Organ microcirculatory disturbances in experimental acute pancreatitis. A role of nitric oxide.

Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis (AP). The aim of the study was to investigate an influence of L-arginine (nitric oxide substrate) and N(G)-nitro-L-arginine (L-NNA, nitric oxide synthase inhibitor) on organ microcirculation in experimental acute pancreatitis induced by four consecutive intraperitoneal cerulein injections (15 microg/kg/h). The microcirculation of pancreas, liver, kidney, stomach, colon and skeletal muscle was measured by laser Doppler flowmeter. Serum interleukin 6 and hematocrit levels were analyzed. AP resulted in a significant drop of microperfusion in all examined organ. L-arginine administration (2 x 100 mg/kg) improved the microcirculation in the pancreas, liver, kidney, colon and skeletal muscle, and lowered hematocrit levels. L-NNA treatment (2 x 25 mg/kg) caused aggravation of edematous AP to the necrotizing situation, and increased IL-6 and hematocrit levels. A further reduction of blood perfusion was noted in the stomach only. It is concluded that L-arginine administration has a positive influence on organ microcirculatory disturbances accompanying experimental cerulein-induced AP. NO inhibition aggravates the course of pancreatitis.

[Management of postoperative pancreatic fistula resistant to octreotide therapy]. / Postepowanie z pooperacyjnymi przetokami trzustkowymi opornymi na leczenie oktreotydem.

Pancreatic fistula is a rare postoperative complication, usually occurring after pancreatic surgery. Majority of them heal spontaneously, some patients require somatostatin/octreotide treatment. The authors have presented 11 patients with postoperative pancreatic fistula, in whom octreotide therapy in dose of 0.1 mg t.i.d./10 days has been ineffective. The causes of pancreatic fistula have been as follows: necrosectomy of the infected pancreatic necrosis--5 patients, distal pancreatic resection--2 patients, insulinoma enucleation--2 patients, gastrectomy with partial pancreatectomy--2 patients. In 9 patients endoscopic stenting of the main pancreatic duct has been performed. In remained 2 patients after Roux-en-Y gastrectomy the endoscopic access to Vater papilla has been impossible and the patients have received one intramuscular injection of long acting somatostatin analogue. In 8 of 9 patients with pancreatic stenting and in two patients after gastrectomy the fistula has been closed within the period of 6-17 days. In one patient after the necrosectomy the prosthesis implacement has been ineffective. This patient has been successfully treated with two additional injections of long acting somatostatin analogue (one injection/14 days). Authors have concluded that endoscopic pancreatic stenting has been an effective method of treatment of the postoperative pancreatic fistula, resistant to octreotide therapy. In some cases, additional administration of long acting somatostatin analogue has been necessary.

Nonrandom chromosomal aberrations and cytogenetic heterogeneity in gallbladder carcinomas.

Chromosome banding analysis of 11 short-term cultured gallbladder carcinomas revealed acquired clonal aberrations in seven tumors (five primary and two metastases). Three of these had one clone, whereas the remaining four were cytogenetically heterogeneous, displaying two to seven aberrant clones. Of a total of 21 abnormal clones, 18 had highly complex karyotypes and three exhibited simple numerical deviations. Double minutes and homogeneously staining regions were observed in one and two carcinomas, respectively. To characterize the karyotypic profile of gallbladder cancer more precisely, we have combined the present findings with our three previously reported cases, thereby providing the largest cytogenetic database on this tumor type to date. A total of 287 chromosomal breakpoints were identified, 251 of which were found in the present study. Chromosome 7 was rearranged most frequently, followed by chromosomes 1, 3, 11, 6, 5, and 8. The bands preferentially involved were 1p32, 1p36, 1q32, 3p21, 6p21, 7p13, 7q11, 7q32, 19p13, 19q13, and 22q13. Nine recurrent abnormalities could, for the first time, be identified in gallbladder carcinoma: del(3)(p13), i(5)(p10), del(6)(q13), del(9)(p13), del(16)(q22), del(17)(p11), i(17)(q10), del(19)(p13), and i(21)(q10). The most common partial or whole-arm gains involved 3q, 5p, 7p, 7q, 8q, 11q, 13q, and 17q, and the most frequent partial or whole-arm losses affected 3p, 4q, 5q, 9p, 10p, 10q, 11p, 14p, 14q, 15p, 17p, 19p, 21p, 21q, and Xp. These chromosomal aberrations and imbalances provide some starting points for molecular analyses of genomic regions that may harbor genes of pathogenetic importance in gallbladder carcinogenesis. Genes Chromosomes Cancer 26:312-321, 1999.

Nitric oxide, heparin and procaine treatment in experimental ceruleine-induced acute pancreatitis in rats.

The aim of the study was to investigate the impact of L-arginine (nitric oxide donor), L-NNA (NO synthase inhibitor), heparin and procaine on the pancreas' microcirculation, serum interleukin 6 (IL-6) level, and microscopic alterations of the pancreatic gland in acute pancreatitis (AP) in rats. AP was induced by 4 i.p. injections of cerulein (15 micrograms/kg/h). Microcirculatory values of the pancreas were measured by means of laser Doppler flowmetry 5 h after the first cerulein injection. Remarkable morphologic changes in the pancreas, including parenchymal necrosis, an elevation of serum IL-6 activity, and significant drop of pancreatic capillary perfusion was observed in rats with NO synthase inhibition. L-arginine improved the pancreatic microcirculation but worsened the microscopic alterations within the pancreas. Heparin had a beneficial effect on the microcirculatory values, serum IL-6 activity, and morphologic changes. Procaine had no effect on the course of AP. Authors conclude that heparin, improving the pancreatic capillary blood perfusion, may be considered as a promising therapeutic agent in acute pancreatitis.

[Laparoscopic adrenalectomy from the lateral retroperitoneal approach]. / Adrenalektomia laparoskopowa z dostepu pozaotrzewnowego.

From April to November 1998 eleven patients (8 female and 3 male, mean age 48.5; range 23-69) with adrenal gland tumor underwent laparoscopic adrenalectomy from the lateral retroperitoneal approach. Authors report their primary experience; introduce their own material and describe the operative technique of laparoscopic adrenalectomy from lateral retroperitoneal approach. Besides one case of Conn syndrome, all tumors were hormonally non-active. In 10 patients the adrenal masses were incidentally discovered during such imaging examination as abdominal ultrasonography and computed tomography. All tumors were benign in postoperative histopathological examination. The localization was unilateral and suprarenal in all cases (7 right, 4 left). Both operation and postoperative course in all patients were uncomplicated. One conversion to "open" procedure had been performed due to laparoscopic equipment damage.

Effect of Helicobacter pylori infection, smoking and dietary habits on the occurrence of antrum intestinal metaplasia. Clinico-epidemiological study in Poland.

The purpose of the study was to assess risk factors for intestinal metaplasia arising from H. pylori-related chronic gastritis in a subset of the population referred to endoscopic examinations due to dyspeptic complaints. We aimed specifically to establish whether H. pylori itself may be responsible for the occurrence of intestinal metaplasia and to which extent the metaplasia may be associated with life style factors such as cigarette smoking, alcohol consumption or dietary habits. The study was carried out in a sample of 1290 outpatients referred for the first time to gastroenterologic outpatient clinics in 6 university centers in Poland. The study methods covered standardized health interviews, endoscopy and histology of gastric antral specimens taken at endoscopy. The interviews performed by trained interviewers sought information on tobacco and alcohol intake, diet, socioeconomic status, and other variables. In non-ulcer dyspepsia subjects there was 54.9% H. pylori related gastritis and 25.1% of non-H. pylori-related gastritis. The corresponding rates in the group of ulcer dyspepsia were 67.5% and 20.5%. The increased risk of chronic gastritis in antrum was associated with Helicobacter pylori infection (OR = 2.28; 95% CI:1.93-2.69), and with gastric peptic ulcer (OR = 1.88; 95% CI:1.20-2.94). In the non-ulcer dyspepsia the prevalence of metaplasia was 11.1% and in ulcer dyspepsia 19.7%. The risk of intestinal metaplasia within antrum depended greatly upon the presence of gastric peptic ulcer (OR = 3.85; 95% CI:2.35-6.32) and increased with age (OR = 1.05; 95% CI:1.04-1.07), smoking cigarettes currently or in the past (OR = 1.42; 95% CI:1.10-1.84), higher frequency of drinking vodka (OR = 1.32, 95% CI:1.01-1.75) and antral chronic gastritis (OR = 1.31; 95% CI:1.00-1.70), however, it was inversely related to daily consumption of fresh fruits or vegetables (OR = 0.59; 95% CI:0.38-0.93). The results of the study suggest that there is no sufficient evidence supporting the hypothesis about an association between H. pylori gastritis and intestinal metaplasia, however, the transition of gastritis to metaplasia depends greatly on life style factors such as cigarette smoking or vodka drinking and is impeded by daily consumption of fresh fruits or vegetables.

Heparin and nitric oxide treatment in experimental acute pancreatitis in rats.

The aim of this study was to investigate the impact of L-arginine (nitric oxide synthase substrate), L-NG-nitro-L-arginine (nitric oxide synthase inhibitor), and heparin on the pancreas microcirculation, serum IL-6 level and microscopic alterations of the pancreas in acute pancreatitis in rats. Acute pancreatitis was induced by 4 i.p. injections of cerulein (15mg/kg). Microcirculatory values were measured by means of laser Doppler flowmetry 5 h after the first cerulein injection. Remarkable histopathological changes in the pancreas, including parenchymal necrosis, an elevation of serum IL-6 level, and a significant drop of pancreatic capillary perfusion was observed in rats with nitric oxide synthase inhibition. L-arginine improved the pancreatic microcirculation but worsened the microscopic alterations within the pancreas. Heparin had a beneficial effect on the microcirculatory values, serum IL-6 concentration, and morphologic changes. Authors conclude that inhibition of nitric oxide synthase aggravates acute pancreatitis. L-arginine treatment improves pancreatic perfusion but potentiates morphological alterations. Heparin, improving the microcirculation and inflammatory changes within the pancreatic gland, may be considered as a promising therapeutic agent in acute pancreatitis.

Microcirculatory disturbances of the pancreas in cerulein-induced acute pancreatitis in rats with reference to L-arginine, heparin, and procaine treatment.

Local microcirculatory dysfunction within the pancreatic gland might be an important factor in the conversion of oedematous to necrotizing pancreatitis. Therapeutic agents, improving the pancreatic blood flow, might be valuable in acute pancreatitis treatment. An influence of nitric oxide, heparin and procaine treatment on microcirculatory values in acute pancreatitis (AP) in rats was investigated. Acute pancreatitis was induced by i.p. injection of cerulein in four doses of 15 microg kg-1 each at 1-h intervals. The rats with pancreatitis were divided into five groups, 12 animals each. One group remained without treatment, four groups were treated i.p. either with NO synthase inhibitor L-NNA (2x25 mg kg-1 or heparin 2x2.5 mg kg-1 or L-arginine 2x100 mg kg-1 or procaine 2x25 mg kg-1. Five control groups, ten animals each, received saline, L-NNA, heparin, L-arginine or procaine only. Five hours after the first ceruleine injection microcirculatory values within the pancreas were measured by means of laser Doppler flowmetry. Acute pancreatitis caused a significant drop of microcirculatory value to 37% of the basal value. The L-NNA administration resulted in a further insignificant reduction of the pancreatic blood flow to 34%. An improvement of microcirculation was observed in rats with pancreatitis receiving heparin (76%) and L-arginine (72%). Procaine had no effect on microcirculatory disturbances within the pancreas in rats with pancreatitis. Cn-induced acute pancreatitis (AP) causes microcirculatory deterioration within the pancreas. Heparin and nitric oxide donor, L-arginine, might be considered as therapeutic agents, improving the diminished pancreatic tissue perfusion observed in acute pancreatitis. Procaine does not improve the pancreatic blood flow in acute pancreatitis.

[Microcirculation disorders of the pancreas in cerulein induced acute pancreatitis in rats with regard to nitrogen oxide and heparin]. / Zaburzenia mikrokrazenia w trzustce w ceruleinowym ostrym zapaleniu trzustki u szczurów z uwzglednieniem wplywu tlenku azotu i heparyny.

UNLABELLED: Microcirculatory disturbance may play an important role in the development of severe pancreatitis, leading the edematous form of the disease to the necrosis. The aim of this study was to investigate the impact of L-arginine (nitric oxide donor), L-NN (NO synthase inhibitor), and heparin on the pancreas microcirculation, serum interleukin-6 level and microscopic alterations of the pancreas in acute pancreatitis in rats. METHODS: Acute pancreatitis was induced in 72 rats by four intraperitoneal injections of cerulein (CN) (15 micrograms/kg body weight). Microcirculatory values was measured by means of laser Doppler flowmetry five hours after the first cerulein injection. The animals were divided into the following groups (12 rats each), according to the kind of treatment: Group 1 (CN), Group 2 (CN + L-NNA), Group 3 (CN + L-arginine), Group 4 (CN + Heparin), Group 5 (Control), Group 6 (L-NNA), Group 7 (L-arginine), Group 8 (Heparin). RESULTS: Remarkable morphologic changes in the pancreas including parenchymal necrosis, an elevation of serum IL-6 level, and significant drop of pancreatic capillary perfusion was observed in rats with NO synthase inhibition. L-arginine improved the pancreatic microcirculatory but worsened the microscopic alteration within the pancreas. Heparin had a beneficial effect on the microcirculatory values, serum IL-6 concentration, and morphologic changes. CONCLUSIONS: Acute pancreatitis causes microcirculatory disturbance within the pancreatic gland. The inhibition of NO synthase aggravates AP. L-arginine treatment improves pancreatic perfusion but potentiates morphologic alterations. Heparin has beneficial impact on AP, it improves the microcirculation and inflammatory changes within the pancreatic gland.

[Modification of proteins in the course of oxidative stress in acute experimental pancreatitis]. / Modyfikacja bialek w przebiegu stresu tlenowego w ostrym doswiadczalnym zapaleniu trzustki.

This study aimed to investigate the protein peroxidation process in cerulein induced acute pancreatitis. Eighteen rats were divided into three equal groups: group 1 acted as control rats had intraperitoneal injection of 0.9% NaCl, in group 2 and 3 rats had injection of cerulein 40 micrograms kg-1 for 3 or 6h of induction period respectively. Protein carbonyls which reflect peroxidative damage were found to be increased after 3h up to 2.53 +/- 0.49 comparing to 1.05 +/- 0.17 in control group and returned to control level 0.95 +/- 0.04 after 6h. These data suggest that during acute pancreatitis free radicals may play an essential role in protein damage. Decrease in protein carbonyls content after 6h suggests an elevated proteolysis of oxidatively damaged proteins.

[Continuous arteriovenous hemofiltration in the management of patients with shock and multiorgan insufficiency syndrome]. / Samoistna ciagla tetniczo-zylna hemofiltracja w leczeniu chorych we wstrzasie z zespolem niewydolnosci wielonarzadowej.

Spontaneous continuous arterio-venous hemofiltration (CAVH) is a blood purification system based on blood filtration through capillary hemofilters without pumps, using the arterio-venous pressure gradient for blood perfusion. In 2-nd Department of Surgery of Medical University of Gdansk in the years 1989-1996 we introduced CAVH 13 times in 6 women and 7 men, aged from 17 till 79 years. We used this technique to maintain fluid balance in anuric patients needing parenteral fluids. Due to circulatory and respiratory insufficiency all patients needed catecholamines infusion and controlled respiration. In 7 patients acute renal failure was caused by septic shock and in 6 patients by shock after severe multiorgan injuries. The CAVH therapy lasted from 3 till 16 days. The stabilisation of hemodynamic and renal parameters was observed in all patients. 3 patients died of cranio-cerebral injuries and 2 due to longlasting septic shock induced by necrotic pancreatitis. In all patients CAVH was required to remove the excess water given as carrier in total parenteral nutrition. Experience with 13 cases has shown the CAVH technique, to be particularly useful in patients with vascular instability or severe fluid overload. The above method which needs no technical investment is simple to handle.

[Evaluation of using fibrin tissue adhesive (Beriplast) and preparations of thrombin and adrenalin in injection hemostasis methods for gastric and duodenal ulcer hemorrhage. Randomized, prospective clinical trial]. / Ocena zastosowania fibrynowego kleju tkankowego (Beriplastu) oraz roztworu trombiny z adrenalina w metodzie iniekcyjnej tamowania krwawien z owrzodzen trawiennych zoladka i dwunastnicy. Randomizowana, prospektywna próba kliniczna.

A prospective randomized trial involving 30 patients was performed to assess whether second-look endoscopy could improve the efficacy of injection therapy for bleeding peptic ulcers. The inclusion criteria were the presence of active arterial bleeding or a non-bleeding visible vessel at emergency endoscopy. All the patients received emergency injection of thrombin with adrenaline solution and were subsequently randomized (15 patients in each group). All the patients receive a second elective endoscopy within the first 24 hours with repeated injection of thrombin-adrenaline solution (Group I) or fibrin sealant-Beriplast-(Group II). A tendency towards better results was noted in the Group II. Recurrent bleeding was observed in 6.6% versus 26.6% patients in Group I. The need for emergency surgery occurred in (6.6% in Group I versus 0 in Group II) and length of hospital stay was (13.2 in Group I versus 7.4 in Group II [p < 0.05]). No mortality was observed in both of the groups. In conclusion, our data suggest the possibility of a small benefit with second-look endoscopy with repeated injection of fibrin sealant.

Is nitric oxide and heparin treatment justified in inflammatory bowel disease? An experimental study.

Microcirculatory disturbances of the colon may contribute to the pathogenesis of inflammatory bowel disease. The aim of the study was to investigate the alterations of rectal blood perfusion in experimental colitis with reference to nitric oxide and heparin treatment. The study was carried out on 36 rats, divided into six groups: group I, control; group II, control + NG-nitro-L-arginine (L-NNA); group III, colitis without treatment; group IV, colitis + L-arginine; group V, colitis + L-NNA; group VI, colitis + heparin treatment. Experimental colitis was induced by 4% acetic acid enema, and 48 h after the enema, besides the measurement of rectal capillary blood flow by means of laser Doppler flowmetry, the serum interleukin-6 (IL-6) level and histopathological alterations within the rectal mucosa were examined. Experimental colitis resulted in a drop in rectal wall perfusion. L-Arginine and heparin treatment improved the microcirculatory values. The highest IL-6 level and the most advanced histopathological alterations were observed in the rats treated with L-NNA. L-Arginine treatment had no influence on IL-6 concentration, however it aggravated the inflammatory changes within the rectal mucosa. Heparin administration reduced the IL-6 values and also had a positive impact on the microscopic alterations within the rectal wall. It is concluded that heparin treatment has a beneficial effect on the microcirculatory disturbances and inflammatory changes observed in experimental colitis. The inhibition of nitric oxide-synthase aggravated the course of experimental colitis. L-Arginine administration improves the rectal blood flow but aggravates the histopathological alterations within the rectal wall.

Does nitric oxide protect from microcirculatory disturbances in experimental acute pancreatitis in rats?

The aim of the study was to investigate the potential role of nitric oxide (NO) on the microcirculation in experimental acute pancreatitis in rats. Twenty-five rats were divided into the following groups: group A (5 rats) = control; group B (5 rats) = acute pancreatitis induced by retrograde taurocholate infusion into the pancreatobiliary duct without treatment; group C (5 rats) = acute pancreatitis treated with the NO donor L-arginine; group D (5 rats) = acute pancreatitis treated with the NO synthase inhibitor N-nitro-L-arginine (L-NNA); group E (5 rats) = without pancreatitis receiving L-NNA. The animals were observed throughout 4 h. The microcirculatory values of the pancreas, liver, colon, stomach and kidney were measured by means of laser Doppler flowmetry. Three animals of group D died after the third hour of the experiment. In rats with pancreatitis, a rapid decrease in microcirculatory values was observed. The most pronounced drop in capillary blood flow within all the organs was observed in rats treated with the NO synthase inhibitor L-NNA, L-arginine administration in rats with acute pancreatitis slightly improved the microcirculatory values, although the improvement was significant in colon perfusion only. We conclude that NO may have a beneficial influence on the capillary organ perfusion in acute pancreatitis. The administration of an NO synthase inhibitor seems to have a detrimental effect on acute pancreatitis.

Protective effect of 4-hydroxy-TEMPO, a low molecular weight superoxide dismutase mimic, on free radical toxicity in experimental pancreatitis.

Rats develop acute pancreatitis when infused iv for 3 h with cerulein (10 micrograms/kg/h). Autopsies of the pancreas seen by light microscope show interstitial edema, acinar cells vacuolization, and leukocyte margination in pancreatic capillaries; under electron microscope, severe damage concerning mitochondrial and zymogen granules structures are apparent. Particularly, swelling of the mitochondria and disruption of mitochondrial cristae was observed as well as formation of large vacuoles arising from zymogen granules and liposome fusion. A significant increase of lipid hydroperoxide level in the pancreatic tissue was observed. The purpose of this study was to evaluate the effect of 4-hydroxy-TEMPO--a low-mol-wt superoxide dismutase mimic--in a rat cerulein model of acute pancreatitis, with the expectation that free radical mediated hydroperoxide formation and tissue damage may be reduced significantly. Twenty-one male Wistar rats were divided into three groups: Group 1 (n = 5) served as a control and was infused iv for 3 h with physiologic saline; Group 2 (n = 8) was infused i.v. for 3 h with cerulein 10 micrograms/kg/h; and Group 3 (n = 8) infused i.v. both with cerulein and 4-hydroxy-TEMPO 22.6 mg/kg/h. Pancreatic tissue damage was quantified by measuring lipid hydroperoxide (LOOH) level, the weight of the organ, and by light and electron microscopic examination. 4-hydroxy-TEMPO penetration across cellular membrane barriers was quantified by ESR spectrometric measurements of 4-hydroxy-TEMPO concentration in pancreatic tissue samples and pancreatic juice as well. Administering 4-hydroxy-TEMPO to rats resulted in preventing both lipid hydroperoxide formation and severe morphological damage. 4-hydroxy-TEMPO crossed cellular membrane barriers and was excreted to pancreatic juice. Infusion of 4-hydroxy-TEMPO appears to prevent pancreatic injury caused by free radicals in experimental cerulein pancreatitis.

[Thyroid cancer in material of the II Department of Surgery, Medical University of Gdansk]. / Rak tarczycy w materiale II Katedry i Kliniki Chirurgii Akademii Medycznej w Gdansku.

The aim of study is an evaluation of the diagnostic methods and results of surgical treatment 202 patients suffered from thyroid cancer. Those patients were operated on in II Department of Surgery Medical University of Gdansk in the years 1950-1993. There were 146 female and 56 males. Most frequently histological finding was papillar cancer--71 cases, follicular cancer in 57 cases, medullar cancer in 31 cases and anaplastic cancer in 43 cases. FNB diagnosis of the cancer was established 89% of the patients before operation, during operation in 96% cases. In the majority of the patients with papillar cancer total thyroidectomy were carried out but the medullar and anaplastic cancer this treatment was possible only in small numbers of cases. In majority of those patients adjuvant treatment was performed. 128 patients with well-differentiated thyroid cancer was treated 131. Radiotherapy have been applied in all patients with medullar and anaplastic cancer. In cases of well-differentiated thyroid cancer the serum thyroglobulin level was also determined.

[Advantages and controversies regarding physiologic electrostimulation of the heart in sinus node disease]. / Korzysci i kontrowersje tzw. fizjologicznej elektrostymulacji serca w chorobie wezla zatokowego.

UNLABELLED: Pacing mode in sinus node disease (SND) is one of controversies in cardiac pacing. We evaluated atrial pacing mode (AAI) in SND patients (pts). Between 1985 and 1994 AAI pacemaker was inserted in 179 pts due to symptomatic SND of varied etiology. RESULTS: The majority of pts (91.6%) were free from syncopal episodes after AAI implantation, in 15 pts (8.4%) syncopes were occasionally observed due to disturbances in pacemaker function, AVB III degrees, vaso-vagal syndrome, orthostatic hypotonia or atherosclerotic insufficiency of the cerebral circulation. In 49 (51%) out of 96 pts with brady-tachy syndrome (BTS), episodes of supraventricular tachyarrhythmia were not observed after AAI insertion and in the majority of the remaining pts the frequency of the episodes decreased significantly. Chronic atrial fibrillation developed in 5 (5.2%) pts. In some of the pts the symptoms related to chronic heart failure decreased or disappeared. A reoperation was performed in 44 (24%) pts due to electrode dislocation or fracture, atrio-ventricular conduction disturbances, an increase in pacing threshold or due to local infections. During the follow-up period 13 (7.3%) pts died of reasons unrelated to cardiac pacing therapy. CONCLUSION: In the majority of SND pts AAI pacing mode prevents from syncopal episodes caused by sinus node disfunction. It decreases the symptoms of heart failure in SND pts and stabilizes the sinus rhythm in the majority of BTS pts. Complications accompanying AAI do not post a major threat for the pts and can be easily resolved. They should by no means discourage from AAI implantation in SND.

The role of endoscopic thrombin injections in the treatment of gastroduodenal bleeding.

One hundred and ninety-one patients who had emergency endoscopy performed for acute gastroduodenal haemorrhage and were found to be bleeding actively (N = 141) or to have an ulcer containing a non-bleeding visible vessel (N = 50) were studied. Patients with active bleeding were divided into two groups: group I included 47 patients in whom diagnostic endoscopy was performed and conventional management applied; and group II contained 94 patients in whom, apart from conventional treatment, endoscopic thrombin injections could also be offered. Fifty patients with non-bleeding visible vessels were admitted to a prospective randomised trial and assigned to either endoscopic injections (group A, N = 25), or no primary endoscopic treatment (group B, N = 25). The introduction of the injection therapy in patients who were actively bleeding resulted in a significant reduction of the emergency operation rate (70.2% v. 12.8%; P < 0.001), mortality rate (21.3% v. 8.5%; P < 0.05 and blood transfusion requirements (4,220 +/- 1,840 ml v. 1,980 +/- 980 ml; P < 0.05). Endoscopic thrombin injections of non-bleeding visible vessels reduced the rebleeding rate (40% v. 4%; P < 0.01) and blood transfusions (2,939 +/- 1070 ml v. 1,390 +/- 552 ml; P < 0.05).