New technologies used in mini-systems have proven to lower activation of the immune system, which can be monitored using kinetics of proinflammatory mediators. In spite of these comparable laboratory results, we did not find differences in short-term clinical results when comparing both these groups of low-risk patients.
In 10 patients with acute pancreatitis and in 10 patients with cholelithiasis the thoracic duct was a cannulated and a prolonged external drainage of the lymph was performed. Initial lymph flow per min, total volume of the lymph diverted, and the levels of lymph and blood serum amylase were measured. In patients with acute pancreatitis, the initial lymph flow, lymph and blood serum amylase were found to be significantly higher than those in cholelithiasis. In patients with acute pancreatitis, lymph amylase was significantly higher than blood amylase. Early in the course of acute pancreatitis, there was a considerable increase in lymph flow followed subsequently by a reduction. The prolonged external drainage of the thoracic duct resulted in a rapid improvement of the clinical picture. It is concluded that [1] the thoracic duct lymph is an important pathway for the rise in blood serum enzymes in acute pancreatitis, and [2] by the external drainage of the thoracic duct a considerable amount of toxic substances originating in the necrotic tissues may be removed from the organism.
The result of this first measurement seems to demonstrate that the standard technique of conducting cardiopulmonary bypass produces low muscle oxygen tension and, thus, little perfusion of skeletal muscle. The data also indicate that both high mean arterial blood pressure and high flow are necessary during CPB to ensure skeletal muscle perfusion. The investigation is continuing.
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