ObjectiveTo explore the effects of urinastatin(UTI) on microcirculation of extrapancreatic organs in rats with acute necrotizing pancreatitis(ANP). Methods A total of 48 rats were randomized into control group, ANP group and UTI group. The model of ANP was established by uniform injection of 5% sodium taurocholate solution under pancreatic capsule, only injection of normal saline in control group. Then the rats of UTI group were injected with UTI through the femoral vein, the rats of ANP group and control group were injected with normal saline. The blood flow of lung, kidney and distal small intestine was measured by radioactive biomicrosphere technique at 2 h and 6 h after ANP.ResultsCompared with the control group, the blood flow of lung, kidney and intestine was decreased significantly in the ANP group at the 2 h and 6 h after ANP （P＜0.05）, compared with the ANP group, the blood flow was increased significantly in UTI group （P＜0.05）. ConclusionMicrocirculation disorder is an important factor of the extrapancreatic organ damage in ANP, and UTI plays a protective role against microcirculation disorder of the extrapancreatic organ in ANP.
This prospective animal study was designed to investigate the changes of plasma endothelin (ET) levels in acute necrotizing pancreatitis (ANP). Sprague-Dawley rats were randomly devided into 3 groups: acute necrotizing pancreatitis (ANP) group in which ANP was induced by infusion of 5% sodium taurocholate (STC) into biliopancreatic duct, sham operation (SO) group and platelet activating factor antagonist BN50739 (BN) group. Blood levels of ET and platelet activating factor (PAF) were detected. Pancreatic microcirculatory blood flow was measured and pancreatic histological scores were evaluated. Results showed that the pancreatic microcirculatory blood flow in ANP group was decreased to a great extent immediatly after induction of ANP and soon began to rise slowly for 3 hours and again decreased steadily after that. The blood levels of ET, PAF and histological scores in ANP group were significantly higher than those in SO group. In BN group, the blood flow was significantly improved and the levels of blood ET, PAF and histological scores were all significantly lower as compared to those in ANP group. It is concluded that ischemia/ reperfusion is present in the initiation of acute necrotizing pancreatitis induced by STC in the rat. This leads to injuries of endothelial cells and increase in the production of ET and PAF. I/R lesions,and interaction of ET and PAF lead to a vicious circle, thus augmenting the pathological changes in the pancreas.
In order to observe activity of tumor necrosis factor (TNF) in the serum, pancreatic histopathological damage, as well as their relationships in acute necrotizing pancreatitis (ANP), thirty five SD rats were randomly divided into 7 groups according to their sampling time with 5 in each group. ANP was induced by retrograde infusion of 5% sodium taurocholate through biliopancreatic duct in 6 experimental groups (Group B1～B6).Blood and pancreatic tissue samples were obtained at hour 0,0.5,2,4,6 or 8 respectively when the animals were sacrificed.Results showed that serum level of TNF activity rose significantly in Group B2,and reached the maximal value in Group B4.The pancreatic histopathological damage in ANP rats was getting worse along with time. Serum TNF activity had close relation to pancreatic histopathological score (r=0.63, Ｐ＜0.01),suggesting that serum TNF may play an important role in the process of deterioration of pancreatic tissue damage during ANP.
In the early stage of acute necrotizing pancreatitis (ANP) of experimental monkeys, the concentration of tumor necrosis factor (TNF) in blood was significantly increased. Stilamin could significantly reduce the level of TNF, decrease the mortality, and prolong the survival time of monkeys. The authors draw the conclusion that TNF is an important inflammatory media in the early stage of ANP. Stilamin can significantly inhibit the inflammatory process and has good effect in the treatment of ANP in experimental monkeys.
Nineteen cats were randomly divided into two groups, 7 cats (group A) recieved about 200 times spotty injections of total of 2 ml of 94% alcohol in pancreatic parenchyma and 12 cats (group B) underwent intraductal alcohoh, partial obstruction of the main pancreatic duct (MPD) and intraparenchymal alcohol. Acute necrotizing pancreatitis occurred in all of the experimental cats after operation. 2 cats in group A (28.6%) died within 48 hours postoperatively. 4 cats in group B (33.3%) died, among them, 3 within 48 hours and 1 died after 2 weeks. Morphological and functional recovery of the exocrine pancreas were found in all the 5 survivals in group A, while 8 cats in group B developed chronic pancreatitis 15 weeks after the operation. The above results show that simple pancreatic necrosis can be recovered after eliminating the etiological factors and if these factors, whatever is primary or secondary still exist and continue to damage the pancreas, chronic pancreatitis may develop.
【Abstract】ObjectiveTo describe the imaging manifestations of acute necrotizing pancreatitis (ANP) on multidetectorrow spiral CT (MDCT). To investigate the relationship between pancreatic glandular necrosis and retroperitoneal inflammatory spreading and the clinical severity of ANP. MethodsA 16detector row spiral CT was used to perform contrastenhanced abdominal scanning in 90 patients diagnosed as ANP， who were prospectively enrolled into this study. Scoring of the extent of pancreatic glandular necrosis and Balthazar grading based on retroperitoneal inflammatory spreading were done at the same time. For 44 patients who met the criteria of Ranson scoring, both scoring by CT severity index (CTSI) and Ranson criteria. Multiplanar reformation technique was used for image postprocessing. Results①In 40 out of 90 patients, the pancreatic glandular necrosis was less than 30%, in 23 the necrosis was between 30%-50%, and in 27 the necrosis was more than 50%. Peripancreatic fat swelling and thickening of anterior renal fascia were observed in all cases of ANP; Peripancreatic and retroperitoneal phlegmonous fluid collection occurred in 78 patients (86.7%); 12 had fluid collection in lesser sac (13.3%); Thickening and swelling of posterior gastric wall in 71 patients (78.9%); 87 developed intestinal ileus (96.7%) and 35 patients had peritoneal effusion (38.9%); Splenic infarction in 4 patients (4.4%); 82 had pleural effusion (91.1%). ②Twelve patients were classified as Balthazar grade C， 42 as grade D and 36 as grade E. There was a statistically significant positive correlation between the extent of pancreatic glandular necrosis and Balthazar CT grade. ③In 44 ANP patients suitable for Ranson criteria, 12 cases were classified as mild (27.3%), 23 as moderate (52.3%), 9 as severe (20.5%). CTSI grading of these patients was as follows： Mild cases 0, moderate cases 25 (56.8%), severe cases 19 (43.2%). Correlation between the CTSI grades and the clinical severity of ANP was of statistical significance. ConclusionANP can demonstrate a series of imaging manifestations on MDCT. To some extent, the degree of pancreatic glandular necrosis and the extent of retroperitoneal spreading is positively correlated, and CTSI grading based on MDCT imaging features is also positively correlated with the clinical severity of ANP.
Objective To investigate the etiology, symptoms, diagnosis, surgical treatment, and outcomes of acute necrotizing mediastinitis (ANM) in order to guide future diagnosis and treatment of ANM. Methods The clinical data of patients with ANM referred to West China Hospital, Sichuan University from March 2012 to April 2021 were retrospectively analyzed. The etiology, clinical manifestations, demographic characteristics, bacterial culture results, surgical approach and prognostic factors of these patients were summarized. ResultsA total of 176 patients were enrolled in this study. The median age was 60 ( 0-84) years. There were 124 (70.5%) males and 52 (29.5%) females. The most common origin of infection was neck (n=66, 37.5%). The most common symptom was fever (n=85, 48.3%). Streptococcus constellatus represented the most common pathogens in secretion culture. Surgical treatment was administered to 119 (67.6%) patients through different approaches, including 54 (30.7%) patients of cervical approach, 9 (5.1%) patients of thoracotomy, 18 (10.2%) patients of video-assisted thoracoscopic surgery (VATS), 7 (4.0%) patients of cervical combined with thoracotomy, 30 (17.0%) patients of cervical combined with VATS, and 1 (0.6%) patient of subxiphoid approach. Among this cohort, 144 (81.8%) patients were cured, while 32 (18.1%) patients died. Age-adjusted Charlson comorbidity index (OR=2.95, P=0.022), perioperative sepsis (OR=2.84, P=0.024), and non-surgical treatment (OR=2.41, P=0.043) were identified as independent predictors of poor outcomes. Conclusion For patients with corresponding history and manifestations of ANM, it is crucial to go through imaging examination to confirm the presence of an abscess and guide the selection of surgical approach. Once the diagnosis of ANM is made, it is imperative to promptly perform surgical intervention for effective drainage. Our study highlights the significance of age-adjusted Charlson comorbidity index, perioperative sepsis and surgical treatment in predicting patients’ outcomes.
【Abstract】Objective To investigate therapeutic effect and mechanism of hyperbaric oxygen and ulinastatin respectively or combinatively used to treat acute necrotizing pancreatitis (ANP). Methods One hundred and twenty SD rats were divided into 6 groups randomly: group of normal control, group receiving sham operation, group of untreated acute necrotizing pancreatitis (ANP group), group of acute necrotizing pancreatitis treated with hyperbaric oxygen (HBO group), group of acute necrotizing pancreatitis treated with ulinastatin (ULT group), and group of acute necrotizing pancreatitis treated with combined hyperbaric oxygen and ulinastatin (HBO+ULT group). The rat model of acute necrotizing pancreatitis was established according to Aho HJ et al. Concentrations of amylase, TNFα, TXB2 and 6ketoPGF1α in blood were measured through ELISA or radioimmunoassay. Changes of pancreatic histopathology were investigated. SPSS 10.0 was used in statistical analysis. Results The concentrations of amylase, TNFα, TXB2 in the ANPtreated groups were significantly lower than those of ANP group (P＜0.01) except for 6ketoPGF1α and the levels of amylase and TNFα of HBO group were strikingly higher than those in HBO+ULT group. Only the level of AMS was significantly different between ULT group and HBO+ULT group (P＜0.01). Pancreas histopathological scores(HS) and CD8 counts of ANP group were significantly higher than those the other three group, but CD4 counts and CD4/CD8 ratio were on the contrary (P＜0.05). HS of HBO and ULT were strikingly higher than those of HBO+ULT (P＜0.05).Conclusion ①Hyperbaric oxygen or ulinastatin can effectively decrease the blood levels of enzymes and cytokines and improve the pancreatic immunity. ②Hyperbaric oxygen in combination with ulinastatin are more effective than either of them in the treatment of ANP.