > adult males > castrated adult males substituted with testosterone. These results indicated that the pancreatic tissue possessed transcriptional activity of the AR gene, although to a lesser extent than the typical androgen responsive tissues (prostate and seminal vesicles). In conclusion, transcriptional activity of the AR gene in the pancreas seemed to be modulated by the androgenic milieu in the tissue similar to that reported for the classical androgen-responsive organs.

Androgens↗
PubMed1991

Testosterone biotransformation by the isolated perfused canine pancreas.

There is strong evidence indicating that the pancreas is under the influence of sex steroid hormones, and that it may even participate in their biosynthesis and metabolism. In the present study, [3H]testosterone was perfused into the isolated canine pancreas, and measured in the effluent with several of its metabolites (5 alpha-dihydrotestosterone, androstenedione, and estradiol). Results show that testosterone is readily transformed by the canine pancreas. The main product found in the effluent is androstenedione. The testis and spleen were also perfused with [3H]testosterone and used as controls. In both cases, this hormone appeared mostly unchanged in the effluent as compared to the pancreatic perfusion (p less than 0.0001). From our data, we conclude that the canine pancreas has the capacity to transform sex steroid hormones, and could be considered an extragonadal site of sex steroid biosynthesis.

Androstenedione↗
PubMed1991

Serum testosterone:dihydrotestosterone ratio and CA 19-9 in the diagnosis of pancreatic cancer.

The testosterone:dihydrotestosterone ratio (T:DHT) and the antigenic marker CA 19-9 were studied in the serum of 21 male patients with pancreatic cancer and 62 controls with other gastrointestinal malignancies or benign pancreatobiliary disease. Specificity of the T:DHT ratio was 98%, significantly better than the specificity of CA 19-9 at both a 37 U/ml cutoff level (61%) and at 100 U/ml (79%). Sensitivity of the T:DHT ratio was 67%, and that of CA 19-9, 71% and 90% at the upper and lower cutoff levels, respectively. False-negative results of the T:DHT ratio were found predominantly in cases of advanced pancreatic cancer, whereas all four stage I patients had an abnormal (less than 5) T:DHT ratio. These results suggest that the T:DHT ratio is a useful marker for pancreatic cancer in males. It can be used alone or in combination with CA 19-9, and should be further evaluated in the differential diagnosis of patients with the early stages of this disease.

Adult↗
PubMed1990

Chronic pancreatitis in Mexico City.

The incidence, etiology, clinical characteristics, and long-term outcome of patients with chronic pancreatitis (CP) studied at the Instituto Nacional de la Nutrición in a 12-year period were retrospectively analyzed. One hundred fifty cases were identified, with an overall incidence of 4.4 per 1,000 hospital admissions and of 5.4 per 1,000 in the last 6 years. In 68% of the cases, CP was secondary to alcoholism, in 29% it was idiopathic, and in the rest it was secondary to other causes. Overall, 74% of patients had pancreatic calcifications at time diagnosis was established, and 21% were asymptomatic regarding pain. Patients with idiopathic CP had an earlier age of onset than did patients with alcoholic CP, and in addition the former developed symptoms of diabetes or pancreatic exocrine insufficiency less frequently than alcoholic patients did (p less than 0.05). The sex ratio was different in both groups, with a marked male predominance in alcoholic CP and an equal distribution in the idiopathic group. A 30% actuarial mortality was found in the first 10 years after the onset of the disease, which remained the same at 20 years with a tendency to better survival in nonalcoholic patients. Five patients developed pancreatic cancer throughout the study period.

Adult↗
PubMed1990

Pancreatic cancer and androgen metabolism: high androstenedione and low testosterone serum levels.

Serum androstenedione and testosterone levels were measured in 39 male patients with pancreatic cancer, and compared with the values obtained from 37 male patients with chronic pancreatitis or benign obstructive jaundice, and with those from 36 male patients with other gastrointestinal malignancies. Mean androstenedione values were significantly higher in the pancreatic cancer patients when compared to both control groups, and mean testosterone levels were significantly lower. The testosterone/androstenedione ratio was calculated and was also found to be significantly lower in the patients with pancreatic cancer. There was no difference in this ratio or in the androstenedione or testosterone levels when comparing both control groups. In two patients with stage I pancreatic cancer, serum androstenedione and testosterone levels were significantly altered, and returned to normal values after successful resection. These results confirm previous findings indicating that there is significant derangement in the androgen profile of patients with pancreatic cancer.

Aged↗
PubMed1990

Tuberculosis of the pancreas.

A 67-year-old woman was admitted to the hospital because of intermittent pain in the upper left quadrant of the abdomen. Ultrasound and computed tomography (CT) scan revealed a mass in the body of the pancreas, and angiography demonstrated encasement of the celiac trunk and splenic vein thrombosis. She was thought to have a pancreatic carcinoma and was surgically explored to obtain tissue for diagnosis. A hard and irregular tumor was found, and biopsies revealed granulomatous inflammation with caseous necrosis. The final diagnosis was tuberculosis, and treatment with rifampicin, isoniazid, and ethambutol was undertaken. One year later the patient is asymptomatic and new CT scan shows disappearance of the pancreatic mass.

Aged↗
PubMed1990

Association of pancreatic biotinidase activity and intestinal uptake of biotin and biocytin in hamster and rat.

Pancreatic biotinidase activity was higher in hamster than in rat; these results were reversed in plasma. Uptake was studied in everted intestinal rings. Saturation kinetics at 37 degrees C were observed for biotin in hamster and for biocytin in rat, with a Vmax of 1.83 and 1.05 nmol min-1 ml-1 and an apparent Kt of 25.14 and 40.7 microM, respectively. Biotin uptake by hamster intestine was reduced at 4 degrees C and when choline or potassium replaced sodium; it was inhibited by biocytin only at very high concentrations. Biocytin uptake in the rat was small compared to passive diffusion and was not influenced by sodium or temperature; it was not inhibited by biotin. We observed only passive diffusion of biotin in rat and of biocytin in hamster. Our results suggest that protein-bound biotin may be absorbed mainly in its free form in the hamster. In the rat, on the other hand, at least part of the dietary biotin may be absorbed lysine-bound, as biocytin.

Amidohydrolases↗
PubMed1987

Microcystic adenoma of the pancreas.

Three cases of pancreatic microcystic adenoma (PMA) are presented. These tumors comprise less than 1% of all pancreatic tumors in a large series, and exhibit a benign course, in contrast to mucinous cystadenomas, which have a definite malignant potential. The cases here presented are middle and advanced aged women who complained of epigastric discomfort and mild weight loss. Two of them also had a palpable epigastric mass and one of them diabetes mellitus. They were treated surgically with total excision of the tumor. During surgery and thereafter no evidence of spreading beyond the pancreas was found. CT scan shows a characteristic image of PMA, which may then be confirmed by a percutaneous biopsy. If the patient is asymptomatic or a poor surgical risk, it is reasonable to rely on this evidence and follow the patient rather than operate.

Adenoma↗