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Experimental chronic pancreatitis is associated with microcirculatory disturbances but can also be induced or aggravated by perfusion changes. Microcirculatory alterations in human chronic pancreatitis are poorly defined. In this clinical study we investigated pancreatic microcirculation in the normal human pancreas and in chronic pancreatitis by laser Doppler flowmetry. Laparotomy was performed on 13 patients with nonpancreatic disease and on nine patients with chronic alcoholic pancreatitis for pancreatic head resection. Blood flow was measured over the pancreatic head, the uncinate process, over the mesenteric vein, the pancreatic corpus, and over the pancreatic tail by laser Doppler flowmetry. Blood flow was highest in the head of a normal pancreas with a mean of 436 f Chronic and acute pancreatitis are accompanied or aggravated by circulatory changes within the pancreas (1-3). Ligation of splenic arterial branches in dogs induces pancreatic fibrosis, fat replacement, and cellular infiltration resembling the histopathologic changes also seen in human chronic pancreatitis (4). Cerulein-induced pancreatitis in rats is accompanied by hyperemia in the initial phase and ischemia in moderate and severe pancreatitis. The investigation of those changes has therefore become a main topic in recent pancreatology (5-7). Methods to assess circulatory events include video microscopy for the microcirculation (8), ultrasound Doppler sonography and microsphere as well as H, and 133xenon washout studies for whole-organ perfusion (9). In clinical situations, however, most research tools to assess microcirculatory events are difficult to apply. Microcirculatory

Hypothesis:Recent controlled clinical studies suggest a positive effect of early antibiotic treatment on late morbidity and mortality in severe acute pancreatitis. However, widespread use of antibiotics may lead to an increased number of fungal infections and multiresistant bacteria, thereby worsening the outcome of the disease.

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