ABSTRACT
OBJECTIVE: Understanding the biological mediators involved in the complex inflammatory response of sepsis and acute lung injury offers the possibility of future investigations targeting treatment based on these mediators. This study investigated whether macrophage activator beta-glucan has a protective effect on acute lung injury in an experimental model of sepsis. DESIGN AND SETTING: Experimental study in an experimental research center. MATERIALS: 30 rats randomized into three groups (sham, sepsis, and beta-glucan). INTERVENTIONS: Cecal ligation and puncture were performed in the beta-glucan and sepsis groups. The beta-glucan group was given a single intraperitoneal dose of beta-glucan (4 mg/kg) following cecal ligation. MEASUREMENTS AND RESULTS: Rats treated with beta-glucan had fewer circulating neutrophils, more blood monocytes, and higher serum interleukin 6 levels than septic animals. The percentages of neutrophils and lymphocytes from the bronchoalveolar lavage fluid and the myeloperoxidase activity measured in the lung tissue were lower in the beta-glucan group than in the sepsis group. Less alveolar hemorrhage and neutrophil infiltration were observed in lungs from animals in the beta-glucan group in the septic groups. CONCLUSIONS: In this rat model of intra-abdominal sepsis beta-glucan treatment partially protected against secondary lung injury, decreased lung hemorrhages, and lung neutrophilia. These results suggest that beta-glucan protects against sepsis-associated lung damage.
Subject(s)
Immunologic Factors/therapeutic use , Respiratory Distress Syndrome/prevention & control , Sepsis/drug therapy , beta-Glucans/therapeutic use , Analysis of Variance , Animals , Bronchoalveolar Lavage Fluid/immunology , Interleukin-6/blood , Leukocyte Count , Lung/metabolism , Lung/pathology , Male , Peroxidase/metabolism , Rats , Rats, Wistar , Respiratory Distress Syndrome/metabolism , Survival AnalysisABSTRACT
BACKGROUND/AIMS: To evaluate the results of the patients who underwent surgery for biliary pancreatitis, with respect to timing of operation. METHODS: 192 Patients underwent surgery for biliary pancreatitis between January 1990 and December 1999. The patients were retrospectively separated into three groups: early surgery (within 72 hours after admission), delayed surgery (between 3 and 15 days after admission) and elective surgery (after 15 days). RESULTS: There were 98 patients in the early surgery group, 46 in the delayed surgery group and 48 in the elective surgery group. The number of Ranson's criteria present was between 3 and 5 in 58.2% of the cases in the early surgery group and in 54.3% of the cases in the delayed surgery group, whereas 62.5% of the cases in the elective surgery group had 0-2. APACHE II score was in the 6-10 range in 43.9% of the cases in the early surgery group and in 39.1% of the cases in the delayed surgery group, whereas 66.7% of the cases in the elective surgery group had between 0 and 5. The most frequent operations in the early and delayed surgery groups was cholecystectomy, common bile duct exploration, and T-tube placement (60.2% and 69.6%, respectively), whereas it were laparoscopic cholecystectomy in the elective surgery group (66.7%). Pancreatitis-related complication rates in the early, delayed and elective surgery groups were 20.4%, 17.4% and 8.3%, respectively. Mortality rates were 5.1% and 4.3% in the early and delayed surgery groups, respectively. There was no deaths in the elective surgery group. CONCLUSION: In biliary pancreatitis, surgery should not be considered as a primary option until the resolution of the pancreatic inflammation and its systemic effects. It should be employed only when the clinical picture does not ameliorate in spite of conservative treatment.
