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

Between 1954 and 1975, 80 pancreaticojejunostomies were performed on 77 patients for intractable pain of chronic pancreatitis. All patients had a history of chronic alcoholism. Drainage operations done primarily for pseudocysts were excluded. Operative procedures included seven caudal pancreaticojejunostomies, 42 longitudinal pancreaticojejunostomies with splenectomy and implantation of the pancreas into the jejunum, and 31 side-to-side pancreaticojejunostomies. Eighty-one percent of the patients noted substantial improvement or complete resolution of their abdominal pain on follow-up that ranged up to 21 years. The operative mortality was 5%. Thirty-two patients died during the period of the follow-up. Continued alcohol abuse, carcinoma, and cardiovascular disease were the leading causes of mortality. Data from this review confirm the effectiveness of pancreaticojejunostomy in relieving the pain of chronic relapsing pancreatitis.
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PMID:Pancreaticojejunostomy for chronic pancreatitis. Two- to 21-year follow-up. 7 68

47 of 170 cases of chronic pancreatitis observed and controlled in the last 12 years in this department were of unknown etiology (idiopathic form). The age distribution of these 47 cases showed 2 peaks, a "juvenile" group of 9 cases (average age 29 years) and a "senile" group of 38 cases (average age 62 years). Idiopathic "senile" chronic pancreatitis (ISCP) is characterized by advanced age at the time of first manifestation (95% over 50 years), a prevalence of males (81%), a high incidence of calcifications (60%) and a rather benign, often painles course (74%). Clinically there is some overlap between ISCP and painless chronic pancreatitis (PSCP). In contrast to PSCP, ISCP seems, however, to comprise a homogeneous group of patients as far as etiology is concerned, and typical episodes of pancreatitis occurred in about 25% of cases with ISCP. Ther is an unusually high incidence of signs of arteriopathy associated with ISCP. Arteritis of the lower limbs and/or coronary heart disease was detected in 42% of cases, 14 of 17 deaths were due to cardiovascular disease and arteriosclerotic risk factors were found in 87% of the patients. In our experience ISCP seems to be a special form of chronic pancreatitis which can be differentiated from alcohol-induced chronic pancreatitis and from the other forms with rare causes. Furthermore, our findings suggest that a vascular factor is of importance in causing ISCP.
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PMID:["Senile" chronic pancreatitis; a new nosologic entity? Studies in 38 cases. Indications of a vascular origin and relationship to the primarily painless chronic pancreatitis]. 77 3

In a small percentage of patients with acute pancreatitis, recurrent attacks of pain and hyperamylasaemia occur when feeding is commenced. Recurrences of this type may occur because the pancreas is still swollen and inflamed, and indicate the need for a longer period of "pancreatic rest" before food is introduced. Alternatively, they may reflect the presence of "mechanical" factors leading to the recurrent pancreatitis, such as a gallstone in the common bile duct, a pseudocyst of the pancreas, or pancreatic duct obstruction. Successful resolution of the pancreatitis may require treatment of underlying causative factors. A stone in the pancreatic duct (probably a gallstone) was found to be the cause of recurrent acute pancreatitis in an elderly patient with severe cardiovascular disease, who was unfit for surgery. Pancreatitis settled after percutaneous drainage of the pancreatic duct, the technique described.
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PMID:Treatment of acute pancreatitis caused by calculous obstruction of the pancreatic duct by ultrasound-guided percutaneous drainage. 155 36

Sixteen pancreatico-duodenal transplants were performed on 15 insulin-dependent diabetics, aged 25-46, during a 20-month period beginning May 1, 1988. Fourteen patients received a combined cadaveric pancreas/renal transplant with bladder drainage. One patient received a second pancreas transplant 24 hours after the first pancreas graft failed due to portal vein thrombosis. One patient received a pancreas graft 3 years after kidney transplantation. Complications included five cases of hematuria, two bladder leaks, two wound infections, one cytomegalovirus pneumonia, three cases of graft pancreatitis, one pseudocyst, one urine reflux pancreatitis requiring conversion to pancreatico-enterostomy, and two late deaths. Average time to discharge was 17 days following transplant, with 2.9 re-hospitalizations per patient and an average of 38 in-hospital days during the first 6-12 months. Seventeen rejection episodes occurred in 12 patients, diagnosed by declining urine amylase and pH and/or finding of rejection on kidney biopsy. Patient and kidney graft survival is 87 per cent. Pancreas graft survival is 81 per cent (1-20 months follow-up). All patients are insulin-independent and normoglycemic. Mean glycosylated hemoglobin concentration is 4.0 +/- 0.9 post-transplant vs. 7.5 +/- 0.6 pretransplant. Mean serum creatinine is 1.4 +/- 0.7 mg/dl. A new program of pancreas transplantation can be successful in carefully selected diabetic patients, with special attention to avoidance of preservation injury to the pancreas during multiorgan donor procurement. Combined pancreatic/renal transplantation is believed to be the therapeutic treatment of choice in Type I diabetic patients who have impaired renal function and have no significant cardiovascular disease.
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PMID:Pancreas transplantation. A new program. 199 66

Screening for dyslipoproteinemias should be undertaken in all individuals older than 20 years of age at least once every 5 years. The initial screening, as recommended by the Adult Treatment Guidelines Panel of the National Cholesterol Education Program, is to determine the concentration of total blood cholesterol. This initial determination can be made on blood obtained in the nonfasting state. Further evaluation of the patient's lipoprotein concentrations is dependent upon the presence of other cardiovascular risk factors. in the absence of definite coronary heart disease, hypertension, diabetes mellitus, a family history of coronary artery disease, cigarette smoking, or severe obesity, the patient with a total blood cholesterol concentration less than 200 mg/dL requires no specific instruction and should have a repeated screening performed within 5 years. Patients with blood cholesterol concentrations greater than 200 mg/dL should have their lipoprotein profiles determined if they have atherosclerotic cardiovascular disease or two other cardiovascular disease risk factors. The lipoprotein profile includes the determination of fasting cholesterol and triglyceride and HDL cholesterol concentrations. From these values, the LDL cholesterol concentration can be calculated. This LDL cholesterol concentration is central in selecting the appropriate therapy. HDL cholesterol concentrations may be useful in evaluating patients with ischemic heart disease. Concentrations of HDL cholesterol less than 35 mg/dL are associated with increased risk for coronary artery disease. Although there is currently no convincing evidence that support the specific treatment of depressed HDL cholesterol concentrations, therapy directed to modulating lipoprotein metabolism in patients with heart disease and low HDL concentrations may be of benefit. Patients with recurrent abdominal pain, pancreatitis, and eruptive xanthomatosis frequently have fasting hypertriglyceridemia concentrations exceeding 1000 mg/dL. These patients should be identified in order to effectively reduce their triglyceride concentrations, which can prevent these complications.
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PMID:Detection and evaluation of dyslipoproteinemia. 219 76

Angiographies (a total of approximately 9 500) and patient records revealed 56 patients with renal artery aneurysm during the period 1960 to 1974. Fifteen patients were operated upon electively and 3 were lost for follow-up. Rupture occurred in four leading to acute nephrectomy. Thus, 34 patients were left for studies on the natural course. They were 29-82 years old (mean 58 years) at diagnosis and were followed for at least 90 months. Twelve were males and 22 females. The aneurysms had a diameter of 3-25 mm (mean 12 mm), were fusiform in 7 and saccular in 27 cases; 9 were calcified. Repeated angiographies were carried out in 7 patients at intervals of up to 73 months showing slight enlargement of one aneurysm, disappearance of another and no change in 5. Sixteen patients were alive at the end of the follow-up period 90-220 months (mean 157 months) after the first or only angiography. Eighteen patients died after 2-204 months (mean 84 months), 14 of cardiovascular disease unrelated to the renal arteries, 3 of malignant tumour and one of pancreatitis. Autopsy in 12 patients did not show rupture of any renal artery aneurysm. Thus, in a considerable number of patients the disorder was uncomplicated and compatible with a long life.
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PMID:Angiographically discovered, non-operated renal artery aneurysms. 671 50

Treating hyperlipidemia in diabetics requires distinguishing between hypercholesterolemia, with its high risk of cardiovascular disease, and hypertriglyceridemia, which, if severe, may cause pancreatitis. Hypercholesterolemia is best managed with diet and, if necessary, colestipol and niacin. Hypertriglyceridemia with chylomicrons responds best to diabetic control, weight loss, and low-fat diet.
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PMID:Hyperlipidemia - a diabetic emergency. 705 73

Primary lipoprotein lipase deficiency is a rare autosomal recessive disease that causes hyperchylomicronaemia complicated by pancreatitis. Recent advances in molecular biology have facilitated its diagnosis and enabled heterozygous subjects to be identified. Numerous mutations are responsible for lipoprotein lipase deficiency. In some eastern regions of Quebec province homozygotes have been found in very high concentrations: up to 200 times the frequency observed in all other parts of the world. Heterozygocity may represent 1 in 40 subjects. Two mutations account for 95 percent of the Quebec cases, and each of them has its own characteristic geographical distribution. These peculiarities have been ascribed to a founder effect suggested by the analysis of the first colons' migrations and by the study of homozygotes' genealogy. Most of the ancestors of the Quebec carriers came from northwestern France in the 17th century, and heterozygotes alleged to be healthy carriers of the trait may have a predisposition to premature development of a cardiovascular disease. Their blood lipid levels and the composition of their lipoproteins (particularly those with low density) are suggestive of an atherogenic potential similar to that of hyperapobetalipoproteinaemia or familial combined hyperlipidaemia. Molecular biology would be a useful tool to confirm or infirm this hypothesis and to identify subjects at risk of developing a cardiovascular disease.
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PMID:[Primary lipoprotein lipase deficiency. Study in Quebec]. 851 Nov 35

In the majority of patients suffering from chronic pancreatitis an endocrine pancreatic insufficiency is correlated with exocrine dysfunction. The prevalence of impaired or diabetic glucose tolerance is 40-70%, half of these patients suffer from an insulin-dependent diabetes mellitus. In general the probability of endocrine insufficiency progressively increases within the ten years following diagnosis of chronic pancreatitis. Onset and severity of the endocrine dysfunction depend on parenchymal destruction of the pancreas but are also influenced by ongoing alcohol consumption. Pathological findings in the endocrine pancreas are a loss of B-cells with decrease in secretion of insulin but also a loss of B-cell responsiveness to glucose by impaired perisinusoidal diffusion. Disturbances of the enteroinsulinar axis with diminished levels of incretins due to an exocrine insufficiency are also discussed. In addition, an impaired A-cell function may be important, that is characterized by diminished levels of stimulated glucagon. Increased plasma levels of somatostatin were found, the source of which is unknown. The susceptibility to severe hypoglycemia in patients with diabetes mellitus secondary to chronic pancreatitis is higher than in Type I diabetics. This is mainly caused by the impaired glucagon secretion but also influenced by malnutrition and concomitant hepatic dysfunction due to the toxic affect of alcohol. Diagnostic procedures are the measurement of C-peptide-concentrations and profiles of blood glucose after fasting and stimulation with L-arginine or glucose. Especially in the beginning of the endocrine insufficiency the determination of basal levels of blood glucose or C-peptide are not useful. Unless treatment by diet is effective, the therapy of diabetes secondary to chronic pancreatitis should be done by insulin replacement. A certain degree of hyperglycemia may be tolerated due to the risk of hypoglycemia and the persistent alcohol consumption in these patients. Intensified insulin therapy should only be done in selected patients with good compliance. Long-term complications in patients with pancreatogenic diabetes are comparable to diabetes Type I and largely depend on the duration of the diabetes. Life expectancy is reduced, death in these patients is mainly due to persistent alcohol and nicotine abuse (cardiovascular disease, malignant tumors, etc.), in only a minority pancreatitis or diabetes (mainly hypoglycaemia) are relevant risk factors.
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PMID:[Secondary diabetes in chronic pancreatitis]. 1044 9

Reports of metabolic disorders, such as diabetes mellitus and hyperlipidemia, occurring during treatment with protease inhibitor (PI) regimens are prompting patients and providers to try to better understand the links between these disorders and antiretroviral treatments. The Food and Drug Administration (FDA) first reported PI-associated diabetes in June 1997. Diabetes mellitus can be managed by controlling diet and exercise, or by supplementing treatment with oral hypoglycemic drugs. Hypertriglyceridemia has also been associated with PI therapies, and is apparent even in patients experiencing good results from antiretroviral therapy. Treatment for hypertriglyceridemia encompasses monitoring diet and exercise, limiting alcohol, watching hypertension, and quitting smoking. Patients at higher risk for pancreatitis can consider using lipid-lowering drugs and fibric acid derivatives. Alterations in fat distribution have also been linked to PI use, particularly in the back of the neck and upper back, and abdominal area. Researchers have seen evidence of anomalous fat distribution in some patients prior to PI treatment. Management has not consistently been remedied by diet and exercise. Sustaining overall health, reducing blood lipids, and controlling risk factors for cardiovascular disease need to be implemented. Unless the abnormalities are severe and potentially harmful to the patient, it is not commonly recommended to change the PI treatment.
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PMID:Metabolic complications of antiretroviral therapies. 1136 97


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