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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical, biochemical and radiological findings in 16 patients with carcinoma of the head of the pancreas were compared with that of 13 with cholestatic jaundice due to chronic pancreatitis. Patients presenting with malignancy had more severe hyperbilirubinemia (18.5 +/- 2.1 vs 5.6 +/- 1.6 p to ten days of hospital admission was the single most accurate test distinguishing carcinoma from pancreatitis. The mean bilirubin rose in carcinoma but fell in pancreatitis (mean net change 15.1 +/- 2.9 vs 3.9 +/- 0.6, p less than 0.001). Calcification in the pancreatic region was identified on a flat plate of the abdomen in 8/13 with pancreatitis but 0/16 with malignancy. Preoperative percutaneous transhepatic cholangiography was helpful in defining the site of biliary obstruction but the radiologist was unable to clearly predict the definitive diagnosis in five of the 29 patients. A point score based upon the major significant differences noted, predicted the presence or absence of malignancy in all patients (16/16 vs 0/13, p less than 0.01).
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PMID:Mass in the head of the pancreas in cholestatic jaundice: carcinoma or pancreatitis? 50 68

Contrast enhancement of pancreas, liver, kidney, muscle, and blood was measured from computed tomography scans of 46 patients, including patients with normal pancreas (20), pancreatitis (20), and pancreatic carcinoma (6). A bolus injection of contrast agent was given intravenously. Contrast enhancement and contrast distribution volume in a single scan of the pancreas were measured at 40 sec and at 2, 5, and 15 min after the injection. There was a slight delay in the uptake of contrast material by pancreatic tissue if the disease was severe. In all other aspects, the pattern of contrast enhancement was equal in various patient groups and included great individual variations. Visually, the contrast agent distribution in severe pancreatitis was uneven. In severe pancreatitis, edema was seen both in the pancreas and surrounding tissues. It is concluded that gross anatomic changes and visual estimation are the only means of studying pancreatic pathology with an 18 sec scan time, and that contrast enhancement in such a study provides little additional diagnostic information.
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PMID:Contrast enhancement of the pancreas in computed tomography. 51 4

The authors carried out a retrospective review of intraoperative biopsy of the head of pancreas in 47 patients. Vim-Silverman needle biopsy (32 patients), or wedge biopsy (9 patients), or both (5 patients) were used. The correct diagnosis in the 34 patients with carcinoma was made in 76% by paraffin section and in 65% by frozen section. Diagnositic accuracy was 77% with needle biopsy and 38% with wedge biopsy. Complications occurred in six patients and consisted of pancreatitis, fistula and hemorrhage. Two patients required reoperation because of hemorrhage. The case of one patient who died of a pancreaticoperitoneal leak at the biopsy site is described in detail. The overall complication rate was 15%. These results indicate that wedge biopsy carries significant risks and frequently does not detect carcinoma. Needle biopsy is relatively safe and is more likely to provide an accurate diagnosis of carcinoma.
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PMID:Evaluation of intraoperative biopsy of the pancreas. 58 20

The five major diseases of the pancreas together make a significant contribution to morbidity and mortality among the people of the United States. These diseases are diabetes, cystic fibrosis, acute and chronic pancreatitis, and carcinoma of the exocrine pancreas. Four of these diseases can be modeled in laboratory animals by acute or chronic administration of chemical poisons or carcinogens. Human pancreatic diseases attributed to the effect of chemical agents including alcohol and drugs include many cases of chronic pancreatitis and some cases of acute pancreatitis. The cause is not known in many cases of human pancreatitis, including interstitial, acute, and chronic clinical forms. Epidemiologic studies suggest that the increasing incidence of carcinoma of the exocrine pancreas in the United States may reflect chemical carcinogenesis. On the basis of experimental observations, we know that pancreatic islet cells can be damaged directly by toxic chemicals, and that islet cell tumors can be chemically induced. Thus, there is adequate background data to conclude that several pancreatic diseases of obscure etiology may be due in part to hitherto unidentified toxic effects of chemical agents encountered in personal or general environments.
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PMID:Environmental factors and diseases of the pancreas. 59 42

113 cases of pancreatic and renal disease studied by both ultrasound and computed tomography (CT) were analyzed retrospectively. CT provided a diagnosis when pancreatic ultrasound was unsuccessful due to overlying bowel gas or obesity and when renal ultrasound was unsuccessful due to obesity, reverberations from ribs, small lesions, or multiple lesions. Conversely, ultrasound provided a diagnosis when CT was unsuccessful due to lack of fat planes or respiratory motion. CT usualy distinguished carcinoma from pancreatitis when ultrasound showed a focal echogenic mass. CT resolved renal cyst from neoplasm when ultrasound showed a mixed echo pattern mass.
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PMID:Complementary use of ultrasound and computed tomography in studies of the pancreas and kidney. 61 98

We report on eight cases of parathyroid carcinoma seen at the Bowman Gray School of Medicine, Winston-Salem, NC, since 1969. Diagnosis of a parathyroid disorder was made on the basis of elevated serum calcium levels and associated disorders such as renal calculi, peptic ulcer disease, pancreatitis, and demineralization of bone. Six of the involved glands were on the left side. In seven patients, the disease was localized to the gland or adjacent structures; one patient had cervical lymph node invasion. Except for the last patient, in whom radical neck dissection and wide excision was done, local excision with adequate margins was the only procedure done. The patient with metastases died of his disease four years later. One patient died of myocardial infarction two years later, but had been normocalcemic in the interval between operation and death, and one patient is hypercalcemic and has had two local recurrences within a 3 1/2 year period. The other five patients are alive and well. The routine use of automated serum level determinations of all hospitalized patients has led to early detection of this malignancy, while it is still a stage I lesion in many instances. On the basis of this material, we conclude that radical neck dissection can no longer be advocated as a routine measure in the treatment of parathyroid carcinoma.
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PMID:Carcinoma of the parathyroid. 62 71

CT-x-ray examination of 98 patients yielded pathologic results in 42 patients; in 33 patients results of CT could be controlled by surgery or at autopsy. In 14 cases necrotizing pancreatitis or pancreatic pseudocysts were suspected and these cases were operated upon; only 1 case turned out to be a falsely positive diagnosis. In 15 cases pancreatic carcinoma were found at surgery; 13 of these cases had been diagnosed preoperatively by CT; the diameters of the 2 tumors not diagnosed were below 3-4 cm. Differentiation between cysts, pancreatitis and tumors was possible in 2/3 of all cases; in 1/3 of the cases differentiation was neither possible by applying morphological criteria nor by evaluating absorption spectra. It turned out to be advantageous to examine the parenchymatous organs surrounding the pancreas by CT as well; in about 12% of cases with pathological findings the processes were found to be localized extrapancreatically.
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PMID:[Diagnostic relevance of computer tomography (CT) in pancreatic disease (author's transl)]. 63 10

Of over 300 pancreatic arteriograms done in this hospital group adequate follow-up was possible in only 103 patients, with carcinoma in 35 of them. Based on the prospective report there were three false negatives and seven false positive carcinoma diagnoses, an overall accuracy rate of 90.3%. A retrospective review could eliminate all but one false negative and one false positive diagnosis. Angiographic findings are reviewed separately for periampullary and truely pancreatic carcinoma. Subselective catheterisation and adequate opacification of the arterial network of the pancreas allows the reliable demonstration or exclusion of even 1--2 cm carcinomas, provided the clinical presentation of the patient has not been that of jaundice or pancreatitis. Taking into account the availability of newer non-invasive imaging techniques, clinical situations are listed in which the angiographic diagnosis of carcinoma is no longer required. The new purpose of angiography in pancreas carcinoma diagnosis is the demonstration of small and still curable lesions, the prerequisite for this being a much earlier clinical suspicion of the disease and an earlier referral for angiography.
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PMID:Evaluation and follow-up of pancreatic arteriograms. A new role for angiography in the diagnosis of carcinoma of the pancreas. 64 85

Information from 72 patients from 7 families in England and Wales confirms that hereditary pancreatitis is inherited as an autosomal dominant conditions with limited penetrance. The degree of penetrance is approximately 80%. These patients have had recurrent attacks of abdominal pain starting from childhood or young adult life. The mean age of onset in the 7 families studied was 13.6 years. There were two peaks, with maximum numbers at 5 years and 17 years. The second peak was thought to represent genetically susceptible individuals having pain brought on by alcohol rather than representing evidence of genetic heterogeneity. Five of the 7 families had members with both childhood and adult ages of onset. Only 4 patients out of 72 had life-threatening disease and in the majority of cases the attacks of pain were of nuisance value only. Hereditary pancreatitis was implicated in only 1 patient's death and this was not definite. Patients appear to get better after a period of symptoms usually as they approach middle age, or after a severe attack. In older patients alcohol, emotional upsets, and fatty food appear to precipitate attacks. Pancreatic insufficiency (5.5%), diabetes mellitus (12.5%), pseudocysts (5.5%), and haemorrhagic pleural effusion are uncommon complications. Portal vein thrombosis occurred definitely in 2 patients and was suspected in 3 others. Carcinoma of the pancreas was not found in any of 72 patients studied in detail; however, 2 members from a family not visited personally had chronic pancreatitis and malabsorption going on to carcinoma. They may have suffered from a different disease. Genetic linkage information was too slight for many definite conclusions. However, there was no suggestion of linkage with any of the markers tested.
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PMID:Hereditary pancreatitis in England and Wales. 67 83

The value of endoscopic retrograde cholangiopancreatography (ERCP) in a surgical unit was established by analysing 200 consecutive studies. The selective success rate was 80%. The groups of indications were jaundice (27%), postcholecystectomy pain (22%), recurrent acute pancreatitis (19%), complicated attack of acute pancreatitis (14%), and other (18%). A normal ERC was found and operation thus avoided in 26% of cases with persistent jaundice. In patients with postcholecystectomy pain pathological findings were found in 50% and half of them were operated upon. In pancreatitis demonstration of the pancreatic ducts and grading of the disease facilitated selection of the treatment and enabled preoperative planning of the surgical procedure. The pancreas was resected in 13 of 59 cases with diagnostic ERP. In pancreatic carcinoma ERCP led directly to diagnosis, but only two (ampullary carcinomas) out of ten were operable. The overall complication rate was 4%, including one case of fatal haemorrhagic pancreatitis.
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PMID:Endoscopic retrograde cholangiopancreatography in a surgical unit. 67 99


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