[Treatment of acute fulminant pancreatitis].
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Acute Disease↗
Biomedical subjects
M Lempinen
Publications and source records attributed to M Lempinen.
Early detection of acute fulminant pancreatitis by contrast-enhanced computed tomography.
Twenty-eight consecutive patients with a first attack of acute alcohol-induced pancreatitis were examined by computed tomography (CT). After a survey scan of the abdomen a rapid contrast bolus (400 mg I/kg) was given intravenously, and the contrast enhancement of the pancreatic parenchyma was measured from a consecutive series of pancreatic scans. Nine patients with a fulminant course of the disease were operated on, and haemorrhagic necrotizing pancreatitis was found in eight. In all of these the contrast enhancement was decreased or absent. Patients recovering by conservative treatment showed normal or increased enhancement. The contrast enhancement seems to constitute a useful criterion for the early differentiation of acute fulminant pancreatitis from less severe forms of the disease.
Acute Disease↗
Effect of vasopressin on portal venous pressure.
Portal venous pressure measurements were made through percutaneous transhepatic portal vein catheterization in 29 cirrhotics with portal hypertension and in seven controls before and after intravenous vasopressin infusion in a dosage of 0.24 IU/min. In cirrhotic patients the decrease in portal pressure was 8.5% being not statistically significant, while in the control group the decrease was 12% (p less than 0.05). Five of six cirrhotic patients (85%) whose acute bleedings were previously controlled with i.v. vasopressin infusion had reversed portal vein flow. On the other hand, only three of ten (30%) patients whose bleeding failed to be controlled with vasopressin had reversed flow in the portal vein. The difference between these two groups is statistically significant (p less than 0.05) and may suggest that variceal bleeding is most effectively controlled with i.v. vasopressin in cirrhotics with well developed collaterals and reversed portal vein flow.
Adult↗
Gastric blood flow, tissue gas tension and microvascular changes during hemorrhage-induced stress ulceration in the pig.
Various features of blood supply to the gastric mucosa were studied in the piglet stomach during stress ulceration induced by hemorrhagic shock. Gastric blood flow, as measured by the radioactive microsphere technique, significantly decreased during shock, but no major change occurred in the gastric function of total cardiac output. There was no difference in the magnitude of the decrease of mucosal blood flow between the nonulcerating antral mucosa and the more readily ulcerating corpus or fundic mucosa. At the same time, a significant decrease in tissue partial pressure of oxygen and increase in tissue partial pressure of carbon dioxide occurred, but again no difference was observed between the antrum and the corpus. Microangiographic studies demonstrated a clearly diminished filling of the arterial and capillary bed of the gastric mucosa during shock, suggesting intense vasoconstriction, thrombosis of the mucosal blood vessels, or both. These changes were more prominent in the corpus portion of the stomach than in the antrum. At the site of mucosal lesions, the filling defects persisted even after the shock, suggesting permanent thrombosis of the blood vessels.
Angiography↗
Serum phospholipase A2 and pulmonary changes in acute fulminant pancreatitis.
Twenty-three patients with acute fulminant pancreatitis were studied. The diagnosis was confirmed at laparotomy in every case. Blood samples for the assay of phospholipase A2 were collected for 14 days, and the pulmonary status of the patients was followed by monitoring the blood gases and the inspired oxygen fraction and studying a derived variable, the alveolar to arterial oxygen tension difference--the arterial oxygen tension ratio (A--aDo2/PaO2). The serum phospholipase A2 activities correlated with the changes in pulmonary function and with the outcome of the disease. Eight patients succumbed and they showed higher phospholipase A2 activities and A--aDo2/PaO2 ratios than the five patients who survived after major complications and the ten patients who survived without major complications. The results suggest that in acute fulminant pancreatitis serum phospholipase A2 activity correlates with the severity of the pulmonary changes. Furthermore, it seems to reflect the prognosis.
Acute Disease↗
Diseases mimicking thrombosis of the limb--a retrospective radiological study.
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Cysts↗
In vitro synthesis of triglycerides and cholesterol in human gallbladder mucosa.
Triglyceride and sterol synthesis was investigated in vitro in the gallbladder mucosa from control subjects and patients with acalculous cholesterolosis. The incorporation rate of 14C-acetate was 1.6 +/- 0.2 nmol/g/h into cholesterol (sum of squalene, methyl sterols, and cholesterol) and 5.7 +/- 0.8 nmol/g/h into triglycerides. The rates were significantly correlated with each other (r = 0.667). The conversion of 3H-mevalonate into cholesterol (49 +/- 10 nmol/g/h) and triglycerides (4.7 +/- 1.2 nmol/g/h) indicated a high activity in the postmevalonate cholesterol synthesis and an active shunt pathway of mevalonate metabolism. The synthesis rates of cholesterol, triglycerides, and sterol esters were closely interrelated, were unaltered in cholesterolosis, and were not correlated with the serum, biliary, and mucosal lipid concentrations. Thus, despite marked lipid accumulation the lipid synthesis proceeds effectively in the gallbladder mucosa with cholesterolosis.
Cholesterol↗
Serum phospholipase A2, immunoreactive trypsin, and trypsin inhibitors during human acute pancreatitis.
Serum immunoreactive trypsin and phospholipase A2 were analyzed at regular intervals in seven patients hospitalized as a result of acute hemorrhage pancreatitis. alpha 1-Antitrypsin and alpha 2-macroglobulin levels and trypsin-inhibitor capacity of serum were determined simultaneously. Serum trypsin concentrations were markedly raised in all patients. The levels of immunoreactive trypsin remained elevated for longer periods than those of urinary amylase. alpha 1-Antitrypsin and trypsin-inhibitor capacity were also significantly increased as compared with the post-illness values, but alpha 2-macroglobulin decreased considerably, reaching the lowest levels on the 5th day after admission. Consequently, phospholipase and trypsin are released to the circulation during hemorrhagic pancreatitis, but the increase in trypsin is compensated for by an increase in trypsin-inhibitor capacity of serum due to elevated alpha 1-antitrypsin levels. The decrease of alpha 2-macroglobulin in hemorrhagic pancreatitis was one of the most interesting findings, and it is proposed that this inhibitor may be consumed in the elimination of proteases through the reticuloendothelial system. The two patients who died had higher phospholipase values than those who recovered, but the prognosis could not be predicted from the values of the other measured variables.
Acute Disease↗
Hepatic actinomycosis presenting as repeated cholestatic reactions.
A patient with hepatic actinomycosis caused by Actinomyces odontolyticus is presented. The clinical course was characterized by 2 yr of episodic abdominal pains and fever together with marked acute elevations of serum alkaline phosphatase. The diagnosis escaped extensive laboratory studies, 2 liver biopsies and 1 laparotomy and was finally verified at a second laparotomy by histology and a positive culture. Histopathology showed multiple small abscesses. No primary focus of infection was found. Treatment with doxycycline was successful.
Actinomycosis↗
Lipid composition of bile and gallbladder mucosa in patients with acalculous cholesterolosis.
To investigate pathogenetic factors of cholesterolosis of the gallbladder, the lipid composition of both the hepatic and gallbladder bile and gallbladder mucosa were compared with each other in 6 patients with and 5 patients without acalculous cholesterolosis. The molar percentage of biliary cholesterol and total bile acid pattern were similar in the two groups. Of the biliary cholesterol precursors, methyl sterols, but not squalene, correlated closely with cholesterol both in the hepatic (r = 0.901) and gallbladder bile (r = 0.747). Methyl sterols, expressed either per cholesterol or bile acids, were higher and squalene was lower in the gallbladder bile than in the hepatic bile. In addition, methyl sterols were increased in the hepatic and gallbladder bile of the patients with cholesterolosis, as if the hepatic production of these precursors had been enhanced--probably as a consequence of altered hepatic cholesterol synthesis. In cholesterolosis the gallbladder mucosa was characterized by a marked increase in triglycerides and significant elevations of the esterified sterols and free methyl sterols. The esterification degrees of sterols, which were consistently higher for methyl sterols than for cholesterol, were closely correlated with the respective mucosal sterol concentrations. The methyl sterols/cholesterol ratio in the bile correlated significantly with mucosal free and esterified methyl sterols, esterified cholesterol, and the methyl sterols/cholesterol ratio. The data suggest that free sterols can be transferred from the bile to the gallbladder mucosa, and that altered hepatic cholesterol synthesis is associated with the development of the cholesterolosis of human gallbladder.
Adult↗
Chlorpromazine treatment of experimental acute fulminant pancreatitis in pigs.
Acute pancreatitis was induced in 20 piglets. In the controls (10 piglets) no specific treatment was given, while in the experimental group the animals were treated with chlorpromazine, a potent phospholipase A2 inhibitor in vitro. Blood samples were taken from all animals for the assay of amylase, lipase, phospholipase A2, calcium, blood glucose and arterial blood gases both before the experiment and at various time intervals after its commencement. At autopsy, tissue specimens were taken from the pancreas, liver, lungs, heart and kidneys for histological studies. In the untreated animals there was a continuous rise in the phospholipase A2 levels, while the level decreased to zero on the second day in the treated animals (p less than 0.01, Student's t test). Moreover, in the untreated animals there was a sharp drop in the arterial pO2, while this remained unchanged in the treated animals (p less than 0.1, Student's t test). The mortality was significantly less (p less than 0.01, chi-square test) in the chlorpromazine-treated animals than in the controls. Serum phospholipase A2 levels correlated with the changes in pulmonary function and mortality. The results support the view that phospholipase A2 is of importance in the pathophysiology of acute pancreatitis.
Acute Disease↗
Disturbances in gastric motility during hypovolaemic shock.
In piglets hypovolaemic shock causes motorical disturbances and gastroduodenal dysrhythmia which both lead to increased duodenogastric reflux and to elevated concentrations of lysolecithine in the stomach. During a long lasting and severe shock gastric movements and electrical control activity waves totally cease. These changes can be observed as well endoscopically as using myoelectrogrammes. Exposition of the gastric mucosa to duodenal juice together with ischemia causes intramucosal haemorrhages and superficial erosions resembling human stress ulcers.
Animals↗
Distal splenorenal shunt for portal hypertension.
A distal splenorenal shunt was performed electively in 25 patients with bleeding oesophageal varices. Early postoperative mortality was 16%. During the follow-up period (mean 41 months) three patients died, one of liver insufficiency and two of cardiac complications. Two patients of 17 survivors (12%) had endoscopically demonstrable varices. One of these patients had one upper gastrointestinal rebleeding period. The actual three year survival was 71%. Reverse portal blood flow was demonstrated postoperatively in eight of 17 patients (47%). In these cases the distal splenorenal shunt had in fact slowly turned to a total shunt. Even though in certain patients the original selectivity of the shunt is lost it gives a good long-term variceal decompression and certainly is a useful alternative in the treatment of selected good risk patients for bleeding oesophageal varices.
Adult↗
Interposition mesocaval shunt for bleeding oesophageal varices in moderate and poor risk cirrhotics.
A series of 45 mesocaval interposition shunt operations for bleeding oesophageal varices in Child's class B and C cirrhotics is presented. Twelve operations were carried out electively and 33 as emergencies. The primary mortality rates were 8% and 48% in these groups, respectively. Eleven (39%) of the 28 survivors died during a follow-up of 5 months to 4 years. Cumulative overall survival was 48% at one year and 33% at four years. Mortality was influenced more by surgery if performed as an emergency than the functional reserve of the liver. Continued alcoholism after surgery correlated with late mortality. Two cases of variceal rebleeding occurred in the primary survivor group (7%); both of them had shunt occlusion. Shunt patency rate was 89%. All patients had some degree of encephalopathy before surgery, but severe or chronic cases were not observed during the follow-up. Ascites when present preoperatively always disappeared after shunt. As a technically relatively simple procedure, mesocaval interposition shunt effectively prevents variceal rebleeding and ascites formation, thus offering improvement also in the quality of life. In elective cases an acceptably low mortality is achieved even in poor risk patients. In emergency cases mesocaval shunt provides about 50% chance of survival, if conservative methods to stop the bleeding fail.
Adult↗
Resection of the pancreas for acute fulminant pancreatitis.
The records of 30 consecutive patients treated by pancreatic resection for acute hemorrhagic or necrotizing pancreatitis from 1974 to 1978 were reviewed. Formal subtotal or near to total resection of the pancreas was undertaken whenever vigorous nonoperative therapeutic measures did not bring rapid improvement of the condition of the patient. The rationale was that removal of the diseased pancreatic tissue would prohibit the progress of inflammation and abolish the development of complications directly associated to the inflammatory process itself. There was no intraoperative mortality, but 11 patients died after the operation. Of the 19 survivors, eight had an uncomplicated postoperative course, whereas 11 patients recovered only after severe complications, usually requiring multiple reoperations. Among the most important complications were intra-abdominal sepsis, septicemia, upper gastrointestinal tract bleeding, respiratory insufficiency, renal insufficiency and perforations of the gastrointestinal tract. After a follow-up period of one to five years, five patients have remained completely free of symptoms. In 12 patients, diabetes has developed, and four patients had recurrent mild attacks of pancreatitis. All but two patients have resumed their previous work or other activities of living.
Acute Disease↗
Management of trauma to the parenchymatous organs.
The incidence of abdominal trauma is increasing, and is related to both increased violence in the society and to the increased frequency of road traffic accidents. Injuries to the liver, pancreas with duodenum, and kidneys are almost always associated with other lesions, and we see the multi-traumatized patient. Splenic injuries however, may be solitary. Since the duodenum and pancreas lie in the depth of the abdominal cavity, they are to some extent surrounded and cushioned against impact by the overhanging liver, the lower lateral and posterior rib cage and the vertebral column. The spleen, on the other hand, is attached to its vascular pedicle, but very mobile and susceptible of injuries involving deceleration and direct blunt trauma.
Abdominal Injuries↗
[Differential diagnosis of deep venous thrombosis].
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Adult↗
Studies on the effect of hepatectomy on pig post-heparin plasma lipases.
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Animals↗