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

The diagram of the mortality of acute pancreatitis is characterized by two distinct peaks, in a similar manner to other generalized acute inflammatory responses. In the first phase, which is characterized by "hyper-inflammatory" mechanisms, death occurs due to overwhelming SIRS and subsequent multi-organ failure. The second peak of death is usually detected much later, at least two weeks after the onset of acute pancreatitis. Infection in necrotising pancreatitis is frequently observed in this so-called "compensatory antiinflammatory" phase. Since there has been no effective therapy evolved to prevent the activation of inflammatory and proteolytic cascades, the treatment of acute pancreatitis is merely symptomatic. Adequate fluid resuscitation and analgesia are the mainstays of treatment. In case of development of multi-organ failure, extensive medical and ventilatory supportive therapy is usually necessary. However, recent studies suggested certain methods might decrease the incidence of infection in pancreatic necrosis, which is usually due to bacterial translocation from the gut. Numerous attempts have been published in the literature to decrease the frequency of septic complications. Furthermore, the outcome of studies favouring antibiotic prophylaxis in acute pancreatitis were debatable. The development of multi-resistant strains of Gram-positive bacteria and Candida, due to long-term antibiotic use, is a strong argument against the indication of prophylactic antibiotic use. Recently, various clinical studies aimed to decrease bacterial translocation, including probiotic use and enteral feeding as part of the treatment. This paper provides a systematic review on data available in the evidence based literature on the use of antibiotics and the role of alternative and supportive therapy in the treatment of severe acute pancreatitis.
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PMID:Preventive strategies for septic complications of acute pancreatitis. 1796 33

A cockatiel (Nymphicus hollandicus) examined because of weight loss, polydipsia, and polyuria was diagnosed with diabetes mellitus based on the presence of glucosuria and marked hyperglycemia. Medical attempts to manage the diabetes mellitus were unsuccessful, and the bird was euthanatized. Histopathologic examination of the pancreas revealed a chronic active pancreatitis with herpesviral inclusions in many of the pancreatic acinar and duct cells. Psittacid herpesvirus-1 (PsHV-1) DNA was amplified from the lesion by polymerase chain reaction. Sequencing of the amplicon showed it to be the genotype 1 variant, which is most commonly associated with Pacheco's disease, an acute rapidly fatal systemic infection. The findings in this case suggest that the PsHV-1 genotype may also cause a localized disease of the pancreas. Infection with this virus should be considered as a differential diagnosis in birds with pancreatitis with or without diabetes mellitus.
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PMID:Endocrine pancreatic insufficiency secondary to chronic herpesvirus pancreatitis in a cockatiel (Nymphicus hollandicus). 1806 36

Intra-abdominal abscesses formation in patients with no preceding symptoms is rare. Infection of the pancreas occurs in 5-9% of patients with acute pancreatitis, more commonly as a complication of necrotising or severe pancreatitis. We have reported a case of a 64-year-old almost entirely asymptomatic man who underwent a Whipple's procedure following extensive investigation of a pancreatic mass. The pathology and histology showed no evidence of malignancy, and instead a true pancreatic abscess, centred around an impacted cholesterol calculus in the distal CBD. Of suspicious pancreatic masses that are resected, chronic choledocholithiasis is the aetiology in less than 5% of nonmalignant or "false positives." This report describes such a case.
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PMID:Pancreatic mass with an unusual pathology: a case report. 1847 14

Medical records and incidence data were analyzed retrospectively to document the epidemiology, clinical features, and outcomes of mumps in relation to vaccination status in the Lviv province of Ukraine over a 7.5-year period, beginning in 2000, when a second dose of mumps vaccine was introduced. Lviv, 1 of 27 provinces in western Ukraine, with a land area of 21,833 km(2), had a total population of about 2,555,834 in 2006. The initial success of the second dose introduction in 2000 in Ukraine was limited by a local outbreak of mumps in Lviv province in 2000-2002 due to a vaccine shortage; most cases were over the age of 7 years. The vaccine with the Leningrad-3 virus strain used before 2001 was then replaced by the triple vaccine "Priorix", with the RIT 4385 derivate of the Jeryl Lynn strain, Belgium. Orchitis and aseptic meningitis were associated with the Russian vaccine. Of the 10,894 reported cases, the most severe (367 cases, 3.4%) were hospitalized in the Lviv Hospital for Infectious Diseases. Admitted patients were predominantly male and over 14 years old. Of the 367 patients admitted to the Lviv Hospital for Infectious Diseases, 45.8% had been vaccinated (mostly by a first dose of Russian vaccine), 15.9% had not been vaccinated, and 38.1% had an unknown vaccination status. More mumps cases occurred in winter and spring than in summer and autumn. The clinical picture and complications (orchitis, pancreatitis, meningitis, and encephalitis) were typical of this disease. The vaccine shortage and an increase in the susceptible population among those who received the Russian vaccine contributed to the outbreak. The use of vaccine with a derivate of the Jeryl Lynn strain has resulted in a dramatic drop in mumps cases since 2002.
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PMID:Effectiveness of a vaccination program against mumps in Ukraine. 1861 56

The aim of this study was to examine whether the detection of pulmonary fat embolization is valid as a significant indicator of heat exposure in forensic autopsies. In 54 cases where there was no evidence of fracture, burn or pancreatitis, 25 cases (46.3%) showed pulmonary fat embolization, the degree of which was pathohistologically classified as slight in all cases. Among the 25 cases where the pulmonary fat embolization was detected, the individual had died under a high ambient temperature in 14 cases (56%). Based on logistic regression analysis, pulmonary fat embolization was found to be associated with a high ambient temperature, but not associated with coronary arteriosclerosis, fatty infiltration in the liver, severe infectious diseases, intracranial hemorrhage or the detection of methamphetamine in the blood. Further investigations are necessary before these findings can be applied in forensic autopsy cases; however, it is likely that the detection of pulmonary fat embolization is valuable as one of the diagnostic findings indicating antemortem heat exposure.
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PMID:Pulmonary fat embolization as a diagnostic finding for heat exposure. 1865 64

Infection of mice with coxsackievirus B4 results within days in a severe acute necrotizing pancreatitis, which resolves completely within weeks. Gelatinase B or matrix metalloproteinase 9 (MMP-9) has previously been shown to be involved in several models of pancreatitis, but its role in virus-induced pancreatitis has never been investigated. We here report that MMP-9 levels are markedly increased in the pancreas of mice that developed acute pancreatitis following infection with coxsackievirus B4. Moreover, using in situ zymography, we demonstrated that MMP-9 is active in vivo. Double immunohistochemical analysis revealed that macrophages and neutrophils were the cellular source of MMP-9. Extensive tissue rearrangements involving collagen turnover were observed, and these were associated with extensive pathology and resolution of the disease. In summary, this report demonstrates that acute coxsackievirus B4-induced pancreatitis involves the action of MMP-9, which is mainly originating from macrophages and neutrophils.
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PMID:Increased gelatinase B/matrix metalloproteinase 9 (MMP-9) activity in a murine model of acute coxsackievirus B4-induced pancreatitis. 1892 80

Infection with coxsackievirus B4 (CVB4) may result in an acute severe necrotizing pancreatitis that mostly remains restricted to the acini of the exocrine parenchyma. The mechanisms responsible for this tissue damage, however, remain poorly understood. We here report that COAM, a polyanionic carboxylic acid, provides marked protection against CVB4-induced pancreatitis in a mouse model. Despite the fact that COAM largely reduced disease severity, as detected by serum amylase and lipase levels as well as histologically, titres of replicating CVB4 in the pancreas were virtually unaffected. COAM treatment diminished the infection-associated MMP-9 levels and also resulted in a decreased influx of neutrophils into the infected pancreas. Moreover, we demonstrate that titres of replicating virus in the pancreas did not directly correlate with the severity of disease. In conclusion, our data suggest that immunopathological effects, rather than direct virus-induced destruction, are responsible for the damage to acinar tissue in CVB4-induced pancreatitis.
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PMID:Inflammatory rather than infectious insults play a role in exocrine tissue damage in a mouse model for coxsackievirus B4-induced pancreatitis. 1914 76

A leading cause of biliary tract disease and pancreatitis worldwide is parasitic disease. In the United States, increased global travel and the AIDS epidemic has led to a rise in the frequency of parasitic disease. Biliary disease and pancreatic disease secondary to parasitic infestation is relatively new in this country, with the first case being described in 1977. These diseases are no longer the exclusive realm of infectious disease specialists and require general practitioners and gastroenterologists to be well versed in the spectrum of parasitic pancreatic and biliary disease.
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PMID:Parasitic causes of pancreatic and biliary tract disease: a growing concern in a highly mobile population. 2005 32

The aim of this study was to examine differences in presentation and outcome in pancreaticoduodenectomy for benign and malignant processes. Pancreaticoduodenectomies performed for pancreatic adenocarcinoma or chronic pancreatitis from 2000 to 2008 were identified from a prospectively maintained database and compared. Pancreaticoduodenectomy revealed adenocarcinoma in 220 patients and benign chronic pancreatitis in 40 patients. Patients with adenocarcinoma were older (64 +/- 10.6 years and 47.6 +/- 10.8 years, respectively, P < 0.001) and more likely to demonstrate jaundice (92 and 13%, respectively, P < 0.001), weight loss (76 and 58%, respectively, P = 0.01), and discrete masses (72 and 55%, respectively, P = 0.03). By contrast, chronic pancreatitis presented with increased pain (98 and 49%, respectively, P < 0.001) and nausea (68 and 32%, respectively, P < 0.001). Patients with pancreatitis experienced reduced blood loss (227 +/- 156 and 571 +/- 626 mL, respectively, P = 0.05) and transfusion (10 and 42%, respectively, P < 0.001). Postoperatively, the groups were similar in risk of fistula, gastroparesis, overall morbidity, and mortality. Infection rates were higher in adenocarcinoma (42 and 20%, respectively, P = 0.01). Forty-nine patients underwent pancreaticoduodenectomy for presumptive chronic pancreatitis, of which nine had adenocarcinoma; logistic regression identified increasing age and jaundice as predictors of malignancy. Compared with patients with adenocarcinoma, those who undergo pancreaticoduodenectomy for chronic pancreatitis are less likely to require preoperative biliary drainage and perioperative transfusion. Infectious complication risk is higher in patients with adenocarcinoma. Increased age and jaundice should raise suspicion of cancer in patients with chronic pancreatitis undergoing evaluation for surgical treatment.
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PMID:Differences in presentation and perioperative outcome after pancreaticoduodenectomy for cancer and benign pancreatitis. 2058 16

Infection of pancreatic necrosis, although present in less than 10% of acute pancreatitis, carries a high risk of mortality; debridment and drainage of necrosis is the treatment of choice, followed by 'open' or 'close' abdomen management. We recently introduced the use of intra-abdominal vacuum sealing after a classic necrosectomy and laparostomy. Two patients admitted to ICU for respiratory insufficiency and a diagnosis of severe acute pancreatitis developed pancreatic necrosis and were treated by necrosectomy, lesser sac marsupialisation and posterior lumbotomic opening. Both of the patients recovered from pancreatitis and a good healing of laparostomic wounds was obtained with the use of the VAC system. Most relevant advantages of this technique seem to be: the prevention of abdominal compartment syndrome, the simplified nursing of patients and the reduction of time to definitive abdominal closure.
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PMID:Intra-abdominal vacuum-assisted closure (VAC) after necrosectomy for acute necrotising pancreatitis: preliminary experience. 2072 23


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