Therapeutic Small-Volume Resuscitation Preserves Pancreatic Microcirculation in Acute Experimental Pancreatitis of Graded Severity in Rats |
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| Authors: | Oliver Mann Jussuf Kaifi Christian Bloechle Claus G Schneider Emre Yekebas Dietrich Kluth Jakob R Izbicki Tim Strate |
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| Institution: | 1. Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands;2. Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Rotterdam, The Netherlands;3. Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Department of Urology, Nijmegen, The Netherlands;4. Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;5. Radboud Institute for Health Sciences, Radboud University Medical Center, Department for Health Evidence, Nijmegen, The Netherlands;1. Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan;2. Division of Pathology, Tohoku University Hospital, 980-8574, Sendai;3. Division of Pathology, Tohoku Rosai Hospital, Sendai;4. Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Shizuoka, Japan;5. Department of Diagnostic Pathology, University Hospital Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan;6. Department of Radiation Health Management, Fukushima Medical University, Fukushima, 960-1295, Japan;7. Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, 980-8575, Sendai;1. Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, 980-8575 Japan;2. Faculty of Health Sciences, University Sultan Zainal Abidin, 21300 Kuala Terengganu, Terengganu, Malaysia;3. Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, 980-8574 Japan;4. Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, 980-8574 Japan |
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| Abstract: | Background: Microcirculatory disorders play a major part in the pathogenesis of acute pancreatitis. Improvement of microcirculation is hypothesized to open a therapeutic window. The aim of this study was to evaluate the effects of small-volume resuscitation in acute pancreatitis. Methods: In rats, acute pancreatitis of graded severity was induced and pancreatic microcirculation was observed in vivo with an epiluminescent microscope. Primary outcome measures were microcirculation, leukocyte adherence, concentration oftrypsinogen-activating peptide, amylase activity and histopathologic tissue damage. Results: In necrotizing pancreatitis patients receiving prophylactic intervention with 7.5% hypertonic saline the functional capillary density was 76%. Postcapillary venular leukocyte adherence was 45% of vein cross-section. The median histopathologic damage scored 8 points. In controls, a complete microcirculatory breakdown was observed, and in the group with therapeutic intervention no significant difference was detected. In intermediate pancreatitis, the number of perfused capillaries remained 55.0 versus 23.3% in controls. Leukocyte adherence was 40.0 versus 51.7%. The histopathologic damage scored 6.0 versus 9.0 points. Trypsinogen-activating peptide concentration was reduced to 164 versus 402 nM in controls. In cerulein pancreatitis, the number of perfused capillaries was equally preserved in both groups. Conclusion: Small-volume resuscitation preserves capillary microcirculation and prevents pancreatic injury in intermediate necrotizing pancreatitis. |
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