[Lipid metabolism disorders in acute pancreatitis]. / Zaburzenia metabolizmu lipidów w ostrym zapaleniu trzustki.

On the course of acute pancreatitis which occurred in 30 patients treated in our clinic changes in cholesterol, triglycerides and phospholipids levels were monitored during 7 days of hospitalization taking into account the severity and aetiology of disease. The decrease of cholesterol and phospholipids levels were observed in 3-rd and 7-th day of hospitalization. TGs concentrations however showed variability regarding aetiology and severity of acute pancreatitis lack of mentioned above lipid levels changes before the disease onset as well as their rapid normalization with healing suggest, that they are rather a consequence not a cause of acute pancreatitis.

[Levels of alpha-amylase, C-reactive protein and lipoprotein (a) in acute pancreatitis]. / Przydatnosc oznaczania alpha-amylazy trzustkowej, bialka C-reaktywnego i lipoproteiny (a) w okreslaniu ciezkosci przebiegu ostrego zapalenia trzustki.

On the course of acute pancreatitis which occurred in 30 patients treated in our clinic changes in levels of alpha-amylase, C-reactive protein and lipoprotein (a) were monitoring during 7 days of hospitalisation talking into account the severity and aetiology of disease. The highest level of the alpha-amylase were observed in 1-st day, C-reactive protein in 3-rd day and lipoprotein (a) in 7-th day of observation. These parameters are very useful to monitoring course and heaviness of acute pancreatitis.

Low molecular weight heparin versus acenocoumarol in the secondary prophylaxis of deep vein thrombosis.

The aim of this study was to determine the efficacy and safety of subcutaneous weight-adjusted dose low molecular weight heparin (LMWH) compared with oral anticoagulant (OA) in the prevention of recurrent venous thromboembolism. In a prospective multicenter trial, 202 patients with symptomatic proximal deep vein thrombosis (DVT) were included. As soon as the diagnosis of DVT was confirmed by phlebography, 101 were randomly assigned to receive LMWH (nadroparin) for secondary prophylaxis and 101 to receive OA (acenocoumarol). Patients in both groups were initially treated with nadroparin in a dose of 85 anti-Xa IU/kg s.c. every 12 h. Secondary prophylaxis with either nadroparin, 85 anti-Xa IU/kg s. c. once daily, or acenocoumarol was continued for at least 3 months. Three patients in the LMWH group and 6 in the OA group were excluded from analysis for various reasons. During the one-year combined secondary prophylaxis and surveillance period, 7 of of the 98 evaluable patients (7.1%) in the LMWH group and 9 of the 95 evaluable patients (9.5%) in the OA group had a documented recurrence of venous thromboembolism (Fisher's exact test, p = 0.61). Of these, 2 patients who received LMWH and 7 patients on acenocoumarol had recurrences in the 3-month period of secondary prophylaxis. Four patients (4.1%) in the LMWH group developed bleeding complications during this study period, as compared with 7 (7.4%) in the OA group (Fisher's exact test, p = 0.37). There were two major bleedings, one in the LMWH group and one in the OA group. Eleven patients died, 5 (5.1%) in the LMWH group and 6 (6.3%) in the OA group. It is concluded that nadroparin in a dose of 85 anti-Xa IU/kg s.c. once daily provides an effective and safe alternative to oral anticoagulants in the secondary prophylaxis of DVT.

[The role of nutrition on the treatment of septic syndrome and multiple organ failure]. / Rola zywienia w leczeniu zespolu septycznego i niewydolnosci wielonarzadowej.

Basing on current literature the issues regarding nutrition in patients with septic syndrome and multiple organ failure were discussed. It was emphasised that patient feeding along with providing metabolic substrates also serves as a treatment method. Diet ingredients in specific carbohydrate, protein and fat metabolism disorders were analysed. We focused upon the role of emulsion of fat, especially medium chain triglycerides (MCT) and -3-linolenic acid (fish oil). The unique role o f glutamine, arginine and branched chain amino acids (BCA) was highlighted. Patient nutrition with accordance to the presented new methods has become an efficient routine of treatment in septic syndrome. It may constitute an efficient prophylaxis against multiple organ failure.

[Participation of various bacterial species in translocation in intestines of rats subjected to stress]. / Udzial poszczególnych gatunków bakterii w translokacji jelitowej u szczurów poddanych stresowi.

In the rats, which were treated with impairing factors such as: malnutrition, cooling down and ischaemia, translocation was studied. Aerobes as well as anaerobes which penetrated beyond the intestine into the mesenterium, liver, spleen and kidneys were sought. Bacteria in peripheral blood were not found. The results show that the type of bacterium undergoing translocation does not depend on the factor impairing "intestinal barrier" and translocation mechanisms are most probably the same for all the bacteria found.

[The effect of new diagnostic and treatment methods on the course and prognosis of pancreatic pseudocysts]. / Wplyw nowych metod diagnostycznych i leczniczych na przebieg i rokowanie w rzekomych torbielach trzustki.

We performed a retrospective analysis of 672 patients treated because of acute pancreatitis (AP) in the years 1962-1996. In 95 of them (14%) pancreatic pseudocysts (PP) were diagnosed. Two patient groups were compared: Ist (1962-1985), which consisted of 320 patients with acute pancreatitis, including 20 PP with IInd (1986-1996), comprising 322 patients with AP, including 75 PP. Pancreatic pseudocysts are diagnosed much more frequently nowadays (6-23%), especially in men with AP of alcohol etiology. Ultrasound CAT guided percutaneous drainage of PP proved to be an effective method of treatment in 64% of patients. Indications and complications of this method were discussed. Thirty-three patients underwent primary operative treatment. The indications were complications of PP and pathologic ER CP findings in pancreatic ducts. Secondary operative treatment was indicated in patients, where percutaneous procedure failed. Pancreatic pseudocysts produce complications much less frequently and the death rate decreased from initial 35 to 5% nowadays. It is mainly due to early diagnosis, monitoring and treatment after introduction of ultrasound and CAT.

[Usefulness of enteral feeding in surgery]. / Przydatnosc zywienia dojelitowego w chirurgii.

Eighty malnourished patients with neoplasms, enteric fistulae, multiorgan trauma and septic complications administered food by means of enteral feeding (EF). It was found that EF prevents weight loss and even causes weight gain in patients, increases total protein and albumin concentrations and decreases urea and creatinine levels in blood which is a proof of catabolism fall. Patient condition improvement and healing of the majority of enteric fistulae was achieved after EF. Factory diet intolerance affected 5% of patients and diarrhoea-6%. Investigations prove that enteral feeding is a good alternative to parenteral nutrition. If enteral feeding follows proper indications, technique and route of administration are chosen the right way, it allows the surgeon to perform operation, decreases the number of complications and enables the patient's organism fight septic syndrome. Enteral feeding is a state of the art method of severely ill patient nutrition.

Pathogenesis and treatment of multiorgan failure dysfunction syndrome in shock.

Pathogenesis and treatment of multiorgan dysfunction syndrome (MODS) have been presented, basing on literature and own experience. The term multiple organ dysfunction syndrome--MODS is now regarded to be the most accurate. The classification and the pathogenesis of primary and secondary MODS are discussed. In the primary MODS causes are to be looked for in the extensive injuries of tissues, hypoxia and the ischemia-reperfusion syndrome. In the secondary MODS, because of the effects of other deteriorative factors, the systemic infection response syndrome (SIRS) appears. The course of this reaction has been discussed, pointing the attention to the effects of proinflammatory cytokins (mainly TNF alpha), then to the role of neutrophils and the intestinal translocation. Various approaches to the prevention and treatment of MODS are presented. In the primary MODS very important is an appropriate tissue perfusion restoration and elimination of necrotic tissue. In the secondary MODS there are new ways of treatment. Used are: monoclonal antibodies, antioxidants, inhibitors of cytokins and proteases, hemofiltration, selective bowel decontamination. Enteral nutrition, if possible--provides not only the supply of food substrates but it may also inhibit cytokin release, decrease translocation and improves hemodynamics. The prognosis in MODS is still very serious, however, its improvement is to be regarded after the application of new therapeutic methods.

Long lasting effects of audiogenic seizures on synaptosomal neurotransmitter amino acids in Rb mice.

Long lasting alterations of synaptosomal amino acid neurotransmitters following a single or several audiogenic seizures and/or acoustic stimulations were investigated in six brain areas -olfactory bulbs (OB), amygdala (A), hippocampus (Hi), cerebellum (C), inferior colliculus (IC), pons-medulla (P)- of three sublines of Rb mice: audiogenic seizure-prone Rb1 and Rb2, seizure-resistant Rb3. Changes in the synaptosomal levels of aspartate (Asp), glutamate (Glu), taurine (Tau), 4-amino butyrate (GABA), glycine (Gly) and some closely related precursors, serine (Ser) and glutamine (Gln), were recorded 15-18 hours after a single or multiple acoustic stimulations. Changes were more frequent, or larger, after polystimulation. Some alterations appeared to be attributable to an effect of the acoustic stress. In both seizure-prone sublines, after a single or repeated seizures, an increase in synaptosomal Asp was observed in IC. Decreases in Asp and Tau in OB and Ser in A, an increase in Gln in IC were only observed after repeated seizures, in Rb1 and Rb2 mice.

Age-associated changes of rat brain neuronal and astroglial poly(ADP-ribose) polymerase activity.

Nuclear poly(ADP-ribose) polymerase levels as well as the DNA strand break levels of whole-brain neuronal and astroglial cells were investigated. Three- and 30-month-old rats were used. Low-molecular-weight neurofilaments and glutamine synthetase served as neuronal and astroglial markers, respectively. A large increase in the poly(ADP-ribose) polymerase activity was observed in the neurons (threefold) and astrocytes (3.7-fold) derived from 30-month-old rats. Similarly, the amount of poly(ADP-ribose) polymerase, evaluated per milligram of DNA, increased approximately 3.5-fold in neurons and 3.9-fold in astrocytes prepared from 30-month-old rats. Whether the increase in the poly(ADP-ribose) polymerase activity was due to an enhanced rate of DNA strand break was investigated by determining the rate of DNA unwinding. A significant increase in DNA unwinding rate was detected in the neurons (2.7-fold), although a lower increase was observed in the astroglia (1.3-fold) of aged animals.

Brain monoamines following castration of aggressive muricidal rats.

The effect of castration on the levels of brain monoamines and their metabolites has been investigated in rats which became or did not become muricidal following long-term isolation. Fourteen brain areas were explored: olfactory bulbs (OB), olfactory tubercles (OT), septum (Se), striatum (Sr), amygdala (A), thalamus (Th), hypothalamus (Hy), hippocampus (Hi), superior colliculus (SC), inferior colliculus (IC), raphe (Ra), pons-medulla (PM), frontal cortex (FC), temporal cortex (TC) and parietal cortex (PC). Except in the raphe of non muricidal rats and in the striatum of muricidal animals, all other areas examined demonstrate some changes of monoamines neurotransmitter or their metabolites after castration. The strongest changes, always increases, were found in the thalamus. In several brain areas, the changes occurring after castration, differ quantitatively and qualitatively in muricidal and non-muricidal rats.

Alcohol exposure before pregnancy: effect on GABA levels and turnover in rat offspring.

The GABA levels and turnover rates in various brain areas from 2-month-old rats born to mothers who consumed 20% (v/v) alcohol during 1 month only before pregnancy, were investigated. A decreased level was found in the olfactory tubercules and an increase was observed in the hypothalamus. The turnover rates were reduced in both areas, whereas an increase was observed in the frontal cortex. These results indicate that biochemical alterations may occur in the offspring even if the fetus did not develop under alcoholization.

[Results of abdominal operations in patients with liver cirrhosis]. / Wyniki operacji brzusznych u chorych z marskoscia watroby.

A retrospective analysis was done of 45 patients with cirrhosis who were operated on for abdominal diseases and their complications, mainly cholelithiasis. Out of seven studied risk factors, of greatest importance were serum albumin deficiency which appeared in 45% of patients and was fraught with 100% mortality, prothrombin time (in 40%-89% mortality), and jaundice (25%-82% mortality). Postoperative complications occurred in 71% of patients with cirrhosis, mainly hepatic coma (22%), sepsis (35%), haemorrhage (18%), and eventration (22%). Postoperative mortality was 64.5%, including 76% after emergency operations, and 54% after elective surgery. After operations on the bile ducts 55% patients died. So the operations should not be performed in asymptomatic cholelithiasis during cirrhosis since there is no evidence that it deteriorates the patients' condition, and the mortality is very high. The causes are discussed of poor prognosis after surgery in cirrhosis, as well as the principles of management which may contribute to reduction of the number of complications and to a drop in mortality.

Involvement of synaptosomal neurotransmitter amino acids in audiogenic seizure-susceptibility and -severity of Rb mice.

The involvement of synaptosomal neurotransmitter amino-acids in seizure susceptibility and seizure severity was explored. The amino-acid contents of brain synaptosomes were determined in three sublines of Rb mice differing in their response to an acoustic stimulus: Rb1, clonic-tonic seizure-prone, Rb2, clonic seizure-prone, and Rb3, seizure-resistant. Synaptosomes were prepared from 6 brain areas considered to be involved in seizure activity: olfactory bulbs, amygdala, inferior colliculus, hippocampus, cerebellum, pons-medulla. The steady-state levels of GABA and glycine (Gly), inhibitory amino-acids, of taurine (Tau), an inhibitory neurotransmitter of neuromodulator, of aspartate (Asp) and glutamate (Glu), excitatory amino-acids, as well as of serine (Ser) and glutamine (Gln), two precursors of neurotransmitter amino-acids, were determined by HPLC. Low levels of Tau, GABA, and Ser in hippocampus, Gly in amygdala, Glu in hippocampus, inferior colliculus and pons, Gln and Asp in inferior colliculus appeared to correlate with seizure-susceptibility. GABA and Asp in olfactory bulb, Gln in amygdala, hippocampus and pons, ser in olfactory bulb and pons, appeared to be associated either with seizure-severity or -diversity. A strong involvement of hippocampus (Tau, GABA, Ser, Glu, and Gln) and inferior colliculus (Asp, Glu, Gln) in audiogenic seizure-susceptibility, and of olfactory bulb (GABA, Asp) in seizure-severity and/or -diversity is suggested.

Subcutaneous low molecular weight heparin versus subcutaneous unfractionated heparin in the treatment of deep vein thrombosis: a Polish multicenter trial.

In a prospective multicenter trial, 149 consecutive patients with phlebographically proven proximal and/or distal deep vein thrombosis of the leg were randomly allocated to receive subcutaneously for 10 days either low molecular weight heparin CY 216 (Fraxiparine) in a fixed dose or unfractionated heparin (UFH) in doses adjusted according to the activated partial thromboplastin time. Pre- and post-treatment phlebograms were assessed blindly using the Arnesen's score system in 134 patients available for analysis of the treatment efficacy. The mean phlebographic score after 10 days of treatment was significantly decreased in both groups (p less than 0.001) in comparison with the baseline score but the difference in score changes between the two groups was not statistically significant. There was an improvement in 45/68 patients (66%) in the Fraxiparine group and in 32/66 patients (48%) in the UFH group, and an increase in the thrombus size in 10/68 (15%) and 12/66 (18%), respectively. One symptomatic non-fatal pulmonary embolism and one major bleeding episode were observed in the UFH group. During a follow-up period of 3 months, two rethromboses had occurred in the UFH group and none in the Fraxiparine group. It is concluded that subcutaneous fixed dose Fraxiparine is safe and at least as effective as subcutaneous adjusted UFH in the treatment of deep vein thrombosis.

[Postoperative complications and mortality; results of skin tests in delayed hypersensitivity]. / Powiklania pooperacyjne i smiertelnosc a wyniki testu skórnej opóznionej nadwrazliwosci.

In 221 patients the test of cutaneous delayed hypersensitivity was done before the operation and 4 days after it, using 3 antigens: tuberculin, distreptase and phytohaemagglutinin. The patients were divided into three groups: I control (109) subjected to minor and moderately serious operations, and study group (II) with peritonitis (IIa 40 cases), digestive tract cancer (IIb 65 cases) and digestive tract diseases (IIc 7 cases). The study showed that in cases with preoperative anergy to antigens the operations were followed significantly more frequently by serious septic complications and mortality from these complications was much higher. No patients with preoperatively normal responses to the antigens died after the operations. The test makes possible preoperative detection of high surgical risk connected with infection, and early treatment reducing postoperative mortality.

GABAA sodium independent receptor sites in a strain of rats presenting generalized non-convulsive seizures.

The role of gamma-aminobutyric acid (GABA), a major inhibitor neurotransmitter in the central nervous system (CNS), is well established in the genesis and the control of epilepsies. The purpose of this work was to study the binding parameters of the Na(+)-independent GABA receptors in the brain of a strain of rats presenting spontaneous generalized non-convulsive seizures. The high- and low-affinity binding sites were evaluated in cerebral cortex, cerebellum, and hippocampus using [3H]muscimol. No significant modification was observed for the Bmax and the Kd of high-affinity binding sites, although a slight decrease of Bmax was noted in the three brain areas in rats with seizures. Concerning the low-affinity binding sites, significant decreases were observed in the values of Bmax in the cortex, cerebellum, and hippocampus of animals with spontaneous seizures, without modification of Kd values. Such changes could be considered to be involved in some of the physiological and behaviour activities observed in this strain of rats.