Recurrent pericardial effusion as a result of chronic pancreatitis. Successful treatment with somatostatin.

We report a well-documented case of relapsing chronic calcifying pancreatitis with recurrent pleural and pericardial effusions during episodes of clinical and biochemical relapse of the pancreatitis. Pericardial effusions in association with pancreatitis have been reported only very occasionally, almost exclusively in chronic alcoholic pancreatitis with pseudocyst formation. Our successful conservative treatment consisted of parenteral nutrition and a continuous infusion of somatostatin for 6 weeks. We discuss other reported cases and proposed mechanisms of pathogenesis.

Influence of the arterial blood pressure and nonhemodynamic factors on regional arterial wall properties in moderate essential hypertension.

Structural and functional abnormalities may occur at the left ventricle and in different large arteries in essential hypertension. Noninvasive high resolution pulsed doppler echo-tracking technique allows calculation of regional arterial wall properties, which might be determined by either hemodynamic or non-hemodynamic factors. Therefore we aimed to study regional arterial wall properties in three different vascular territories and examined whether hemodynamic and non-hemodynamic parameters were significantly associated to a specific vascular territory. In 30 patients (mean age 47 +/- 2 years) with newly diagnosed and untreated essential arterial hypertension, arterial wall properties were determined at the carotid (common, external and internal), femoral, and brachial artery using a noninvasive ultrasound wall movement detector system. The study parameters were arterial diameter, relative diameter change, arterial distensibility (DC) and cross-sectional compliance (CC) coefficient. On the day of the experiments office blood pressure (BP) was measured as well as an ambulatory 24 h BP profile performed on an outpatient basis. Blood samples were taken on the day of the vascular examination for the determination of plasma renin activity (PRA), aldosterone, intact (1-84) parathyroid hormone (PTH), insulin and plasma noradrenaline and adrenaline. Among the studied vascular territories, only DC and CC of the common carotid artery were significantly (P < 0.01) correlated with office and ambulatory systolic BP. Intact PTH was significantly correlated with the diameter (r = 0.61, P = 0.005) and DC (r = -0.53, P = 0.01) of the internal carotid artery. Noradrenaline was inversely correlated with DC of the femoral artery (r = - 0.55, P < 0.01). All correlations remained significant after adjustment for age and body mass index as confounding variables. In conclusion, in mild to moderate arterial essential hypertension there is a heterogeneity of vascular wall properties and their relationship to BP and humoral factors between brachial, femoral and carotid (common, external and internal) arteries. Our findings might renew interest in the old concept of the 'circulatory paradox'.