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Query: UMLS:C0001339 (acute pancreatitis)
 10,593 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The acute pancreatitis is a disease which is unchangedly characterized by a high lethality. The actual frequency of this disease is difficult to be established, but its increase is probable particularly in the countries with high living standard. Factors of nutrition play an important role in the etiology and in the actual development, and the consumption of alcoholic beverages gains increasingly significance. Despite modern apparative possibilities for making the diagnosis the clinical picture and proved laboratory findings--fermentative lapses, disturbances of the carbohydrate metabolism--are in the first place. At first a conservative treatment is demanded with the preceding aim to prevent shock as well as renal and pulmonary insufficiency. None of the substances, which were experimentally introduced into treatment during recent years, could clearly prove a superiority in contrast to conventional therapeutic principles. Single cases may be saved by timely operation, the problem is here the certain recognition of the borderline to the surgical treatment.
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PMID:[Acute pancreatitis]. 31 8

Sixty-three patients with severe acute pancreatitis have been studied. Pancreatitis was associated with biliary tract disease in 23 patients (36.5%) and with alcoholism in 21 (33.3%). It occurred post-operatively in 9, and was associated with other conditions in 10. We evaluated the Ranson prognostic signs (RPS) with the appearance of complications. 36 patients (57.2%) had 3-4 RPS, 9 (30.2%) had 5-6 RPS and 8 (12.6%) had 7 or more RPS. Diagnostic laparotomy was performed in 11 patients (17.5%). 55 patients were operated one or more times due to failure of medical treatment and/or local and septic complications. The most frequent complications were pancreatic abscess (60.3%), sepsis (58.7%) and pulmonary insufficiency (52.4%). Renal failure occurred in 26 patients and 9 required dialysis. Of the patients with renal failure, 84.6% (22/26) had 4 or more RPS; 78.4% (29/37) of those with sepsis and 71.6% (27/38) of those with pancreatic abscess also had 4 or more RPS. The mean duration of hospitalization of survivors was 58 +/- 30 days. Overall mortality was 28.6%. We conclude that RPS are helpful to predict complications in patients with severe pancreatitis.
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PMID:[Acute severe pancreatitis. Analysis of mortality and morbidity]. 184 70

The activities of a number of lysosomal hydrolases were determined in sera from 100 patients with cystic fibrosis (CF), age 2-35 yr, and age-matched controls: beta-hexosaminidase activity was significantly elevated (p less than 0.005) in CF patients from all age groups. alpha-Mannosidase activity was increased only in the older CF patients (greater than 13 yr). The following enzyme activities were not altered in CF serum: alpha-fucosidase, beta-glucuronidase and acid phosphatase. The abnormal patterns of serum alpha-mannosidase and beta-hexosaminidase in CF cannot be explained by pancreatic disease or undernutrition, since serum values of these hydrolases in patients with anorexia nervosa or acute pancreatitis were not altered. However, the altered activities of the alpha-mannosidase and beta-hexosaminidase were proportional to the degree of pulmonary insufficiency in the CF group, indicating that these changes are probably a secondary consequence of the primary disease process. Except for beta-hexosaminidase, because differences in the serum hydrolases in CF do not become apparent until the second decade of life, determinations of lysosomal enzyme activities in serum will probably be of little diagnostic value.
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PMID:Serum lysosomal hydrolases in cystic fibrosis. 316 78

Serious pulmonary complications are often associated with acute pancreatitis. The destruction of pulmonary surfactant by the action of pancreatic phospholipase A2 (PLA2), together with pulmonary edema, is considered an important etiopathogenic factor of acute respiratory insufficiency. This experimental study was undertaken to elucidate the destruction of pulmonary surfactant in acute pancreatitis using the lung pressure volume curve (P-V curve). Acute hemorrhagic pancreatitis was induced in mongrel dogs by a retrograde injection of Na-taurocholate into the main pancreatic duct. Pulmonary surface tension was measured by P-V curve and the effect of PLA2 on pulmonary surfactant was assessed by the ratio of lysolecithin and lecithin, which are essential components of pulmonary surfactant (Ly/Le) in lung wash. Extravascular lung water volume (Ww/Dw) and blood gases were also measured. The value of Ly/Le and serum PLA2 rose significantly from the 3rd hour. On the contrary, no significant differences were seen on P-V curve until the 12th hour but after 20 hours surface tension increased significantly. Ww/Dw and A-aDO2 increased after 3 and 12 hours, respectively. These findings, the degradation of lecithin and the elevation of surface tension accompanied with an increase of serum PLA2, suggest that pulmonary surfactant is destroyed in severe acute pancreatitis, and that the increased capillary permeability of the lung precedes the deterioration of surface tension as the cause of pulmonary insufficiency.
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PMID:[Experimental study on the pathogenesis of pulmonary insufficiency in acute pancreatitis and changes in the pulmonary surfactant]. 322 26

An acute pancreatitis is possible, both in a hitherto healthy organ (mainly together with gallstones) and in a chronically danaged gland (maily together with alcoholism). Toxic damage of the pancreas is found in hypercalcemic states and with drugs. It is unknown what directly induces acute inflammation in the pancreas. The pathophysiological consequences of acute pancreatitis are mainly volume deficiency and shock, renal failure, pulmonary insufficiency, disturbances of carbohydrate metabolism and blood clotting. Prognosis of acute pancreatitis is difficult to evaluate. Clinical findings and laboratory parameters are utilized together to judge the presumable course of the disease.
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PMID:[The pathophysiology of acute pancreatitis (author's transl)]. 700 44

Local septic complications in acute pancreatitis (AP) should be characterized and defined in order to assess the validity of early diagnosis and various therapeutic measures. The purpose of this study was therefore to distinguish between two local septic complications which have been termed 'abscess' and 'infected necrosis' in regard to their morphological, clinical, laboratory criteria. Moreover, the validity of various diagnostic procedures and therapeutic interventions were compared. Septic necrosis is defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue. The morphologic substrate of pancreatic abscess is a localized collection of pus surrounded by a capsula or pseudocapsula. Infected necrosis become clinically evident in the early phase of AP. The patients suffer from a fulminant course of AP with signs of sepsis and laboratory alterations typical for AP. Concomitantly, these patients develop pulmonary and renal insufficiency, in 71.5 and 44.2% of the patients, resp. Overall mortality rate of patients with infected necrosis amounts to 20.8%. In contrast, pancreatic abscess develops not before week 5 after onset of AP. Concomitantly, the laboratory signs of AP like amylasemia and hypocalcemia as well as LDH and C-reactive protein increases are rarely observed. Correspondingly, these patients suffer significantly less form pulmonary insufficiency (22.6%) or other organ complications. Consequently, the mortality rate is with 6.5% significantly lower. Timely diagnosis is possible with acceptable sensitivity by contrast-enhanced CT scan and fine-needle aspiration. Other imaging procedures do not show similar sensitivity and specificity. Therapeutically, patients with infected necrosis as well as pancreatic abscess have to be operated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diagnosis and therapy of primary pancreatic abscess]. 766 88

Major pancreatic resection is still accompanied by considerable morbidity and even mortality. Complications which occur after pancreatic surgery are chiefly associated with exocrine pancreatic secretion, hence, the inhibition of exocrine pancreatic secretion perioperatively is a promising concept in the prevention of complications. The hormone somatostatin and its synthetic analogue octreotide have been shown to profoundly inhibit exocrine pancreatic secretion, particularly the secretion of proteases. In a randomized, placebo-controlled, multicenter double-blind trial we analyzed the potential role of octreotide in the prevention of postoperative complications after major pancreatic surgery. A significant reduction in complications such as fistula, abscess, fluid collection, sepsis, pulmonary insufficiency, and postoperative acute pancreatitis could be demonstrated in patients who received octreotide at 3 x 100 micrograms/day subcutaneously. Octreotide was particularly effective in patients undergoing Whipple resection for cancer.
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PMID:Prevention of postoperative complications following pancreatic surgery. 810 13

Major pancreatic resection still carries a considerable risk for morbidity and even mortality. Complications occurring after pancreatic surgery are chiefly linked with exocrine pancreatic secretion. Therefore to inhibit exocrine pancreatic secretion perioperatively seems to be a promising concept in the prevention of complications following pancreatic resection. The hormone somatostatin and its synthetic analogue octreotide have been demonstrated to inhibit exocrine pancreatic secretion profoundly, particularly the secretion of proteases is decreased. In a randomized placebo-controlled multicentric and double-blind trial we analyzed the role of octreotide in the prevention of post-operative complications after major pancreatic surgery. A significant reduction of complications (fistula, abscess, fluid collection, sepsis, pulmonary insufficiency, postoperative acute pancreatitis) could be demonstrated in patients receiving octreotide (3 x 100 micrograms/day s.c.). The effect of octreotide was particularly true in patients undergoing a Whipple resection for cancer.
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PMID:Prophylaxis of complications after pancreatic surgery: results of a multicenter trial in Germany. 813 35

Major pancreatic resection still nowadays carries a considerable risk for morbidity and even mortality. Complications occurring after pancreatic surgery are chiefly linked with exocrine pancreatic secretion. Therefore to inhibit exocrine pancreatic secretion perioperatively, seems to be a promising concept in the prevention of complications following pancreatic resection. The hormone somatostatin and its synthetic analogue octreotide have been demonstrated to inhibit exocrine pancreatic secretion profoundly, particularly the secretion of proteases is decreased. In a randomized placebo-controlled multicentric and double blind trial we analysed the role of octreotide in the prevention of postoperative complications after major pancreatic surgery. A significant reduction of complications (fistula, abscess, fluid collection, sepsis, pulmonary insufficiency, postoperative acute pancreatitis) could be demonstrated in patients receiving octreotide (3 x 100 micrograms per day sc.). The effect of octreotide was particularly true in patients undergoing a Whipple resection for cancer.
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PMID:Inhibition of pancreatic secretion to prevent postoperative complications following pancreatic resection. 826 70

This article realize a retrospective analysis of the course of acute pancreatitis and evidence changes of concepts upon physiopathogenesis aspects, the natural history of the disease and the therapeutic management. The responsability of the biliary factor its accepted but the classic mechanism of the biliopancreatic reflux by common chanel its on discussion. Relativeness to natural history of the acute pancreatitis, however of to remain un known sone aspects to ellucidate on the future, today its accepted the biphasic course of the severe pancreatitis, with one initial period and other tardif, to second or their week, with septic complications or evolution to resolution of process. The concept of systemic inflammatory response syndrome and failure of organ systems (renal insufficiency, pulmonary insufficiency) its essential for interpretation of the ominous consequences of one inopportune surgical approach on the early period, associated with high mortality. One schematic personnel square present the different therapeutics procedures along the years, from the distant and dogmatic surgery for principle, until the actual moment where the conservative attitude its of unanimous acquiescence on critic period of disease. The surgery its indicated on second phase, with developing of septic complications, reactivation or persistence of systemic inflammatory response syndrome with increasing severity of pancreatitis.
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PMID:[Chronology and current status of the therapy in acute pancreatitis]. 1628 22


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