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

The records of twenty-one patients treated for pancreatic abscesses were reviewed. Pancreatitis developed following alcohol ingestion, operative procedures, biliary tract disease, ulcers, and undetermined causes. The clinical findings included abdominal pain in 19 patients (90%); fever in 18 (86%); tenderness in 18 (86%); and leukocytosis in 18 (86%). Ultrasonographic examination aided the diagnosis in seven of 11 patients. Computerized tomography was useful in diagnosing eight of ten cases. There were twenty-nine hospital admissions, with a mean length of hospitalization of 76 days per patient. The operative findings varied with extent and duration of underlying pancreatitis. The surgical approach depended on clinical presentation and prior localization of the abscess. Eleven additional operations were performed. Complications included respiratory failure (three patients); fistula formation (five patients); hemorrhage (two patients); renal failure (one patient); and splenic vein thrombosis (one patient). Thirteen patients were treated with hyperalimentation and nine patients had gastrostomy and jejunostomy placed for decompression and feeding. Of 15 patients in whom microbial studies were reviewed, nine patients had polymicrobial infections. Three patients had Candida albicans. There was one death.
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PMID:Management of pancreatic abscesses. 729 26

Hyperamylasemia of pancreatic origin has been noted in patients with severe head injury without abdominal trauma or evidence of pancreatitis. Thirty-eight patients with intracranial bleeding of various types were evaluated for elevated pancreatic amylase and lipase enzymes without associated pancreatitis. Twenty-five patients had elevated serum lipase; 17 of 25 also had elevated amylase without pancreatitis. Most lipase elevations occurred earlier than those of amylase. Six clinical variables--mannitol, ceftriaxone, nimodipine, steroids, Glasgow Coma Score, and total parenteral and enteral hyperalimentation--were evaluated to determine relationship to the enzyme elevations. A significant relationship exists between patients not treated with steroids and elevated lipase and amylase enzyme activities. Multivariate analysis revealed a significant interaction between lipase elevation and decreasing Glasgow Coma Score, indicative of increasing severity of intracranial bleeding. Proposed causes of enzyme elevations in intracranial bleeding include vagal stimulation, altered modulation of the central control of pancreatic enzyme release, and release of cholecystokinin from the brain. Physician awareness of the association of intracranial bleeding with the elevation of amylase and lipase without pancreatitis can save the patient needless cost and manipulation.
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PMID:Significance of elevated pancreatic enzymes in intracranial bleeding. 752 51

Pancreatitis following the administration of L-asparaginase (L-asp) has been well documented. However, the progression of such pancreatitis to pseudocyst formation in some patients has been rarely reported. The few reported cases have been teenagers, with the exception of one adult. All pseudocysts required surgical management. This report documents a pancreatic pseudocyst in a seven-year-old girl with acute lymphoblastic leukemia whose treatment regimen included L-asp. The pseudocyst was managed medically with nasogastric decompression, intravenous hyperalimentation, and antibiotics. The pseudocyst resolved spontaneously in one month without complication.
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PMID:L-asparaginase-related pancreatic pseudocyst: report of a case. 792 87

Abdominal problems and catastrophes often complicate the clinical course after bone marrow transplantation (BMT) in children. These complications can be grouped into categories of infection, chemotherapy and radiation toxicity, graft-versus-host disease (GVHD), recurrent or de novo malignancy, and miscellaneous complications and can involve the hepatobiliary system, pancreas, spleen, gastrointestinal tract, and urinary tract. Infection is common after BMT: the causative organism depends on the changing immunologic state of the recipient and even on environmental factors such as recent construction, humidity, and antibiotic use. Chemotherapy and radiation therapy can cause hepatic veno-occlusive disease, pancreatitis, nephritis, and hemorrhagic cystitis. GVHD is a process in which donor lymphoid cells produce damage to recipient target organs, especially skin, liver, and intestinal mucosa. Recurrent or de novo disease or malignancies, particularly B-cell lymphomas, may develop in chronically immunocompromised children. Other problems include stone disease, splenic and renal infarction, and complications of hyperalimentation therapy. Abdominal imaging, including plain radiography, contrast material-enhanced studies of the bowel, real-time and duplex sonography, and computed tomography, is essential in diagnosing these problems and evaluating response to therapy.
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PMID:Abdominal complications in pediatric bone marrow transplant recipients. 821 May 93

Conflicting data have been reported on the use of total enteral nutrition (TEN) in pancreatic disease. TEN was used in 17 patients who were candidates for nutritional support with total parenteral nutrition (TPN). There were 7 patients with internal pancreatic fistulas, 2 with protracted traumatic pancreatitis, 7 with severe alcoholic pancreatitis and 1 with a traumatic pancreatic pseudocyst. The mean inhospital stay was 30 days. Precision LR was administered orally or nasally for a mean of 16 days. Five patients with internal pancreatic fistulas were healed during the initial admission on TEN, 1 required surgery and 1 defaulted from hospital treatment. Nine patients with pancreatitis improved on TEN with resolution of pseudocysts or phlegmons (8 patients); 1 patient required a cystojejunostomy. Three patients who defaulted on TEN and consumed a ward diet had relapse of the pancreatitis, which responded rapidly to re-institution of hyperalimentation. There was no mortality in this group of patients. This preliminary report suggests that TEN may be considered as an alternative to TPN for nutritional support in pancreatic disease.
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PMID:The role of total enteral nutrition in pancreatic disease. 821 8

Torulopsis glabrata, a fungus commensal with the human gastrointestinal tract, so far has not been recognized as a cause of pancreatic sepsis. We report the cases of two patients with pancreatic pseudocysts that became infected with T. glabrata. A 20-year-old woman 6 weeks postpartum had acute gallstone pancreatitis complicated by pseudocyst formation and pancreatic sepsis. Pseudocyst fluid obtained at cystogastrostomy showed a pure culture of T. glabrata. A 52-year-old man with multiple medical problems showed signs of an infected pseudocyst 9 days after he was hospitalized for alcoholic pancreatitis. Computed tomography (CT)-guided aspiration of the the pseudocyst fluid confirmed T.glabrata as the infecting organism. Neither patient had a history of endoscopic or surgical manipulation. Prolonged therapy with broad-spectrum antibiotics and parenteral hyperalimentation were implicated as risk factors, and other possible pathogenic mechanisms were considered. Both patients were treated successfully with a combination of percutaneous or surgical drainage and amphotericin B, which appears to be the most active drug in vitro. The efficacy of other antifungal agents is discussed. In the context of pancreatitis and/or pseudocysts, empiric therapy with broad-spectrum antibiotics should be minimized because it predisposes patients to superinfection by opportunistic pathogens.
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PMID:Torulopsis glabrata-infected pancreatic pseudocysts. Diagnosis and treatment. 864 59

Although ductal disruptions are common in persistent, smoldering pancreatitis, pancreatic necrosis, or acute pancreatic fluid collections, chronic pancreatic fistulas have traditionally been defined as internal or external. Closure of these fistulas depends upon site and size of duct disruption, superinfection, downstream obstruction as a consequence of stricture or stone, or the presence of the "disconnected duct syndrome." Medical treatment is aimed at minimizing pancreatic secretion (low fat diet, pancreatic enzymes vs. NPO/hyperalimentation, octreotide, repeated/chronic drainage procedures). Resective or decompressive pancreatic surgery requires preoperative ERCP to define the anatomy. More recently, transpapillary endoprostheses have been used in a patient subset and deserve additional consideration in patients who fail to respond to conservative measures.
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PMID:Endoscopic therapy of complete and partial pancreatic duct disruptions. 940 50

A patient with a history of diabetes, coronary artery disease, stroke, previous renal transplantation, and multiple hospital admissions for recurrent pancreatitis was transferred to the hospital from a chronic care facility because of fever and severe epigastric discomfort. At the time of admission, she was receiving hyperalimentation through a central venous TPN catheter. Multiple blood cultures obtained on the first and second hospital days yielded pure cultures of the yeast, Pichia ohmeri. The patient developed acute renal failure, and despite high-dose amphotericin B therapy, ultimately expired.
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PMID:Pichia ohmeri fungemia. 957 30

In recent years, chronic massive pleural effusions have been increasingly recognized as a serious complication of pancreatitis. We describe the third reported case of a pancreatic pleural effusion accompanied by bronchopleural fistula. A 49-year-old man suffering from chronic alcohol-related pancreatitis was admitted to our hospital complaining of cough and shortness of breath. A chest x-ray film disclosed a large right pleural effusion with an air-fluid level. Ultrasonography and computed tomography of the upper abdomen demonstrated a giant pancreatic pseudocyst in the pancreatic tail and a fistulous tract reaching into the posterior mediastinum via the esophageal hiatus. Thoracentesis revealed sterile hemorrhagic fluid with markedly elevated amylase activity of 20,955 IU/l (pancreatic isozyme, 100%) and no malignant cells. A diagnosis of pancreatic pleural effusion was made. The therapy for pancreatic internal fistula is somewhat controversial. We employed conservative therapy, including hyperalimentation and chest tube drainage that successfully decreased the pleural effusion and closed the fistulous tract. Nonetheless, we were still troubled by a continuous air-leak via the drainage tube. Pleurodesis confirmed the tentative diagnosis of bronchopleural fistula and successfully stopped the air-leak. No re-accumulation of pleural effusion has been seen for 2 years. We concluded that pancreatic enzyme-rich effusions, if long-standing, may be complicated by bronchopleural fistula, thus underscoring the need for urgent drainage and initially conservative management.
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PMID:[Pancreatic pleural effusion accompanied by bronchopleural fistula]. 1049 9

Two cases of severe acute pancreatitis associated with type V hyperlipoproteinemia are reported. A 39-year-old obese woman was hospitalized with continuous severe abdominal pain. The diagnosis was made on the day of admission to our hospital, and treatment using continuous regional arterial infusion of a protease inhibitor and an antibiotic was performed with good results. The other patient was a 35 year-old woman in the 35th week of pregnancy, and a diagnosis of gestational hyperlipidemic pancreatitis was made on the day of onset. She was treated supportively using intravenous hyperalimentation, protease inhibitors, and antibiotics. She recovered from the acute pancreatitis and delivered a healthy term infant. It is difficult to diagnose acute pancreatitis in patients with type V hyperlipoproteinemia, because even when serum amylase levels are high, the value is reduced by high serum triglycerides. Early diagnosis was achieved in both of the present cases, and early intensive therapy was performed, which may be of the utmost importance in saving the life of a patient.
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PMID:Severe acute pancreatitis associated with hyperlipidemia: report of two cases and review of the literature in Japan. 1057 88


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