Pulmonary microvasculature in experimental acute haemorrhagic and oedematous pancreatitis

Renal vein thrombosis in pancreatitis: a rare vascular complication

Extrasplanchnic venous thrombosis is a rare complication of chronic pancreatitis. Thrombosis of inferior vena cava and renal vein, in particular, is extremely rare. We present our recent experience of managing two patients of chronic pancreatitis who presented with renal vein thrombosis. We also highlight the treatment dilemmas facing a clinician managing patients with this atypical and rare vascular complication.

Renal Vein and Inferior Vena Cava Thrombosis: A Rare Extrasplanchnic Complication of Acute Pancreatitis

Acute pancreatitis is an inflammatory disorder often associated with various complications. Approximately one fourth of patients with acute pancreatitis develop vascular complications, of which venous thrombosis forms a major group. Extrasplanchnic venous thrombosis is less common, and simultaneous renal vein and inferior vena cava thrombosis is reported only twice. We report a case of alcohol-related acute pancreatitis complicated by simultaneous renal vein and inferior vena cava thrombosis.

Acute lung injury in two experimental models of acute pancreatitis: infusion of saline or sodium taurocholate into the pancreatic duct

OBJECTIVE

To compare acute pulmonary changes secondary to sodium taurocholate hemorrhagic pancreatitis with those changes secondary to a less severe pancreatitis induced by saline infusion into the biliopancreatic duct.

DESIGN

Prospective, randomized controlled trial.

SETTING

University pulmonary laboratory.

SUBJECTS

A total of 110 male Wistar rats.

INTERVENTIONS

Pancreatitis was induced by either 0.5 mL of a 4% solution of sodium taurocholate (TAU group) or 0.5 mL of normal saline (SAL group) injection into the biliopancreatic duct. Data were compared with data from control (sham-operated) animals (SHAM group).

MEASUREMENTS AND MAIN RESULTS

The severity of pancreatic and pulmonary injuries was evaluated 1, 3, and 8 days after the induction of acute pancreatitis by morphometric and pulmonary mechanical studies. Biliopancreatic duct pressure was measured during infusion of solutions in SAL and TAU groups. SAL and TAU groups developed an intense necrohemorrhagic pancreatitis on day 1 without differences in biliopancreatic duct pressures (134.0+/-45.1 cm H2O vs. 123.3+/-23.4 cm H2O). Acute pancreatic lesions were still intense on day 3 in the TAU group only. Pulmonary resistance in SAL and TAU groups was significantly greater than in the SHAM group on day 3 only. On day 1, there was an increase in intraalveolar edema in both groups (p < .02). There was an increase in polymorphonuclear cells in alveolar septa on day 1 only in the TAU group (p < .001). In contrast, both experimental groups presented greater values of PMN cells on day 8 compared with the SHAM group (p < .001). Both groups with pancreatitis showed an increase in alveolar distention and collapse on day 1 that persisted only in the TAU group on days 3 and 8. No deaths were observed in the control (SHAM) group. In contrast, the SAL group had lower mortality than the TAU group in the first two days (17% and 52%, respectively, p = .03).

CONCLUSION

High-pressure infusion of normal saline into the biliopancreatic duct of rats results in significant pancreatic and lung alterations. These changes are worse in the presence of sodium taurocholate.

Proinflammatory cytokine release by peripheral blood mononuclear cells from patients with acute pancreatitis

Proinflammatory cytokine release was measured from peripheral blood mononuclear cells (PBMCs) isolated from six volunteers and, on admission, from 16 patients with acute pancreatitis. Tumour necrosis factor (TNF) release in patients did not differ significantly from that of volunteers, whereas both interleukin (IL) 6 and IL-8 release in patients was raised when compared with that in the volunteer group (mean(s.e.m.) IL-6 20.7(4.6) versus 9.3(1.7) ng/ml, P = 0.03; IL-8 283(40) versus 128(22) ng/ml, P = 0.04). When variation in white cell count was accounted for, IL-6 and IL-8 release but not that of TNF was significantly greater in patients with severe disease than in those with mild disease. These results point to a complex upregulation of proinflammatory cytokine release from PBMCs in patients with acute pancreatitis, components of which relate to the clinical progress of the disease.

Respiratory failure in acute pancreatitis

There are a number of important pulmonary complications of acute pancreatitis which make a significant contribution to the morbidity and mortality of the condition. The pathophysiology and management guidelines are given for each and approaches towards better treatment in the future are discussed.

Pancreatic phospholipase A2 in cerulein-induced acute pancreatitis in the rat

We investigated the concentration of immunoreactive pancreatic phospholipase A2 (pan-PLA2) and the catalytic activity of phospholipase A2 (CA-PLA2) in plasma and pancreases of rats with cerulein-induced acute pancreatitis. Edematous pancreatitis with ascites and fat necroses in the abdominal cavity developed after 8 h infusion of cerulein (5 micrograms/kg/h). Large vacuoles were found in acinar cells and there were small areas of acinar cell necrosis. No pathological changes were seen in saline-infused control animals. Pancreatic PLA2 was localized by immunohistochemistry in pancreatic acinar cells in both groups of animals and in the proximal tubular cells of the kidney in cerulein-infused animals. The lungs and kidneys appeared normal by light microscopy in all animals. The pan-PLA2 values increased markedly, whereas the CA-PLA2 values did not change during the cerulein-infusion. The CA-PLA2 values in the homogenates of pancreatic tissue of cerulein-infused animals did not differ significantly from those of saline-infused controls. The results indicate that the CA-PLA2 in plasma is independent from the concentration of pan-PLA2 in cerulein-induced acute pancreatitis in rat.