Previously we have investigated the cerulein-induced acute pancreatitis and provided data on its micro-rheological impact in the rat. We hypothesized that non-steroid anti-inflammatory agent flunixin, the xanthine-derivate pentoxifylline and the low molecular weight heparin enoxaparin may have various beneficial effects improving microcirculatory and rheological parameters. In female rats, under general anesthesia, 10 g/kg cerulein s.c. was administered and 2 hours afterwards microcirculation was tested by laser Doppler flowmetry on the tongue and after performing laparotomy on the small intestine, liver and pancreas prior to terminal blood sampling. From blood samples hematological parameters, blood pH, lactate concentration, erythrocyte deformability, osmoscan parameters and erythrocyte aggregation were tested. Compared to normal control in acute pancreatitis group we found severe deterioration in tissue microcirculation together with impaired erythrocyte deformability and enhanced aggregation, accompanied by acidic pH and increasing lactate concentration. Improvement was found when using flunixin (s.c.), pentoxifylline (i.p.) or enoxaparin (s.c.). These drugs could partly improve the blood flux on the surface of the investigated organs, and the flunixin had the most expressed improving effects on micro-rheological parameters. Surprisingly, the improving effect of pentoxifylline on micro-rheological parameters was not obvious (red blood cell deformability did not improved better than in the other treated groups), however, microcirculatory parameters improved.
Background: We compared retrospectively the results of the patients who underwent hemihepatectomy through anterior approach (AHH) with those undergoing conventional hemihepatectomy (HH). Patients and Methods: In 119 patients hemihepatectomy was done, 52 of them were anterior approaches. We used this technique if the tumor size was large or if the tumor seemed to be fragile, and thus a liver mobilization would be very dangerous. We started the operation with dissecting parenchyma from the anterior surface toward hilus without preparation of the hilus. Resection of the liver was performed with the help of CUSA dissector. Results: No patient died following AHH. Two re-operations were performed in the HH group, and 2 patients died. The operation time was not significantly different in both groups. The need for blood transfusion was much less during AHH. The average nursing days were also similar in both groups. However, in those cases in which the operations were performed because of liver malignancies, there were no differences in the survival rate after 32-month follow-up between both groups. Conclusions: AHH can be performed safely. The blood consumption during AHH is significantly lower than during HH. The median survival rate was similar in both groups. Our team suggest the anterior approach for liver resection in those cases when the hilar structures and the hepatic veins cannot be isolated easily.
Beneficial effect of triclosan against Gram positive bacteria could not be confirmed in our study due to the relatively low number of patients with SSI. Furthermore, triclosan did not influence the incidence of SSI due to Gram negative bacteria. SSI rate decreased by 50% compared to our previous study, however, it was regardless of the use of coated or uncoated PDS loop. Finally, operative factors were more important than patient's risk factors in terms of incidence of SSI. In case SSI developed, delayed discharge from hospital as well as special wound care significantly increased overall cost of treatment.
What to drain? Acute peripancreatic fluid collection (APFC)According to the Atlanta Classification peripancreatic fluid collection develops in the early phase of acute pancreatitis in about 40% of cases. The acute fluid collection usually develops around the pancreas but sometimes emerges in the glandular area and does not contain a high quantity of necrosis. Not rarely, it spreads into the chest, mediastinum and/or into the pararenal area. Several fluid collections can develop at the same time and can shuttle together. The rich pancreatic enzyme content of the fluid can indicate communication with the pancreatic duct or indicate parenchymal necrosis. They do not have definite walls, and are limited by the walls of the surrounding organs. In a significant number of cases (about 30-50%), spontaneous resolution occurs without surgical or other intervention. If they do not show tendency towards resolution, they can become of significant size and cause clinical symptoms or complications [5,6,33,44]. The most frequent complaints caused by a big, 8-15 cm size acute fluid collection are pain, tension, and increasing abdominal pressure which can significantly worsen the efficiency of breathing [1,9]. In other cases they can cause compression symptoms (jaundice, duodenal obstruction) or bleeding can develop inside of them. Another frequent complication is the
Female patients suffering from severe biliary acute pancreatitis have higher morbidity and mortality rate. Therefore an elective cholecystectomy is suggested in old female patients with serious co-morbidity and gallstones, before any complications.
Although microcirculatory disturbances play pivotal role in the pathomechanism of acute pancreatitis (AP), very few papers can be found which had been tested any of hemorheological parameters. The aim of our study was to analyze the hemorheological changes in cerulein-induced experimental acute pancreatitis in rat in two doses (5 and 10 g/kg, s.c.). Male and female rats were subjected to Control group, or AP with 5 or 10 g/kg cerulein groups. Blood samplings (lateral caudal vein) were completed before cerulein administration, and 1, 2 and 24 hours later. Hematological parameters, amylase activity, erythrocyte deformability (ektacytometry) and aggregation (light-transmission method) were tested. The presence of AP could be confirmed by amylase testing and histological examination. The earliest impairment of the red blood cell deformability could be observed 1 hour after cerulein administration in 10 g/kg dosage. Female animals had the worst rheological results with high mortality. In conclusion, subcutaneously administrated cerulein in dosage of 5 and 10 g/kg resulted in AP in rats, with significant changes in red blood cell deformability and alterations in erythrocyte aggregation. This model seems to be suitable for further comparative studies.
sterile pancreas necrosis is rarely but septic necrosis is an indication for surgery if the conservative treatment is unsuccessful. Therapy resistant multiple organ failure, abdominal compartment syndrome and other surgical complications such as bleeding, perforation need surgery treatment. In biliary pancreatitis associated with cholestasis urgent endoscopic sphincterotomy and later cholecystectomy is suggested. In case of pancreas necrosis the ideal time of operation is 21 days after the beginning of the disease because the rate of complications and mortality is high in early operations. Careful necrosectomy is important which has to be extended to the retrocolic and retroduodenal areas as well. Open abdominal surgery has more complications so it is suggested only in selected cases. Operation should be amended with postoperative bursa omental lavage.
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