Acid ingestion in an experimental model

Following acid ingestion, the mortality of operative intervention is clearly related to late recognition of perforation. Experimentally, fiber-optic endoscopy can be used to accurately predict the depth of gastric injury. Operative intervention can be undertaken before gross perforation. Flexible endoscopy should be performed upon admission and repeated at intervals of 12 to 24 hours until one is satisfied that the injury is stable, reversible and will not progress. The risk of gastric perforation is minimal if the endoscopic procedure is performed by a competent individual. Continued careful medical follow-up examination and nutritional support is indicated when major damage to the stomach occurs to ensure that the patient will tolerate anticipated operative reconstruction.     

Low molecular weight dextran in experimental pancreatitis: effects on pancreatic microcirculation

Although low molecular weight (LMW) dextran has been said to decrease the lethality of experimental acute pancreatitis (AP) by reversing stasis in the pancreatic microcirculation, the actual mechanism(s) of action is unknown. This investigation was designed to measure the effects of low molecular weight dextran on pancreatic capillary flow (QCAP) and arteriovenous shunt flow (QAVS), and on pancreatic oxygen consumption (O2CP) following bile-trypsin-induced AP in dogs. Total pancreatic blood flow (QT) was measured with an electromagnetic flow probe on the superior pancreaticoduodenal artery (SPDA). QAVS was measured by liver trapping of 99mTc-albumin microspheres after SPDA injection. QCAP was calculated as QT minus QAVS. Seventeen dogs were treated with lactated Ringer's (LR) solution at 6.5 ml/kg/hr; 10 dogs were treated with LMW dextran 10% in normal saline at 1.5 ml/kg/hr plus LR at 5.0 ml/kg/hr. Mean arterial and central venous pressures remained constant throughout the 4-hr experiment. In the dogs receiving LR only, QT decreased from 42.7 to 24.4 ml/min (P less than 0.001); QAVS remained constant at 1.35 +/- 0.04 ml/min. During the first 30 min O2CP decreased from 1.17 to 0.76 ml O2/min (P less than 0.05) and remained constant thereafter. LMW dextran treatment altered none of these hemodynamic or metabolic parameters significantly. Conclusions: bile trypsin AP in the dog causes significant decreases in QT and QCAP without altering QAVS. The decrease in O2CP in association with a constant QAVS suggests a metabolic block to oxygen uptake at the cellular level. Continuous infusion of LMW dextran at a dose of 1.5 ml/kg/hr in the dog does not reverse these abnormalities.     

Ex vivo normothermic hemoperfusion of the canine pancreas: Applications and limitations of a modified experimental preparation

Ex vivo recirculation perfusion preparations of the canine pancreas are useful for the study of pancreatic physiology and exocrine secretory function. Vagaries of isolated ex vivo organ perfusion, however, require a thorough familiarity with available circulation media and component technology. Electrolyte and acid-base homeostasis can be facilitated by incorporating a dialysis unit into the perfusion circuit. Viability of the preparation is best assessed by constancy of vascular resistance and oxygen extraction during the period of perfusion. Limitations imposed by this closed method of organ perfusion on studies of pancreatic endocrine function and on duodenopancreatic hormonal interactions (enteroinsular axis) must be recognized.     

普罗布考和抗氧化维生素不影响体外实验条件下内皮细胞的白细胞粘附

为探讨预防动脉粥样硬化的药物普罗布考,维生素C和维生素E是否抑制内皮细胞表面粘附分子表达和白细胞一内皮细胞的粘附,以及这种抑制是否通过影响核因子－kB的活性来实现的,在液体流动小室中进行细胞粘附实验。用ELISA方法测定内皮细胞粘附分子E－选择素的表达;用电泳迁移率分析测定内皮细胞核因子－kB的活性,经肿瘤坏死因子α刺激的内皮细胞核因子－B活性增加,粘附分子E－选择素的表达上调（是基础水平的3．5倍）,其表面HL60细胞的粘附增加（是基础水平的4－26倍）,而抗氧化剂PDTC使所有这些变化都受到抑制。PDTC浓度为18umol/L时对粘附分子E－选择素的表达呈最大半抑制;PDTC浓度为52umol/L时对内皮细胞表面HL60细胞的粘附呈最大半抑制,普罗布考,维生素C和维生素E对肿瘤坏死因子α诱导的粘附分子表达和HL60细胞与内皮细胞的粘附没有作用,对核因子－kB的活性没有影响,临床上常用的这三种抗氧化剂并未影响作为动脉粥样硬化始动机制之一的E－选择素介导的白细胞－内皮细胞粘附水平。     

Demand for post-qualifying professional education in the health care sector in England

The British National Health Service is proposing to establish local consortia for educational contracting, with the wider involvement and responsibility being devolved to service providers This paper addresses the economic considerations of purchasing post-qualifying professional education in the English hospital sector, for hospital nurses, doctors and physiotherapists in England     

Completion gastrectomy for postsurgical gastroparesis syndrome. Preliminary results with 15 patients.

Postsurgical gastroparesis syndrome (PGS) is a complex disorder characterized by postprandial nausea, vomiting, and gastric atony without evidence of mechanical gastric outlet obstruction. These symptoms can be disabling and are frequently unresponsive to drug therapy. Fifteen patients with documented PGS, including 13 women and two men, were recently treated by completion gastrectomy (CG) over a 5-year period. Gastric emptying study (GES) was markedly prolonged in 12 of the patients studied, and improved partially in only one patient (8%) with the administration of metoclopramide alone or combined with other gastrokinetic drugs. Patients were evaluated both before and after surgery, using a modified Visick rating system and a severity of symptoms (SS) score based on seven gastrointestinal (G.I.) and five systemic variables. All 15 patients underwent CG and reconstruction with a 50 cm Roux-en-Y limb. There were no operative deaths or complications related to the esophagojejunal anastomosis. Mean postoperative follow-up was 13.9 months, with a range of 2-65 months. After CG, the Visick rating and overall SS score improved significantly. The improvement in SS score was primarily due to a significant decrease in G.I. symptoms with little or no change in systemic symptoms. Overall, 86% of patients reported a satisfactory clinical result. CG, while seemingly radical, can be performed with low risk, and for properly selected patients with PGS, may be the treatment of choice.