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.

[Drug-induced agranulocytosis. Discussion of the responsibility of metronidazole]. / Agranulocytose d'origine médicamenteuse. Discussion de la responsabilité du métronidazole.

A case of severe agranulocytosis is reported in a 43 year old white male with Guillain-Barré syndrome. This patient was treated for an acute aspiration pneumonia and received several antibiotic regimens. An acute agranulocytosis occurred during the stay in the intensive care unit and was followed by a severe septic shock. Bone marrow aplasia was confirmed by needle aspiration. Metronidazole was withdrawn and agranulocytosis improved within three days. None of the other drugs given to the patient were withdrawn. Another bone marrow examination performed several days later revealed a markedly improved granulopoiesis. The patient died with multiple organ failure. The role of metronidazole is discussed in this case as this drug seemed highly responsible for the observed agranulocytosis.