Information regarding the size of the hematoma and the presence of extravasation helps to select the appropriate management of patients with traumatic adrenal hemorrhage. TAE appears to be useful for treating patients with massive adrenal hemorrhage.
The effects of glutamine-supplemented parenteral nutrition on protein metabolism, small intestinal mucosal metabolism, morphology, and barrier function were studied in endotoxin-treated rats. Forty-six male Wistar rats were randomized to two groups of 23 animals each and received total parenteral nutrition solutions supplemented with either glutamine (GLN group) or glycine (GLY group) at 2% wt/vol. Endotoxemia was induced by continuous intravenous infusion of endotoxin at a dose of 2 mg/kg per day throughout the 4-day study period. The GLN group had a less-negative cumulative nitrogen balance (-14.0 +/- 132.8 mg of nitrogen in the GLN group and -86.8 +/- 161.7 mg of nitrogen in the GLY group, p < .05) and less cumulative excretion of urinary 3-methylhistidine (2910 +/- 593 nmol) than the GLY group (4447 +/- 933 nmol, p < .01). Jejunal mucosal glutaminase activity and the arterio-portal venous blood glutamine concentration differences were significantly higher in the GLN group compared with the GLY group (15.6 +/- 2.3 vs 11.1 +/- 1.9 mumol/g per minute, p < .05, and 181 +/- 52 vs 147 +/- 36 nmol/mL, p < .05, respectively). The morphology of the jejunal mucosa in the GLN group was significant for having greater mucosal weight (23.4 +/- 3.1 vs 17.6 +/- 2.5 mg/cm), villus height (445 +/- 75 vs 357 +/- 57 microns), crypt depth (197 +/- 34 vs 161 +/- 28 microns), and wall thickness (751 +/- 77 vs 648 +/- 102 microns) than the GLY group (p < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
We report a patient whose upper abdominal pain was due to an alcoholic pancreatic pseudocyst with hemorrhage. CT showed a gradually enhancing pancreatic pseudocyst about 6 cm in diameter. It exhibited hyposignal intensity on T2-weighted images and hypersignal intensity on T1-weighted images. Enlargement of the pancreatic pseudocyst was thought to be attributable to hemorrhage into the pancreatic pseudocyst. Angiography revealed a pseudoaneurysm in the anterior superior pancreaticoduodenal (ASPD) artery. Selective transcatheter arterial embolization (TAE) of the ASPD artery stopped the bleeding and his abdominal pain lessened. After 1 month, the diameter of the pseudocyst was reduced to about 3 cm and it showed hypersignal intensity on T2-weighted images and hyposignal intensity on T1-weighted images. TAE was considered to be a minimally invasive, highly effective treatment in this patient with hemorrhage into a pancreatic pseudocyst.
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