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

The physiology and pathophysiology of the sphincter of Oddi are poorly understood. The relationships of functional disorders of the sphincter to biliary and pancreatic disease and of organic lesions of the papilla to pancreatic inflammatory disease are subjudice to say the least. The efficacy of sphincter section in the treatment of chronic pancreatitis is unproved. Section of the sphincter may be necessary to treat biliary tract pathology but its use should not be routine or indiscriminative since, there is morbidity as well as mortality. Finally, the price of sphincterotomy is: 1. hemorrhage; 2. duodenal perforation; 3. pancreatic duct damage--a. acute pancreatitis; b. chronic pancreatitis; 4. sphincter incompetence--a. common duct regurgitation--cholangitis; b. pancreatic duct regurgitation--pancreatitis; 5. sphincter stenosis--obstructive jaundice; 6. stasis cholecystitis; 7. diarrhea; 8. morbidity 10%; 9. mortality 1.9%.
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PMID:The sphincter of Oddi, sphincterotomy and biliopancreatic disease. 39 44

Ultrasonically visualized pancreatic ducts seen in patients over two and a half years were reviewed. Pancreatic ducts ranging from 2 to 16 mm were identified in 41 patients. All proved to have pancreatic disease. Of these, 25 had inflammatory disease, including acute pancreatitis, chronic pancreatitis, and pancreatolithiasis, and 16 had ampullary or pancreatic head tumors. There was no correlation between the pancreatic duct diameter and the underlying pathology. A careful search for tumor must be made in all patients in whom the pancreatic duct is demonstrated, using current gray-scale instrumentation.
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PMID:Ultrasonic demonstration of the pancreatic duct: an analysis of 41 cases. 42 48

A ductographical and histological study was carried out in 70 human pancreata postmortem. The diameter, the thickness and the length of the major pancreatic duct were measured. The obtained data were evaluated statistically. The autopsy revealed in 7 cases an acute or a mild chronic pancreatitis, in 20 cases a disease of the bile duct system, in 4 both an acute pancreatitis and a bile duct disease, while the other patients showed no inflammatory or neoplastic diseases of the pancreas or the bile ducts. The relative wall thickness of the duct increases with growing distance from the papilla, while the real thickness of the wall decreases. The inner and outer diameter of the duct steadily rises with aging. The relative thickness decreases with aging, but in a considerable less degree. The length of the duct growths with aging. All these relations were expressed in mathematical equations. In acute pancreatitis, in mild chronic pancreatitis and in disease of the bile duct system no statistically significant differences of the outer and inner diameter, of the length and the relatative thickness of the wall were found in comparison to normal pancreata.
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PMID:[Comparative radiological and morphological study of the human pancreas. III. Morphometric investigation of the major pancreatic duct (author's transl)]. 43 76

The authors observed 103 cases of pancreatic cysts caused by acute pancreatitis, aggravation of chronic pancreatitis (81.0%) and trauma to the pancreas (12.0%). The posttraumatic cysts were more common in children and young adults (86.0%). The use of the complex method of diagnosis (x-ray examination of the gastrointestinal tract, celiacography, and upper mesentericography, endoscopic pancreatography, ultrasound echolocation of the pancreas) allowed to establish the diagnosis in 91.6% of cases. The external drainage of the cysts was carried out in cases of infected cysts with poorly formed walls. In case of a dilated and deformed main pancreatic duct with disorder of its patency (21 cases) the longitudinal cystopancreatojejunostomy was performed. The lethality after internal drainage constituted 2.4%. 80.8% of patients showed good long-term results of the treatment and 14.4%--showed fair results. 2 patients (2.1%) developed the recurrence of the cyst.
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PMID:[Surgical treatment of pancreatic cysts]. 44 35

Pancreatic necrosis is a principal determinant of the severity, duration, and infectious complications of acute pancreatitis. There has been no objective index for pancreatic necrosis, and its recognition has necessarily rested upon nonspecific clinical signs, including later deterioration or appearance of sepsis. In search of such an index, we have measured serum levels of a poly-[C]-specific acid ribonuclease (RNase) in 38 patients with acute pancreatitis, 12 patients with chronic pancreatitis, and 50 control patients. The values in chronic pancreatitis (mean, 52 units; range, 33 to 80 units) were within observed normal limits (mean, 51; range, 17 to 94). The values in acute pancreatitis segregated into two groups, normal values (group A) and high values (group B). Of 25 patients in group A (mean, 46; range, 19 to 87), only one developed evidence of pancreatic necrosis or abscess. In contrast, of the 13 patients in group B (mean, 192, range, 98 to 385), 11 required surgical debridement/drainage for pancreatic necrosis (six) or abscess (five) (P less than 0.001). Each of the other two patients had prolonged pancreatic inflammation with fever and a pancreatic mass which persisted for more than 2 weeks. RNase levels in group B patients rose within a few days after onset of pancreatitis and tended to parallel the clinical course. These findings suggest that measurement of serum RNase in acute pancreatitis gives a reliable indication of pancreatic necrosis. Therefore RNase determinations should be of value for earlier identification and monitoring of patients at high risk of late complications, and for helping to select those who will benefit from early debridement before secondary infection occurs.
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PMID:Serum ribonuclease elevations and pancreatic necrosis in acute pancreatitis. 46 72

A multicenter study on the etiology and diet of patients with pancreatic diseases has been realized with the collaboration of 36 centers in 19 countries having widely different climatic and racial conditions. 2,478 cases were studied: acute pancreatitis (AP), 222 males, 208 females; calcified chronic pancreatitis (CCP), 801 males, 134 females; non-calcified chronic pancreatitis (NCCP), 525 males, 155 females; pancreatic cancer (PK), 69 males, 14 females; controls, 281 males, 62 females. The analysis of mutual information and the factorial analysis of correspondences have been used. With regard to chronic pancreatitis, the 19 countries could be classified into 4 classes presenting relative similarities. (A) Southern Europe: The diet is rich in carbohydrates, protein and lipids, alcohol intake is primarily in the form of wine and the pathology is dominated by CCP. There are much fewer women than men with chronic pancreatitis. (B) Northern Europe, to which may be added Argentina and Chile, is characterized by a protein- and lipid-rich diet, a beer-based alcohol consumption and a distinct prevalence of AP and NCCP. The prevalence of males with chronic pancreatitis is less marked than in southern Europe. (C) Japan has a lipid-poor diet and a low frequency of CCP and NCCP. (D) A fourth group is mostly composed of tropical countries with mixed races. It may be divided into 2 subclasses: (a) India is the most characteristic country of the first type with low fat, low protein diet, no alcoholism, high frequency of CCP (at an early age); (b) Brasil and South Africa are representative of the second subclass with very high alcohol intake in the form of spirits and a high frequency of CCP.
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PMID:A multicenter inquiry into the etiology of pancreatic diseases. 47 88

The management of four patients with severe pancreatic pain is discussed. Bilateral coeliac plexus block with alcohol gave effective pain relief to the three patients with pancreatic carcinoma and the one patient with acute pancreatitis. The treatment of the pain of acute and chronic pancreatitis is reviewed.
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PMID:The treatment of severe pancreatic pain. 48 Dec 51

Immunoreactive serum trypsin was measured with a double antibody radioimmunoassay in normal subjects and patients with various diseases of the pancreas. The normal range is 115-350 ng/ml with a geometric mean of 212 ng/ml. No trypsin was found in serum after total duodenopancreatectomy, in about 75% of patients with cystic fibrosis and in a few patients with pancreas carcinoma or chronic pancreatitis. Reduced serum trypsin levels between 10 and 100 ng/ml were measured in the remaining 25% of cystic fibrosis and in one third of the patients with chronic pancreatitis. Serum trypsin was increased to 700-17,000 ng/ml in all patients with acute pancreatitis or during the acute phase of chronic pancreatitis. Absent or reduced serum trypsin is a reliable indicator of total or partial exocrine pancreatic insufficiency whereas considerably increased serum trypsin concentration do indicate acute pancreatitis.
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PMID:Immunoreactive serum trypsin in diseases of the pancreas. 52 26

The radiographic gastric changes associated with acute and chronic pancreatitis are described. The pertinent literature is reviewed and forms of involvement previously not reported are illustrated and discussed. Intramural and perigastric permeation of extravasated pancreatic enzymes and the secondary inflammatory reaction that follows are responsible for the radiographic changes observed. Generalized rugal thickening and particularly a localized spiculated appearance to the posterior wall of the stomach are transitory findings seen in acute pancreatitis. Radiographic abnormalities associated with chronic pancreatitis include patterns mimicking linitis plastica, indurated and nondistensible rugae involving the proximal stomach and a severely distorted gastric configuration induced by perigastric adhesions. The recognition of these patterns of involvement helps in the radiographic diagnosis and avoids confusing or evasive interpretations.
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PMID:Effects of acute and chronic pancreatitis on the stomach patterns of radiographic involvement. 53 1

Stenosing odditis represents only 4.5 p. cent of all benign lesions of the extrahepatic bile ducts. Their diagnosis is made by peroperative radiomanometry, but clinically they are suggested by a past history and serious clinical signs. The pancreatic involvement is rarely macroscopic (10 p. cent of cases of which 5 p. cent are severe) and acute pancreatitis due to stricture of the sphincter without gall stones is exceptional. Associated biliary lesions are frequent; in 50 p. cent of cases, of lithiasis of the common bile duct or pancreatitis, in 66 p. cent of cases of residual odditis. The treatment is surgical. Sphincterotomy should be reserved for young subjects with a slightly dilated common bile duct, or when necessary to extract a gall stone from the lower end of the bile duct. Biliary by pass operations are all the more indicated when the patient is elderly or the common bile duct more dilated. Local complications are the most frequent and the most serious after sphincterotomy; the local complications of biliary by pass operations are usually very simple. The late results of biliary by-pass operations are better than those of sphincterotomy, which confirms that the pancreatic complications of odditis are rare or well tolerated. The presence of chronic pancreatitis in association is not an aggravating factor.
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PMID:[Stenosing odditis: diagnosis and treatment. Report of 109 cases (author's transl)]. 59 95


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