The morphological changes of the pancreas in hypovolemic shock and the effect of pretreatment with steroids.

Previous reports from this laboratory have described the effect of hypovolemic shock of varying duration on the exocrine function of the pancreas, and the ability of steroids to reverse the inhibition of secretion observed. This report is a study of pancreatic morphology in prolonged hypovolemia, as well as the effect of steroid pretreatment on the pathology observed. Twelve mongrel dogs were divided into two groups, one with and one without steroid pretreatment. The animals were bled until at least 30-35% of their blood had been withdrawn, or until mean blood pressure (BP) dropped to around 60 mmHg. When BP dropped to 80-90% mmHg, six animals received intravenous (i.v.) prednisolone in 50 cc of 0.9% NaCl, at the rate of 10 cc/min, for a dosage of 30 mg/kg. Of the twelve dogs, six were exposed to 120 min of hypovolemia, and six to 180 min. At the end of the observed hypovolemic period, the blood withdrawn was quickly retransfused. After an hour of recovery, the animals were killed and their pancreases removed. The pancreases were weighed, fixed and examined by light microscopy. Three pancreases were obtained as control from animals not subjected to shock or steroids. The steroid-treated animals displayed an insignificant (5%) increase in pancreatic weight following prolonged hypovolemia. Untreated canine pancreases, on the other hand, showed a significant weight gain (37%, P less than 0.001) after 3 h of hypovolemia. Microscopically, the untreated group revealed marked interstitial edema, hemorrhage and inflammation, as well as focal acinar cell necrosis and fat necrosis, while in the steroid group only very mild edema and inflammatory changes were seen. This study indicates a beneficial effect of steroids on the morphological changes seen in shock-induced pancreatitis in canines and a possible use in the therapy of acute pancreatitis in man.

Malignant Brenner tumor of the ovary. Report of three cases.

A clinico-pathological study of 48 malignant Brenner tumors (MBT) includes three new cases and 45 cases from the literature since 1945. Construction of a profile of this neoplasm was undertaken. The mean age of patients was 60 years, and most were postmenopausal with abdominal symptoms and a unilateral abdominopelvic mass. Only one case had bilateral tumors. The pattern of spread of this tumor is usually regional with only occasional distant metastases. Diffuse peritoneal seeding is not a characteristic feature of MBT. 56% of the patients with MBT died of their tumor, usually within 3 years of initial diagnosis. Mean survival in fatal cases was 1 year. Microscopically, foci of characteristic benign Brenner tumor may or may not be seen in individual examples of MBT. Admixture of adenocarcinoma (often mucinous carcinoma) and squamous carcinoma may also be seen. diagnostic problems can arise when a mixture of histologic patterns is present. In order to establish the diagnosis of malignant Brenner tumor a prominent histologic pattern of malignant urothelium is usually necessary.