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급성췌장염의 발생인자에 관한 실험적 연구

Title
 급성췌장염의 발생인자에 관한 실험적 연구 
Other Titles
 Elucidation of factors in the production of acute pancreatitis 
Issue Date
1963
Publisher
 연세대학교 대학원 
Description
의학과/박사
Abstract
[한글] Elucidation of factors in the production of acute pancreatitis Dong Shik Chin, M.D. Departments of Pediatrics and Pharmacology, Yonsei University college of Medicine, Seoul, Korea (Directed by Drs. T.S. Cho, W.C. Lee, and S.S. Hong) This paper deals with the effect of intraductal instillation of various agents including the pancreatic microsome fractions to elucidate a possible factor concerning the pathogenesis of acute pancreatitis. The rabbits weighing approximately 2.0kg, regardless of the sex, were used and divided into following six groups: 1) Intraductal instillation of bile, 1% taurocholate and desoxycholate, and complete ligation of the pancreatic duct; 2) Intraductal instillation of 20% ethanol or methanol, and complete ligation of the pancreatic duct; 3) Intraductal instillation of N/10 hydrochloric acid and complete ligation of the pancreatic duct; 4) Intraductal instillation of 1 μ/cc enterokinase and complete ligation of the pancreatic duct; 5) Intraductal instillation of pancreatic or myocardial microsome fractions and complete ligation of the pancreatic duct; 6) Simple ligation of the pancreatic duct of intraductal instillation of saline and complete ligation of the pancreatic duct, as a control group. Technic of infusion into pancreatic duct: The abdomen of the rabbit was opened through an upper midline incision under pentobarbital anesthesia, aseptic technic was used throughout the operative procedure. The major pancreatic duct, which enters into the duodenum at a point approximately 20 cm from the pylorus, was easily cannulated in its intramural potion with a small polyethylene tube. With a syringe 2.0ml of each prepared solution was infused slowly at a pressure below 30 cm of water. Then, cannula was removed after ligation of the pancreatic duct, and the abdominal incision was closed. The serum amylase activity was measured by Nelson's method and serum lipase activty by Cheery and Crandall's method Histopathologic examination were carried out on routine hematoxylin-eosin stained section after 10% formalin fixation and paraffin embedding. Results and Summary: 1. Instillation of desoxycholate, taurocholate, ethanol or hydrochloric acid into pancreatic duct following complete ligation in rabbits resulted in marked elevation of both serum amylase and lipase above the preoperative levels. The maximum rise in both enzymes usually occurred on the first postoperative day and returned to preoperative levels on the third day in the case of lipase and on the fourth day in the case of serum amylase. Thereafter, these enzyme levels were stabilized and did not vary significantly throughout the duration of the experiment. The slight elevation of the serum enzymes in rabbits having intraductal methanol, enterokinase of microsome fractions following complete ligation of the duct is observed. This change of enzyme value is somewhat similar to those seen in group of simple ligation or saline instillation. It was also noticed that the levels of serum enzymes were paralleled with the histologic lesions in the pancreas. 2. Histological examination revealed severe parenchymal necrosis of pancreas in animals receiving intraductal instillation of bile, desoxycholate. ethanol or hydrochloric acid. Instillation of taurocholate or enterokinase into the pancreatic duct following complete ligation induced fat necrosis with marked neutrophilic infiltration in the pancreas, however, no parenchymal necrosis is observed except a mild focal necrosis of parenchyma I a part of each group. None of animals showed parenchymal necrosis in the pancreas following instillation of methanol into the duct. Moderately severe parenchymal necrosis was noted in animals receiving pancreatic microsome fraction, whereas, similar treatment with myocardial microsome fraction failed to produce parenchymal necrosis. After ligation alone or with intraductal instillation of saline, pancreatic changes were analogous to those seen in acute edematous or interstitial pancreatitis. Histologic pictures of animals sacrificed at 4 days or more after procedure showed more or less similar in all experimental groups, namely acinar atrophy with ductal transformation and dilation of ductules likely as the effect of ligation, accompanied by fibroblastic proliferation and chronic interstitial inflammatory reaction similar to those of chronic pancreatitis in human. From above results acute necrotizing pancreatitis following instillation of bile, desoxycholate, ethanol or hydropchloric acid seems to be elicited by their inherent toxicity to the pancreatic tissue other than activation of proteolytic enzymes, since it is a well known fact that the pancretic enzymes are not activated, but rather inhibited by those, particularly by alcohol or hydrochloric acid. On the other hand, enterokinase treatment following ligation of the pancreatic duct failed to produce the severe parenchymal necrosis in spite of its activating activity to proteolytic enzymes. With intraductal instillation of pancreatic microsome fraction following ligation of the pancreatic duct a moderate degree of parenchylmal necrosis was resulted. This fact, together with the concept of Reid et al. that intracellular enzymes might be causing the pancreatic lesion, given rise to the interesting speculation that the severe pancreatitis with parenchymal necrosis may be caused by the release of intracellular enzymes, particularly the enzyme or enzyme system in microsome faction resulting from an admixture of pancreatic juice and bile or alcohol. Such situation, however, is not induced in case of mild pancreatitis.
[영문] This paper deals with the effect of intraductal instillation of various agents including the pancreatic microsome fractions to elucidate a possible factor concerning the pathogenesis of acute pancreatitis. The rabbits weighing approximately 2.0kg, regardless of the sex, were used and divided into following six groups: 1) Intraductal instillation of bile, 1% taurocholate and desoxycholate, and complete ligation of the pancreatic duct; 2) Intraductal instillation of 20% ethanol or methanol, and complete ligation of the pancreatic duct; 3) Intraductal instillation of N/10 hydrochloric acid and complete ligation of the pancreatic duct; 4) Intraductal instillation of 1 μ/cc enterokinase and complete ligation of the pancreatic duct; 5) Intraductal instillation of pancreatic or myocardial microsome fractions and complete ligation of the pancreatic duct; 6) Simple ligation of the pancreatic duct of intraductal instillation of saline and complete ligation of the pancreatic duct, as a control group. Technic of infusion into pancreatic duct: The abdomen of the rabbit was opened through an upper midline incision under pentobarbital anesthesia, aseptic technic was used throughout the operative procedure. The major pancreatic duct, which enters into the duodenum at a point approximately 20 cm from the pylorus, was easily cannulated in its intramural potion with a small polyethylene tube. With a syringe 2.0ml of each prepared solution was infused slowly at a pressure below 30 cm of water. Then, cannula was removed after ligation of the pancreatic duct, and the abdominal incision was closed. The serum amylase activity was measured by Nelson's method and serum lipase activty by Cheery and Crandall's method Histopathologic examination were carried out on routine hematoxylin-eosin stained section after 10% formalin fixation and paraffin embedding. Results and Summary: 1. Instillation of desoxycholate, taurocholate, ethanol or hydrochloric acid into pancreatic duct following complete ligation in rabbits resulted in marked elevation of both serum amylase and lipase above the preoperative levels. The maximum rise in both enzymes usually occurred on the first postoperative day and returned to preoperative levels on the third day in the case of lipase and on the fourth day in the case of serum amylase. Thereafter, these enzyme levels were stabilized and did not vary significantly throughout the duration of the experiment. The slight elevation of the serum enzymes in rabbits having intraductal methanol, enterokinase of microsome fractions following complete ligation of the duct is observed. This change of enzyme value is somewhat similar to those seen in group of simple ligation or saline instillation. It was also noticed that the levels of serum enzymes were paralleled with the histologic lesions in the pancreas. 2. Histological examination revealed severe parenchymal necrosis of pancreas in animals receiving intraductal instillation of bile, desoxycholate. ethanol or hydrochloric acid. Instillation of taurocholate or enterokinase into the pancreatic duct following complete ligation induced fat necrosis with marked neutrophilic infiltration in the pancreas, however, no parenchymal necrosis is observed except a mild focal necrosis of parenchyma I a part of each group. None of animals showed parenchymal necrosis in the pancreas following instillation of methanol into the duct. Moderately severe parenchymal necrosis was noted in animals receiving pancreatic microsome fraction, whereas, similar treatment with myocardial microsome fraction failed to produce parenchymal necrosis. After ligation alone or with intraductal instillation of saline, pancreatic changes were analogous to those seen in acute edematous or interstitial pancreatitis. Histologic pictures of animals sacrificed at 4 days or more after procedure showed more or less similar in all experimental groups, namely acinar atrophy with ductal transformation and dilation of ductules likely as the effect of ligation, accompanied by fibroblastic proliferation and chronic interstitial inflammatory reaction similar to those of chronic pancreatitis in human. From above results acute necrotizing pancreatitis following instillation of bile, desoxycholate, ethanol or hydropchloric acid seems to be elicited by their inherent toxicity to the pancreatic tissue other than activation of proteolytic enzymes, since it is a well known fact that the pancretic enzymes are not activated, but rather inhibited by those, particularly by alcohol or hydrochloric acid. On the other hand, enterokinase treatment following ligation of the pancreatic duct failed to produce the severe parenchymal necrosis in spite of its activating activity to proteolytic enzymes. With intraductal instillation of pancreatic microsome fraction following ligation of the pancreatic duct a moderate degree of parenchylmal necrosis was resulted. This fact, together with the concept of Reid et al. that intracellular enzymes might be causing the pancreatic lesion, given rise to the interesting speculation that the severe pancreatitis with parenchymal necrosis may be caused by the release of intracellular enzymes, particularly the enzyme or enzyme system in microsome faction resulting from an admixture of pancreatic juice and bile or alcohol. Such situation, however, is not induced in case of mild pancreatitis.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117106
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 박사
Yonsei Authors
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