Plasmapheresis in the management of acute severe hyperlipidemic pancreatitis: report of 5 cases.

BACKGROUND/AIM: Hyperlipidemic pancreatitis is an acute and potentially life-threatening complication of hypertriglyceridemia that can be provoked when triglyceride levels (TGL) exceed 11.3 mmol/l (1,000 mg/dl). Except for standard symptomatic treatment, plasmapheresis has been performed to rapidly reduce TGL and chylomicron levels in the blood. In 5 patients with hyperlipidemic pancreatitis, treatment with plasmapheresis was evaluated. METHODS: Five male patients who suffered from acute pancreatitis with severe primary hyperlipidemia were studied. In addition to the standard treatment, they were treated with plasmapheresis. RESULTS: Plasma exchange lowered the lipid level and TGLs in all cases. It also improved abdominal pain, the clinical state of the patients, and signs and symptoms of the disease. Complications of treatment were not encountered, none of the patients died and only 1 patient underwent surgery. Follow-up of the patients lasted 4-28 months, and recurrence of pancreatitis was not noted. CONCLUSION: Our study showed that plasmapheresis was successfully applied in patients with hyperlipidemic pancreatitis, especially to improve the acute phase of the disease.

[Surgical treatment of ruptures of hydatid cysts of the liver]. / Traitement chirurgical des ruptures des kystes hydatiques du foie.

During the last 20 years (1972-1992), 421 patients underwent surgery for hydatid disease of the liver. 96 out of 421 patients had a rupture such as, intrabiliary rupture 49 patients, intrathoracic rupture 43 patients and free rupture in the peritoneal cavity 4 patients. The surgical treatment required a variety of procedures: 1) Prolonged tube drainage of the residual cavity and exploration of the common bile duct followed by either T tube drainage or sphincteroplasty or choledocho-duedonostomy if it was necessary, for intrabiliary rupture. 2) Lung resection if it was necessary, and evacuation plus drainage and the hepatic cavity followed by suture of the diaphragmatic rupture of closure of the bronchial opening if present for intrathoracic rupture. 3) Lavage and prolonged tube drainage of the hepatic cavity for free rupture in the peritoneal cavity. Five patients died in the postoperative period one from suppurative cholagitis, one from pulmonary embolism and 3 from M.O.F.

[Role of cyclic AMP in gastric secretion. The secretion and mechanism of action of gastrin]. / Le rôle de l'AMP cyclique dans la sécrétion gastrique. Sécrétion et mécanisme d'action de la gastrine.

The present study involved evaluation of the role played by cyclic AMP on the secretion and mechanism of action of gastrin in man. On the basis of the results obtained, gastrin secretion induced by an excessive rise in gastric pH is accompanied by a simultaneous increase in plasma cyclic AMP concentrations (p less than 0.05) as well as a tissue cyclic AMP in the region of the fundus (p less than 0.001). By contrast, no significant change was seen regarding antropyloric AMP. As a result, it is felt that cyclic AMP does not play a direct role in the secretion of gastrin by G cells but is a mediator of the mechanism of action of gastrin in terms of the secretion of HCl by the parietal cell.

[Role of cyclic AMP in gastric secretion. Mechanism of action of pentagastrin and cimetidine]. / Le rôle de l'AMP cyclique dans la sécrétion gastrique. Mécanisme d'action de la pentagastrine et de la cimetidine.

Studies were conducted to explore the effects of pentagastrin, cimetidine, cimetidine with pentagastrin and atropine with pentagastrin, on the gastric acidity and on cAMP accumulation in gastric fundic mucosa in six healthy human beings. Following gastroscopy, gastric juice was collected, and total gastric acidity was measured. Biopsies of fundic mucosa were obtained for estimation of cAMP. All these measurements were taken place before (control) and after the administration of the medicaments. Pentagastrin increased total gastric acidity and cAMP accumulation. Cimetidine decreased both respectively. Combination of cimetidine with pentagastrin and atropine with pentagastrin increased total gastric acidity and cAMP concentration of gastric mucosa. An excellent linear correlation was also found between gastric acidity and fundic mucosal cAMP. These results support the hypothesis of a regulatory role for pentagastrin and cimetidine in total gastric acidity via a cAMP dependent mechanism in gastric mucosa in human. Our findings give a strong indication in Grossman's proposal that the parietal cell has multiple receptors sites.

[Long-term recurrence and complications of 300 supra-selective vagotomies for simple chronic duodenal ulcer]. / Récidives à long terme et complications de 300 vagotomies supra-sélectives pour ulcère duodénal chronique simple.

Three hundred H.S.V. for chronic duodenal ulcer, performed between 1972 and 1982, are reviewed. A thorough analysis of intra and post-operative complications points out that only ulcer recurrence still set problems. These concern their definition, frequency, diagnosis and treatment. The personal experience of the authors leads them, in case of failure of the medical treatment with and endoscopically proved ulcer--what happened in 6 patients of 17 (35,8%)--to prefer gastric resection to re-vagotomies, the performance of which is often difficult and the results uncertain.

Effect of aprotinin on fibrinopurulent peritonitis in rats.

The effect of aprotinin on the clinical and pathologic course of experimentally induced peritonitis in the rat was studied. Peritonitis was induced in 40 rats by creating a closed ileal loop 4 cm long 5 cm from the ileocecal valve. The rats were divided into two groups of 20 rats each. Group 1 served as a control group, whereas each animal in Group 2 received a bolus dose of aprotinin (10 ml) intraperitoneally immediately after closing the laparotomy. In the aprotinin-treated group, survival was drastically increased (p less than 0.01) and formation of adhesions and abscesses was considerably reduced. The results of peritoneal cultures showed a decreased incidence of Escherichia coli and Clostridia in the aprotinin-treated group. We conclude that the administration of aprotinin significantly prolongs the survival time of animals with peritonitis and reduces the development of adhesions and abscesses in the peritoneal cavity. This beneficial effect can be attributed to decreased fibrinogen deposits within the peritoneal cavity and the stabilization of the organism after bacterial shock. Thus, bacteria were more susceptible to cellular and noncellular clearing mechanisms.

[Secretion of gastric acid, gastrin and cyclic nucleotides in relation to the action of the vagus nerve]. / La sécrétion de l'acide gastrique, de la gastrine et des nucléotides cycliques en rapport avec l'action du nerf vague.

Changes on levels gastric acidity, on serum gastrin, cAMP and cGMP levels were studied in 18 healthy volunteers after either stimulation (injection of 0.2 IU of soluble insulin/kg body weight to a group of 9 subjects) or stimulation and inhibition (injection of insulin plus atropine per os to the other group of 9 subjects) of the vagus nerve. After vagus nerve stimulation, gastric acid levels, serum gastrin and cGMP were raised and cAMP reduced. After stimulation and inhibition of vagus nerve, gastrin and cAMP were increased, cGMP reduced and gastric acid levels remained unchanged. These findings suggest that the vagus nerve, and more particularly the acetylcholine released from its metaganglionic fibers, stimulate parietal cells provoking acid secretion, and also stimulate G cells with subsequent gastrin secretion through cGMP.