Methylprednisolone in acute canine hemorrhagic pancreatitis

The effect of methylprednisolone on hemodynamics and oxygen transport was investigated in acute hemorrhagic pancreatitis in 13 dogs randomly allocated to a fluid treatment group, a methylprednisolone prophylaxis (MPP) group and a methylprednisolone therapy (MP) group. Methylprednisolone (30 mg/kg) was given as a bolus dose, starting 30 min before induction of pancreatitis in the MPP group and 30 min after induction in the MP group. Acute hemorrhagic pancreatitis was induced with a mixture of trypsin and sodium taurocholate, and hemodynamics and blood gases were monitored for 4.5 hours. MPP improved cardiac output significantly and prevented the initial increase in the arteriovenous oxygen content difference. In the MP group there were no significant differences from the control group in hemodynamics or oxygen transport. Prophylactically administered methylprednisolone thus partially attenuated the hemodynamic changes caused by acute hemorrhagic pancreatitis. It seemed especially to improve cardiac performance, assessed from changes in cardiac output.     

Early operation in acute hemorrhagic necrotizing pancreatitis]

Between 1973 and 1975, the "early" operation was carried out in 15 patients suffering from acute haemorrhagic-necrotizing pancreatitis to eliminate necrotic parts. Partially necrotizing pancreatitis was identified in 10 patients: 7 survived. All patients with total pancreatic necrosis died. Surgery consisted of digital removal of the necrosis (digitoclasia) and in left resection with adequate drainage. Patients with partially necrotizing acute pancreatitis can be saved by "early" surgery while in patients with total necrosis surgery must be undertaken even earlier, namely before fatal complications set in.     

Protease inhibitors and experimental acute hemorrhagic pancreatitis.

Proteolytic enzyme inhibitors have been reported to decrease morbidity and mortality from certain types of experimental pancreatitis, although recent randomized trials have been unable to demonstrate that they are of benefit in the treatment of clinical acute pancreatitis. We have evaluated the effect of two proteolytic enzyme inhibitors (trasylol and chlorophyll-a, on experimental acute pancreatitis induced in mice by the feeding of a choline-deficient ethionine-enriched diet. The mortality rate and the biochemical and morphological severity of pancreatitis were not altered by either trasylol or chlorophyll-a administration. Thus, in this respect, diet-induced pancreatitis appears to resemble clinical acute pancreatitis. The reasons for the lack of effectiveness of proteolytic enzyme inhibitors in the treatment of both forms of pancreatitis are discussed.     

Pancreatic microcirculation in acute pancreatitis of dogs

Pancreatic microcirculation in acute pancreatitis and the effect of dopamine and pancreatic protease inhibitor were investigated in 35 mongrel dogs. Acute pancreatitis was induced by the injection of autologous bile added trypsin into pancreatic duct. In acute pancreatitis dogs femoral artery pressure and pulse pressure gradually decreased and pancreatic microflow in basal state temporarily increased immediately after bile injection, however, thereafter continuously decreased during the experiments. Portal flow severely decreased just after onset of acute pancreatitis. By administration of dopamine femoral artery pressure was maintained during the first 90 minutes of experiments, however, thereafter decreased until the end of experiments. Pancreatic microflow, 56.1 +/- 15.3 ml/min/100g in basal level was shown 66.1 +/- 13.7 and 60.3 +/- 10.3 ml/min/100g at 1 and 2 hours, respectively, after bile injection, which were significantly high values as compared with those of non dopamine administration. However those values decreased at 5 hours of both experiments. Portal flow whose basal level was 237 +/- 67 ml/min was maintained during the first 1 hour however it decreased to 139 +/- 25 ml/min at 5 hours. By administration of pancreatic protease inhibitor femoral artery pressure and pulse pressure, temporarily decreased immediately after bile injection, however, they were maintained thereafter. Pancreatic microflow, 57.1 +/- 18.3 ml/min/100g in basal level, was maintained during the first 2 hours, however significantly decreased to 27.6 +/- 9.7 ml/min/100g at 5 hours. Portal flow significantly increased to 442 +/- 115 ml/min at 2 hours, however, thereafter decreased 219 +/- 93 ml/min at 5 hours.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prostacyclin and thromboxane in chronic uremia: effect of hemodialysis

To study the effects of uremia and hemodialysis on the production rates of antiaggregatory prostacyclin (PGI2) and proaggregatory thromboxane A2 (TxA2), we collected serial plasma samples from eight patients with chronic uremia before, during and after hemodialysis and assayed them for 6-keto-PGF1 alpha and TxB2, the stable metabolites of PGI2 and TxA2, respectively. In addition, the capacity of the platelets to produce TxB2 during spontaneous clotting was studied by measuring the TxB2 levels in serum incubated at +37 degrees C for 60 minutes. The PGI2 production of the uremia patients before hemodialysis was less (P less than 0.001) than that of healthy volunteers. It rose significantly following heparinization and remained elevated during hemodialysis. TxB2 generation by platelets during clotting was diminished in uremia. Plasma TxB2 levels were normal before, but increased during hemodialysis. Thus, profound changes in the PGI2/TxA2-system seem to be associated with uremia and hemodialysis.     

Systolic time intervals in canine experimental acute hemorrhagic pancreatitis

The effect of experimental acute hemorrhagic pancreatitis on hemodynamics and systolic time intervals were studied simultaneously by catheterization in dogs. Following the initial hemodynamic measurements pancreatitis was induced by a mixture of trypsin and sodium taurocholate infused into the pancreatic duct (PG, n = 7). After 60 min of surveillance the hemodynamic measurements were repeated and the results were compared to those obtained from the sham-operated group (CG, n = 7) paced at a similar contraction frequency to the PG after the follow-up time. Left ventricular ejection time (LVET) and the ratio of PEP/LVET (PEP, preejection period) increased more in the PG than in the CG (P less than 0.05 and P less than 0.001, respectively). This was related to a lower left ventricular end-diastolic volume and pressure in the PG in comparison to the CG (P less than 0.05). PEP remained unaltered in both groups during the interventions. No significant differences between the groups were observed in the responses of the maximum value of the left ventricular systolic pressure rise (dP/dtmax). The ejection fraction decreased more in the PG than in the CG (P less than 0.05), which was related to the decreased end-diastolic volume in the PG (P less than 0.001). Mean aortic pressure decreased significantly in the PG (P less than 0.01). The results indicate that experimental acute hemorrhagic pancreatitis leads to altered loading conditions of the heart and causes marked alterations in the systolic phases of the contraction cycle. This model of experimental pancreatitis does not depress the myocardial contractility on the basis of these results.     

川芎嗪对急性胰腺炎大鼠血浆血栓素、前列环素的影响

为探讨急性胰腺炎（AP）大鼠血浆血栓素、前列环素比值的变化及川芎嗪（TMP）对该比值的影响及其意义。笔者通过十二指肠胆胰管逆行加压注射5%牛磺胆酸钠的方法制备大鼠AP模型，动态测定AP大鼠血浆血栓素与前列腺环的比值（T/P）、淀粉酶（AMY）、腹水量及胰腺病理改变等的变化及TMP对上述指标的影响。结果示AP时，T/P值增高，其增高程度与AP病变程度有关；经TMP治疗后，大鼠T/P值明显降低（P<0.05），且与AP病理改变的减轻、血清淀粉酶的下降基本同步（P<0.05）。提示TMP通过降低T/P值，减轻胰腺微循环障碍，对AP有治疗作用。     

Prostacyclin and thromboxane A2 moderate postischemic renal failure

Since prostacyclin (PGI2) is known to regulate renal cortical blood flow and since ischemia stimulates thromboxane (Tx) A2 synthesis, the role of these prostanoids in moderating the response to renal ischemia was studied in the rat. At baseline, plasma TxB2 concentration in untreated animals (n = 13) was 357 pg/ml. The left renal pedicle was clamped for 45 minutes after a right nephrectomy (n = 16), which led after 5 minutes of reperfusion to a rise in TxB2 to 2825 pg/ml (p less than 0.001), but there was no change in 6-keto-PGF1 alpha. After 24 hours creatinine levels rose from 0.4 to 3.0 mg/dl (p less than 0.001), and left renal weight rose from 94% to 117% (p less than 0.001) relative to the weight of the right kidney. In nephrectomized but nonischemic sham control rats (n = 7), creatinine level was 0.9 mg/dl and kidney weight 91% after 24 hours. Pretreatment with OKY 046 (n = 13) (2 mg/kg administered intravenously) blocked ischemia-induced TxB2 synthesis, while 6-keto-PGF1 alpha levels rose from 96 to 302 pg/ml (p less than 0.001). There was no increase in creatinine levels or kidney weight relative to the sham group. Pretreatment with ibuprofen (n = 10) (12 mg/kg) or OKY 046 and ibuprofen (n = 9) inhibited TxB2 and 6-keto-PGF1 alpha synthesis, but creatinine levels and renal weight rose (p less than 0.001). Renal histology in OKY 046-pretreated animals was equal to that in nephrectomized controls, while all other ischemic groups showed tubular necrosis. Results indicate that a high PGI2/TxA2 ratio protects against renal ischemia.     

Resection of the pancreas for acute hemorrhagic and necrotizing pancreatitis

The role of surgery in the treatment of acute hemorrhagic or necrotizing pancreatitis is discussed on the basis of a series of 996 patients with all types of acute pancreatitis who were treated in the years 1967–1976. Pancreatic resection was performed in 29 patients with hemorrhagic or necrotizing pancreatitis during the past 3 years. The extent of resection ranged from 60 to 100% of the pancreas. Eight patients died, for a mortality rate of 28%. Eight of 21 surviving patients developed diabetes requiring substitution therapy. During a follow-up period of 6 to 36 months, 17 patients were able to resume work, 3 are still convalescing, and 1 has retired.

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Résumé La place de la chirurgie dans le traitement de la pancréatite aiguë hémorragique ou nécrosante est discutée à partir de 996 cas de pancrèatites aiguës de tous types traités entre 1967 et 1976. Au cours des 3 dernières années, une pancréatectomie a été faite chez 29 malades atteints de pancréatite hémorragique ou nécrosante. L'étendue de la résection a été de 60 à 100%. Huit malades sont morts (28%). Parmi les 21 survivants, 8 ont développé un diabète exigeant une thérapeutique de substitution. Le follow-up est de 6 à 36 mois: 17 malades ont pu reprendre le travail; 3 sont encore en convalescence; le dernier a pris sa retraite.

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This work is supported by the Emil Aaltonen Foundation.     

Total pancreatectomy in the treatment of acute necrotising and hemorrhagic pancreatitis indications-technique

The place of total pancreatectomy in the treatment of pancreatitis is still not clear: the author is in favour of this operation and gives the indications, surgical technique, complications and results. The operation is indicated in cases of necrosis involving more than ${\raise0.5ex\hbox{${\raise0.5ex\hbox{ rds of the gland, or the whole of the head and part of the body of the pancreas. The duodenum and pancreas should be removed in one piece and intestinal continuity should be restored performing choledocho-jejunal and gastro-jejunal anastomoses.It is important to carry out this operation early, between the 3rd and 6th days, treating all areas of necrosis before the lesions become the site of uncontrollable infection.     

Total pancreatectomy in acute necrotizing hemorrhagic pancreatitis. Indications and technic]

The place of total pancreatectomy in the treatment of pancreatitis is still ill- defined. The author makes a plea for this operation and notes the indications, the surgical technique and its results and possible complications. The operation is indicated in cases of total or 2/3 rds necrosis of the gland, in cases involving the head of the pancreas and part of the body. The gland should be dissected out and continuity should be restored by choledoco-jejunal and gastro-jejunal anastomoses. The important thing is to carry out this operation early, between the 3rd and 6th day, treating the areas of necrosis before the lesions become the site of uncontrolled infection. 7 patients out of 9 operated on in this way, are alive with easily controlled diabetes, a low fat diet and pancreatic extract.     

Near total pancreatectomy in the treatment of acute hemorrhagic pancreatitis.

A case of near total pancreatectomy for acute hemorrhagic pancreatitis is presented. The procedure is highly recommended for severely ill patients, when biliary and gastric diversion have failed to arrest the inflammatory process, and retroperitoneal drainage has proved inadequate in removing the vasoactive polypeptides. These play a decisive role in the overall picture of shock.