Plasmapheresis: a rational treatment for fulminant acute pancreatitis?
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Acute Disease↗
Biomedical subjects
M Larvin
Publications and source records attributed to M Larvin.
Intra-peritoneal aprotinin therapy for acute pancreatitis. Preliminary pharmacodynamic studies.
In acute pancreatitis a toxic exudate accumulates within the peritoneal cavity, which contains activated pancreatic proteinases. Peritoneal lavage removes the exudate effectively, washing it away with large volumes of saline solution, but is of unproven therapeutic value and may have deleterious effects. These may be avoided by combining lower volume peritoneal washouts with intra-peritoneal installation of a proteinase inhibitor, although therapeutic effectiveness may be compromised by systemic absorption depending on the inhibitor selected. This latter effect was studied in fifteen patients with acute pancreatitis, treated by simple peritoneal washout and bolus intra-peritoneal administration of aprotinin (Trasylol) solution.
Absorption↗
Fatigue fracture of a femoral sliding compression screw-plate device after bone union.
A failure of a femoral screw compression plate is described, the first such case to be reported after bone union. A fatigue fracture had started from an internal screw thread, near a keyway. Design improvements, such as lengthening the barrel around the lag screw, are suggested. The question as to whether keyways are necessary for the function of such devices is discussed. The morbidity of removal operations in elderly patients means that fatigue life improvements are needed, to avoid increasing numbers of failed implants in the continuing epidemic of fractures of the proximal femur.
Aged↗
Early increase in intestinal permeability in patients with severe acute pancreatitis: correlation with endotoxemia, organ failure, and mortality.
Sepsis accounts for 80% of deaths from acute pancreatitis. This study aimed to investigate early changes in intestinal permeability in patients with acute pancreatitis, and to correlate these changes with subsequent disease severity and endotoxemia. The renal excretion of enterally administered polyethylene glycol (PEG) 3350 and PEG 400 was measured within 72 hours of onset of acute pancreatitis to determine intestinal permeability. Severity was assessed on the basis of APACHE II scores and C-reactive protein measurements. Serum endotoxin and antiendotoxin antibodies were measured on admission. Eight-five patients with acute pancreatitis (mild in 56, severe in 29) and 25 healthy control subjects were studied. Urinary excretion of PEG 3350 (median) was significantly greater in patients who had severe attacks (0.61%) compared to those with mild disease (0.09%) and health control subjects (0.12%) (P <0. 0001), as was the permeability index (PEG 3350/400 excretion) (P <0. 00001). The permeability index was significantly greater in patients who subsequently developed multiple organ system failure and/or died compared with other severe cases (0.16 vs. 0.04) (P = 0.0005). The excretion of PEG 3350 correlated strongly with endotoxemia (r = 0.8; P = 0.002). Early increased intestinal permeability may play an important role in the pathophysiology of severe acute pancreatitis. Therapies that aim to restore intestinal barrier function may improve outcome.
APACHE↗