Risk factors for pancreatic cellular injury after cardiopulmonary bypass

Article Abstract:

Heart-related deaths following heart surgery have decreased, and any further declines will probably result from the prevention of other types of complications. Pancreatitis (inflammation of the pancreas, a gland in the abdomen) occurs in as many as 5 percent of patients after any type of cardiac surgery, evidently caused by decreased blood flow or as a side effect of some drugs. Mortality is high. In order to determine the cause of pancreatitis, 300 patients about to undergo heart surgery with cardiopulmonary bypass (in which the circulation is routed outside the body while the heart is being operated on) were examined. Hyperamylasemia (increased concentrations of the enzyme amylase in the blood) indicates pancreatic injury, and was found in 27 percent of the patients. Because pancreatic involvement ranged from acute pancreatitis to a level of disease that could only be determined by biochemical analysis, the entire cluster was referred to as 'pancreatic cellular injury.' One factor that was closely associated with pancreatic complications was administration of calcium chloride at the time of the operation. The higher the dose of calcium chloride, the higher the risk of injury, with the risk rising very rapidly when the dose exceeded 800 mg. per square meter of body surface area. The use of calcium chloride is controversial, but it is routinely used at many medical centers because it is thought to improve heart function. However, if vasoconstriction (constriction of the blood vessels) is required, other drugs can be used. The other risk factor for pancreatic injury was ischemia (decreased blood flow) from low blood pressure (hypotension), low cardiac output, and a longer time spent in surgery. Heart valve surgery and previous kidney insufficiency also raised the risk of pancreatic cellular injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Acute pancreatitis - another piece of the puzzle?

Article Abstract:

The pancreas is the small gland toward the back of the abdomen that secretes digestive enzymes, insulin and glucagon. Acute pancreatitis, or inflammation of the pancreas, is most often caused by gallstones (cholelithiasis) or chronic alcoholism. Other causes include viral infection, certain drugs, impaired circulation, and excessive lipids (fats) in the blood (hyperlipidemia). Models tested in animals for the development and progression of pancreatitis are discussed. In the August 8, 1991 issue of The New England Journal of Medicine, Carlos Fernandez-del Castillo and his colleagues present the results of a study demonstrating that an unusual type of pancreatitis is related to lack of adequate circulation to the organs during cardiopulmonary bypass surgery. However, they also found quite unexpectedly that pancreatic cellular injury was related to the dosage of calcium chloride, which is given during surgery. It is possible that this seeming correlation was really caused by patients with more severe low blood pressure receiving larger doses of calcium, but a causative role for calcium cannot be dismissed. This new clue in the still mysterious causes of pancreatitis should be investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Alcoholism, Gallstones, editorial, Alcoholic myopathy

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Pancreatic carcinoma

Article Abstract:

Pancreatic cancer occurred in nine out of every 100,000 people in the United States in 1988, and it has one of the lowest five-year survival rates. People who have an increased risk of developing pancreatic cancer are those who smoke cigarettes, have a high fat and/or meat diet, have had peptic-ulcer surgery or work with certain industrial chemicals. Oncogenes, genes that can change normal cells to cancer cells, may be involved in pancreatic cancer. Patients with pancreatic cancer are most often identified by their symptoms, and their diagnoses are usually confirmed using ultrasound and CT. Staging of, or evaluating, pancreatic tumors is done surgically or by using X-ray imaging techniques. Many patients with pancreatic cancer are treated surgically. Radiation therapy is the most effective treatment for patients with inoperable pancreatic cancer that has not spread. Other less effective treatments are chemotherapy and endocrine therapy, and scientists are testing new treatments on animals.

Management, Pancreatic cancer

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