In order to understand the mechanism of acute renal failure frequently observed in severe acute pancreatitis, renal microcirculation and renal hemodynamics were investigated during experimental acute pancreatitis in dogs induced by autologous bile and trypsin mixture into the pancreatic duct. Renal tissue blood flow (hydrogen gas clearance method), renal arterial blood flow, and cardiac output (transonic blood flow meter) were each measured for 5 h after induction of pancreatitis. The effect on renal hemodynamics of a new synthesized protease inhibitor--E-3123; 4-(2-succinimidoethylthio)phenyl-4-quanidinobenzoate methane sulfonate--intravenously infused at the rate of 3 mg/kg/h was also investigated. The mean blood pressure and pulse pressure decreased after induction of pancreatitis. Renal microcirculation and renal artery blood flow decreased during the experiment. However, in dogs with treated by E-3123, renal microcirculation was preserved during the first hour of the experiment and decreased gradually afterward, but it was significantly higher than that of the dogs without E-3123 during 3-5 h. The mean blood pressure and pulse pressure were preserved nearly at preoperative levels during the experimental period. We concluded that renal microcirculation decreased concomitantly with a deterioration of acute pancreatitis, and that the new pancreatic protease inhibitor E-3123 may have some beneficial effect to improve renal hemodynamics in the early period of acute pancreatitis.
10 patients underwent a 3rd CE. In 7/10 patients with concordant initial CEs, the DY of repeat CE was 0/7. Where the 2 initial CEs disagreed, DY was 2/3. Conclusion 1. In patients with a negative or inconclusive initial CE for IDA or OGIB, repeating the procedure has an overall DY of 25% (7/28).The DY is highest when fresh blood was seen in the initial procedure (71.4%) even if no lesions were found initially.Patients with initially normal studies had lower DY (22.7%).3rd CE is only warranted by a change in presentation or discordance in the previous results, especially when one examination has identified active bleeding.
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