Róbert Kotán

Effects of various drugs (flunixin, pentoxifylline, enoxaparin) modulating micro-rheological changes in cerulein-induced acute pancreatitis in the rat

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 μg/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.

[Analysis of clinical course of severe acute biliary and non biliary pancreatitis: a comparative study].

UNLABELLED The acute pancreatitis is a relative common disease with incidence of 5-80 per 100000 people of the population. The number of new cases has steadily increased in recent years. The two main etiological factors are alcohol and cholelithiasis. The incidence of alcoholic pancreatitis is higher in male, and the incidence of gallstone pancreatitis is higher in female. AIM To summarize the difference between the clinical course of biliary and not biliary type of severe acute pancreatitis by analyzing the data of these patients. METHODS 139 patients treated with severe acute pancreatitis were divided in two groups: biliary (A group) and non biliary (B group) of origin. The two groups were compared on the basis of sex and age, mortality, morbidity, number of surgery and hospital stay. chi 2 probe was used for the statistical analysis. RESULTS The complications in biliary group were more serious. The average mortality rate was 15.1%, 17.8% in group A and 13.8% in group B. The mortality rate of female patients in group A was significantly higher. CONCLUSION 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.

Micro-rheological changes during experimental acute pancreatitis in the rat

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 μg/kg, s.c.). Male and female rats were subjected to Control group, or AP with 5 or 10 μg/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 μg/kg dosage. Female animals had the worst rheological results with high mortality. In conclusion, subcutaneously administrated cerulein in dosage of 5 and 10 μg/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.

Surgical treatment of acute pancreatitis today

UNLABELLED In case of mild acute pancreatitis the treatment is basically conservative, but in severe cases surgical treatment has an important role. METHODS authors analyze the indications for operation, the timing and the technical questions of it on the basis of the literature published in the previous ten years. RESULTS AND CONCLUSIONS 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.

A Duplicate Peritoneal Sheet of the Lateral Abdominal Wall May Create Internal Hernias: A Rare Case of Intestinal Obstruction

Small bowel obstruction and necrosis caused by an internal hernia is a rare occurrence. Due to the variety of symptoms, the location of the hernias and the limited diagnostic means, the establishment of a preoperative diagnosis is very difficult. Here, we describe a unique case of intestinal obstruction caused by an internal hernia. The patient was admitted with acute abdominal pain without concurrent nausea or vomiting. There was no history of previous abdominal surgery or abdominal trauma. The preoperative examination showed a suspicious mass in the ascending colon. A diagnostic laparoscopy was performed and surprisingly revealed an incarcerated loop of small intestine in a peritoneal sac located in the right ventrolateral abdominal wall. Between the duplicate peritoneal membranes, a necrotized section of the ileum was discovered which was removed by laparotomy, followed by an end-to-end anastomosis. Although internal hernias are only very rarely the cause of acute intestinal obstructions, the possibility should always be kept in mind, particularly in patients who do not show external hernias or have no history of previous abdominal surgery or abdominal trauma.

Anterior Approach for Liver Resection in the Treatment of Large Liver Tumors

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.