Atheromatous embolization resulting in acute pancreatitis after cardiac catheterization and angiographic studies.

Acute pancreatitis has a spectrum from mild disease to severe organ destruction resulting in multiple system organ failure. In this study, we report data from 21,680 discharge summaries during a 10-year period of patients who had undergone transabdominal angiographic procedures in whom the diagnosis of pancreatitis was noted in the discharge coding. We detected 39 patients in whom pancreatitis was coded during the same hospitalization, but only nine patients had no other risk factors for pancreatitis other than the temporal relation with the angiographic procedure. Three of these nine patients died of complications caused by pancreatitis. All of the patients with poor outcomes in this report fulfilled more than three Ranson criteria within 48 hours of the original angiographic procedure. Abdominal imaging with ultrasound or computed tomography was abnormal in all the patients who fulfilled more than three Ranson criteria. The histology from the surgical procedures or the autopsies performed on the three patients who died showed extensive cholesterol embolization primarily to the visceral organs. Extensive pancreatic necrosis was evident in these patients. We conclude that acute pancreatitis after transabdominal angiographic procedures is a rare but a potential fatal event. The prognosis from this event is partially predicted by the Ranson criteria that are evident within the first 48 hours.

[Peptic ulcer disease and Helicobacter pylori. A comparative study of two different three-drug regimens].

Helicobacter pylori (H. pylori) is now known to be strongly associated with gastritis type B, duodenal ulcer, gastric ulcer and perhaps gastric cancer. To cure peptic ulcer disease has become reality. This prospective study included 60 patients, 41 male and 19 females, with long history of peptic ulcer disease (1 - 41 yr, mean 16.5 yr), diagnosed with active duodenal ulcer (50) or gastric ulcer (10) during endoscopy of the upper gastrointestinal tract. After a positive CLO test and histologic confirmation as well as positive culture of H. pylori from the antral mucosa, patients were treated with conventional anti-ulcer therapy. After ulcers were healed (usually in 4 - 6 weeks) patients were randomized to take one of two regimens: 1) colloid bismuth sub-citrate 120 mg, four times a day for 28 days, metronidazole 400 mg, three times a day for 10 days and tetracyclin (DMT) 250 mg, four times a day for 14 days, 2) De-Nol 120 mg, four times a day for 28 days, metronidazole 400 mg, three times a day for 10 days and ampicillin 500 mg, four times a day for 14 days (DMA). Careful monitoring of compliance, symptoms, side effects, H. pylori status and ulcer recurrence by endoscopy was performed at one, two, six and 12 months after completion of triple therapy. Duodenal ulcer recurred in all six patients, that remained H. pylori positive (10%). Eradication of H. pylori was achieved in all patients (30) treated with DMT, and they remained H. pylori negative throughout the 12 months follow-up period. The compliance to the treatment regimens was excellent (<95%). Side effects were frequent (38%), but mild in most cases, mainly soft stool and nausea. One patient had to discontinue the treatment. Re-infection rate was 2% (one patient) during the 12 months follow-up period. A triple therapy with DMT was 100% effective in eradicating H. pylori and statistically superior (p = 0.0105) to DMA at 12 months follow-up. No ulcer recurrence occured in H. pylori negative patients. The importance of persistent and marked symptomatic improvement observed in this study as compared to conventional maintenance treatment has not been emphasized enough in the recent debates on ulcer treatment modalities. The ultimate benefit of H. pylori eradication in peptic ulcer disease should be evaluated by long term follow up studies..

Biomechanical characteristics of the human esophagus.

Biomechanical wall properties of the human esophagus were studied. A probe, with a balloon designed for simultaneous measurement of cross-sectional area and intraluminal pressure, was placed in the esophagus 30 cm from the incisors. Tone was not detected before inflation of the balloon. When the balloon was inflated stepwise with pressures up to 40 cm H2O (30.7 mmHg), measurement of cross-sectional area allowed calculation of distensibility and circumferential wall tension. Balloon cross-sectional area increased linearly with increased balloon pressure. Balloon distension induced contractions, both proximal to the balloon and at the site of distension, at a balloon pressure of about 15 cm H2O (11.5 mm Hg). The cross-sectional area for the threshold for distension induced contractions was 153 +/- 12 mm2 (diameter 14 mm). At the onset of these contractions, the contraction force was 15-20 cm H2O (11.5-15.3 mm Hg) and it increased to 47-58 cm H2O (36.1-44 mm Hg) at a balloon pressure of 20-40 cm H2O (15.3-30.7 mm Hg). Circumferential wall tension increased with increasing intraluminal pressure in an almost exponential manner. The pressure elastic modulus increased steeply at lower balloon pressures (10-20 cm H2O) (7.7-11.5 mm Hg), but at higher balloon pressures (20-40 cm H2O) (15.3-30.7 mm Hg) this increase was less. The circumferential wall tension and wall stiffness of the human esophagus increased with increasing balloon pressure and cross-sectional area. When a threshold is reached, distension induced contractions both proximal and distal to the balloon and at the distension site.

Biomechanical properties of duodenal wall and duodenal tone during phase I and phase II of the MMC.

We used a new method, impedance planimetry, to look at variations in compliance, tone, and distension-induced peristaltic activity during phase I and phase II of the migrating myoelectric complex (MMC) in the human duodenum. A balloon was inflated stepwise with pressures up to 30 cmH2O in the duodenum, while the pressure and balloon cross-sectional area (CSA) were measured simultaneously. The biomechanical wall parameters were calculated from these measurements. Nine duodenal phase IIIs were recorded in six subjects. A balloon pressure of 20 cmH2O induced a smaller CSA in early phase I [266 (236-324) mm2] than in late phase II [385 (276-474) mm2] (P < 0.05). Balloon distensions elicited no contractions in phase I, whereas they increased contractile activity 60% (P < 0.05) proximal to the balloon and 4% distal to the balloon in late phase II. Step distensions in phase I with balloon pressures between 10 and 30 cmH2O increased the CSA from 40 (30-81) to 645 (603-704) mm2. It increased circumferential wall tension from 35 (28-63) to 429 (402-466) mm x cmH2O and the pressure elastic modulus from 9.7 (9.0-14.7) to 33.8 (27.6-33.8) cmH2O, respectively. Thus compliance differs from phase I to phase II. This is most likely caused by increased smooth muscle tone during phase I. Duodenal wall stiffness increases with the balloon pressure applied.