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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Samples of the stomach, duodenum and pancreas removed from 76 patients obtained during organ-preserving operations for ulcer and chronic pancreatitis were examined morphologically. It is found that the most frequent type of changes in the intraorgan arteries is their wall hypertrophy in combination with hyperelastosis and elastotic fibrosis. This characterizes chronic local arterial hypertension. An additional morphological symptom complex caused by a vegetative vascular crisis is formed in the arteries of the damaged organ in exacerbation of the disease. The complex includes prominent dystonic and alterative changes of small arteries leading to stasis and thrombogenesis in the microvessels. Unknown so far phenomenon of arterial invagination in 18 patients was observed. It leads to a complete block of circulation, acute ischemia followed by tissue necrosis which was most typical for ulcer exacerbation and chronic pancreatitis.
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PMID:[Morphofunctional characteristics of arterial bed in exacerbation of gastroduodenal ulcer disease and chronic pancreatitis]. 1496 64

The pathophysiology of pain in chronic pancreatitis (CP) is incompletely understood. Several hypotheses have been advanced, including pancreatic and extrapancreatic causes. The existence of different hypotheses to explain the genesis of pain in CP also reflects the different therapeutic approaches to pain in these patients. Increased intraductal pressure as a result of single or multiple strictures and/or calculi is believed to be a common cause of pain in CP patients with a dilated main pancreatic duct. Other suggested causes include pancreatic fibrosis, interstitial hypertension and pancreatic ischemia. Additionally, extrapancreatic causes like duodenal and common bile duct stenosis with scarring due to pancreatic inflammation are suggested as factors causing pain in CP. The 'neurogenic inflammation' hypothesis is a fascinating theory which is supported by different studies. Immunohistological reports have shown that the amount of neurotransmitters, such as substance P and its receptor, calcitonin gene-related peptide and other neurotransmitters, are increased in afferent pancreatic nerves and a correlation between pain and immune cell infiltration of the nerves has been reported in CP. In this review we will discuss the different pain hypotheses and will present the perspective that neuroimmune interaction is an important factor for pain generation in CP.
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PMID:Pathogenesis of pain in chronic pancreatitis. 1575 9

Pain is a major clinical manifestation of chronic pancreatitis (CP) and a common indication for surgery in these patients. Pathogenesis of pain in CP is multifactorial and the mechanisms of pain may differ from patient to patient. This can explain why one therapeutic method of treatment of pain does not work in all patients and in different stages of the disease. Two main complimentary pathogenetic theories have been proposed to explain the mechanisms of pain in CP, the neurogenic theory and the theory of increased intraductal/intraparenchymal pressures. According to the neurogenic theory, in CP there are alterations of pancreatic/peripancreatic nerves, exposing them to noxious substances and/or activated immune cells, thereby generating pain ("neuroimmune interaction"). The other theory of intraductal/intraparenchymal hypertension suggests that pain in CP is generated as a result of increased pressures within the pancreatic ductal system and/or pancreatic parenchyma, like the pain in the classic compartment syndrome. The theory of intraductal/intraparenchymal hypertension is strongly supported by the good results of drainage procedures in the surgical management of CP. Pancreatic ischemia, oxygen-free radicals, centrally sensitized pain state, acute exacerbations of CP, development of complications from the pancreas (most commonly, pseudocysts) or adjacent organs (usually, duodenal and/or common bile duct stenosis), etc. are other possible contributing factors. Different patterns of pain have been described in idiopathic (early vs. late onset) and in alcoholic CP. Interestingly, pain is automatically relieved during the natural course of the disease in some patients (the "burn-out" phenomenon), after a relatively long time (from a few years to up to 3 decades). However, this is an unpredictable evolution for the individual patient. Therefore, surgery should be offered when pain is intense and after failure of conservative treatment. Surgical management should be individualized, depending on the particular findings of each patient. The knowledge of the pathophysiologic basis and of natural course of pain in CP is of paramount importance for the surgeon to select appropriate therapy for the individual patient with CP.
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PMID:Mechanisms and natural history of pain in chronic pancreatitis: a surgical perspective. 1766 54

Endoscopic double papillotomy occupied the place of surgical transduodenal double sphincteroplasty for disorders of papilla of Vater or chronic pancreatitis several years ago. Endoscopic cystoenterostomy and cystogastrostomy can also replace surgery in the treatment of pseudocysts and walled-of necrosis even in cases of severe acute pancreatitis with/or without sepsis. In chronic pancreatitis endotherapy may be the treatment of choice at first, although surgical techniques give somewhat better long-term results for pain relief. Extracorporeal shock wave lithotripsy, stone resolution or extraction and multiple pancreatic stents without aggressive balloon dilatation can progressively calibrate dominant stricture of the main pancreatic duct without further damage, ischemia or obstruction of side branches. Relapse-free period becomes longer (also after stents removal) if alcohol consumption and smoking are stopped definitively. Well-controlled, randomised studies are still needed to demonstrate clinical advantage of multiple endoscopic stent placement in comparison to surgery.
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PMID:[Invasive endoscopy or surgery for pancreatic disorders?]. 1904 84

The aim of this study was to determine the role of stomach resection in the pathogenesis of a chronic pancreatitis. Experiments were carried on 14 outbred dogs. The animals were categorized into two groups according to problem put by. The first group was composed of (n=4) animals in intact state, and pancreas blood vessels were studied. The second group was composed of (n=10) animals. An experimental animal model of chronic pancreatitis was produced and the resection of stomach was performed. The investigation showed that after the surgical treatment there was a significant reductions in arterial diameter and in microcirculation channels. It was concluded, that stomach resection may be the cause of pancreatic ischemia and necrosis. Adequate treatment to improve blood supply in the pancreatic blood vessels after surgery is recommended.
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PMID:[Change blood supply of a pancreas after a resection of a stomach in conditions of a chronic pancreatitis]. 1935 38

Chronic pancreatitis is a state of chronic inflammation characterized by progressive destruction of the pancreas. Pancreatic pain, a cardinal symptom in chronic pancreatitis patients has always been a subject of great interest and controversy. The precise mechanism of pain and its persistence in chronic pancreatitis patients remain unknown. Several pancreatic, neurogenic and central hypotheses have been proposed for the pathogenesis of pain. In patients with a dilated main pancreatic duct, increased intraductal pressure due to strictures/calculi, presence of interstitial hypertension, pancreatic ischemia and fibrosis and pseudocyst have been proposed to contribute to chronic pain. "Neurogenic" or "neuropathic" theory is based on the fact that patients with chronic pancreatitis have enlarged intrapancreatic nerves with microscopic damage to nerve sheaths (mediated by growth-associated protein 43 (GAP-43), that makes them more susceptible to mediators like brain derived neurotrophic factor, nerve growth factor and TrkA and artemin, the expression of which directly correlates with severity of pain frequency and intensity. The central theory proposes that reorganization of neurons in the insula may explain the chronic pain in these patients. However all these studies have been observational. Further studies are required in the future to characterize these immune response observed in the intrapancreatic neurons in chronic pancreatitis and the neuronal changes in the brain if we are to manage these patients with chronic pain and give them a better quality of life.
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PMID:Recent advancements in the pathogenesis of pain in chronic pancreatitis: the argument continues. 2019 Jul 25

Chronic pancreatitis (CP) is a painful, yet benign inflammatory process of the pancreas. Surgical management should be individualized because the pain is multifactorial and its mechanisms vary from patient to patient. Two main pathogenetic theories for the mechanisms of pain in CP have been proposed: the neurogenic theory and the theory of increased intraductal/intraparenchymal pressures. The latter theory is strongly supported by the good results of drainage procedures in the surgical management of CP. Other possible contributing factors include pancreatic ischemia; a centrally sensitized pain state; and the development of complications, such as pseudocysts and stenosis of the duodenum or common bile duct. Common indications for surgery include intractable pain, suspicion of neoplasm, and complications that cannot be resolved with radiological or endoscopic treatments. Operative procedures have been historically classified into 4 categories: decompression procedures for diseased and obstructed pancreatic ducts; resection procedures for the proximal, distal, or total pancreas; denervation procedures of the pancreas; and hybrid procedures. Pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy, once the standard operations for patients with CP, have been replaced by hybrid procedures, such as duodenum-preserving pancreatic head resection, the Frey procedure, and their variants. These procedures are safe and effective in providing long-term pain relief and in treating CP-related complications. Hybrid procedures should be the operations of choice for patients with CP.
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PMID:Current surgical treatment for chronic pancreatitis. 2219 67

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.
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PMID:Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis. 2240 95

We have studied the frequency and structure of cardiac rhythm (CR) disturbances in the women presenting with abdominal obesity (AO) in the postmenopausal period. The single-step study involved 210 postmenopausal women (median age 57 years) who were examined by 24-hour ECG monitoring, measurement of arterial pressure, body mass index, and the relationship between waist and hip circumferences. CR disturbances were revealed in all 159 women with abdominal obesity, ischemia in 16.9%, supraventricular extrasystole in 89.3%, ventricular extrasystole (VE) in 58.5%, high-grade extrasystole in 23.9%, paroxysms of supraventricular tachycardia in 1.9%, periods of asystole in 1.3%, synoatrial and atrioventricular blockade in 9.9%, His bundle branch block in 3.3%, sinus tachycardia in 48.8%, and sinus brachycardia in 23.9% of the patients. The risk of development of VE in the women with AO increased by 3.8 times in the presence of concomitant coronary heart disease and by 2.9 times in case of chronic cardiac failure. The frequency of VE was significantly higher in the patients with abdominal obesity than without it (odds ratio 2.2). It is concluded that women presenting with abdominal obesity during the postmenopausal period are characterized by the high frequency of cardiac rhythm disturbances and ischemia, with each fourth patient being at high risk of sudden death. The elevated risk of ventricular extrasystole in the postmenopausal period is associated with AO, coronary heart disease, and chronic heart failure. The frequency of VE is unrelated to ulcer disease, chronic cholecystitis, cholelithiasis, chronic pancreatitis, and impaired function of the thyroid gland.
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PMID:[The frequency and structure of cardiac rhythm disturbances in the women presenting with abdominal obesity during the postmenopausal period]. 2264 66

Cardiovascular diseases could be a risk factor for acute pancreatitis (AP), specifically hypertension and ischemic heart disease. Smoking is associated with AP (OR 2.34), with the association being less marked than with chronic pancreatitis. Moreover, smoking may worsen the prognosis of AP. The bedside index for severity in AP (BISAP) prognostic system has a similar ability to predict mortality to the Acute Physiology and Chronic Health Evaluation II (APACHE II) index and is much simpler to calculate. Magnetic resonance imaging is a safe technique (it does not radiate the patient) and is useful in the diagnosis of complications, severity prediction and clinical decision making. Peripancreatic venous thrombosis is frequent in AP and is rarely associated with gastric variceal bleeding or mesenteric ischemia. The treatment of organized pancreatic necrosis by combined endoscopic and percutaneous drainage is safe and effective, avoiding the need for surgery. Aggressive fluid therapy does not seem to improve the outcome of patients with AP. The administration of early enteral nutrition in mild-moderate AP reduces abdominal pain and the risk of intolerance of oral refeeding.
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PMID:[Latest advances in acute pancreatitis]. 2301 15


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