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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Course and prognosis of 125 patients with chronic pancreatitis (CP) were evaluated. Follow-up period ranged from 1-20 years with a median of 6.3 years. The following conclusions were obtained. Recent increase of CP in our clinics was ascribed to alcoholic CP and idiopathic CP in the aged. Of 106 patients with pain, 74 showed improvement or disappearance of pain. Drinking habit and observation period were the main factors determining the rate of pain relief. Serial endoscopic retrograde pancreatography (ERP) showed aggravation in 17/47 patients, cholecystokinin-pancreozymin (CCK-PZ) secretin test in 4/40 patients, and oral glucose tolerance test (OGTT) in 7/25 patients. Exocrine function showed improvement in five patients, whereas endocrine function showed none. Improvement or aggravation of exocrine function was closely related to drinking habit. Main complications included 15 cases of peptic ulcer, 19 of pancreatic pseudocyst, and 15 of bile duct stenosis. Twenty-six patients died, often due to malignant neoplasms and diabetic complications. Those who continued drinking as much showed a lower survival rate than those who discontinued or decreased alcohol intake. The socioeconomic status deteriorated often due to pain or alcoholism. Three patients had to degrade jobs and six fell into inactive social life.
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PMID:Clinical course and prognosis of chronic pancreatitis. 362 35

The correlation of pancreatic pain and the degree of morphological and functional changes was prospectively investigated in 64 patients (45 males, 19 females) with chronic pancreatitis. All patients underwent clinical examination and diagnostic investigations by means of endoscopic retrograde pancreatography (ERP), computed tomography (CT) and exocrine pancreatic function test (secretin-ceruletide; SC). The individual tests were performed within 4 weeks in all patients. No significant correlation was found between the degree of pain and the severity of ERP and CT findings. Severe pain was found in 62% of patients with advanced ductal changes, and in 41% of patients with advanced parenchymal lesions. 58% of patients with severe pain had marked exocrine insufficiency. Ductal changes characterized by obstruction of the main pancreatic duct were most frequently associated with severe pain (58%). Less often, severe pain was associated with duct dilatation (34%) or with slight duct changes (26%). Among parenchymal lesions as revealed in CT, large cysts were most frequently related to severe pain (62%). A notable finding was that 89% of patients presenting with calcifications in CT still experienced pain and 39% of them had severe pain. The combined diagnostic approach is useful for the individual therapeutic management, but does not provide insight into the mechanisms of pain in chronic pancreatitis.
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PMID:Pancreatic morphology and function in relationship to pain in chronic pancreatitis. 368 Oct 34

Ultrasonography can detect changes in pancreatic and bile duct sizes after pancreatic stimulation by secretin or morphine and prostigmine. The effects of the two pharmacologic regimens on pancreatic duct dilatation were comparable and correlated with papillary stenosis determined at surgery, but the morphine and prostigmine combination produced more false-positive responses than did secretin. After administration of intravenous secretin (1 unit/kg), the pancreatic duct dilated in 83 percent of 12 symptomatic patients found at surgery to have a stenotic sphincter of Oddi and in 72 percent of 17 symptomatic patients found to have a stenotic accessory papilla associated with the pancreas divisum anomaly. Comparable dilatation occurred in 14 percent of 14 control subjects without suspected ampullary disease and in none of 10 patients with surgically disproved stenosis (p less than 0.001). The morphine and prostigmine combination produced more false-positive results in both the pancreatic duct and bile duct. Concomitant elevation of the serum amylase level and reproduction of pain were found to be of no discriminatory value. In patients whose pancreatic duct dilated preoperatively during secretin stimulation, dilatation did not occur after surgical sphincteroplasty. A positive test result was associated with a 90 percent success rate in preventing recurrent pancreatitis and ameliorating pain. A negative test result was associated with a 29 percent success rate. Ultrasonography of the pancreatic duct with secretin stimulation may provide objective criteria to supplement clinical judgment in selecting patients for sphincteroplasty to treat stenosis of either the sphincter of Oddi or the accessory papilla in pancreas divisum.
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PMID:Objective evaluation of ampullary stenosis with ultrasonography and pancreatic stimulation. 388 Oct 57

The practical implications of the new Marseilles classification (1984) of pancreatitis are discussed and the present-day diagnostic methods critically reviewed. The new classification distinguishes between two typical long-term profiles, i.e. acute (reversible) and chronic (progressive) pancreatitis. Modern diagnostic tests such as sonography, CT, ERCP and the secretin-CCK test do not provide a "gold standard" for early chronic pancreatitis. Thus, long-term studies of function and morphology are needed to differentiate chronic pancreatitis (progressive dysfunction, calcification, ERP changes) from acute (reversible) pancreatitis. The etiology is a helpful prognostic guide since gallstone pancreatitis virtually never becomes chronic. However, alcoholic "acute" pancreatitis may not always progress to chronic pancreatitis. Drug or surgical treatment of pain is symptomatic and empirical, since the pathomechanisms of pain are poorly understood. A prerequisite for optimum therapy is exact staging of the disease into: uncomplicated early stages with short, self-limiting episodes of pancreatitis: conservative therapy, persistent pain, mainly due to pseudocysts (diagnosis by morphological tests): surgical therapy, advanced painless forms of chronic pancreatitis associated with diabetes and/or steatorrhea: diet and substitution therapy. After successful surgical drainage persistent pain subsides, but postoperative episodic recurrences of pancreatitis are common in the early stages of the disease and in association with continued alcohol intake. However, spontaneous pain relief occurs in all cases in the late stages of the disease and with progressive pancreatic dysfunction (despite continued alcohol abuse).
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PMID:[Diagnosis and therapy of chronic alcoholic pancreatitis. A critical review of the status]. 390 86

Pancreas divisum is a variant of pancreatic ductal drainage. Its existence is being observed more frequently with the widespread use of endoscopic retrograde cholangiopancreatography (ERCP). On occasion, a relative stenosis of the accessory sphincter will cause a symptom complex which includes nausea, vomiting, upper abdominal pain, and intermittent pancreatitis. In 20 patients seen over the past 4 years, symptoms have been severe enough to consider the patient for transduodenal sphincteroplasty. The use of morphine prostigmine stimulation as a screening tool, has been helpful in 79 per cent of the patients in the series. Intravenous secretin has been a valuable adjunct to both ERCP identification and cannulation of the duct, as well as in two patients in whom the diagnosis was only suspected, and confirmed at the operating table. Operative common duct manometry has shown 40 per cent of the patients to have abnormal flow dynamics, suggesting possible disturbance in the biliary sphincter, as well as the accessory pancreatic sphincter. Pathologic examination has demonstrated abnormal gallbladders in nine of nine patients without previous cholecystectomy. The suggested procedure of dual sphincteroplasty has resulted in no mortalities, but a 50 per cent complication rate. Follow-up shows 70 per cent of the patients to be currently asymptomatic, two patients have had recurrent pancreatitis, and four patients have other problems causing continued post-operative pain. This study suggests dual sphincteroplasty is an acceptable form of therapy for patients with pancreatic divisum and no other source for their pain. Further follow-up will be necessary to insure that therapy is truly curative.
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PMID:Pancreas divisum. Detection and management. 399 78

Review of a 5 year clinical experience with the histamine H2-receptor antagonists metiamide, cimetidine, and ranitidine in 20 patients with Zollinger-Ellison syndrome disclosed a treatment failure rate of 50 percent. The criterion for failure was hemorrhage in four patients, obstruction followed by hemorrhage in one patient, perforation in one, and intractable pain in four. Nine of the 10 patients in whom treatment failed required total gastrectomy for control of complications; the 10th patient refused operation. Retrospective analysis identified hepatic metastases, the multiple endocrine adenomatosis-type I syndrome, refractory diarrhea, and breaks in the medication schedule as being more common in the treatment failure group, but these trends were not statistically significant in our small series of patients. Nonhealing or recurrent ulcers were found in 90 percent of the patients in whom drug therapy failed and in only 10 percent of those patients in whom therapy was successful (p less than 0.01). There were no differences related to age, sex, duration of symptoms, previous gastric operation, ulcer location, presence of diarrhea, or amount of drug prescribed. Basal and peak acid outputs, basal serum gastrin levels, and response to secretin challenge were also nondiscriminatory. The degree of acid inhibition in response to cimetidine was highly variable from one patient to another and on repeat testing in individual patients, and there was no correlation between acid secretory inhibition and clinical course. When severe complications occurred, reinstituting H2-receptor antagonist therapy or increasing the dose did not avert the need for total gastrectomy. Patients refractory to drug treatment who have persistent or recurrent ulcers should be managed with prompt total gastrectomy to prevent life-threatening complications.
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PMID:Failure of histamine H2-receptor antagonist therapy in Zollinger-Ellison syndrome. 612 12

The purpose of this report is to evaluate the role of endoscopic elimination of protein plugs in the treatment of chronic pancreatitis (CP) and suspected CP. Endoscopic aspiration of pure pancreatic juice (PPJ) was performed on 69 patients with CP or suspected CP. PPJ was collected from within the main pancreatic duct by endoscopic retrograde catheterization of the papilla after a rapid intravenous injection of secretin and CCK-PZ. Following results were obtained. (1) Various numbers of protein plugs were obtained along with PPJ in 26 of the 69 patients. (2) Endoscopic elimination of protein plugs provided 17 of the 26 patients with dramatic relief from abdominal pain and back pain, indicting that the procedure was often useful, at least, for relieving pain in patients with protein plugs in the pancreatic duct system. (3) Follow-up studies suggested that the procedure could be an effective therapeutic tool in selected cases of CP or suspected CP in which no prominent stenotic lesions were noted in the major pancreatic duct system and abstinence from alcohol beverage was strictly observed. (4) In 43 patients with no protein plugs in the pancreatic juice, in contrast, transient or partial relief from abdominal pain was provided in only one patient, respectively.
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PMID:Role of endoscopic elimination of protein plugs in the treatment of chronic pancreatitis. 621 3

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

A group of 47 carefully assessed patients with noncalcific pancreatitis was studied with ERCP and the secretin pancreozymin pancreatic function test (PFT). A simple scoring system was constructed for each of the PFT indices to create a PFT score for each patient and four grades of ERCP abnormality were documented, from minimal to gross. A simple pancreatic pain score was constructed to allow for the inclusion of patients with classical pancreatic pain in the absence of acute attacks associated with an elevated serum amylase. In general there was a correlation between the degree of structural change and functional impairment, with patients with the worst pancreatic function having the grossest ERCP changes. ERCP was abnormal in 45 of the 47 patients (96%) and the PFT in 34 of the 47 (72%). However, there were some marked discrepancies between the two methods, in particular two patients with normal function in the presence of gross structural changes. ERCP proved to be the more sensitive diagnostic technique than the PFT in this group of patients.
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PMID:Structure and function in noncalcific pancreatitis. 674 33

In 104 patients with longstanding abdominal pain of unknown origin endoscopic pancreatography was carried through after a thorough noninvasive exploration (Secretin-CCK-test included). Pancreatography revealed in 18% slight but distinct-pathological changes at the pancreatic duct system compatible with chronic pancreatitis. As the frequency of the pathological pancreatographic findings showed no correlation with duration of pain history but a significant correlation with age it is suggested that the duct changes encountered represent rather age-dependent irrelevant fibrosis of the pancreas tan clinically relevant chronic pancreatitis. Slight pathological duct changes are by themselves no proof of chronic pancreatitis because there is no possibility to discriminate between chronic pancreatitis and age-dependent fibrosis on the ground of pancreatography. ERP therefore is of little or no value in patients with otherwise insubstantial suspicion of chronic pancreatitis.
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PMID:[Frequency and significance of inflammatory pancreatic duct changes in patients with upper abdominal pain of unknown origin]. 712 18


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