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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pancreas divisum is an anatomic duct variant, which may predispose to pancreatitis. Most patients are managed conservatively, but some patients justify attempts to improve drainage. The correct surgical approach is not yet established, and there has been no series published concerning pancreatic resection in this context. A 6-year experience with resection performed in 14 patients with severe pain is reported. There were no operative deaths, and 11 patients had good pain relief; steatorrhea developed in two patients and diabetes in one. The hypothesis that pancreas divisum may cause pancreatitis is supported by examination of resection specimens after pancreaticoduodenectomy; the dorsal part showed chronic pancreatitis and the ventral portion was normal.
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PMID:Resection for pancreatitis in patients with pancreas divisum. 638 80

We have reviewed ten children who underwent surgical therapy for persistent neonatal hypoglycemia over a 5-year period. All had inappropriately high insulin levels in the face of hypoglycemia, and all failed medical management with intravenous glucose, frequent feeds, diazoxide and glucagon. Two groups of five patients each were analysed retrospectively. Group 1 underwent 95% pancreatectomy, leaving a small amount of pancreatic tissue on the duodenum and common bile duct. The only major complication in this group was in one patient with common duct obstruction requiring choledochoduodenostomy. All these children are developing normally, without diabetes, steatorrhea, or recurrent hypoglycemia. Group 2 underwent 85% pancreatectomy, leaving the uncinate process in situ. Two of these children are well. Two required conversion to 95% resection because of recurrent hypoglycemia; one of these required a subsequent total pancreatectomy, at which time the pancreatic remnant had significantly regenerated. The other Group II patient was normoglycemic but died at age 3 from pneumonia. Pathology in nine cases showed islet cell dysplasia; 5 of these also had microadenomatosis. One case had a histologically normal pancreas. We conclude that 95% pancreatectomy is a safe operation with a lower failure rate than less radical resections, and should be used early in the management of this condition.
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PMID:Surgical management of persistent neonatal hypoglycemia due to islet cell dysplasia. 639 33

Forty five cases of chronic pancreatitis have been diagnosed between January 1966 to July 1983 in the Hospital A. Posadas. The diagnosis was confirmed by the presence of one or more of the following data: pancreatic calcifications positive in 35, abnormal secretin test 37, ultrasonography and computed tomography pathological findings 10. Surgical operations were carried out in 25 patients and biopsy taken in 5. Thirty nine (86.6%) were males, 6 (13.3%) females, the mean age in each group was 47.4 and 39.8 years. Chronic alcoholism was certain in 41 (91.9) patients, in the remainder 4 no other etiologic factors were found. The main clinical data were: Weight loss 38 (84.4%) diabetes 34 (75.5%) pain 33 (73.3% in 7 as acute pancreatitis) Steatorrhea 23 (51.1%) jaundice 16 (35.5%- 11 by extrahepatic biliary tree obstruction, 5 by hepatic cirrhosis) pseudocysts 12 (26.6%). The more common associated diseases were: hepatic cirrhosis 6, fatty liver 2 (17.7%) gastroduodenal ulcer 6 (13.3%) cancer 4 (8.8%--gastric 1, pancreatic 3). In order to study the frequency of the clinical data the patients were grouped according to the presence or absence of calcifications and the etiologic factor Symptoms and signs were matched and statistic analysis (coefficient association phi) was made. Only a moderate association between acute pancreatitis in no calcified group and diabetes in calcified group were found. The chronologic study of certains clinical data shows that acute pancreatitis, jaundice, pseudo-cyst and surgical operations were significative more frequent in the first five years while diabetes has little more frequency in the second five year period. Twenty six surgical operations were carried out in 25 patients; 20 (76.9%) due to complications, 6 (23.1%) secondary to pain (pancreatic resection 3, pancreatoyeyunostomy 2, exploration 1). Twenty three patients were lost to follow-up, 12 died and 10 are still alive. This last group was followed at regular period, 8 remained asymptomatic and 2 have intermittent abdominal pain related to alcoholic ingestion.
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PMID:[Chronic calcified pancreatitis. Our experience]. 639 6

Severe abdominal pain was the major indication for operation in 85 patients with chronic pancreatitis. Preoperative endoscopic retrograde cholangiopancreatography (50 patients) or intraoperative pancreatic ductograms (44 patients) demonstrated dilated or obstructed major pancreatic ducts in 50 patients (59%), nonvisualization of the distal duct in 10 patients (12%), and normal or small sized ducts in 34 patients (40%). Operative procedures, tailored according to duct morphology, included pancreatic duct drainage (46 patients), subtotal (40% to 80%) pancreatectomy (21 patients), near-total (85% to 95%) pancreatectomy alone (eight patients), and near-total or total pancreatectomy and intrahepatic islet autotransplantation (10 patients). Pancreatic duct drainage resulted in pain relief in 37/46 patients (80%) followed for 6 years. However, 20/46 patients (43%) had continued loss of pancreatic function after duct drainage as measured by the development of insulin-dependent diabetes (16 patients) or steatorrhea (seven patients). Seven years after subtotal pancreatectomy, pain relief was partial in 9/21 patients (43%) and complete in five patients (24%). A higher incidence of hypoglycemic or ketoacidotic complications was noted in patients treated by subtotal pancreatectomy (three patients, 14%) than by duct drainage (one patient, 2%). Near-total pancreatectomy was the most effective surgical procedure in relieving pain, but late sequelae in three patients (38%) included one hypoglycemic death and two ketoacidotic episodes. Five years after near-total pancreatectomy and islet autotransplantation, one patient remained permanently insulin independent; three patients were insulin independent for 4, 5, and 15 months, respectively, but subsequently developed nonketosis-prone diabetes (tested by insulin withdrawal) and require 15 to 30 U of insulin daily; three patients had immediate insulin requirements and currently need 20 to 30 U of insulin per day but are nonketosis prone; and two patients are ketosis prone and require 30 to 60 U of insulin daily. Our analysis suggests that 5-year survival of patients undergoing operation for chronic pancreatitis is similar after treatment by duct drainage, subtotal pancreatectomy, or near-total pancreatectomy, regardless of duct morphology. Five years after duct drainage or subtotal pancreatic resection, a high incidence of diabetes (59% and 48%) and/or continued pain (20%) and (35%) can be expected.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Chronic pancreatitis: long-term surgical results of pancreatic duct drainage, pancreatic resection, and near-total pancreatectomy and islet autotransplantation. 643 70

Diabetic diarrhea and steatorrhea occur predominantly in young adult males who have juvenile-onset diabetes mellitus complicated by neuropathy. The presentation is often severe, with nocturnal or postprandial watery diarrhea and tenesmus. Massive malabsorption of fat may occur; however, malabsorption of other nutrients and generalized wasting are quite rare. Because the symptoms are relatively refractory to treatment, it is important to rule out other, more easily treatable causes of this presentation. Bacterial overgrowth, exocrine pancreatic insufficiency, and celiac disease are also associated with diabetes mellitus and can mimic this process. Although the mechanism of diabetic diarrhea and steatorrhea remains unclear, neuropathy, gastrointestinal motor abnormalities, bacterial overgrowth, and bile acid abnormalities have been implicated in the pathogenesis.
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PMID:Small intestinal manifestations of diabetes mellitus. 665 61

A 14C-triolein breath test was carried out on 49 subjects suffering from chronic pancreatitis or from other digestive diseases, and its results were compared with the daily fecal fat excretion. The 14CO2 peak excretion was abnormal in all the subjects with a fecal fat excretion above 14 g/day, whereas individual values of 14CO2 peak excretion in subjects without steatorrhea and with a fecal fat excretion ranging from 7.1 to 14 g overlapped. The lowest value observed in patients not suffering from steatorrhea was chosen as the lower normal limit of 14CO2 peak excretion. A test sensitivity as high as 64% was attained. The correlation between fecal fat and 14CO2 peak excretion was highly significant (r = 0.802; p less than 0.0001), and it followed a negative exponential function. Therefore, small variations in the 14CO2 peak excretion can be associated with a wide range of fecal fat excretion. Well-compensated diabetes secondary to pancreatitis did not interfere with the results of the test. In conclusion, in our experience this test proved to be a qualitative diagnostic tool with a low sensitivity.
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PMID:Is the 14C-triolein breath test useful in the assessment of malabsorption in clinical practice? 673 60

In 6 male patients, who had duodenopancreatectomy, oral fat respectively carbohydrate tolerance tests were performed. Intake of at least 10 g pancreatine did reduce the ensuing steatorrhea. Increased oral intake of carbohydrates led to increased levels of glucose in blood and urine. In addition, the patients were subjected to excessive exercise tests; in the course of these tests hormones, substrates and metabolites of fat and carbohydrate metabolism were measured. The values were compared to corresponding values from 6 type I diabetes patients and 7 normal persons. In the operated group lactate and free glycerol increased because of reduced hepatic glucose neogenesis, catecholamines increased little, and HGH not at all. Capacity for work was reduced in the operated group. Malassimilation and diabetes may be compensated for by drug therapy after duodenopancreatectomy. However, endocrine as well as metabolic derangements do follow duodenopancreatectomy, and ought to be taken into account preoperatively, since they may reduce the benefit of surgery in patients with chronic pancreatitis.
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PMID:[Effect of diet and stress on fat and carbohydrate metabolism after duodenopancreatectomy]. 684 69

Three typical clinical patterns can be distinguished based upon the experience with the long-term course in 258 cases of chronic relapsing pancreatitis. In chronic pancreatitis without local complications there is 1. an early phase, characterized by recurrent episodes of pancreatitis; 2. a late phase, characterized by the triad: absence of pain, severe global pancreatic insufficiency (diabetes/steatorrhea), and pancreatic calcifications (if any). 3. Local complications (e.g. pseudocysts) produce a different pattern characterized by persistent pain and the symptoms of the "pancreatitis tumor", which may cause many different complications such as cholostasis, gastrointestinal bleeding, duodenal obstruction etc. Local complications are observed mainly in the early phase of the disease. Late symptoms such as diabetes, steatorrhea and calcifications indicate that the pancreatitis is virtually "burned out". The occurrence of late symptoms in the course of the disease varies individually.
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PMID:[Clinical aspects and differential diagnosis of chronic pancreatitis. Emphasis on the long term course in 258 patients]. 700 6

We studied 16 patients with diabetes and fecal incontinence. The onset of incontinence coincided with the onset of chronic diarrhea in most patients. Episodes of incontinence occurred when stools were frequent and loose; however, 24-hour stool weights were usually within normal limits. All patients had evidence of autonomic neuropathy, and one third had steatorrhea. Incontinent diabetics had a lower mean basal anal-sphincter pressure than 35 normal subjects (63 +/- 4 vs. 37 +/- 4 mm Hg; P less than 0.001), reflecting abnormal internal-anal-sphincter function. The increment in sphincter pressure with voluntary contraction (external-sphincter function) was not significantly different from normal. Incontinent diabetics also had impaired continence for a solid sphere and for rectally infused saline. In contrast, 14 diabetics without diarrhea or incontinence had normal sphincter pressures and normal results on tests of continence, even though 79 per cent had evidence of autonomic neuropathy and nearly half had steatorrhea. We conclude that incontinence in diabetic patients is related to abnormal internal-anal-sphincter function, and that as a group, diabetics without diarrhea do not have latent defects in continence.
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PMID:Pathogenesis of fecal incontinence in diabetes mellitus: evidence for internal-anal-sphincter dysfunction. 714 65

The clinical picture of the hereditary chronic relapsing calcifying pancreatitis is demonstrated on the basis of a family. In 7 members of the family the disease could be ascertained, in other 3 members it is probably existing. Main symptom in all patients are severe relapsing epigastric pains with manifestations already in childhood or time of youth. Calcifications of the pancreas were always found and except one female patient an exocrine insufficiency of the pancreas with superficial steatorrhoea. A diabetes mellitus became manifest only in three of the seven patients. A larger attention is to be paid to the diagnosis of this special form of the chronic relapsing pancreatitis, in order to avoid long diagnostic wrong ways and non-indicated laparotomies in etiologically not clarified epigastric complaints. The therapy of the hereditary pancreatitis is conservative. Only in complications or in a not controllable so-called syndrome of pain it is recommended to decide on an operative approach, as in the family demonstrated in two female patients.
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PMID:[Hereditary chronic relapsing calcifying pancreatitis]. 714 48


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