急性胰腺炎大鼠血清、腹水对离体胰腺腺泡细胞的损伤

目的：观察急性胰腺炎（AP）大鼠血清、腹水对大鼠离体胰腺腺泡细胞的损伤作用，探讨AP细胞钙超载的可能机制。方法：采用大鼠胰胆管逆行注射3％去氧胆酸钠复制AP模型，分别在1、5、10h取动物的血清、腹水备用。胶原酶法分离、培养正常大鼠胰腺腺泡细胞，给予1、5、10hAP大鼠血清、腹水刺激；采用MTT法检测胰腺腺泡细胞的存活率；用荧光染料Fura-2／AM负载后，给予1、5、10hAP大鼠血清、腹水刺激，采用钙离子成像系统，观察单个胰腺腺泡细胞游离钙水平的变化。结果：AP模型复制后1h，血清淀粉酶活性即明显升高，同时胰腺组织破坏严重；经AP腹水、血清刺激的胰腺腺泡细胞，其存活率降低；胰腺腺泡细胞内游离钙浓度明显升高（P〈0．05），且随AP病程时间延长，AP腹水、血清的刺激作用越明显。结论：在AP大鼠血清、腹水刺激下，胰腺腺泡细胞存活率下降，同时有细胞钙超载发生。     

高脂血症对大鼠急性胰腺炎发生的影响

目的: 研究高脂血症对大鼠急性胰腺炎发生的影响,即高脂血症是否是急性胰腺炎的高危因素.方法: 在中剂量Cerulein造成一定比例的急性胰腺炎发病率的基础上,通过研究高脂血症对急性胰腺炎发病率的影响来确定高脂血症是否是急性胰腺炎的高危因素.Wistar雄性大鼠随机分为:①Bal组,均衡饲料饲养2 w;②NS组,均衡饲料饲养2 w,手术日腹腔注射生理盐水0.5 ml/kg,每小时1次,共4次;③M组,均衡饲料饲养2 w,手术日腹腔注射Cerulein 10 μg/kg(0.5 ml/kg),每小时1次,共4次;④H组,高脂饲料饲养2 w;⑤H+NS组,高脂饲料饲养2 w,手术日腹腔注射生理盐水0.5 ml/kg,每小时1次,共4次;⑥H+M组,高脂饲料饲养2 w,手术日腹腔注射Cerulein 10 μg/kg(0.5 ml/kg),每小时1次,共4次.剖腹主动脉采血检测血清淀粉酶、血甘油三脂,并取胰腺组织做胰腺病理切片观察.结果: 高脂血症增加急性胰腺炎的发病率,H+M组与M组有明显差异(P<0.05).结论: 较正常稍高的高脂血症并不能单独诱发急性胰腺炎,但是增加Cerulein诱发的急性胰腺炎的发病率,证明高脂血症是急性胰腺炎的高危因素.     

大鼠急性重症胰腺炎Bcl-2基因mRNA转录水平的实验研究

目的：研究急性重症胰腺炎（SAP）中细胞凋亡现象及Bcl-2基因对急性重症胰腺炎中细胞凋亡的影响。方法：采用大鼠胆胰管逆行注入牛磺胆酸钠的方法，制作大鼠SAP模型。对各组模型进行血淀粉酶、腹水量测定，利用原位末端标记法和琼脂糖凝胶电泳检测凋亡小体及凋亡梯形。采用定量逆转录聚合酶链式反应检测细胞凋亡调控基因Bcl-2基因mRNA转录水平。各组胰腺标本进行病理学检查。结果：各时间组血淀粉酶含量、腹水量随着时间的延长而升高。凋亡小体造模后2h组即可检出，术后4h组检出明显且数量较多，造模后16h时极少见到。造模后2h组凋亡梯形出现，造模后4h组凋亡梯形明显规整，造模后16h无梯形检出。胰腺组织Bcl-2基因mRNA表达水平于模型制作后增高，2h组达到高峰，后于8、16h组下降到正常水平。结论：大鼠急性重症胰腺炎的发病过程中，同时存在细胞坏死和凋亡两种不同的细胞死亡方式。胰腺组织中存在明显的细胞凋亡现象同时伴有凋亡梯形的出现。抑制凋亡基因Bcl-2基因mRNA表达水平发生明显的变化。细胞凋亡现象可能具有保护与加重损害的双重作用。     

高脂血症促使大鼠急性胰腺炎胰腺腺泡由凋亡趋向坏死

目的 通过建立高脂血症性急性胰腺炎大鼠模型,探讨高脂血症可能加重急性胰腺炎病程的机制.方法 D-果糖饮食诱导SD大鼠的产生高脂血症,在此基础上通过腹腔注射蛙皮素诱导急性胰腺炎,并且设立正常组、高脂血症组和急性胰腺炎组作为对照.8周后,取大鼠血浆检测血糖、血脂和游离脂肪酸等指标;收集大鼠胰腺以及胰周组织,检测组织匀浆中ADP与ATP比值,通过Western blot法检测组织中caspase-3和caspase-8等蛋白以及其底物的表达情况,对组织切片进行HE染色并通过TUNEL法分析组织凋亡和坏死的情况.结果 高脂血症性急性胰腺炎大鼠的血浆中血脂、游离脂肪酸等指标偏高;caspase-3和caspase-8活性片断表达下调,而其底物蛋白降解较少;TUNEL分析阳性率偏低,以上提示胰腺组织凋亡蛋白活性受到一定的抑制;另外,ADP与ATP比值相对较高,提示胰腺组织更易产生坏死反应.结论 笔者推测高脂血症可能通过促进大鼠胰腺组织由凋亡趋向坏死,从而加重急性胰腺炎病变程度.     

缺血-再灌注损伤对大鼠急性胰腺炎胰腺细胞凋亡的影响

目的探讨缺血一再灌注(I／R)损伤对大鼠急性胰腺炎(AP)胰腺细胞凋亡的影响。方法将SD大鼠54只按编号法随机分为对照组(n=6)、胰腺炎组(n=24)和I／R损伤组(n=24)。经胆胰管逆行加压注入3％牛磺胆酸钠建立大鼠AP模型，在此基础上，I／R损伤组通过暂时阻断脾下动脉造成局部胰腺I／R模型，对照组于术后lh，其余两组于术后1h、3h、6h和12h采取断颈方法分批处死动物，应用末端脱氧核苷酸转换酶(TdT)介导的原位末端标记(TUNEL)法检测缺血一再灌注区胰腺细胞凋亡。并观察其病理改变。结果胰腺炎组大鼠术后1h、3h胰腺组织仅为充血、水肿性改变，6h出现出血、坏死性改变；而1／R损伤组大鼠术后1h缺血一再灌注区胰腺呈现出血、坏死性改变，病变持续加重；AP后胰腺凋亡细胞明显增多，I／R损伤组和胰腺炎组的凋亡细胞高峰值分别在术后3h和6h；I／R损伤组术后1h、3h缺血一再灌注区胰腺凋亡细胞显著高于相应时相的胰腺炎组(P＜0．01，P＜0．05)．而6h、12h明显低于胰腺炎组(P＜O．05，P＜O．01)。结论I／R损伤在促发胰腺炎从水肿型向出血坏死型转化过程中，同时诱导胰腺细胞凋亡，细胞凋亡可能是阻止AP病变加重的一个有利反应。     

大黄素诱导细胞凋亡对不同类型急性胰腺炎腺泡死亡方式的影响

目的 探讨大黄素(emodin)诱导细胞凋亡对不同类型急性胰腺炎(AP)腺泡细胞死亡方式影响及其可能机制.方法 制作大鼠急性水肿型胰腺炎(AEP)与急性坏死型胰腺炎(ANP)模型.使用大黄素进行治疗.采用原位TUNEL及RT-PCR等技术,观察胰腺组织内细胞凋亡、NF-κBmRNA、Bax mRNA及TNF-α mRNA等变化情况.结果 各组大鼠胰腺细胞凋亡指数与胰腺组织病理学评分呈负相关;大黄素治疗可诱导各型AP模型腺泡细胞凋亡,胰腺病理学改变及组织学评分改善,胰腺组织内NF-κB mRNA及Bax mRNA表达增加.结论 诱导不同类型AP胰腺细胞凋亡可明显减轻AP病情.大黄素为治疗AP的有效药物,可能通过影响NF-κB活化及Bax的表达来诱导AP时腺泡细胞的凋亡,减轻胰腺炎的严重程度.     

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。     

缬沙坦治疗大鼠急性胰腺炎的实验研究

急性胰腺炎（AP）因其发病机理复杂而治疗棘手。新近研究发现，血管紧张素Ⅱ水平在AP病程中异常升高，并加重胰腺持续缺血，机体微循环紊乱，使AP病情进一步恶化。据此，本研究通过复制大鼠AP模型，探讨血管紧张素Ⅱ受体拮抗剂缬沙坦（valsartan）对大鼠AP的治疗作用。     

血管紧张素Ⅱ受体拮抗剂早期干预大鼠急性胰腺炎的疗效

目的观察急性胰腺炎大鼠血浆血管紧张素Ⅱ水平变化并探讨血管紧张素Ⅱ受体拮抗剂——缬沙坦(Valsartan)对其的早期干预作用。方法 54只雄性Wistar大鼠随机分为对照组、急性胰腺炎组、缬沙坦干预组。采用胆胰管逆行注射法制做大鼠急性胰腺炎模型。缬沙坦干预组在制模后10 min给予缬沙坦 40 mg/kg。在病程不同时间点测定大鼠血清淀粉酶、脂肪酶、血浆血管紧张素Ⅱ水平,并观察胰腺组织病理学改变。结果急性胰腺炎组随病变进展,胰腺炎病理由水肿向出血坏死发展,血管紧张素Ⅱ水平持续升高。缬沙坦干预组血浆血管紧张素Ⅱ水平较急性胰腺炎组明显升高(P<0．05),其血清淀粉酶、脂肪酶水平,胰腺组织病理学评分较急性胰腺炎组明显下降(P<0．05)。结论早期应用缬沙坦可使急性胰腺炎大鼠血浆血管紧张素Ⅱ水平明显升高,对大鼠急性胰腺炎有一定的治疗作用。     

雅施达治疗大鼠急性胰腺炎的实验研究

为观察雅施达（ACE－1）对实验大鼠急性胰腺炎（AP）的生化指标及胰腺组织结构的影响，探讨ACE－I在治疗AP中的作用和意义。笔者将70只健康SD大白鼠随机分为对照组（n=10)、AP组（n=30)和治疗组（n=30)。监测各组大鼠的血清淀粉酶、血清脂肪酶、全血黏滞度，并观察胰腺光镜和电镜下病理学改变。结果：（1）治疗组与AP组比较，血清淀粉酶、血清脂肪酶和全血黏滞度明显下降，差异有显著性（P＜0．05）；（2）治疗组胰腺病理改变较AP组轻。提示雅施达可使AP的血清淀酶、血清脂肪酶降低及全血黏滞度降低，对胰腺微循环障碍可能有一定的改善作用，对大鼠AP有治疗作用。     

Hormonal and cholinergic effects on amylase and lysosomal enzyme activities in pancreatic tissue and ascites of rats with acute experimental pancreatitis

The effects of hormonal or cholinergic stimulation on survival and on activities of lysosomal enzymes and amylase in pancreatic tissue and ascites were studied in rats with induced pancreatitis. Pancreatitis per se caused an increase of the activities of cathepsin D, N-acetyl-beta-D-glucosaminidase and amylase, and a decrease of acid phosphatase in pancreatic tissue. Pancreatic protein concentration was not influenced. In pancreatitic rats administration of cerulein or carbachol markedly decreased survival rate. Cerulein increased the activities of cathepsin D and amylase in ascites and cathepsin D and acid phosphatase in pancreatic tissue. Carbachol increased the activities of cathepsin D and amylase in ascites and acid phosphatase in pancreatic tissue. Both cerulein and carbachol decreased the activity of amylase in pancreatic tissue. Administration of secretin or the anticholinergic drug Pro-Banthine did not influence survival rate or the activities of lysosomal enzymes and amylase in ascites. In pancreatic tissue the activity of acid phosphatase was slightly increased by secretin or Pro-Banthine. In conclusion, the results show a nonparallel alteration of lysosomal enzyme activities in pancreatic tissue in rats with pancreatitis. Cerulein and cholinergic stimulation decreased survival rate and brought about a marked increase of cathepsin D activity in ascites and, in the case of cerulein, also in pancreatic tissue. The implication of lysosomes and especially the catheptic proteases in the pathogenesis and outcome of acute pancreatitis deserves further attention.     

Effects of heparin in experimental models of acute pancreatitis and post-ERCP pancreatitis

BACKGROUND: Acute pancreatitis (AP) is a complication of diagnostic or therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In a recent clinical trial, a decreased rate of post-ERCP pancreatitis was shown after prophylactic heparin treatment. The aim of this study was to evaluate the effects of prophylactic heparin application in various experimental models of AP and pancreatic duct obstruction and to assess the underlying mechanisms. METHODS: In various experimental models, pancreatic injury of graded severity was induced in Wistar rats: (1) mild pancreatitis by IV cerulein infusion over 6 hours; (2) severe pancreatitis by infusion of glycodeoxycholic acid into the pancreatic duct plus IV cerulein application over 6 hours. The clinical ERCP situation was imitated in groups (3) obstruction of the pancreatic duct and (4) infusion of contrast medium into the pancreatic duct plus obstruction. In every group the animals received either no heparin (n=six per group) or continuous IV heparin (n=six per group) starting before pancreatic injury. Histologic changes, amylase, and lipase in plasma were evaluated 12 hours after induction of pancreatic injury. Additional animals were treated to investigate pancreatic microcirculation by intravital microscopy (n=six per group). RESULTS: In groups 1, 3, and 4 (mild AP/duct obstruction/duct obstruction plus contrast medium), IV heparin-treated animals showed reduced edema, inflammation, and peak amylase values compared with the corresponding non-heparin-treated animals (P<.05). Moreover, mean erythrocyte velocity was significantly higher and leukocyte-endothelium interaction was reduced in these groups after prophylactic administration of heparin. In contrast, group 2 (severe AP) did not show any difference between control animals and animals that received heparin as assessed by histology and intravital microscopy. CONCLUSIONS: Prophylactic systemic application of heparin provides a protective effect in mild AP and in experimental post-ERCP pancreatitis. The mechanism of the protective effects of heparin seems to be the reduction of leukocyte-endothelium interaction and the normalization of pancreatic microcirculation.     

Beneficial effects of recombinant platelet-activating factor acetylhydrolase and BN 52021 on bacterial translocation in cerulein-induced pancreatitis

BACKGROUND: Bacterial translocation (BT) has been suggested to be responsible for the high incidence of infections occurring after acute pancreatitis (AP). The aim of this study was to investigate the effects of the platelet-activating factor (PAF) inactivator, recombinant PAF-acetylhydrolase (rPAF-AH), and the PAF receptor antagonist, BN 52021, in AP. METHODS: Forty-eight male Wistar rats were divided into 4 groups: the sham group received saline intraperitoneally every hour for 6 h; the control group received cerulein 50 g/kg i.p. every hour for 6 h; the rPAF-AH group received AP plus rPAF-AH (5 mg/kg i.v. bolus), and the BN52021 group received AP plus BN 52021 (5 mg/kg i.v. bolus). The animals were sacrificed 12 h after the first cerulein injection. RESULTS: Supramaximal cerulein stimulation induced an increase in serum pancreatic enzymes, interleukin (IL)-6, pancreatic edema, and produced histologic evidence of AP. Compared with the control group, the addition of PAF receptor antagonists had a significant effect on serum pancreatic enzymes, pancreatic edema, and the histologic score of the pancreatitis. AP caused significant increases in BT in mesenteric lymph nodes (MLNs), pancreas, liver, spleen and blood. Compared with the control group, both rPAF-AH and BN 52021 decreased BT in the pancreas and blood. In addition, rPAF-AH decreased BT in the MLNs. We also found that PAF receptor antagonists suppressed the elevation in IL-6 levels. CONCLUSION: PAF antagonists attenuated the severity of experimental AP and reduced pancreatitis-induced BT to distant sites.     

The effect of interleukin-10 on acute pancreatitis induced by cerulein in a rat experimental model.

To investigate whether interleukin-10, a potent anti-inflammatory cytokine, could have a therapeutic effect on rats on that were made pancreatitis by cerulein. Thirty Wistar Albino rats were randomized into sham, pancreatitis, and therapy groups (n = 10 in each). Nothing was applied to the sham group; pancreatitis by inject-ing cerulein (50 micro/g/kg/h) was induced in the pancreatitis and therapy groups. Interleukin-10 (10.000 U) was injected at 1 and 4 h after pancreatitis inductions in the therapy group. The rats were sacrificed at postoperative hour 24. The following parameters were investigated: the leukocyte count, blood glucose, amylase, lipase and tumor necrosis factor-alpha levels in the blood samples; histopathological search, and wet/dry weight ratios of the pancreas tissues. The ratio of wet/dry pancreatic tissue weight, serum tumor necrosis factor-alpha, amylase and lipase lev-els, and histologic damage scores in the pancreatitis and therapy groups were significantly higher when they were compared with the sham group(p < .01). However, all of these values were significantly lower in the therapy groups than in the pancreatitis group (p < .01). Interleukin-10 decreases pancreatic tissue injury induced by cerulein-induced pancreatitis in rats. Nevertheless, more experimental studies are needed to compare endogenous interleukin-10 with exogenous interleukin-10 effects before clinical usage of this drug.     

Enzymatic and histological alterations in the isolated perfused rat pancreas in the taurocholate and cerulein model of acute pancreatitis]

METHODS: The pancreas of 24 male Wistar rats was perfused extracoporally by modified Krebs-Ringer-buffer for 80 minutes (including a 20 minutes equilibration period). To verify any organ damage we measured the activity of pancreatic enzymes like amylase, lipase and lactatdehydrogenase in the portal effluent. Furthermore histological changes were analysed after perfusion. Organ damage was induced by adding cerulein in a physiological dose (10(-10) M, n = 6) and in a supramaximal dose (10(-8) M, n = 6) and by intraductal injection of taurocholate (3.5 %, n = 6). RESULTS: Already 10 minutes after stimulation with cerulein (10(-8) M) and after intraductal injection of taurocholate increased activities (p < 0.01) of amylase and lipase were measured in the portal effluent compared to the group without any treatment. Lactatdehydrogenase levels did not changed. Apart from marked oedema in both groups considerable zones of necrosis could be noticed especially in the taurocholate group. CONCLUSION: Our data suggest that the isolated perfused rat pancreas (IPRP) is a valuable experimental tool to verify pathophysiological changes in the early phase of acute pancreatitis (AP). Various established models of AP such as by cerulein hyperstimulation or intraductal injection of taurocholate, could be applied to the IPRP. We conclude that this method enlarges the spectrum of established experimental models of acute pancreatitis.     

Peptide YY exhibits a mitogenic effect on pancreatic cells while improving acute pancreatitis in vitro

BACKGROUND: Peptide YY (PYY), a gastrointestinal regulatory peptide, improves survival and histologic parameters in animal models of acute pancreatitis. Its effects on pancreatic cell growth and acute pancreatitis in pancreatic acinar and ductal cells are unknown. We hypothesized that PYY would affect cell growth and attenuate acute pancreatitis in pancreatic acinar and ductal cells in vitro. METHODS: Rat pancreatic acinar and ductal cells were cultured in the presence of 1) cerulein, a synthetic cholecystokinin analog that induces pancreatitis, 2) PYY, or 3) a combination group pretreated with PYY prior to addition of cerulein. Cell survival was measured at 48 h using MTT assay. Amylase secretion, as marker for pancreatitis, was measured at 48 h using an amylase activity assay. Statistical significance was calculated using analysis of variance and the Student's t test. RESULTS: Peptide yy significantly increased cell growth and decreased amylase secretion compared with control and cerulein groups. Pretreatment with PYY significantly protected against the pancreatitis effects of cerulein. CONCLUSIONS: We have shown for the first time that PYY has a mitogenic effect on pancreatic acinar and ductal cells in vitro. In addition, it directly protects against cerulein-induced pancreatitis. Its potential therapeutic benefit in acute pancreatitis would therefore be twofold: amelioration of the inflammatory process, and augmenting growth of normal pancreas to replace necrotic or apoptotic cell loss.     

Platelet Function in Acute Experimental Pancreatitis

Acute pancreatitis (AP) is characterized by disturbances of pancreatic microcirculation. It remains unclear whether platelets contribute to these perfusion disturbances. The aim of our study was to investigate platelet activation and function in experimental AP. Acute pancreatitis was induced in rats: (1) control (n = 18; Ringer’s solution), (2) mild AP (n = 18; cerulein), and (3) severe AP (n = 18; glycodeoxycholic acid (GDOC) + cerulein). After 12 h, intravital microscopy was performed. Rhodamine-stained platelets were used to investigate velocity and endothelial adhesion in capillaries and venules. In addition, erythrocyte velocity and leukocyte adhesion were evaluated. Serum amylase, thromboxane A2, and histology were evaluated after 24 h in additional animals of each group. Results showed that 24 h after cerulein application, histology exhibited a mild AP, whereas GDOC induced severe necrotizing AP. Intravital microscopy showed significantly more platelet–endothelium interaction, reduced erythrocyte velocity, and increased leukocyte adherence in animals with AP compared to control animals. Thromboxane levels were significantly elevated in all AP animals and correlated with the extent of platelet activation and severity of AP. In conclusion, platelet activation plays an important role in acute, especially necrotizing, pancreatitis. Mainly temporary platelet–endothelium interaction is observed during mild AP, whereas severe AP is characterized by firm adhesion with consecutive coagulatory activation and perfusion failure. Parts of the results of this study were presented at the congress of the German Surgical Society, Berlin (May 2004), the Digestive Disease Week (May 2004), and the Annual Meeting of the American Pancreatic Association, Chicago (November 2004).     

Proteases and protease inhibitors in cerulein-induced acute pancreatitis in rats.

BACKGROUND: Proteases and protease inhibitors are important in acute pancreatitis (AP), although little is known about the time course in cerulein-induced AP in the rat. MATERIALS AND METHODS: AP was induced by supramaximal stimulation of cerulein, 10 microgram/kg/h, and during 72 h we measured lipase, amylase, albumin, prekallikrein, factor X, alpha(1)-protease inhibitor, alpha(1)-macroglobulin, alpha(2)-antiplasmin, antithrombin III (all in plasma) and macroscopic and histologic variables. RESULTS: Within 12 h an edematous pancreatitis was evident with peak values of peritoneal exudate, pancreatic wet weight ratio, and plasma amylase and lipase activities. Histologically, edema and vacuolization were prominent already after 3 and 6 h, respectively, while inflammation, necrosis, and total histological score gradually increase to reach peak levels at 48 h. Proenzymes and most plasma protease inhibitors decreased to low levels after 6-12 h followed by a gradual increase. The sequential changes over time indicate that kallikrein - kinin activation, and plasminogen activation are probably early events in cerulein-induced AP in rats. alpha(1)-Macroglobulin and alpha(1)-protease inhibitor gradually decreased during the whole study period, probably being "second line" defense inhibitors. Levels above normal were seen for alpha(2)-antiplasmin and factor X at 48 h, normalizing at 72 h. CONCLUSIONS: These results suggest that protease activation and protease inhibitor consumption occur in cerulein-induced AP in the rat.     

Does somatostatin analogue prevent experimental acute pancreatitis?

Because somatostatin is a potent inhibitor of pancreatic secretion, we hypothesized that pretreatment with somatostatin analogue octreotide (SMS 201-995) might prevent cerulein-induced edematous pancreatitis. We studied 18 rats prepared with jugular vein catheters. The following agents were administered intravenously to groups of four rats for 6 hours: 1 mL/h (control) crystalloid solution; 1-microgram/kg bolus then 1 microgram/kg per hour of octreotide; and 5 micrograms/kg per hour of cerulein; also, in a fourth group of six rats, octreotide and cerulein were administered simultaneously. At the end of experiments, blood was drawn for plasma amylase determinations; rats were killed and pancreata were examined. Supramaximal cerulein administration to conscious rats induced hyperamylasemia and edematous pancreatitis, confirming previous observations; in both groups of rats receiving cerulein, there was prominent interstitial edema, acinar vacuolization, and mild-to-moderate acute inflammation. While octreotide pretreatment of rats with cerulein-induced acute pancreatitis was associated with a lesser increase of wet pancreas weight and plasma amylase concentration, there was little overall benefit of octreotide pretreatment in this form of experimental acute pancreatitis.     

Pancreatic ascites and effusion. Risk factors for failure of conservative therapy and the role of octreotide.

The possible risk factors for failure of medical therapy were examined in 23 patients with pancreatic ascites or effusion. The ascites or effusion resolved completely in 10 patients after a mean (+/- SEM) of 30 +/- 2 days of conventional medical treatment. In five patients in whom conventional medical therapy failed, the addition of an octreotide (SMS 201-995) analogue to the medical therapy led to a resolution of the ascites (three patients) or effusion (two patients). Six patients underwent surgery after failed medical therapy, one patient died while receiving conservative therapy, and one patient refused hospital treatment. Serum sodium and albumin levels were significantly lower, and the ratio of total fluid protein to total serum protein was significantly higher in the group that failed to heal in response to conventional medical therapy. Nine of 11 patients with mild to moderately severe chronic pancreatitis healed in response to conservative therapy. Only one of 10 patients with advanced pancreatitis healed in response to conventional medical therapy. Our results suggest that a selective surgical approach is warranted to treat pancreatic ascites and effusion. In patients with mild or moderately severe pancreatitis, medical therapy is recommended. Patients with advanced pancreatic disease should be selected for early surgery. Octreotide may be useful in the patient in whom surgery may be associated with a prohibitive morbidity or mortality.