compensatory anti-inflamatory response syndrome CARS,

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1 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF Vol. 32, pp , 2004 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF CHDF A 13 CHDF B 7 20 A B APACHE, retrospective A 100 % B 57.1 % 28 APACHE 6.0 A %B % A %B % A, CHDF compensatory anti-inflamatory response syndrome CARS, CHDF APACHE severe acute pancrea-titis SAP 25% 22 % 1) 7 2) 1) SAP continuous hemodiafiltation CHDF CHDF 3-7) 72 7) 8) CHDF 5) CHDF 9) 10) 5

2 Table 1. Characteristics of Patients with Severe Acute Pancreatitis in Group A and Group B retrospective Table ) SAP A B ) Stage 2 SAP 2 CHDF 0 6

3 CHDF CT 4Fr 5Fr Seldinger nafamostat mesilate 240 mg 5 % 240 ml 10 ml/hr imipenem0.5 g 5 % 50 ml CHDF Blood access - polymethyl methacrylate PMMA 80 ml/min 300 ml/hr 800 ml/hr 500 ml/hr nafamostat mesilate activated coagulation time ACT sec B F CHDF 7 APACHE acute phyiology and chronic health evaluation 12) Santorini consensus conference 13) 6 Marshall 14) multiple organ dysfunction MOD 1 2 t 2 P 0.05 Stage A B Stage APACHE A 100 % B % APACHE A APACHE B APACHE A A B Fig. 1A APACHE % APACHE %Fig. 2 B 21 APACHE 6 7

4 Fig. 1. Serial changes in APACHE II scores of Groups A and B. There was no statistical significance between the two groups at each time interval. Fig. 4. Serial changes in number of cases with organ dysfunction in Group A. After 28 days, only 1 case (7.7%) had organ dysfunction. Fig. 2. Serial changes in APACHE II scores of Group A( number of cases with scores above 6.0 and below 6.0). After 28 days, 8 subjects (61.5%) had an APACHE II score below 6.0. Fig. 5. Serial changes in the number of cases with organ dysfunction in Group B. After 28 days, 2 cases (40%) had organ dysfunction. Fig. 3. Serial changes in APACHE II scores of Group B( number of cases with scores above 6.0 and below 6.0). After 28 days, only 1 subject (20%) had an APACHE II score below % % Fig. 328 A B 6 A P= Fig A %B % A B A

5 CHDF % Fig. 4 B % 28 B A P=0.0134Fig. 5 A % B % B MOD APACHE MRSA Tountas 15) 16) 3) 84.7 % % 7) A Stage % 48 7) 17) CHDF SAP SAP 18) SAP IL- 10 TNF- soluble TNF receptoril-1 receptor antagonist 19) 20) CHDF 21) Bone compensatory anti-inflammatory response syndrome CARS 22) CARS APACHE 6 40 % 15.4 % 7.6 % 7) B 57.1 % 2 2 MOD

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8 Abstract Comparative Study of Local Intra-Arterial Infusion Therapy of Protease Inhibitor and Antibiotics and Combination Therapy with Continuous Hemodiafiltration for Severe Acute Pancreatitis Suehiro NAKANO 1, Masaki NAGAYA 2 and Hiroyuki KOMORIYAMA 3 The subjects for study consisted of 20 patients with severe acute pancreatitis. Thirteen patients in Group A received local intra-arterial infusion therapy. Seven patients in Group B received combination therapy with continuous hemodiafiltration (CHDF). A retrospective comparative study was conducted to compare the survival rates, serial changes in APACHE II scores, and in the number of organ dysfunctions between Groups A and B. As a result, the survival rate was 100% in Group A and 57.1% in Group B. Eight out of 13 patients (62%) in Group A had APACHE II scores less than 6.0 after 28 days of therapy compared to 1 out of 5 (20%) in Group B. In addition, 1 out of 13 patients (7.7%) had organ dysfunction in Group A compared to 2 out of 5 (40%) in Group B. A statistical significance was noted between Group A and B. Our results showed that there were more favorable therapeutic effects in Group A than in Group B. We have speculated that in combination therapy, local inflammatory cytokine production in the pancreas could be suppressed by intra-arterial infusion therapy; and CHDF would remove anti-inflammatory cytokines and inflammatory cytokine inhibitors rather than the inflammatory cytokines. Under these conditions favorable for compensatory anti-inflammatory response syndrome, CARS, the patient would become and immunodeficient leading to the above-mentioned results. 1 Division of General Surgery, St.Marianna University School of Medicine 2 Department of Emargiency and Clitical Care Medicine, St.Marianna University School of Medicine 3 Department of Gastro-intestinal Surgery, St.Marianna University School of Medicine, Yokohama City Seibu Hospital 12