Dexamethasone and dextran 40 treatment of 32 patients with severe acute pancreatitis.

AIM Based on the pathogenesis of severe acute pancreatitis and our experimental studies, to investigate the effect of dexamethasone and dextran in treatment of patients with severe acute pancreatitis. METHODS Thirty-two patients with severe acute pancreatitis were treated with 0.5-1 mg/kg per day dexamethasone for 3-5 d, and 500-1,000 mL/d of dextran 40 for 7 d, besides the routine therapy. RESULTS After 4-8 h of treatment, abdominal pain began to be relieved; range of tenderness began to be localized in 27 patients. They were cured with nonsurgical treatment. Five of them were deteriorated, and treated with surgery. Four patients in this group died. CONCLUSION Dexamethasone and dextran 40 block the pathologic process of severe acute pancreatitis through inhibition of inflammatory mediators and improvement of microcirculation disorders respectively.

[1]  A. Satoh,et al.  Nitric oxide modulates pancreatic edema formation in rat caerulein-induced pancreatitis , 1995, Journal of Gastroenterology.

[2]  H. Buhr,et al.  Benefits of various dextrans after delayed therapy in necrotizing pancreatitis of the rat , 1996, Intensive Care Medicine.

[3]  W. Uhl,et al.  Hydrocortisone Treatment of Early SIRS in Acute Experimental Pancreatitis , 2001, Digestive Diseases and Sciences.

[4]  M. Franz,et al.  Tissue-Specific Cytokine Production During Experimental Acute Pancreatitis (A Probable Mechanism for Distant Organ Dysfunction) , 1997, Digestive Diseases and Sciences.

[5]  H. Buhr,et al.  Persistent Multiple Organ Microcirculatory Disorders in Severe Acute Pancreatitis: Experimental Findings and Clinical Implications , 2004, Digestive Diseases and Sciences.

[6]  C. Pan,et al.  The role of inflammatory mediators in severe acute pancreatitis and regulation of glucocorticoids. , 2003, Hepatobiliary & pancreatic diseases international : HBPD INT.

[7]  I. Boros,et al.  The anti-inflammatory effect of methylprednisolone occurs down-stream of nuclear factor-kappaB DNA binding in acute pancreatitis. , 2003, European journal of pharmacology.

[8]  Zongguang Zhou,et al.  Pancreatic microcirculatory impairment in experimental acute pancreatitis in rats. , 2002, World journal of gastroenterology.

[9]  A. Kingsnorth,et al.  Cytokine storm in acute pancreatitis. , 2002, Journal of hepato-biliary-pancreatic surgery.

[10]  J. Werner,et al.  Pancreatic capillary blood flow in an improved model of necrotizing pancreatitis in the rat. , 2002, The Journal of surgical research.

[11]  J. Turney,et al.  Thrombotic Microangiopathy in Acute Pancreatitis , 2002, Pancreas.

[12]  K. Kataoka,et al.  The effect of steroid pulse therapy on the development of acute pancreatitis induced by closed duodenal loop in rats , 2002, Journal of Gastroenterology.

[13]  Zongguang Zhou,et al.  Influencing factors of pancreatic microcirculatory impairment in acute panceatitis. , 2002, World journal of gastroenterology.

[14]  H. Buhr,et al.  Therapy of microcirculatory disorders in severe acute pancreatitis: what mediators should we block? , 2002, Intensive Care Medicine.

[15]  B. Rau,et al.  Prevention of severe change in acute pancreatitis: prediction and prevention. , 2001, Journal of hepato-biliary-pancreatic surgery.

[16]  J. Neoptolemos,et al.  Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis , 2001, Gut.

[17]  M. Mutinga,et al.  Does mortality occur early or late in acute pancreatitis? , 2000, International journal of pancreatology : official journal of the International Association of Pancreatology.

[18]  C. Ulrich.  Medical management of acute pancreatitis: Strategies reality, and potential , 2000 .

[19]  P. Lankisch,et al.  No Strict Correlation Between Necrosis and Organ Failure in Acute Pancreatitis , 2000, Pancreas.

[20]  Ulrich CD 2cnd.  Medical management of acute pancreatitis: strategies, reality, and potential. , 2000, Current gastroenterology reports.

[21]  N. O. Jacobsen,et al.  Beneficial Effects of Hydrocortisone in a Model of Experimental Acute Pancreatitis , 1999, Digestive Surgery.

[22]  M. Gladwin,et al.  Dexamethasone Alters Arachidonate Release from Human Epithelial Cells by Induction of p11 Protein Synthesis and Inhibition of Phospholipase A2 Activity* , 1999, The Journal of Biological Chemistry.

[23]  K. Matsushima,et al.  A monoclonal anti-interleukin 8 antibody (WS-4) inhibits cytokine response and acute lung injury in experimental severe acute necrotising pancreatitis in rabbits , 1998, Gut.

[24]  M. Büchler,et al.  Experimental study of a novel phospholipase A2 inhibitor in acute pancreatitis , 1998, The British journal of surgery.

[25]  J. Yamauchi,et al.  Pancreatic microcirculation in acute pancreatitis. , 1998, Journal of hepato-biliary-pancreatic surgery.

[26]  J. Norman.  The role of cytokines in the pathogenesis of acute pancreatitis. , 1998, American journal of surgery.

[27]  C. McKay,et al.  Prospective placebo‐controlled randomized trial of lexipafant in predicted severe acute pancreatitis , 1997, The British journal of surgery.

[28]  M. Büchler,et al.  Pathophysiological role of secretory type I and II phospholipase A2 in acute pancreatitis: an experimental study in rats. , 1997, Gut.

[29]  A. Kingsnorth.  Role of cytokines and their inhibitors in acute pancreatitis. , 1997, Gut.

[30]  H. M. Chen,et al.  The effect of gabexate mesilate on pancreatic and hepatic microcirculation in acute experimental pancreatitis in rats. , 1996, The Journal of surgical research.

[31]  P. Braquet,et al.  The role of neutrophils and platelet-activating factor in mediating experimental pancreatitis. , 1996, Gastroenterology.

[32]  S. Ashley,et al.  Interleukin-10 prevents death in lethal necrotizing pancreatitis in mice. , 1996, Surgery.

[33]  C. McKay,et al.  Increased monocyte cytokine production in association with systemic complications in acute pancreatitis , 1996, The British journal of surgery.

[34]  A. Gullo,et al.  Ingredients of Organ Dysfunction or Failure , 1996, World Journal of Surgery.

[35]  J. Ross,et al.  Serum concentrations of inflammatory mediators related to organ failure in patients with acute pancreatitis , 1996, The British journal of surgery.

[36]  M. Kotb,et al.  Anti-TNFalpha therapy improves survival and ameliorates the pathophysiologic sequelae in acute pancreatitis in the rat. , 1996, American journal of surgery.

[37]  M. Kotb,et al.  Inhibition of TNFα improves survival in an experimental model of acute pancreatitis , 1996 .

[38]  M. Kotb,et al.  Inhibition of TNF alpha improves survival in an experimental model of acute pancreatitis. , 1996, The American surgeon.

[39]  L. Formela,et al.  Randomized, double‐blind phase II trial of Lexipafant, a platelet‐activating factor antagonist, in human acute pancreatitis , 1995, The British journal of surgery.

[40]  P. Fabri,et al.  Decreased Mortality of Severe Acute Pancreatitis After Proximal Cytokine Blockade , 1995, Annals of surgery.

[41]  P. Fabri,et al.  Interleukin-1 receptor antagonist decreases severity of experimental acute pancreatitis. , 1995, Surgery.

[42]  A. Fowler,et al.  Delayed tumor necrosis factor alpha blockade attenuates pulmonary dysfunction and metabolic acidosis associated with experimental gram-negative sepsis. , 1994, Archives of surgery.

[43]  M. Kotb,et al.  Amelioration of the physiologic and biochemical changes of acute pancreatitis using an anti-TNF-alpha polyclonal antibody. , 1994, American journal of surgery.

[44]  C. Frey.  Management of necrotizing pancreatitis. , 1993, The Western journal of medicine.

[45]  P. Malfertheiner,et al.  Management of severe acute pancreatitis. , 1993, The Gastroenterologist.

[46]  H. Reber,et al.  Clinically based classification system for acute pancreatitis. , 1993, Pancreas.

[47]  E L Bradley,et al.  A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. , 1993, Archives of surgery.

[48]  K. Messmer,et al.  Isovolemic Hemodilution with Dextran 60 as Treatment of Pancreatic Ischemia in Acute Pancreatitis Clinical Practicability of an Experimental Concept , 1993, Annals of surgery.

[49]  Bradley El rd,et al.  A clinically based classification system for acute pancreatitis. , 1993 .

[50]  D. Rattner,et al.  Hyperoncotic ultrahigh molecular weight dextran solutions reduce trypsinogen activation, prevent acinar necrosis, and lower mortality in rodent pancreatitis. , 1993, American journal of surgery.

[51]  K. Usadel,et al.  The effect of somatostatin, gabexate mesilate and dextran 40 on the microcirculation in sodium taurocholate-induced pancreatitis. , 1992, Acta physiologica Hungarica.

[52]  D. Remick,et al.  Anti-tumor necrosis factor antibody augments edema formation in caerulein-induced acute pancreatitis. , 1991, The Journal of surgical research.

[53]  K. Messmer,et al.  Therapeutic Effect of Isovolemic Hemodilution with Dextran 60 on the Impairment of Pancreatic Microcirculation in Acute Biliary Pancreatitis , 1990, Annals of surgery.

[54]  D. Green,et al.  Involvement of cholecystokinin receptors in the adverse effect of glucocorticoids on diet-induced necrotizing pancreatitis. , 1989, Surgery.