Therapeutic small-volume resuscitation preserves pancreatic microcirculation in acute experimental pancreatitis of graded severity in rats.
BACKGROUND
Microcirculatory disorders play a major part in the pathogenesis of acute pancreatitis. Improvement of microcirculation is hypothesized to open a therapeutic window. The aim of this study was to evaluate the effects of small-volume resuscitation in acute pancreatitis.


METHODS
In rats, acute pancreatitis of graded severity was induced and pancreatic microcirculation was observed in vivo with an epiluminescent microscope. Primary outcome measures were microcirculation, leukocyte adherence, concentration of trypsinogen-activating peptide, amylase activity and histopathologic tissue damage.


RESULTS
In necrotizing pancreatitis patients receiving prophylactic intervention with 7.5% hypertonic saline the functional capillary density was 76%. Postcapillary venular leukocyte adherence was 45% of vein cross-section. The median histopathologic damage scored 8 points. In controls, a complete microcirculatory breakdown was observed, and in the group with therapeutic intervention no significant difference was detected. In intermediate pancreatitis, the number of perfused capillaries remained 55.0 versus 23.3% in controls. Leukocyte adherence was 40.0 versus 51.7%. The histopathologic damage scored 6.0 versus 9.0 points. Trypsinogen-activating peptide concentration was reduced to 164 versus 402 nM in controls. In cerulein pancreatitis, the number of perfused capillaries was equally preserved in both groups.


CONCLUSIONS
Small-volume resuscitation preserves capillary microcirculation and prevents pancreatic injury in intermediate necrotizing pancreatitis.
Mann
Oliver
O
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. omann@uke.uni-hamburg.de
Kaifi
Jussuf
J
Bloechle
Christian
C
Schneider
Claus G
CG
Yekebas
Emre
E
Kluth
Dietrich
D
Izbicki
Jakob R
JR
Strate
Tim
T
D000818:Animals; D002196:Capillaries / Q000473:pathology / Q000648:ultrastructure; D005260:Female; D008833:Microcirculation; D008856:Microscopy, Fluorescence; D010179:Pancreas / Q000098:blood supply*; D010195:Pancreatitis / Q000188:drug therapy* / Q000473:pathology; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy* / Q000473:pathology; D051381:Rats; D017208:Rats, Wistar; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*
D012462:Saline Solution, Hypertonic