Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A large number of ascitic fluid tests, e.g., fibronectin and cholesterol, have been proposed as helpful in detecting malignancy as the cause of ascites. Unfortunately, these "humoral tests of malignancy" are nonspecific. Although the ascitic fluid concentrations of these proteins or protein-bound substances tend to be quite high in patients with peritoneal carcinomatosis and low in the setting of cirrhotic ascites, the problem is that patients with tuberculous peritonitis, cardiac ascites, pancreatitis ascites, etc. usually have values in the malignancy range, i.e., false-positive results. This can lead to an extensive search for a nonexistent tumor, with confusion and anxiety for patient and physician. The cytology is the single best test to order when peritoneal carcinomatosis is suspected; its sensitivity approaches 100%. However, peritoneal carcinomatosis is only one of several mechanisms by which tumors can cause ascites. No one test can be expected to detect tumors as the cause of these diverse mechanisms of ascites formation. The serum-ascites albumin gradient is a helpful test in classifying ascitic fluid specimens into portal-hypertension-related and non-portal-hypertension-related categories. An elevated serum alpha-fetoprotein test can be useful in raising suspicion of hepatocellular carcinoma. Careful analysis of ascitic fluid, without measurement of "humoral tests of malignancy," combined with information obtained from the history and physical examination, usually lead to an accurate diagnosis of the cause of ascites.
 ...
PMID:Malignancy-related ascites and ascitic fluid "humoral tests of malignancy". 818 30

We report two cases of mucinous pancreatic ductal ectasia including one which progressed to micro-invasive carcinoma. The frequency of this tumor may be under-estimated (24 cases reported in the literature) because of confusion with pseudocysts or mucinous cystadenoma. The diagnosis is made at retrograde cholangiopancreatography. Endosonography is useful for tumors in the head of the pancreas, the predominant localization. At present, there is no test which can distinguish malignant forms from benign mucinous ductal ectasia. Resection of the tumor and the surrounding pancreatitis is the only curative treatment known. Pancreatoduodenectomy may be discussed in elderly patients with a tumor without signs of malignancy.
 ...
PMID:[Mucinous pancreatic ductal ectasia: mucus secreting tumor of malignant potential]. 866 91

A network of lymphatic vessels exists within the pancreas. The majority of vessels forming this network lie in the interlobular septa of connective tissue that subdivide the pancreas into lobes and lobules. Peripheral extensions of these interlobular lymphatics can be found within the lobules, but these intralobular lymphatics are relatively sparse. In the main, the intimate relationships of these internal pancreatic lymphatics are with the blood vessels and associated connective tissue. However in random areas, both intra- and interlobular lymphatics come into close relationship with acinar cells. Rarely are there lymphatics associated with islets of Langerhans, and then only where lymphatic vessels in connective tissue septa pass close to a pancreatic lobule that contains an islet at its periphery. Intra- and interlobular lymphatics are similar in structure. Both are thin walled having an endothelial lining and a delicate component of connective tissue. The pattern of interendothelial cell contacts and the sparsity of gaps between adjacent cells suggest that fluid movement through the intracytoplasmic system of vesicles is important in lymph formation in the pancreas. However intercellular transport is also likely to occur by a dynamic process involving fluid movement through dilatations between cells from interstitium to lymphatic lumen. Both exocrine and endocrine secretions of the pancreas may enter thoracic duct lymph directly in pancreatic lymph, but in normal circumstances this route of entry is not quantitatively important. The structural relationships between lymphatics and pancreatic parenchymal cells also make clear that lymph is not a significant pathway for their secretory products. Rather, the arrangement of lymphatics in the pancreas supports the view that lymph is primarily the drainage medium for substances that, for whatever reason, enter the interstitium. In addition, the low flow of lymph compared with that of plasma lends credence to the view that lymph is not a functionally important pathway for endocrine secretions from the pancreas to reach the blood. Both structural and functional evidence suggests that the proper functioning of the lymphatic system is of critical importance in the homeostasis of the pancreas. The lymphatic system of the pancreas, like that in other organs, is essential in the removal of excess fluid from the interstitium. In this sense, the lymphatics may be considered to serve as an overflow, protective, or safety system. When the system is inadequate or its capacity is exceeded, as in inflammation of the pancreas, exocrine secretions entering the interstitium are not cleared and the proteolytic enzymes cause major damage to the tissue. This, in turn, exacerbates the edema, accentuates the inability of lymphatics to drain the fluid, and results in further damage. The fibrosis that ensues damages the lymphatics either directly or through stricture of the surrounding connective tissue. In consequence, they become inadequate at an even earlier stage in subsequent attacks of inflammation and thereby predispose to chronic and recurrent pancreatitis. The larger interlobular lymphatics formed by the junction of their tributaries emerge upon the surface of the pancreas. There they travel primarily with blood vessels and stream toward a ring of lymph nodes that intimately surrounds the pancreas. A second system of nodes extensively involved in drainage from the pancreas is related to the front and sides of the aorta from the level of the celiac trunk to the origin of the superior mesenteric artery. This second set of nodes receives lymph either directly from the pancreas or indirectly from the first echelon of nodes that rings the organ. Although there is general agreement on the disposition of the groups within these sets of nodes, confusion results from the different classifications used by various authors. These classifications range from being purely descriptive, through an alpha and num
 ...
PMID:Lymphatic system of the pancreas. 922 Apr 24

We report two cases of portal vein visualization during ERCP in patients with pancreatitis, one from inadvertent cannulation of the superior mesenteric vein, and in the other, through a preexisting fistula. Prompt recognition of this potentially significant event will obviate confusion and unnecessary prolongation of the procedure.
 ...
PMID:Portal vein opacification during ERCP in patients with pancreatitis. 943 69

Based primarily on our experience, we review current problems on etiology, pathogenesis, classification, diagnosis, and treatment of chronic pancreatitis. Much of the confusion and difficulty associated with chronic pancreatitis originates from the relative inaccessibility of this organ. A lack of specific and sensitive markers that are suitable for the follow-up of a long natural course of chronic pancreatitis also hinders our understanding of this disease. The resolution of the present imaging tests, even by the latest technology, is not good enough to detect early changes of the pancreas. In the past 10 years, several subgroups of patients with alcoholic and idiopathic pancreatitis have been identified based on the long-term follow-up study. Pain disappeared spontaneously in many patients during the course of the disease, but its mechanism is still poorly understood. Removal of pancreatic stones and protein plugs by chemical, endoscopic, or extracorporeal shock-wave therapy has been tried with some success, but their clinical values remain to be established. Attempts have been made to understand the etiology and pathogenesis of chronic pancreatitis at molecular levels. This approach, together with a prospective follow-up of patients, will improve our understanding on chronic pancreatitis.
 ...
PMID:Chronic pancreatitis: overview of medical aspects. 954 74

Serum amylase and lipase levels are commonly obtained in the emergency department for the diagnosis of acute pancreatitis. The role of these enzymes has frequently been the subject of confusion and controversy. This article comprehensively reviews the history, biochemistry, clinical, and laboratory literature on both enzymes as used in the evaluation of pancreatitis. Specific guidelines are presented to assist the Emergency Physician in the appropriate use and interpretation of these clinical laboratory tests.
 ...
PMID:Amylase and lipase in the emergency department evaluation of acute pancreatitis. 1100 68

We report a case of autoimmune pancreatitis presenting as a mass in the head of the pancreas that was successfully diagnosed without pancreaticoduodenectomy. The patient was a 64-year-old man who had no complaint. A routine physical checkup unexpectedly revealed mild diabetes and a low-echoic mass in the pancreatic head. The diagnosis was made by noting irregular narrowing of the main pancreatic duct, hypergammaglobulinemia, and increased immunoglobulin G levels. An open wedge biopsy of the mass was performed; this showed a marked fibrosis with lymphocyte- or macrophage-predominant inflammatory infiltrates. Immunohistochemical study revealed that the remnant acinar cells expressed Fas (CD95) ligand and not Fas. We review some of the literature and discuss various features and diagnostic clues of autoimmune pancreatitis. Awareness of this pathologic condition may prevent confusion with pancreatic malignancy and unnecessary surgery.
 ...
PMID:Autoimmune pancreatitis presenting as a mass in the head of the pancreas: a diagnosis to differentiate from cancer. 1276 4

Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty. Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n = 20) or knee (n = 21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis. Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.
 ...
PMID:Paradoxical cerebral embolisation. An explanation for fat embolism syndrome. 1476 73

A pseudocyst presents as a cystic cavity bound to the pancreas by inflammatory tissue. Typically the wall of a pancreatic pseudocyst lacks an epithelial lining, and the cyst contains pancreatic juice or amylase-rich fluid. Today the mostly used definitions make a difference between peripancreatic fluid collections, pseudocysts after acute and chronic pancreatitis and pancreatic abscess as in the Atlanta classification system for acute pancreatitis. Distinction between pseudocyst and acute fluid collection leads to a better understanding of the natural history of peripancreatic fluid collections and facilitates the progress of the treatment of these two separate entities even though they are a part of a continuous pathological process. The presence of a well-defined wall composed of granulation or fibrous tissue is what distinguishes a pseudocyst from an acute fluid collection. A pseudocyst is usually rich in pancreatic enzymes and is most often sterile. Formation of a pseudocyst requires usually 4 or more weeks (many clinicians state six) from the onset of acute pancreatitis. The differentiation in the Atlanta classification between acute and chronic pseudocyst is important, but it invite to confusion. It is important to note that in the classification the terms "acute" and "chronic" refers to the pancreatitis behind the pseudocyst and not to the mode of symptomatology of the pseudocyst itself. This means that an acute pseudocyst may have be known for months, whereas a chronic pseudocyst in the next patient has been documented only a week or two.
 ...
PMID:Surgical treatment of pancreatic pseudocysts in the 2000's--laparoscopic approach. 1530 93

West Nile Virus (WNV) infection is a fairly common infection in Israel, especially during the summer season. Common manifestations are fever, headaches, malaise and myalgia. Pancreatitis had been described only twice previously as a complication of WNV infection in the medical literature. In this report, an 88-year-old patient is described, who was admitted to hospital with fever, confusion and general deterioration in her condition, accompanied by severe abdominal pain. WNV infection was diagnosed by a lumbar puncture and serological tests. The laboratory results demonstrated elevated amylase and lipase levels. The patient was treated conservatively and the symptoms regressed slowly until full recovery. WNV infection and its complications are described, along with descriptions of previous reports of pancreatitis associated with WNV infection.
 ...
PMID:West Nile virus-induced pancreatitis. 1898 83


<< Previous 1 2 3 4 Next >>