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Query: UMLS:C0007570 (celiac disease)
 13,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Angiography of the pancreas was performed in 55 patients after the administration of different drugs stimulating the blood flow in the pancreas and the pancreatographic effect in this group was compared with that in a series of 174 celiac angiographies without drugs. With drugs the pancreatographic effect appeared more frequently (74.5 per cent) than without (18.4 per cent). The small pancreatic arteries and veins were better demonstrated with drugs. The pancreatographic effect seems to be of value for the differential diagnosis of chronic pancreatitis and carcinoma of the pancreas.
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PMID:The pancreatographic effect during pharmacoangiography of the pancreas. 115 14

Immunoreactive lipase (IRL) was measured in 368 stool samples from 231 individuals by means of a new enzyme-linked immunoabsorbent assay technic, to test its validity as an indicator of exocrine pancreatic insufficiency. Ninety-seven stool samples from 64 healthy volunteers showed a logarithmically normal distribution of IRL values and a median IRL concentration of 17 micrograms/g (range, 2.75-117.3 micrograms/g) with a statistically calculated lower normal limit of 4 micrograms/g. In 100 stool samples from patients with chronic pancreatitis and proven steatorrhea the median IRL concentration of 6 micrograms/g (range, 0.002-107 micrograms/g) was significantly lower than that of normal controls and of 52 stool samples from patients with chronic pancreatitis without steatorrhea (IRL, 40 micrograms/g; range, 0.55-302 micrograms/g), 45 stool samples from 23 patients with celiac disease (IRL, 96 micrograms/g; range, 6.05-563 micrograms/g), and 30 stool samples from 26 patients with chronic diarrhea (IRL, 57 micrograms/g; range, 4.2-573 micrograms/g). It is concluded that fecal IRL is a promising new enzyme test with low diagnostic sensitivity (34%) but excellent diagnostic specificity (98%) in chronic pancreatitis and for diagnostic study of chronic diarrheal disorders. In contrast to fecal chymotrypsin, the test results are unaffected by pancreatic enzyme replacement therapy.
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PMID:Fecal immunoreactive lipase: a new tubeless pancreatic function test. 158 7

Traumatic pseudoaneurysm of the abdominal aorta has been infrequently reported in the literature. We report a case of an infected pseudoaneurysm of the supraceliac aorta which we believe to be secondary to celiac plexus block performed for pain from chronic pancreatitis. The aneurysm was successfully repaired using a Dacron graft through a thoracoabdominal approach. The possible mechanism of aortic injury from celiac plexus block is discussed.
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PMID:Aortic pseudoaneurysm secondary to celiac plexus block. 199 85

A 58-year-old with acute/chronic pancreatitis was treated with celiac plexus blockade. A percutaneous teflon catheter was placed for intermittent blockade and used for definitive neurolysis. There were no complications using this approach to celiac plexus blockade.
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PMID:Teflon epidural catheter placement for intermittent celiac plexus blockade and celiac plexus neurolytic blockade. 226 53

Breath hydrogen (H2) exhalation after xylose administration reflects the malabsorbed portion of the pentose and thus might facilitate the application of the D-xylose test. Therefore, as a complementary parameter, breath H2-exhalation in response to 25 g D-xylose was assessed in control subjects, in patients with coeliac disease, with chronic pancreatitis and with the irritable bowel syndrome. Patients with coeliac disease showed significantly higher breath H2 concentrations than the controls. Specificity and the positive predictive value of peak H2-increments greater than 56 ppm (i.e. greater than mean + 2 SD of controls) were 100%, but sensitivity was only 40%. In all patients with a positive H2 breath test, urinary D-xylose excretion and serum D-xylose increments were also abnormal. Apart from great overlap between controls and patients with coeliac disease, the failure to produce H2 in response to D-xylose in 12% of the 57 investigated subjects was the major factor limiting diagnostic efficiency of the test. Non H2 production could be shown to reflect a specific metabolic disability of the colonic flora and did not prove complete absorption of the substrate. It is concluded, that the 25 g D-xylose H2 breath test is of no clinical relevance for the diagnosis of celiac sprue but exaggerated breath H2 increases (greater than 56 ppm) with normal urinary and D-xylose tests were indicative for the irritable bowel syndrome in 5 out of 10 patients. The diagnostic impact of this constellation thus merits further investigation.
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PMID:Clinical evaluation of a 25 g D-xylose hydrogen (H2) breath test. 227 52

Pancreaticojejunostomy is the method of choice for surgical treatment of pain in chronic pancreatitis in the case of ductal dilation. The operative risk is small and all remaining glandular tissue preserved. At 5 years postoperatively, about two-thirds of the patients still experience pain relief. In the absence of dilated ducts, the surgical options are somewhat more controversial. Parenchyma-saving alternatives such as nerve-cutting procedures have not met expectations. Instead, percutaneous blockage of the celiac plexus using alcohol and phenol have been more commonly used for short-term pain relief. The relatively great number of different resective procedures probably reflects the dissatisfaction with the effect of each one of them. Neither left resection nor total pancreatectomy is, today, an attractive alternative due to the relatively high mortality and morbidity (short- and long-term) risks, especially when evaluated against the backdrop of the limited pain reduction in many patients. The Whipple procedure is still the best alternative, although it should be used with critical selection by both the patient and the surgeon. As for the new operations presented during the 1980's, it is too early to foresee their possible future role. We feel, however, that we still have to await the operation which fulfills the criteria of an ideal operation for pain in chronic pancreatitis.
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PMID:Chronic pancreatitis: results of operations for relief of pain. 240 38

The management of any patient with recurrent pain following surgery for chronic pancreatitis is far from an easy problem. Even more careful assessment than that preceding the decision for the first operation will be necessary. In-hospital patient assessment is strongly recommended to ascertain the degree of the problem of pain in as objective a manner as possible. The effects of alcohol withdrawal and different analgesic treatments have to be carefully assessed while obtaining essential information on the size and shape of the pancreatic duct as well as the general pancreatic morphology. Relatively simple procedures such as the removal of stones or the enlargement of a strictured anastomosis may be all that is required to ensure freedom from pain; however, there is a tendency for patients who have no obvious new pathology or simple failure of the first operation to move to more extensive resectional procedures. This, ultimately will lead to total pancreatectomy being recommended and long-term follow-up of such patients is under critical scrutiny. Unless the highest caliber of support services can be mustered for these patients subject to total pancreatectomy, the morbidity and mortality in the longer term can reach prohibitive levels. A plea is made for objective reassessment of the place of celiac ganglionectomy in the management of these difficult problems.
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PMID:Management of recurrent pain following previous surgery for chronic pancreatitis. 240 41

Pharmacological, percutaneous celiac plexus blockade is often inefficient in the treatment of pain in chronic pancreatitis. Lack of efficiency could be due to incomplete denervation of the plexus; however, a method for measuring the completeness of celiac plexus blockade is not yet available. We have, therefore, monitored the physiological completeness of pharmacological percutaneous celiac blockade with 40 ml 25% ethanol by measuring the effect of posture on heart rate, blood pressure, hepato-splanchnic vascular resistance, and pancreatic hormone concentrations before and after celiac plexus block in 6 patients with chronic pancreatitis. Blood pressure decreased and heart rate increased after the block (P less than 0.025), whereas no significant change was found in hepato-splanchnic vascular resistance nor in the change of these parameters during transition from the supine to standing position. Pancreatic hormones (C-peptide, free insulin, glucagon, pancreatic polypeptide and somatostatin) did not change in response to standing, either before or after the block. The cardiovascular variables were normalized the day after the block, and all the patients were in their habitual state regarding pain after 1 week. In conclusion, pancreatic hormone concentrations in response to standing are not useful for monitoring celiac plexus block, whereas heart rate, blood pressure and hepato-splanchnic blood flow may yield useful information. From such measurements it was concluded that permanent denervation of the celiac plexus was not achieved in our patients after injection of 40 ml 25% ethanol.
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PMID:Monitoring of celiac plexus block in chronic pancreatitis. 213 12

The dietary treatment of steatorrhea requires knowledge of the cause of the disease associated with the steatorrhea. Once the cause is established, then an approach to the dietary management can be adopted. Guidelines for treatment are reviewed in this article. Recommendations for either the treatment of the primary disease, limitation of fat intake, nutritional support, or pancreatic-enzyme replacement are made depending on the disease process. The most common disease entities causing steatorrhea are discussed in detail. Specific recommendations are made for the treatment of steatorrhea in cystic fibrosis of the child and adult, pancreatic insufficiency caused by chronic pancreatitis, gluten enteropathy, and the short-bowel syndrome. Emphasis is placed on the fact that each patient must be managed by correlating the cause of the steatorrhea with specific modalities of therapy.
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PMID:Dietary therapy of steatorrhea. 250 53

This is a report on 501 pancreatic and periampullary cancers treated at the Mannheim Surgical Clinic during the past 11 years. Modern diagnostic measures (computerized axial tomography, endoscopic retrograde cholangiopancreatography, and angiography), while failing to detect the early operable tumors, have contributed to a rise in the rate of resectability of cancers of the pancreatic head (from 5% to 21%). Tactical problems of surgical treatment include the extent of resection required (total or partial), the rationale of preliminary biliary decompression, the symptomatic but unidentified mass in the head of the pancreas, and concomitant celiac artery stenosis. In 118 duodenopancreatectomies performed for cancer and 81 performed for severe and complicated chronic pancreatitis, the operative and hospital mortality rate was 2.5%. Of the 28 patients whose pancreatic resections for cancer occurred more than 5 years ago, 10 reached the 5-year survival limit.
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PMID:The surgical treatment of pancreatic carcinoma. 257 29


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