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Query: UMLS:C0011849 (diabetes)
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We operated on 102 patients (89 men and 13 women) who had chronic pancreatitis. The mean age at the time of surgery was 45 1/2 years. Of these patients, 77 had resections (57 distal pancreatectomies, 17 duodenopancreatectomies, an three total pancreatectomies) and 25 had diversion procedures (15 Puestow operations and 10 internal drainage of cysts). The indication for surgery was abdominal pain in 88% and the presence of jaundice in 21%. Our patients had severe pancreatic disease: 64% had pseudocysts, 41% had calcifications, and 26% had calculi in the duct of Wirsung. The postoperative mortality rate was low (3%), but morbidity occurred in 18% (mostly after resection procedures). The incidence of diabetes after surgery was high after resection (57%) but it also occurred after diversion procedures (10%). The quality and length of survival was similar after resections and after diversions, although patients with alcoholic pancreatitis had the worst long-term prognosis. Reoperations were performed in 16% of all patients; the incidence was lower after duodenopancreatectomy.
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PMID:Surgery for chronic pancreatitis. 381 Apr 83

Clinical and biochemical studies were carried out in 33 patients with diabetes secondary to chronic calcific, non-alcoholic pancreatitis (tropical pancreatic diabetes) and in 35 Type 2 (non-insulin-dependent) diabetic patients and 35 non-diabetic subjects. Despite lower body mass indices, only 25% of patients with tropical pancreatic diabetes had clinical evidence of malnutrition. There was no history of cassava ingestion. Mean serum cholesterol concentration was significantly lower in the tropical pancreatic diabetic patients (p less than 0.01) in comparison with the Type 2 diabetic patients or non-diabetic subjects, due to a significantly decreased concentration of LDL cholesterol (p less than 0.01) and VLDL cholesterol (p less than 0.05). Basal and post-glucose stimulated concentrations of serum C-peptide were highest in those pancreatic diabetic patients (n = 11) who responded to oral hypoglycaemic drugs, intermediate in the majority (n = 17), who were insulin dependent and ketosis resistant and negligible in a small sub-group (n = 5) who were ketosis prone. The occurrence of microangiopathy in pancreatic diabetic patients was common and similar to that in Type 2 diabetic patients. Thus, tropical pancreatic diabetes in South India appears to be heterogeneous with respect to level of nutrition, severity of glucose intolerance, B-cell function, response to therapy and the occurrence of microvascular complications.
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PMID:Tropical pancreatic diabetes in South India: heterogeneity in clinical and biochemical profile. 401 50

Thirty-five patients with chronic pancreatitis of varying cause have been treated according to a protocol first introduced in 1979. At the end of a mean follow up time of 2.1 years, only 54% of patients were found to have derived benefit defined by pain relief and improved quality of life. Patients with alcoholic pancreatitis did particularly poorly, and alcoholics who continued to drink almost never benefited. Patients with dilated pancreatic ducts were more likely to do well than those with small ducts, and pancreaticojejunostomy had a satisfactory record of pain relief. Patients with biliary pancreatitis generally did well with cholecystectomy and clearance of the common bile duct. The 40-80% pancreatectomy had a poor record for pain relief, and produced diabetes in the majority of patients in whom it was used. Nothing will reverse the established pathology of chronic pancreatitis, which remains an unsatisfactory condition to treat.
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PMID:Chronic pancreatitis: results of a protocol of management. 657 50

1. Alcohol was the most common cause of pancreatitis, irrespective of sex or age. The acute hemorrhagic necrotizing form could arise after the consumption of no more than 100-450 g of alcohol a day for 7-10 days. Chronic pancreatitis was almost invariably caused by alcohol. 2. While alcohol predominantly (93%) among the under-60s, biliary tract disease and cancer were a major cause (53%) of pancreatitis in the over-60s. 3. Pancreatitis usually followed one of three courses: acute hemorrhagic, acute oedematous (acute pancreatitis) or chronic. 4. Patients who have been treated for alcoholic pancreatitis have a high death rate. The mean age at death was 46 years. 5. Most cases of acute hemorrhagic, necrotizing pancreatitis (92%) occurred as the patient's first attack of pancreatitis. 6. The diagnosis acute hemorrhagic, necrotizing pancreatitis can at present be established only at operation or autopsy. 7. Extensive resection of the pancreas should be avoided in acute hemorrhagic necrotizing pancreatitis because the function of the pancreas was often acceptably restituted once the disorder had subsided. 8. Disturbed sugar regulation was the most common complication in patients who had had pancreatitis. Diabetes mellitus often occurred (29%) and might do so months or years after an attack. 9. Patients with alcoholic pancreatitis were greatly disadvantaged socially (little education, poor jobs and housing) and in the event of a recurrence elicited by alcohol it is suggested that they should be cared for at a department for alcoholics. 10. It is suggested that in chronic pancreatitis the diagnosis should specify any exocrine and endocrine disturbances as well as any morphological changes that have been documented by i.e. ERCP or ultrasound. Studies of pancreatic function and morphology for the classification of pancreatitis should be made no earlier than 6 weeks after clinical signs of pancreatitis have subsided, with abstention from alcohol in the intervals. A classification of this type would contribute to a better follow-up and treatment of patients with chronic pancreatitis and improve the possibility of comparing patient materials.
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PMID:Diagnostic criteria, classification and clinical course in pancreatitis. 676 27

Nineteen patients with chronic alcoholic pancreatitis have been followed up for 7 to 81 months (mean 45 months) since resection for the relief of pain. Five had distal pancreatectomy, three had a Whipple resection, seven had 75% pancreatectomy and four had total pancreatectomy. Pain was completely relieved in all patients after total pancreatectomy and in four patients after 75% pancreatectomy. Recurrent acute pancreatitis was frequent after distal pancreatectomy. Alcoholism recurred in six patients. Steatorrhea was noted grossly in 14 patients after operation. It was corrected by enzyme replacement. All patients had long-term weight gain, except one who had undergone a Whipple resection. Diabetes developed in one patient who underwent 75% pancreatectomy, in one after distal pancreatectomy and in all patients who underwent total pancreatectomy; management of the diabetes was complicated by heavy alcohol consumption in one patient who underwent total pancreatectomy.
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PMID:Resection for chronic alcoholic pancreatitis. 722 66

Seventeen Indian patients from Kerala State and 13 Indian controls were submitted to a dietary inquiry. Indian patients and controls had a low fat intake (40.8 g +/- 12.1 and 34.5 g +/- 11.0 per day, respectively) and a moderately low protein intake (52.8 +/- 9.5 and 47.8 +/- 11.3 g per day); 11 patients and 6 controls did not consume cassava. Pure nonactivated pancreatic juice was collected at endoscopy in 10 Indian patients who presented with tropical calcific diabetes, 12 apparently normal controls from the same area, and 23 apparently normal French controls. The only significant differences between Indian and French controls was a decreased pancreatic protein response to cerulein and an increased calcium concentration in the Indian subjects. The pancreatic juice of Indian patients was characterized by decreased volume, normal bicarbonate concentration, increased protein concentration when the acinar cells were not stimulated, with no response to cerulein, increased calcium concentration, and normal citrate concentration. These changes are very similar to the changes observed in French patients with chronic alcoholic pancreatitis. The lesions of 14 surgical resection pancreatic specimens from South Indian patients presenting with tropical pancreatitis were compared to pancreata from French patients presenting with chronic alcoholic pancreatitis. The only difference was that intraductal plugs, lesions of the duct epithelium, and retention cysts or pseudocysts were less frequent in Indians. These results show that the two nutritional forms of pancreatic lithiasis, alcoholic and tropical, have similar histological lesions and biochemical modifications of pancreatic juice.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pancreatic lesions and modifications of pancreatic juice in tropical chronic pancreatitis (tropical calcific diabetes). 820 Feb 68

Chronic alcoholic pancreatitis (CAP) is often complicated by the onset of diabetes mellitus. The aim of this study was to assess the residual beta cell function (evaluated by means of the glucagon test) and the mean disposal rate of insulin (with the insulin tolerance test) in 66 CAP patients with or without abnormalities of glucose metabolism and in 19 control subjects. On the basis of our data, we conclude that the glucose metabolism abnormalities in chronic pancreatitis occurs as a result not merely of impaired production of endogenous insulin, but also as result of a combination of the latter together with insulin resistance.
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PMID:Diabetes in chronic alcoholic pancreatitis. Role of residual beta cell function and insulin resistance. 844 82

Four patients with chronic alcoholic pancreatitis and one patient with idiopathic chronic pancreatitis, who had total or subtotal distal pancreatectomies for persistent pain, underwent simultaneous autotransplantation of a pancreas segment to preserve the pancreatic function. The segment was autotransplanted heterotopically to the iliac fossa with anastomosis of the splenic vessels to the iliac vessels to prevent reinnervation, and the pancreatic duct was anastomosed to the intestine to preserve exocrine function. Postoperatively, the patency of the graft vessels was confirmed by angiography in every patient. Complete pain relief has been obtained in all patients with a followup duration of 4-89 mo. Except for one patient who had been treated preoperatively with insulin injections for diabetes, the patients remained normoglycemic without exogenous insulin administration and demonstrated satisfactory insulin secretion during a 75-g oral glucose tolerance test. An exocrine pancreatic diagnostant test using p-aminobenzoic acid yielded nearly similar levels to the preoperative value for all patients. Heterotopic autotransplantation of the pancreas segment appears to be effective for preserving pancreatic function, as well as providing permanent pain relief for patients with chronic pancreatitis who require extensive resection of the pancreas.
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PMID:Heterotopic autotransplantation of a pancreas segment with enteric drainage after total or subtotal pancreatectomy for chronic pancreatitis. 850 53

Intrasplenic pseudocyst is a rare form of a late complication of chronic pancreatitis. We report the case of a 30-year-old man with an intrasplenic pseudocyst associated with chronic alcoholic pancreatitis. The patient was admitted with the third acute phase of chronic relapsing pancreatitis. Abdominal US and CT showed a large cyst in the pancreatic tail with involvement of the spleen. ERCP revealed marked irregularities of the main pancreatic duct without communication to the large cyst and a narrowing of the distal common bile duct by chronic pancreatitis of the head of the pancreas. Organ preserving surgical treatment with duodenum- preserving resection of the head of the pancreas combined with distal pancreatectomy and splenectomy was performed. This procedure may be indicated in selected patients to preserve functional pancreatic tissue and prevent diabetes. It should be in the armamentarium of the specialized pancreatic surgeon.
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PMID:Pancreatic head enlargement associated with a pancreatitis- induced intrasplenic pseudocyst in a patient with chronic pancreatitis: organ preserving surgical treatment. 897 81

The study, conducted over 4 years among 400 diabetic patients, reports the epidemiological and clinical aspects of diabetes mellitus at the National Hospital of Ouagadougou, Burkina Faso. Epidemiologically, diabetes mellitus affects men by 64% and women by 36%. 76% are over 40 y. o., whereas only 2.2% are under 20. Clinically, the classification of diabetic patients shows that 10.7% are insulin-dependent and 76.5% non insulin-dependent. No usual tropical diabetes has been found. The calcifications observed in 2.5% of cases were combined with chronic alcoholic pancreatitis. The classic triad (polyuria, polyphagia, polydipsia) led to diagnostic by 41% of the patients, whereas 27.5% have been identified when having complications, and 23% by a systematic check-up. Cardio-vascular risk factors combined with diabetes have been found: obesity (28%), high blood pressure (20%), hyperuricaemia (14%), addiction to smoking (20%). The epidemiological characteristics, as well as the various clinical aspects, mostly complies with the observations of the african authors.
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PMID:[Diabetes mellitus at the National Hospital Center of Ouagadougou (Burkina Faso)]. 899 12


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