Enzymatic Debridement in Necrotizing Pancreatitis

Multiple organ failure and pancreatic necrosis are the factors that determine prognosis in acute pancreatitis attacks. We investigated the effects of collagenase on the debridement of experimental pancreatic necrosis. The study covered 4 groups; each group had 10 rats. Group I was the necrotizing pancreatitis group. Group II was the collagenase group with pancreatic loge by isotonic irrigation following necrotizing pancreatitis. Group III was the collagenase group with pancreatic loge following necrotizing pancreatitis. Group IV was the intraperitoneal collagenase group following necrotizing pancreatitis. The progress of the groups was compared hematologically and histopathologically. There was no difference among the groups regarding the levels of leukocyte, hemogram, and urea. The differences in AST levels between Group I and II; and differences in glucose, calcium, LDH, AST, and amylase between Group II and III; between Group II and IV; between Group I and III; and between Group I and IV were statistically significant (P < 0.05). There were statistically significant differences between Group II and III, and Group II and IV regarding edema, acinar necrosis, inflammatory cell infiltration, hemorrhage, and fat necrosis (P < 0.05). In conclusion, the collagenase preparation used in this experimental pancreatitis model was found to be effective in the debridement of pancreatic necrosis.Key words: Acute pancreatitis, Necrose, Collagenase, DebridementAcute pancreatitis (AP) is a nonbacterial inflammatory disease of the pancreas that can range from interstitial edema to pancreatic necrosis in its severest form. In about 20% of AP attacks necrosis can develop in the pancreas while the disease limits itself and regresses in a couple of days in many patients (80%).¹The definitions that are still widely in effect today regarding the classification of acute pancreatitis were determined in 1992 at the Atlanta Conference.² The conference aimed at achieving a common classification for AP and its complications. Within severe acute pancreatitis, of which necrotizing pancreatitis is a part, organ failure and local complications can be seen (necrosis, pseudocyst, and abscess). Multiple organ failure and pancreatic necrosis are the factors that determine the prognosis. Half of the mortalities are observed within a period of 1 or 2 weeks. Necrotizing pancreatitis makes up for the 10–20% of AP cases. Severe pancreatitis has a high mortality rate and functional diseases like diabetes are seen in one-third to one-fifth of the recovered patients.³While the mortality rates are about 10% in the presence of sterile pancreatic necrosis, they go up over 30% in the existence of infected necrosis.¹ Regarding acute necrotizing pancreatitis, there is still no consensus on surgical indications and the time of surgical intervention, the surgical method to be used, and which patients need conservative treatment and which ones need surgical treatment. The goal in the surgical treatment of acute necrotizing pancreatitis is to isolate the necrotic tissue that might cause sepsis and multiple organ failure and to reduce the risk of mortality. The timing of necrosectomy as well as the way in which necrosectomy is performed is significant in necrotizing pancreatitis. The issue of the possibility that necrosectomy can be performed through minimally-invasive interventions instead of open surgery is still being discussed.³We planned to investigate the activity of collagenase clostridiopeptidase A (EC 3.424.3), which has never been attempted before in the debridement of experimental pancreatic necrosis (but which has been used for enzymatic debridement), and the enzyme preparation containing the accompanying proteases (Sterile Novuxol^®, Abbott, Uetersen, Germany). We aimed to evaluate the response of the disease to treatment through laboratory and histopathologic data, by using the enzyme preparation to treat necrotizing pancreatitis.     

Thymoquinone protects end organs from abdominal aorta ischemia/reperfusion injury in a rat model

Introduction

Previous studies have demonstrated that thymoquinone has protective effects against ischemia reperfusion injury to various organs like lungs, kidneys and liver in different experimental models.

Objective

We aimed to determine whether thymoquinone has favorable effects on lung, renal, heart tissues and oxidative stress in abdominal aorta ischemia-reperfusion injury.

Methods

Thirty rats were divided into three groups as sham (n=10), control (n=10) and thymoquinone (TQ) treatment group (n=10). Control and TQ-treatment groups underwent abdominal aorta ischemia for 45 minutes followed by a 120-min period of reperfusion. In the TQ-treatment group, thymoquinone was given 5 minutes. before reperfusion at a dose of 20 mg/kg via an intraperitoneal route. Total antioxidant capacity, total oxidative status (TOS), and oxidative stress index (OSI) in blood serum were measured and lung, kidney, and heart tissue histopathology were evaluated with light microscopy.

Results

Total oxidative status and oxidative stress index activity in blood samples were statistically higher in the control group compared to the sham and TQ-treatment groups (P<0.001 for TOS and OSI). Control group injury scores were statistically higher compared to sham and TQ-treatment groups (P<0.001 for all comparisons).

Conclusion

Thymoquinone administered intraperitoneally was effective in reducing oxidative stress and histopathologic injury in an acute abdominal aorta ischemia-reperfusion rat model.     

Adjunctive Hyperbaric Oxygen Therapy or Alone Antibiotherapy? Methicillin Resistant Staphylococcus aureus Mediastinitis in a Rat Model

OBJECTIVE

In the post-sternotomy mediastinitis patients, Staphylococcus aureus is the pathogenic microorganism encountered most often. In our study, we aimed to determine the efficacy of antibiotic treatment with vancomycin and tigecycline, alone or in combination with hyperbaric oxygen treatment, on bacterial elimination in experimental S. aureus mediastinitis.

METHODS

Forty-nine adult female Wistar rats were used. They were randomly divided into seven groups, as follows: non-contaminated, contaminated control, vancomycin, tigecycline, hyperbaric oxygen, hyperbaric oxygen + vancomycin and hyperbaric oxygen + tigecycline. The vancomycin rat group received 10 mg/kg/day of vancomycin twice a day through intramuscular injection. The tigecycline group rats received 7 mg/kg/day of tigecycline twice a day through intraperitoneal injection. The hyperbaric oxygen group underwent 90 min sessions of 100% oxygen at 2.5 atm pressure. Treatment continued for 7 days. Twelve hours after the end of treatment, tissue samples were obtained from the upper part of the sternum for bacterial count assessment.

RESULTS

When the quantitative bacterial counts of the untreated contaminated group were compared with those of the treated groups, a significant decrease was observed. However, comparing the antibiotic groups with the same antibiotic combined with hyperbaric oxygen, there was a significant reduction in microorganisms identified (P<0.05). Comparing hyperbaric oxygen used alone with the vancomycin and tigecycline groups, it was seen that the effect was not significant (P<0.05).

CONCLUSION

We believe that the combination of hyperbaric oxygen with antibiotics had a significant effect on mediastinitis resulting from methicillin-resistant Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus mediastinitis can be treated without requiring a multidrug combination, thereby reducing the medication dose and concomitantly decreasing the side effects.     

The change of whole lumbar segmental motion according to the mobility of degenerated disc in the lower lumbar spine: a kinetic MRI study

Purpose

To analyze the effects of mobility of degenerated disc in the lower lumbar discs (L4–5 and L5–S1) on both whole lumbar motion and adjacent segment ROM.

Methods

The kMRIs with disc degeneration at L4–5 or L5–S1 were classified into three groups: the normal group, the motion-preserved (MP) group and the motion-lost (ML) group based on range of motion (ROM) of 5° in the degenerated segment. Each segmental ROM, whole lumbar motion, and the contribution % of the upper lumbar spine (ULS: L1–2–3) and the lower lumbar spine (LLS: L4–5–S1) motion to whole lumbar motion were measured and compared with each of the other groups.

Results

There were 94, 99 and 66 patients in the normal group, MP group and ML group, respectively. The normal group showed no significant difference compared to the MP group in all ROM parameters. The ML group showed significantly less whole lumbar motion, more contribution % in the ULS and less in the LLS than the normal and the MP groups. The ROM in the superior adjacent segment in the ML group was not significantly different between that in the normal and MP group.

Conclusions

Degenerated lumbar discs did not show hypermobility within functional ROM. Loss of segmental ROM from advanced disc degeneration did not cause an increase in the ROM of the superior adjacent segment in vivo. When the LLS had motion-lost, advanced disc degeneration, whole lumbar motion was significantly decreased and compensatory increase in ROM was accomplished by the ULS.

     

Ventricular arrhythmias in patients with COPD are associated with QT dispersion

STUDY OBJECTIVE: QT dispersion (QTd) and late potentials derived from signal-averaged ECG (SAECG) have been proposed as noninvasive predictors of cardiac arrhythmias that occur in patients with COPD. In this study, we aimed to investigate QTd and SAECG in patients with COPD. DESIGN: Cross-sectional study. SETTING: Teaching chest disease hospital and cardiology center in a university hospital. PATIENTS: Thirty patients with COPD (28 men and 2 women; mean +/- SD age, 60 +/- 9 years) and 31 age- and sex-matched control subjects (28 men and 3 women; mean age, 57 +/- 7 years) were included. Measurements and results: Respiratory function tests, arterial blood gas analyses, echocardiographic examinations, rhythm Holter recordings, and heart rate variability (HRV) analyses were performed in addition to the measurements of QT intervals and SAECG. Patients with COPD had higher rate of ventricular premature beats (VPBs) as compared to control subjects (924 +/- 493 beats vs 35 +/- 23 beats, p = 0.009). Eight patients with COPD (27%) had nonsustained runs of ventricular tachycardia (VT). QTd rates were significantly increased in patients with COPD as compared to control subjects (57.7 +/- 9.9 ms vs 37.5 +/- 8.2 ms, p < 0.001). On comparing patients with COPD with and without runs of VT, patients with VT had longer QTd (67 +/- 10 ms vs 55 +/- 8 ms, p = 0.001). However no difference in any HRV and late potential parameters were found between patients with COPD with and without runs of VT. VPB rates were strongly correlated with QTd in patients with COPD (r = 0.61, p < 0.001). On SAECG analysis, patients with COPD had significantly increased total QRS duration as compared to control subjects. Nine of the 30 patients with COPD (30%) had positive late potentials. However, QTd and VPB rates were also similar between patients with COPD with and without late potentials. CONCLUSIONS: The development of ventricular arrhythmia in patients with COPD was associated with increased QTd. Increased QTd may be associated with autonomic changes seen in patients with COPD.