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

Splenectomy is performed routinely during distal pancreatectomy, yet the spleen has an important role in host defence and can often be preserved. A personal series of 100 distal pancreatectomies undertaken for pancreatic disease between 1978 and 1990 included 23 patients undergoing total pancreatic resection. The remaining 77 patients, who form the basis of the present report, underwent primary distal pancreatectomy and comprised 34 women and 43 men with a median age of 41 years (range 17-78 years). Conventional distal pancreatectomy including splenectomy was performed in 42 patients (55 per cent) for chronic pancreatitis (34 patients), pancreatic neoplasia (six patients), suspected pancreatitis (one patient) or pancreatitic trauma (one patient). Conservative resection with splenic preservation was performed in 35 patients (45 per cent) for chronic pancreatitis (12 patients), suspected pancreatitis (13 patients, including eight patients with pancreas divisum), pancreatic neoplasia (six patients), recurrent acute pancreatitis (two patients) and pancreatic trauma (two patients). There were no postoperative deaths in either group. Early complications followed conventional resection in 10 patients (24 per cent) and conservative resection in seven patients (20 per cent). In five patients the splenic vessels were ligated away from the splenic hilum and the spleen was left in situ, but subsequent isotope scans and haematological indices showed no hyposplenism. The spleen can safely be preserved in many distal pancreatic resections, including those for inflammatory disease, and we now prefer a retrograde technique for dissecting the pancreas off the splenic vessels.
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PMID:Distal pancreatectomy with and without splenectomy. 191 21

From 1979 to 1990, 33 children required operative treatment for pancreatitis. Causes included ductal abnormalities (12 children), trauma (10 children), idiopathic (four children), gallstones (three children), drug-induced (three children), and tumor (one child). This study reviews the characteristics and outcome of the 12 children with ductal abnormalities. Symptoms were present up to 9 years or less before diagnosis, with two patients undergoing negative appendectomies. At diagnosis, amylase levels averaged 612 IU/L and lipase, 4761 IU/L. Preoperative studies included ultrasonography (11 children), endoscopic retrograde cholangiopancreatography (nine children), and computerized tomography (six children). Intraoperative cholangiopancreatography was performed in nine patients and was essential in four to diagnosis their anomaly. Patients were categorized into those with a common channel (three children), ampullary stenosis (two children), ductal fusion error (one child), or combinations (six children). Operations included sphincteroplasty (seven patients), pancreaticobiliary separation (six patients), pancreatic duct enterostomy (three patients), and distal pancreatectomy (one patient). Three patients required more than one procedure to repair the combination anomalies. Symptoms resolved immediately in nine patients. Two patients had delayed resolution, with one patient requiring the addition of somatostatin. One patient was lost to follow-up. Recurrent or protracted pancreatitis, without obvious cause, requires expeditious endoscopic retrograde cholangiopancreatography and/or intraoperative cholangiopancreatography. Operative therapy should be tailored to ductal anatomy and will resolve symptoms in most children.
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PMID:Pancreatic ductal abnormalities in children. 192 60

During the last twelve years we made in 3868 cases cytological investigations of the pancreatic and bile duct systems. The techniques for endoscopic cell collection and microscopic observation are demonstrated. Cellular material consists of epithelia, inflammatory cells and tumor cells. Their cytological details are described. Of primary importance are the differentiations of the epithelial cells in cases of chronic cholangitis and pancreatitis from tumor cells. We found 211 cases with proven malignant tumors of the papilla, the pancreas or the bile ducts. In 81.5% of these cases a significant cellular material could be collected with 59.3% tumor cell diagnoses. No false-positive tumor cell diagnosis was found (n = 3657). A comparison with preoperative bioptic histology was possible only in the papilla region. Here, the sensitivity of histology was 60% compared to 86% sensitivity of cytology. We conclude that the cytodiagnosis of the papilla, the pancreas and the bile duct by means of endoscopic techniques can be done routinely in order to obtain a preoperative diagnosis of inflammatory as well as malignant cellular findings in these organs.
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PMID:[Endoscopic cytodiagnosis of the pancreas and bile ducts]. 194 82

One hundred twenty-six effusion samples from 102 patients were examined by cytology and flow cytometry (FCM). Overall, there was an 84% correlation between cytologic and FCM results. Of the 36 malignant cases determined by cytologic examination, FCM revealed an aneuploid peak in 20 (56%). Image analysis (IA) performed on the malignant cytologic cases with a diploid flow pattern detected two additional aneuploid peaks. In addition, FCM indicated three aneuploid cases in which cytologic characteristics were initially interpreted as benign (false negative). Aneuploidy was therefore detected in 64% of the malignant effusion specimens by FCM and IA. Twenty-three of the total of 24 aneuploid cases detected by FCM were associated with malignancy (predictive value = 96%). The one nonmalignant case was that of hemorrhagic pancreatitis with infected pseudocyst. FCM is an excellent tool when moderate to large numbers of tumor cells are present, whereas use of IA is advantageous for specimens containing smaller numbers of malignant cells because these can be directly analyzed. When an aneuploid peak is present, a diagnosis of malignancy must be suspected, and, if the initial cytologic screen is negative, a critical review of the cytology slides is justified. In those cases with an equivocal atypical cytology report and an abnormal cytometric histogram, additional investigation is warranted. In some malignancies the tumor cells will be diploid (in this study 36%) and neither FCM nor IA will add to tumor detection, leaving cytologic examination as the definitive technique.
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PMID:Diagnostic value of DNA analysis in effusions by flow cytometry and image analysis. A prospective study on 102 patients as compared with cytologic examination. 198 48

A 34 year old male was hospitalized because of severe abdominal pain and diarrhea. An abdominal X-ray revealed multiple calculi in the head of pancreas and blood tests showed his serum calcium level to be high. He underwent surgery of the parathyroid gland and a parathyroid tumor was removed. Two months later, resection of the head of the pancreas was also performed. Eighteen months after his operation there has been no recurrence of abdominal pain or diarrhea and his serum calcium level is within the normal range. We report this case herein and also discuss the possible cause and effect relationship between primary hyperparathyroidism and pancreatitis, and the appropriate management, in relation to a review of the literature.
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PMID:Chronic calcifying pancreatitis associated with primary hyperparathyroidism--report of a case and review of the literature. 208 96

In an attempt to determine the natural history of ductal adenocarcinoma of the pancreas in patients under 40 years of age, we reviewed the surgical outcomes of all such patients seen at the Mayo Clinic from 1970 to 1985. Histologic sections were reviewed; islet cell tumors and cystadenocarcinomas were carefully excluded. Twenty-six patients were identified. Their mean age was 34 years, with only one patient less than 25 years old. Symptoms included primarily abdominal pain, weight loss, and jaundice. One third of patients had a recent or past history of pancreatic disease including pancreatitis, pseudocysts, benign cystadenoma, and choledochal cyst. The tumor was located in the head of the gland in 62% of patients. "Curative" resections were possible in only three patients (12%); the remaining patients underwent palliative bypass (38%), biopsy alone (42%), or a palliative resection (8%). The hospital mortality rate was 12%, with actual 1-, 2-, and 5-year survival rates of 19%, 8%, and 4%, respectively, with a median survival of 4 months. The only long-term survivor underwent biliary bypass at age 15 years for a large neoplasm in the head of the gland; despite biopsy-proved liver metastases at that time, she continues to do well 5 years later. Histologic review indicated this tumor to be a "solid and papillary neoplasm of the pancreas." Ductal adenocarcinoma of the pancreas in young patients is an aggressive tumor with a poor prognosis behaving much like ductal adenocarcinoma in older patients (greater than 40 years). In rare instances a more favorable outcome can be expected when a solid and papillary neoplasm is found.
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PMID:Nonendocrine cancer of the pancreas in patients under age forty years. 216 85

After an acute episode of pancreatitis, a 63-year-old man was found to have a pancreatic glucagonoma. The tumor was resected without evidence of metastases. Three years later he had symptoms of uncontrolled diabetes, no skin lesions, and diarrhea and was found to have a pancreatic pseudocyst and multiple hepatic metastases. Glucagon concentrations were raised but were suppressible by glucose and somatostatin and responded to arginine stimulation. He was treated for 6 months with octreotide (Sandostatin), which reduced his symptoms; the pseudocyst resolved, but liver metastases continued to grow. Although spontaneous resolution of the pseudocyst is possible, this case appears to illustrate differences in sensitivity of endocrine and exocrine tissues to suppression by Sandostatin.
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PMID:Somatostatin analogue in treatment of coexisting glucagonoma and pancreatic pseudocyst: dissociation of responses. 216 87

Neoplastic lesions of the ampulla of Vater are a rare cause of acute and recurrent pancreatitis. We have recently had the privilege of studying a 58-year-old woman who presented with recurrent pancreatitis. At endoscopic retrograde pancreatography, a mucosal abnormality of the ampulla of Vater was noted and documented to be a villous adenoma. It was resected surgically and the patient has been symptom free. This report documents the ninth patient in the English literature with pancreatitis secondary to a benign neoplasm of the ampulla of Vater. Six of the nine patients have been male. They have ranged in age from 42 to 68 years. Approximately 30% of villous adenomas of the duodenum contain foci of invasive or in situ carcinoma. Villous adenomas of the ampulla of Vater require aggressive therapy. Further, it has been noted that a number of patients with small intestinal neoplasms have concomitant large-bowel polyps.
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PMID:Recurrent acute pancreatitis caused by ampullary villous adenoma. 218 7

We have performed 33 pylorus-preserving duodenopancreatectomies. Twenty patients presented with severe chronic pancreatitis and 13 with periampullary adenocarcinoma. We have no postoperative mortality and a 24% rate of morbidity. Complications include anastomotic leaks (2), surgical bleeding (1), anastomotic ulceration (1), and others (4). We have complete follow-up for all cases. In the tumor group, 8 (62%) patients are alive with a mean survival time of 20 months (range: 2-46). In the pancreatitis series, all patients are alive after a mean of 34 months (range: 4-66). We have observed 5 cases (15%) of anastomotic ulcerations responsible for stenosis (2) and acute perforation with peritonitis (2) occurring after a mean interval of 18 months. Four cases have been confirmed histologically after resection. The short- and long-term beneficial effects of the pylorus-preserving operation on patient well-being and nutritional status were confirmed and compared with the results achieved after a Whipple procedure performed in a series of 18 consecutive patients.
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PMID:Pylorus-preserving duodenopancreatectomy: long-term complications and comparison with the Whipple procedure. 223 66

Tumour-associated trypsin inhibitor (TATI) is a 6 kDa peptide, which is synthesized at low concentrations by several tumours and cell lines. Very high concentrations of TATI occur in mucinous ovarian tumours. Elevated levels of TATI occur in serum and urine in connection with most types of cancer at advanced stages. In mucinous ovarian cancer up to 85% of all cases have elevated serum levels. Because high levels also occur in early mucinous ovarian cancer TATI appears to be the marker of choice for this tumour. Elevated levels may also occur in nonmalignant disease, especially in patients with severe infections, tissue destruction and pancreatitis. Production of TATI in tumours is associated with expression of two new tumour-associated trypsin(ogen) (TAT) isoenzymes, TAT-1 and -2, TAT-2 being the major form. These enzymes are immunologically similar to trypsinogen-1 and -2, respectively. They activate prourokinase and may therefore trigger the tumour-associated protease cascade contributing to the invasiveness of malignant tumours.
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PMID:Tumour-associated trypsin inhibitor and tumour-associated trypsin. 224 88


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