Influence of somatostatin on acute pancreatitis in rats.

OBJECTIVE: To assess the effect of two regimens of somatostatin on the morbidity and short term outcome of acute pancreatitis in rats. DESIGN: Randomised laboratory study. SETTING: Teaching hospital, France. ANIMALS: 24 male Wistar rats. INTERVENTIONS: Rats were randomised to 3 groups of 8, 2 of which were given somatostatin (one 25 microg/kg/hour by continuous infusion and one as a bolus injection of 5 microg before the infusion of 25 microg/kg/hour); the third (control) group was given 0.9% of saline 25 microg/kg/hour. Acute pancreatitis was induced by ligating the pancreatic duct at the junction with the duodenum. MAIN OUTCOME MEASURES: Serum amylase and lipase activities at 2 and 4 hours, and histological changes after 4 hours, at which time the animals were killed and the pancreas removed. RESULTS: Amylase and lipase activities were significantly lower in the somatostatin groups than in the control group throughout the experiment (p < 0.001). They were slightly but not significantly lower in the bolus group than the infusion group. The degree of necrosis and the extent of inflammatory infiltration were significantly less in the somatostatin groups (p < 0.008). CONCLUSION: Somatostatin has an early favourable effect on the course of experimentally induced pancreatitis in rats.

Early operation for severe corrosive injury of the upper gastrointestinal tract.

OBJECTIVE: To describe our experience of treating severe corrosive burns of the upper gastrointestinal (GI) tract. DESIGN: Open study. SETTING: Teaching hospital, France. SUBJECTS: 18 patients who had swallowed an alkaline substance (caustic soda in 10 cases) and 4 who had swallowed either hydrochloric or sulphuric acid. INTERVENTIONS: Endoscopy was done a mean of 4 hours after the substance had been swallowed. 10 patients underwent oesophagogastrectomy without thoracotomy. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: 4 of the 10 patients died and 3 developed postoperative complications. Of the 12 patients treated by feeding jejunostomy 7 developed stenosis that required operation and 3 developed stenosis that responded to dilatation. None of the 12 died. CONCLUSIONS: Early oesophagoscopy allowed optimal management. Patients died if they swallowed more than 60 ml of a strong alkaline substance. When patients are treated conservatively about half will develop stenoses that require operation.

Aneurysms of the visceral and renal arteries.

Visceral aneurysms represent a rare clinical entity; however, 10-20% will rupture and this is accompanied by a significant mortality rate of 20-70%, depending on the location of the aneurysm. The incidence, pathogenesis and clinical aspects of splanchnic and renal artery aneurysms are reviewed from the available literature and the problems of diagnosis and treatment are discussed. Their incidence is increasing and controversy still exists regarding their treatment. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, surgery is advisable. An alternative treatment is the use of endovascular techniques, ie embolisation, or graft stent insertion.

[Treatment of caustic stenoses of the upper digestive tract]. / Traitement des sténoses caustiques du tractus digestif supérieur.

Stenosis of the upper digestive tract developed in 22 patients with stage IIB or stage III caustic burns due to massive ingestion of an alkaline substance in 18 cases and an acid substance in 4 cases is analysed. Emergency oesogastrectomy without thoracotomy was performed in emergency situations in 10 patients in whom mortality reached 30%. For the remaining 12 patients with minimal stage IIB lesions, a jejunostomy was opened for enteral nutrition. After three months, stenosis developed in 10 cases and required surgical treatment in 7 after failure of endoscopic dilatations. Surgery included retrosternal coloplasy with oesophagectomy for 3 patients. There were no deaths. Two patients with a stenosis of the cervical anastomosis were treated endoscopically. These results suggest that the use of the endoscope in the acute phase can help ascertain the best management technique and confirms that stage IIB stenosis can develop a tight stenosis in 50% of the cases. This situation requires surgical treatment in 70% of the cases.

[Treatment of pancreatic fistulas with somatostatin]. / Traitement des fistules pancréatiques par la somatostatine.

Four cases of pancreatic fistula were treated with somatostatin. Two cases occurred after caudal pancreatectomy and the other 2 after duodenopancreatectomy. Somatostatin rapidly reduced fistula flow by 50% 48 hours after treatment. The shorter hospital stay and reduced morbidity underline the importance of somatostatin in the treatment of pancreatic fistulae.

[Prolonged survival in peritoneal mesotheliomas. Apropos of a case]. / Survie prolongée des mésothéliomes péritonéaux. A propos d'une observation.

A case of peritoneal mesothelioma discovered during laparotomy for ascites is reported. A long-term survival of 5 years was observed with combined treatment: surgery and chemotherapy. Peritoneal mesothelioma is a rare neoplasm often related to asbestos exposure and its prognosis is poor. No laboratory test other than histologic examination is specific for the diagnosis. Combined treatment with radiotherapy and chemotherapy seems to improve the survival rate.

[Hepatic tumoral form of bacterial infections. Diagnostic and therapeutic considerations apropos of 3 cases]. / Forme tumorale hépatique des affections bactériennes. Considérations diagnostiques et thérapeutiques à propos de 3 cas.

When the clinical picture and complementary tests reveal a tumoural formation in the liver suggesting cancer, it is often difficult to diagnose such formations resulting from bacterial infection without surgical exploration. The diagnosis is particularly difficult since exclusive hepatic formations are extremely rare, the latency period is often long and specific markers are often lacking. We observed 3 such cases with local hepatic tumour-like formations due to tuberculosis, brucellosis and actinomycosis. Pathology examination of a liver biopsy can contribute to the diagnosis and avoid unnecessary exploratory laparotomy allowing successful medical treatment.

Influence of epidermal growth factor and interferon gamma on healing of oesophageal corrosive burns in the rat.

A study was performed to attempt to modify the healing response to severe oesophageal corrosive burns to prevent complications. The study was performed on four groups each of 15 Wistar rats: a control group, an untreated group and groups given epidermal growth factor (EGF) alone or EGF for 5 days and interferon (IFN) gamma from the sixth to 20th day. In the last three groups an oesophageal lesion was induced with 2.5 mol l-1 sodium hydroxide solution. The efficacy of treatment was assessed on days 2, 5 and 20 by measurement of weight gain, oesophageal internal lumen, stenosis index (wall thickness: lumen diameter) and collagen production. On day 5, collagen synthesis was significantly (P < 0.05) higher in rats given EGF than in the untreated group. On day 20, no significant difference was seen in weight gain between the control rats and either treated group and stenoses were present in all untreated rats and in none of the treated group. The stenosis index on day 20 was lower in the groups given EGF and EGF-IFN-gamma than in untreated rats (P < 0.05) and collagen production was significantly (P < 0.05) lower in the group given EGF and IFN-gamma than in the other animals. The sequential use of EGF and IFN-gamma significantly reduced the frequency of residual stenosis.

[Treatment of caustic burns of the esophagus with interferon gamma. Comparison with epidermal growth factor. Experimental study in rats]. / Traitement des brûlures caustiques de l'oesophage par l'interféron gamma. Comparaison avec l'epidermal growth factor. Etude expérimentale chez le rat.

OBJECTIVES: Effects of sequential use of epidermal growth factor followed by interferon gamma on healing response after severe oesophageal corrosive burns has been demonstrated. This sequential treatment improves the inflammatory response of the initial phase and prevents residual stenosis. The aim of this study was to evaluate the use of interferon gamma alone in the same condition. METHODS: The study was performed in 5 groups (n = 15) of Wistar rats: control, placebo, epidermal growth factor alone, interferon gamma alone and epidermal growth factor for 5 days followed by interferon gamma from the 6th to 20th day. The last 4 groups had an oesophageal injury caused by a solution of 2.5 N NaOH. The efficacy of treatment was assessed on days 2, 5 and 20 on: weight gain, oesophageal internal lumen, stenosis index: wall thickness/lumen diameter, collagen production. RESULTS: Interferon gamma significantly reduced residual stenosis frequency while it did not improves the initial healing process. A complete effect on the two healing phases was only observed in animals having the sequential treatment. CONCLUSIONS: These results could lead to clinical trial in man to evaluate efficacy of sequential treatment with epidermal growth factor-interferon gamma in oesophageal corrosive burns.

[A rare form of internal hernia: hernia of the sigmoid mesocolon]. / Une forme rare de hernie interne: la hernie du mésocôlon sigmoïde.

An internal hernia of sigmoid mesocolon provoking an occlusive syndrome is described, and the different types of hernia of sigmoid mesocolon analyzed and discussed. The diagnosis of these rare (5% of cases) internal hernias is established frequently at operation only, their treatment, always surgical, being simple when instituted in their early stages.

[Cystic lymphangioma of the adrenal gland. Three misleading cases]. / Lymphangiome kystique de la surrénale. Trois observations trompeuses.

Three cases of adrenal cystic lymphangioma are reported. In 1 patient the lesion was complicated by intracystic haemorrhage. The remaining 2 patients had a hepatic lesion which was treated in the same surgical operation as the adrenal cyst. Ultrasonography and computerized tomography play a major role in the exploration of these cysts. Their unexpected discovery has become more frequent since these methods have multiplied, and this raises therapeutic problems. The nature of adrenal cysts is determined at histology. In asymptomatic cysts percutaneous needle aspiration can only have an indicative value.