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

The authors report a series of 30 cases of acute pancreatitis associated with cholelithiasis. There were 9 cases of necrotizing pancreatitis and the latter group included the 4 deaths observed in this series. Clinical, radiological and laboratory data were in favor of this association in 24 out of the 30 cases. Cholelithiasis appeared to be directly responsible for initiating the pancreatitis in 1/3 of cases. In another 1/3 of cases the mecanism was thought to be related to scarring of the sphincter of Oddi. In the remaining 1/3 of cases no direct relationship could be found. On the basis of these findings, the authors recommend that emergency surgery be reserved for these cases in which cholelithiasis appears to be the etiology. (The biliary syndrome overshadowing the pancreatic syndrome) and to postpone treatment of pancreatic lesions. In all other cases, the authors suggest to keep elective surgery, for after a period of initial conservative treatment with the hope of then treating together biliary and pancreatic lesions.
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PMID:[Acute pancreatitis and cholelithiasis. A study of thirty cases (author's transl)]. 23 83

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

Endoscopic sphincterotomy (ES) was performed in 36 patients (age range 33-88 years; median 63 years) with retained bile duct stones after cholecystectomy (32 patients) or cholecystostomy (4 patients). The median time interval between surgery and ES was 28 days (range 10-216 days). At the time of ES, 23 patients had a T-tube in situ. Clearance of the bile duct was achieved by T-tube irrigation in 15 patients, and by basket or balloon extraction in seven patients. Spontaneous clearance of the duct after ES occurred in 12 patients, while two patients required widening of the sphincterotomy to allow successful basket extraction. Complications occurred in four patients (11%). Two patients sustained significant haemorrhage from the ES site and subsequently died. One patient developed mild acute pancreatitis while another had persisting cholangitis before and after ES. Both of these patients recovered with conservative management. While ES performed soon after gallbladder surgery allows for early bile duct clearance, the small but significant risk of potentially lethal haemorrhage suggests that its use should be reserved for patients in whom other non-operative methods have failed or are inappropriate.
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PMID:Early endoscopic sphincterotomy for retained bile duct stones after gallbladder surgery. 175 74

The relative merits of various serum pancreatic enzymes, ultrasonography (US), and computerized tomography (CT) have been evaluated. In practice, the diagnosis of acute pancreatitis (AP) remains hinged on the clinical picture and elevated serum amylase. The advantages of total serum amylase are its technical simplicity, ready availability, and sensitivity. Within 24 h of onset of symptoms, elevation of amylase is as sensitive as that of lipase, pancreatic isoamylase, immunoreactive trypsin, or elastase. However, after the first hospital day, it is the least sensitive of the enzymatic tests. Its greatest disadvantage is its overall low specificity. Lipase assays are now fast, reliable, practical, more specific, almost as sensitive, and not more expensive than amylase assays. The current feeling is that lipase assays should be used more often or even should replace amylase assays. However, comparative studies using objective criteria for AP are required to evaluate the utility of lipase estimations over that of amylase. Other enzymes such as P-isoamylase, immunoreactive trypsin, chymotrypsin, or elastase are more cumbersome, expensive, and not better than lipase. They should be reserved for cases of doubtful diagnoses. The levels of these pancreatic enzymes neither correlate with the severity of the disease nor can they accurately predict the subsequent clinical course of the patients. The main role of ultrasonography remains in the evaluation of the biliary tract in AP. The contrast-enhanced computed tomography (CECT) is useful for estimating the presence and extent of pancreatic necrosis. Thereby, it enables prompt recognition of patients at high risk for systemic and local complications. Routine use of CECT may aid in the identification of pancreatitis when enzyme elevations are modest, but the utility of the procedure in all clinically mild cases is questionable. Patients who are seriously ill or who present a diagnostic problem should have a CECT. A normal CT under such circumstances excludes clinically severe AP. Serial CT should be done in patients demonstrating phlegmonous extrapancreatic spread.
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PMID:Evaluating tests for acute pancreatitis. 218 90

Serum elastase-1, amylase, lipase, and trypsin-like immunoreactivity were measured in a group of 17 consecutive patients with acute pancreatitis. When assayed within 24 h of the onset of symptoms, all enzymes were found to be elevated, thus showing similar sensitivity. Elastase-1 did not improve the diagnostic score of the other enzymes studied. Owing to their much quicker and less expensive determinations, amylase and lipase should be considered the best initial markers of pancreatic injury. However, during the course of pancreatitis, amylase and in a lesser degree lipase returned to normal in more cases than elastase or trypsin; both were still elevated in 90% of the patients 10 days after the onset of the symptoms. Thus, trypsin and/or elastase-1 should be reserved for cases of doubtful or delayed diagnosis. The specificity and the positive predictive value of these enzymes need to be evaluated.
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PMID:Comparison of elastase-1 with amylase, lipase, and trypsin-like immunoreactivity in the diagnosis of acute pancreatitis. 243 92

Chronic pancreatitis of biliary origin, frequently located in the cephalic portion of the organ, etiopathogenically dependent on biliary lithiasis, the anatomoclinical evolution of which is complicated by their presence, have a better prognosis, and are usually reversible following therapy of the biliary affections. Persistent chronic pancreatitis proper, usually of the recurrent type, associated with calcification and the development of pancreatic stones, and with pseudocysts, although rare in our country, raise diagnostic difficulties from the standpoint of surgery, and have a reserved prognosis. The authors have evaluated a total of 321 cases hospitalized between 1960 and 1987 with chronic pancreatitis of biliary origin (252 cases--78.5%), and chronic pancreatitis proper, not associated to biliary affections (69 cases--21.5%). Male patients totalled 33.6% of all cases. The authors stress the high frequency of chronic pancreatitis associated to biliary lithiasis (181 cases), in contrast with pancreatitis associated to nonlithiasic cholecystopathies (38 cases), or to postoperative cholecystic disturbances (33 cases). Chronic pancreatitis non-associated to biliary affections totalled 69 cases, of which 24 were of the persistent type, 13 were of the recurrent type, one had calcifications, two had pancreatic stones, four followed acute pancreatitis, six were complicated by pancreatic abscesses, and 9 were complicated by pseudocysts. The duration of biliary and pancreatic disturbances was between 3 and 5 years in 43.9% of the cases, and between 6 and 10 years in 21.3%. Chronic pancreatitis achieves a complex clinical syndrome, the dominant feature being the painful biliopancreatic syndrome associated to obstructive jaundice (42.4%), angiocholitis (47.6%), weight loss (46%), hepatic and renal failure (10.9%), diabetes (8.4%), and a tumoral mass (15.7%). Indirect surgical interventions aimed at suppressing the biliary factor were carried out in 291 patients, with very good results in 56% of the cases, good results in 32%, mediocre in 7%. In 2.4% of the cases surgery failed to improve the condition of the patients. Direct interventions on the pancreas, which consisted either in pancreatic decompression or in exeresis of the gland have been performed in 30 patients. Drainage of pancreatic abscesses was done in 6 patients (2 deaths), cystic-digestive anastomoses were performed in 8 patients, Wirsung-jejunostomy in 3 patients (1 death), cystostomy in one patient, distal pancreatectomy in one patient (deceased), viscerolysis and novocaine infiltration in 11 patients. In the 321 cases of chronic pancreatitis operated by direct and indirect procedures very good
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PMID:[Chronic pancreatitis: anatomico-clinical and surgical therapy characteristics. Our experience with 321 cases]. 252 82

Two hundred and one biopsies of the pancreas and/or extrahepatic bile ducts were performed in 173 patients using primarily ultrasound (US) or fluoroscopic guidance. Computed tomographic (CT) guidance was used twice. The success rate for detecting malignancy was 82.4%. Patients with primary ductal carcinoma had the lowest success rate. Seven complications occurred: five vasovagal reactions, one fever, and one acute pancreatitis in a patient with a normal variation, which resembled a mass. In this large series, aspiration biopsy of the pancreas and extrahepatic bile ducts proved to be a safe and reliable procedure that often can be performed on an outpatient basis. Fluoroscopic and US guidance are satisfactory for the majority of biopsies. CT guidance probably should be reserved for patients who undergo a repeat biopsy, or when US fails to adequately demonstrate the pancreas.
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PMID:Percutaneous pancreaticobiliary biopsies in 173 patients using primarily ultrasound or fluoroscopic guidance. 313 Sep 94

Two hundred two patients admitted with the clinical suspicion of acute pancreatitis underwent computerized tomography scanning within 36 hours of admission. The diagnostic value of the computerized tomography findings was excellent, with a sensitivity of 92 percent and a specificity of 100 percent. One hundred seventy-six patients with acute pancreatitis defined according to the overall clinical course were included in the prognostic study. The pancreatitis was fatal in 21 patients, severe in 47 patients, and mild in 108 patients. The computerized tomography findings were classified into the following three groups on the basis of the extent of phlegmonous extrapancreatic spread: Group I, no phlegmonous extrapancreatic spread (100 patients, none died); Group II, phlegmonous extrapancreatic spread in one or two areas (28 patients, mortality rate 4 percent); and Group III, phlegmonous extrapancreatic spread in three or more areas (48 patients, mortality rate 42 percent) (p less than 0.0001). The following three scores from prognostic clinical and laboratory data were also obtained: Score 1, zero or one positive sign (82 patients, none died); Score 2, two to four positive signs (54 patients, mortality rate 13 percent); Score 3, five or more positive signs (40 patients, mortality rate 35 percent) (p less than 0.001). The combination of computerized tomography findings and prognostic signs had the best predictive value. Patients in Group III, Score 3 (24 patients) or Group III, Score 2 (19 patients) had mortality rates of 58 percent and 32 percent, respectively, and complications developed in all of the survivors. In addition, all except two acute pancreatitis patients in whom pancreatic abscess developed were found in Group III (p less than 0.0001). Furthermore, for Group III patients, the prediction of death associated with abscesses was enhanced by the number of prognostic signs. The mortality rate increased from 17 percent for Score 2 patients to 81 percent for Score 3 patients (p = 0.0078). As a result of this study, we recommend early computerized tomography for all Score 2 and Score 3 patients, since it allows prompt recognition of patients at high risk for systemic and local complications. Adequate therapy can then be directed to the group of patients to whom it is best suited. Serial computerized tomographies should be reserved for those patients presenting with phlegmonous extrapancreatic spread.
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PMID:Value of contrast-enhanced computerized tomography in the early diagnosis and prognosis of acute pancreatitis. A prospective study of 202 patients. 334 11

The value of a recently reported grading system of early abdominal computed tomography (CT) for predicting development of pancreatic abscess in patients with acute pancreatitis was reassessed. When the previously described CT grading system was used in another patient population, it did not demonstrate the same degree of prognostic value of baseline CT. In this series pancreatic abscess occurred in only eight of 29 patients (28%) with grade E CT scans (with grade E representing the most severe involvement), compared with 60% in the previous series. Of 44 patients with either grade D or E baseline CT scans, abscesses developed in only 30%, with a minimum clinical follow-up of 3 months. A second grading system, which used a semiquantitative analysis of the degree of peripancreatic inflammation (a "CT severity score"), also did not strongly correlate with the future risk of abscess, The authors conclude that early abdominal CT should be performed selectively in patients with acute pancreatitis and reserved for patients who are either diagnostic dilemmas or who fail to respond to supportive treatment and have clinically suspected surgical complications such as pancreatic abscess.
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PMID:Pancreatic abscess: predictive value of early abdominal CT. 379 56

Amylase-rich fluid that incubates ("ages") within a pancreatic pseudocyst undergoes a change that can be detected by isoenzyme analysis of amylase from the serum. This aging is a result of deamination of the asparagine and glutamine residues on the amylase molecule. Eighteen of 20 patients with surgically proved pseudocysts had greater than 15% aged (deaminated) amylase in their serum. Levels of aged amylase returned to normal following treatment of their pseudocysts. Twenty of 23 patients with acute pancreatitis had levels of aged amylase below 15% (P less than .05). A criterion of 15% aged amylase resulted in 87% specificity, and 91% sensitivity for the diagnosis of pseudocysts. Because this test is noninvasive and easy to perform, it should become the ideal screen for patients at risk of development of pseudocysts, Endoscopic retrograde pancreatography, ultrasonography, and abdominal computed tomographic scanning should be reserved for confirmation of the diagnosis when the result of isoenzyme analysis is positive.
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PMID:Aged amylase: a valuable test for detecting and tracking pancreatic pseudocysts. 617 14


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