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Hipertrójglicerydemia (HT) jest rzadką przyczyną ostrego zapalenia trzustki (OZT.). Może mieć charakter idiopatyczny (HT pierwotna) lub wtórny u osób nadużywających alkoholu, w przebiegu cukrzycy, ciąży oraz stosowania niektórych leków. Celem badania byla ocena częstości występowania HT z podziałem według jej przyczyn u chorych z OZT na początku choroby oraz porównanie ciężkości choroby u osób z HT i z prawidłowym stężeniem trój glicerydów w surowicy krwi. Stężenie trój glicerydów w surowicy krwi bylo badane w pierwszym dniu choroby u grupy chorych hospitalizowanych z rozpoznaniem OZT w Klinice Chorób Metabolicznych i Gastroenterologii Instytutu Żywności i Żywienia (214 chorych). Porównano częstość występowania ciężkiej (martwiczo-krwotocznej) postaci choroby oraz powikłań miejscowych i ogólnoustrojowych w grupie chorych z HT w porównaniu do pozostałych chorych. W 3 przypadkach (1,4%) uznano, że HT była przyczyną OZT. U tych chorych stężenie trój glicerydów przekraczało 1000 mg/dl (11,3 mmol/L). U 69 chorych (32,2%) stwierdzono podwyższone stężenie trój glicerydów powyżej 180 mg/dl (2,03 mmol/dl). W 47 spośród tych chorych rozpoznano etanolowe OZT, u 15 pierwotną HT, 6 chorych miało cukrzycę, 1 kobieta była w ciąży a w dwóch przypadkach HT uznano za polekową. W grupie chorych z HT martwiczo-krwotoczne OZT rozpoznano u 32 osób (46,3%) w porównaniu do 23,4% wśród pozostałych chorych (p<0,05). Ogólnoustrojowe powikłania OZT były stwierdzone u 8 chorych z HT (11,5%) w porównaniu do 7,0% w grupie pozostałych chorych (NS), zaś powikłania miejscowe (pseudotorbiele lub ropnie) rozpoznano u 32 chorych z HT (46,4%) w porównaniu do 23,0% wśród pozostałych chorych (p<0,05). U chorych z HT stwierdzono częstsze występowanie martwiczo-krwotocznej postaci OZT oraz miejscowych powikłań choroby w porównaniu do pozostałych chorych z OZT. Hipertrójglicerydemia może być istotnym czynnikiem mającym wpływ na przebieg OZT u części chorych, zwłaszcza u osób z etanolowym ostrym zapaleniem trzustki.
The effects of treating acute pancreatitis are still unsatisfactory. The aim of the study was to evaluate the efficacy of peritoneal lavage when treating acute pancretits, which was experimentally induced using sodium taurocholate. Isotonic salt solution was injected intraperitoneally three times per day. Serum amylase, lipase activity and urinal amylase activity were measured. Macroscopic images were analyzed and microscopic changes of the pancreas were estimated using Spormann's classification. The results indicate that peritoneal lavage appears to be an efficient method of treating acute pancreatitis.
The experiment was carried out using 32 Wistar strain male rats of 280-320 g body weight. The animals were randomly divided into 2 groups. Control group I were healthy animals (8 rats). In group II, acute pancreatitis was induced by injecting 5% sodium taurocholate solution into the common bile-pancreas duct. Twenty-four hours before the operation, animals were food deprived and were given Dormicum (from a vial) in ad libitum drinking water. After acute pancreatitis induction, the animals of group II were additionally divided into 3 sub-groups: A, B, and C according to the time the disease had developed. Blood and internal organs from sub-group A were sampled after 3 hours, from group B after 24 hours, and from group C - after 48 hours. Organs were homogenized in 20 mM Tris buffer at pH 7.4. Products of lipid peroxidation were determined in supernatant: conjugated dienes, hydroperoxilipid dienes and malonic aldehyde. Total anti-oxidation potential was determined in blood serum along with its components: uric acid, urea and bilirubin. a-amylase in serum activity was also recorded to confirm the development of acute pancreatitis. The results of the study revealed very variable dynamics of lipid peroxidation in organs essential for survival during acute pancreatitis. This suggests that the mechanisms of anti-oxidation defense are not able to successfully protect the organism against oxidation stress during acute pancreatitis, which consequently enhances the risk of multi-organ failure syndrome. A detailed explanation of the oxidation stress role in the course of acute pancreatitis and its complications requires further integrated studies at the molecular level, cellular culturing and on animal models.
The aim of the study was to assess the relationships between the degree of changes in concentrations of the biochemical indicators in serum such as: creatinine, uric acid, total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), lipase, amylase, glucose, iron and magnesium, and histopathological lesions occurring in the pancreas within 24 and 48 hours from the induction of acute pancreatitis (AP). An attempt was made to assess the relation between the changes in concentrations of biochemical indicators and the enhancement of histological lesions in the pancreas based on Spormann score. In the experimental model, the laboratory and histological changes in the 24th hour from administration of taurocholan correspond to the seventh day of the disease in humans. Experiments were conducted on 55 male Wistar rats weighing from 250 g to 300 g. The animals were divided into three groups: Z – a group serving to establish the ranges of studied factors and histological structure; K – a group of animals operated on which were injected with 0.9% NaCl into the biliary-pancreatic duct; E – a group of animals operated on in which acute pancreatitis was induced by an injection of 5% sodium taurocholate into the biliary-pancreatic duct. The material for biochemical and histological examinations was collected after 24 and 48 hours from the induction of AP. Whole pancreases were dissected for histological examinations and the samples were dyed with hematoxylin and saturated alcoholic eosin solution. The degree of pancreatic lesions was assessed according to the Spormann score. Quantitative variables were characterised by arithmetic mean, standard deviation, median, minimum and maximum value and 95% CI. After administration of 0.9% NaCl in the K group, foci of purulent inflammation in the fatty tissue of the pancreas and minor foci of Balser’s necrosis appeared. In the E group, after injection of 5% sodium taurocholate into the biliary-pancreatic duct, more intense lesions were observed: foci of fatty tissue necrosis, hemorrhagic necrosis, multifocal fatty tissue necrosis and inflammatory infiltration. The model was developed in order to assess histological lesions, indicating the character of AP, taking into account edema, inflammatory infiltration, fatty tissue necrosis, glandular necrosis, and ecchymoses. In the period of 24 hours, statistically significant differences between the K group and E group were observed for creatinine, total bilirubin, ALT, lipase, amylase, iron and magnesium, while in the period of 48 hours, statistically significant differences were observed for total bilirubin and ALT. In the group E, in the period of 24 hours concentrations of creatinine, total bilirubin, ALT, lipase, amylase and magnesium were significantly higher than in the group K, but concentrations of iron were significantly lower. In the period of 48 hours, in the E group total bilirubin was significantly lower and ALT was significantly higher than in the K group. In the E group, the intensity of pancreatitis increased together with an increase in ALT concentration in the period of 24 hours; in the period of 48 hours, the intensity of pancreatitis increased together with a decrease in ALT in the E group. In the K group, in the period of 48 hours, intensity of fatty tissue necrosis increased together with a decrease in ALT level. In the period of 48 hours, in the E group intensity of glandular necrosis increased together with a decrease in total bilirubin and AST concentration. In the E group, in the period of 24 hours intensity of edema increased together with an increase in magnesium level. In the period of 48 hours, in the E group intensity of glandular necrosis increased together with a decrease in magnesium or AST level, and the intensity of lesions in the form of ecchymoses increased together with an increase in glucose level. Histopathological lesions occurred prior to changes in laboratory test results, whereas significant correlations with the Spormann score concerned changes in: total bilirubin, AST, ALT, glucose and magnesium. The use of regression analysis with the Spormann score shows statistically significant differences for most of the biochemical parameters in the period of 24 hours correspond to the seventh day of the disease in humans. The presented study results confirm the fact that diagnostics of acute pancreatitis is very difficult and requires monitoring of many laboratory parameters. A search is still going on for an ideal marker of AP which would enable an early prognosis of the progress of the disease and the confirmation of its etiology. A discovery of a simple marker which is cheap to use may turn out to be useful if it is confirmed in prospective studies. The current state of knowledge based on scientific and clinical findings makes it possible to apply interdisciplinary clinical procedures based on matching appropriate laboratory and radiological tests, and on implementing therapeutic procedures.
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