David A. Dreiling

Stercoraceous Perforation of the Colon

Three cases of stercoraceous ulceration and perforation of the colon are presented, and another 21 cases found in the literature reviewed. While this condition is rare, the diagnosis should be entertained in any severely and chronically constipated individual who presents with signs of a perforated viscus and fecal impaction.

The morphological changes of the pancreas in hypovolemic shock and the effect of pretreatment with steroids

SummaryPrevious reports from this laboratory have described the effect of hypovolemic shock of varying duration on the exocrine function of the pancreas, and the ability of steroids to reverse the inhibition of secretion observed. This report is a study of pancreatic morphology in prolonged hypovolemia, as well as the effect of steroid pretreatment on the pathology observed.Twelve mongrel dogs were divided into two groups, one with and one without steroid pretreatment. The animals were bled until at least 30–35% of their blood had been withdrawn, or until mean blood pressure (BP) dropped to around 60 mmHg.When BP dropped to 80–90% mmHg, six animals received intravenous (i.v.) prednisolone in 50 cc of 0.9% NaCl, at the rate of 10 cc/min, for a dosage of 30 mg/kg. Of the twelve dogs, six were exposed to 120 min of hypovolemia, and six to 180 min. At the end of the observed hypovolemic period, the blood withdrawn was quickly retransfused.After an hour of recovery, the animals were killed and their pancreases removed. The pancreases were weighted, fixed and examined by light microscopy. Three pancreases were obtained as control from animals not subjected to shock or steroids.The steroid-treated animals displayed an insignificant (5%) increase in pancreatic weight following prolonged hypovolemia. Untreated canine pancreases, on the other hand, showed a significant weight gain (37%,P<0.001) after 3 h of hypovolemia.Microscopically, the untreated group revealed marked interstitial edema, hemorrhage and inflammation, as well as focal acinar cell necrosis and fat necrosis, while in the steroid group only very mild edema and inflammatory changes were seen.This study indicates a beneficial effect of steroids on the morphological changes seen in shock-induced pancreatitis in canines and a possible use in the therapy of acute pancreatitis in man. *** DIRECT SUPPORT *** A00DX032 00003

Hypovolemic shock, pancreatic blood flow, and pancreatitis

SummaryElectromagnetic blood flow determinations were carried out on the superior pancreatic duodena (SPDA), the splenic (SA) and the superior mesenteric (SMA) arteries and compared to cardiac output (CO, thermodilution technique) in 12 anesthetized dogs submitted to hypovolemic shock of various duration: 5 dogs underwent a onehour and 7 a three-hour period of shock. A 50 mm Hg level of mean arterial blood pressure (MABP) was maintained throughout hypovolemia. Dogs were then reinfused. Control preshock values were 4.12 l/min for CO, 38.0 ml/min for SPDA, 405.9 ml/min for SA, and 963.6 ml/min for SMA. SPDA, SA and SMA flows expressed as % of CO amounted to 0.9, 9.8 and 23.4% respectively. No significant changes in SPDA and SMA flows were noted within the first hour of shock. However, from the end of the second hour on, both flows differed significantly (P<0.01), SMA increasing from −75.6% of its control value at the end of bleeding to−61.0%, and SPDA decreasing from −75.6 to −86.9%. Similar observations were made when respective flows were considered as % of CO. The SA behaved somewhat in an intermediate fashion. This relative spoliation in pancreatic blood supply as hypovolemia proceeds supports an ischemic etiology of acute pancreatitis (AP), which could account for some of the so-called idiopathic cases of AP.

The effect of hypovolemic shock on pancreatic secretion.

SummaryA vascular pathogenesis of pancreatitis has been postulated in diabetics, the aged, Ortner’s Syndrome, and various low-flow states. This report studies canine pancreatic secretion in a preparation of hypovolemic shock produced by controlled hemorrhage maintained for varying durations.Pancreatic secretion was collected by cannulation of the main pancreatic duct in anesthetized dogs. Secretin was administered by continuous intravenous (i.v.) infusion of 4 U/kg/h. Four 15-min samples of pancreatic juice were collected. Then the dogs were bled by arterial line withdrawing 25–30% of total blood volume or until the mean blood pressure dropped to about 60 mmHg. Blood was collected in heparinized containers for reinfusion. Blood samples for amylase and 15-min samples of pancreatic juice for volume, bicarbonate, and enzymes were obtained during hypovolemia as well as during and following restoration of the blood volume.Hypovolemia induced significant decreases in pancreatic flow, bicarbonate and amylase secretion, parameters which increased after reinfusion but never returned to pre-shock levels. Increasing the period of hypovolemia increased the inhibition of pancreatic flow, increased blood amylase elevation, and resulted in visible pancreatic edema.We conclude that pancreatic secretion is diminished by hypovolemia, that this is initially reversible when hypovolemia is brief, but that the disturbance of function progresses to inflammatory pathology when hypovolemia is prolonged.

Effect of partial versus complete pancreatic denervation on pancreatic secretion

The aim of this study is to compare the effect of various stimuli on pancreatic secretion in two groups of dogs, one undergoing interruption of the cholinergic and adrenergic branches to the pancreas (long arc reflexes), and the second group undergoing total denervation of the pancreas by its isolation from stomach and duodenum (short arc reflexes). Stimulation of pancreatic secretion was accomplished by (a) hormonal, by i.v. secretin and CCK/PZ and (b) reflex stimulation by intraduodenal administration of fat (Na oleate) or amino acids (Aminosyn). After a few weeks of collected data in stimulated controls, the dogs were divided into two groups: (A) Four dogs underwent proximal truncal vagotomy, celiac ganglionectomy, and stripping of the common hepatic and gastroduodenal arteries for 2–3 cm. (B) Four dogs underwent the same procedures, but in addition the pancreas was dissected away from its vascular and nervous attachments to the duodenal wall and pyloric region, as well as from its mesenteric and peritoneal attachments. All animals were then tested with secretin, Cholecystokinin/pancreozymin (CCK/PZ), intraduodenal fat, and intraduodenal amino acids. The data obtained indicate that secretion of pancreatic bicarbonate is dependent on intact local duodeno-pancreatic nervous reflexes. Fat and amino acids stimulate the secretion of bicarbonate only when the attachments of the pancreas to the stomach and duodenum are intact. Stimulation by secretion or CCK, being humoral–hormonal mediators, appears not to be affected by the local denervation.

Effects of commercial pancreozymin preparation (Cecekin) and gastrin pentapeptide upon acid and pepsin secretion in gastric fistula dogs

Abstract This study compared the stimulatory effects of pancreozymin-cholecystokinin (Cecekin) and gastrin pentapeptide upon gastric secretion and confirmed that small doses of pancreozymin stimulated both acid and pepsin secretion from gastric fistula dogs. Acid output with pancreozymin was about one-third of that in response to pentapeptide, but this difference was narrowed by the addition of a small dose of methacholine. Pepsin secretion was equally stimulated by both drugs. The differences between the effects of the two drugs may be due to an antral inhibitory mechanism; contaminants of the commercial pancreozymin preparation were probably insufficient to account for these differences.

The effect of steroid administration on pancreatic secretion during and after hypovolemic shock.

SummaryIn a previous report from this laboratory, 1 h of hypovolemia induced a significant decrease in pancreatic flow, bicarbonate and enzyme secretion. These parameters recover after restoration of blood volume, but never return to pre-shock levels. Furthermore, increasing the period of hypovolemia produced further decreases in pancreatic flow and bicarbonate secretion only. Enzyme secretion, however, rose significantly, probably due to leakage of protein through damaged cell membranes. Prolonged hypovolemia was also accompanied by visible edema.This model of secretory changes induced by fixed periods of hypovolemic shock is ideal to study the effect of steroids on secretion and to assess its possible cytoprotective properties against early induced ischemia pancreatic pathology.Pancreatic secretion was collected by cannulation of the main pancreatic duct in 12 anesthetized dogs. Secretin was administered by continuous intravenous (i.v.) infusion at 4 U/kg/h. Four 15-min samples of pancreatic juice were collected. Then the dogs were bled, withdrawing 25–30% of total blood volume or until the mean blood pressure dropped to about 60 mmHg. At this point, 30 mg/kg of methyl prednisolone were given in 50 cm3 of NaCl i.v. to six animals. Blood samples for amylase and 15-min collections of pancreatic juice for volume, bicarbonate and enzymes were obtained during hypovolemia, as well as during and following the restoration of blood volume.The responses of the two groups differed as follows: (1) Instead of the increase in protein enzyme secretion seen in the non-steroid group with increased duration of hypovolemia, steroid-treated dogs displayed a significant decrease in protein output. (2) Serum amylase levels rose progressively in the non-steroid group and continued to increase after restoration of blood volume. In the steroid-treated animals, the amylase rise during hypovolemia was significantly less, and following restoration of blood volume, serum amylase actually decreased.This study demonstrates the beneficial effect of steroids on pancreatic secretion, during and after prolonged periods of hypovolemic shock. Reduced enzyme output and decreasing serum amylase levels are evidence of a stabilization of acinar and ductular cell membranes, an activity which augurs less severe resultant pathology and increased possibilities for recovery. These secretory effects would warrant a controlled clinical trial for steroids in treatment of human pancreatic inflammation.

Effect of Low Molecular Weight Dextran on Gastric Ulceration and Gastric Secretion in Pylorus-Ligated Rats∗

Summary The effects of low molecular weight dextran were studied on gastric ulceration and gastric secretion in pylorus-ligated rats. The LMWD protected rats against the development of gastric ulceration and also reduced acid and pepsin output. Further studies need to be undertaken to elucidate its mechanism of action.

Acute pancreatitis in a patient treated for alcoholic hepatitis

SummaryA 33-yr-old white woman treated for alcoholic hepatitis developed acute pancreatitis during her hospital stay. At autopsy, two major pathological processes were found: alcoholic cirrhosis and chronic pancreatitis. In both, there was evidence of an acute episode, i.e., acute alcoholic hepatitis and acute hemorrhagic pancreatitis superimposed on the chronic alcoholic lesions. The sequence of events would indicate that the acute pancreatic pathology was precipitated by supranormal ecbolic stimulation of the acinar segment of the “pancreon” units, triggered as a result of a high protein and fat diet.

Caerulein stimulates pancreatic secretory response in conscious newborn rats

SummaryThe aim of our study was to measure age-dependent, caerulein-stimulated pancreatic enzyme secretion of conscious CFY suckling rats without pancreatic duct cannulation. Pancreatic secretory response was expressed as the decrease in specific enzyme (trypsin, amylase) activity compared to saline-injected control. The study was performed in three phases.In 10-d-old conscious newborn rats, single 1 and 3 ug/kg sc doses of caerulein induced significant decreases in specific trypsin (42 and 47 %) and amylase (34 and 33%) activity 15 min after the caerulein injection; the same doses injected at 0 and 30 min evoked a similar decrease 90 min after the first injection. The 0.5 μg/kg dose was ineffective.In 10-d-old anesthetized rats, the 90-min-decrease in total pancreatic trypsin activity, induced by graded doses (1,3,10, and 30 μ/kg) of caerulein, was compared to the 90-min output of trypsin in their bile-pancreatic juice. Each of the applied doses induced significant change in the total trypsin activity both in the pancreas (-33–57%) and juice (+ 21 ±49%) and its decrease in the gland corresponded quantitatively well (r = 0,52; p<0.01) to the increase in the simultaneous 90-min trypsin output.The age- and dose-dependent pancreatic response of 3-, 5-, 10-, and 20-d-old conscious rats was investigated under the effect of 1,3,10, and 30 μg/kg sc doses of caerulein injected at 0 and 30 min. In 3-d-old rats, the 10 and 30 μg/kg and in 20-d-old rats, the 1 and 3 μg/kg doses were effective, whereas in 5-and 10-d-old rats each caerulein dose applied evoked a significant decrease in pancreatic-specific trypsin activity. Conclusion: The pancreas of newborn rats is in vivo less sensitive to careulein between postnatal d 3 and 10 than in already weaned rats.