The Effect of Postganglionic Sympahectomy on the Development of Hemorrhagic Pancreatitis in the Dog

Ischemia/Reperfusion-Induced Pancreatitis

“…Gilsdorf et al [37]were able to convert mild edematous pancreatitis to necrotizing pancreatitis in cats by active hypothalamic stimulation which induces vasoconstriction by increasing sympathetic activity. In a canine model of biliary pancreatitis, evolution from edematous to necrotizing AP was suppressed by postganglionic sympathectomy [38]. Moreover, numerous studies directed at supporting or enhancing the microcirculation have demonstrated the ability to reduce the degree of pancreatic ischemic injury [39, 40].…”

Towards a Novel Treatment Strategy for Acute Pancreatitis

“…Table 2 lists measures that have been beneficial when instituted once acute pancreatitis is under way and shows that the common denominator is the control of mast cell pathology [9, 28, 29, 57, 71, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98]. Since impedance to exocytosis in the acinar cell is the detonating event and this is best explained by oxidant-induced interruption to the flow of methyl groups [1], it is logical to regard the resumption of that flow as the reason why re-feeding with methionine [73]or treatment with an analogue of ascorbate [74]– which facilitates the recycling of methyl groups from homocysteine via the folate-vitamin B 12 shuttle – ameliorate in the choline-deficient ethionine-supplemented (CDE) dietary model of severe disease.…”

“…An elegant study of human pancreas grafts [115]shows that reperfusion results in an abrupt increase in tissue oxygenation but a rapid fall thereafter, the ‘reflow paradox’ which leads to an impairment of capillary function after reperfusion and worsens in grafts which go on to develop coagulative necrosis (synonyms: necrotising pancreatitis, haemorrhagic pancreatitis): further, an inverse correlation is shown between haemoglobin oxygen saturation in the venous effluent of the graft 90 min after reperfusion and the peak blood level of C-reactive protein in the next 48 h. Reduced splanchnic perfusion can now be inferred from gastric tonometry [62, 63, 64, 65]. The reduction has been ascribed to at least three factors: axon reflexes that result in the release of α-adrenergic agonists [90]; loss of plasma due to increased permeability of post-capillary venules [116]; hyaline thrombi with destruction of vessel walls, especially of post-capillary venules [49]. These aspects are addressed, respectively, by chemical or physical sympathectomy which also intercepts parasympathetic fibres, β-adrenergic agonists, and dextran or heparin (table 2).…”

H�morrhagische Pankreatitis : Effekt von Dextran 40 und Plasma auf die Mikrozirkulationsst�rung des Pankreas

“…Wfinschenswert w~ire ein Volumenersatz, der neben diesem oben genannten Prinzip auch direkt die lokale spezifische Mikrozirkulationsst6rung im Pankreas beeinfluBt [7,13]. Auch die postganglion~ire Sympathektomie ffihrte im Tierexperiment zu einer Zunahme der Pankreasdurchblutung und Verbesserung der Lrberlebensrate [14]. Durch Gabe von Vasopressin wurde die Pankreasdurchblutung bei experimenteller Pankreatitis verbessert und eine h6here Uberlebensrate der Tiere erzielt [4].…”

“…Im Tierexperiment kommt es zu einer frfihzeitigen Isch/imie im Pankreasgewebe mit einem reduzierten Anteil des Herzzeitvolumens zum Pankreas und einer Abnahme des Sauerstoffverbrauches [5,9]. In der Literatur finden sich indirekte Hinweise, dab eine Verbesserung der Pankreasdurchblutung, den Verlauf der experimentellen Pankreatitis beeinflussen kann und konsekutiv zu h6heren Lrberlebensraten ffihrt [4,14]. Auch die Behandlung der haemorrhagischen Pankreatitis mit niedermolekularen Dextranen resultiert im Tierexperiment in einer Verbesserung der Uberlebensrate [7,13] Zum Zeitpukt der Durchblutmagsmessungen wurden zur Kalkulation des O2-Verbrauches des Pankreas, simultan Blutproben mit Glasspritzen aus der Aorta thoracalis, der Vena cava inferior und aus der Vena pancreatico-duodenalis superior entnommen.…”