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

A group of 191 patients with chronic relapsing pancreatitis was followed for about 10 years. Ninety-three of them were selected for surgery because of incapacitating painful relapses or persistent pain and were submitted to side-to-side pancreaticojejunostomy. Ninety-eight were selected for medical management. Seventeen patients died during the follow-up. The cumulative probability of pain relief, 10 years after clinical onset of the disease was 62.9% in the patients who had been submitted to surgery and 42.8% in the nonoperated patients. In the operated group, no case of further relapse was observed after a 3-year pain-free interval, but in the nonoperated group some patients complained of further painful relapses. Complete and lasting alcohol withdrawal and/or steatorrhea were significantly associated with a more favorable result in the patients who had been submitted to surgery. However, the relationship between alcohol consumption, exocrine pancreatic insufficiency, and pain behavior did not reach statistical significance in the nonoperated patients. In patients selected for and submitted to surgery, whose disease before surgery was severe because of a high frequency of painful relapses, the chance of pain relief was similar to, and to some extent higher than, that observed in patients not selected for surgery and suffering from a mild or moderate disease. Alcohol withdrawal and exocrine pancreatic insufficiency have been confirmed as being adjunctive factors toward lessening pain in patients who had been submitted to pancreaticojejunostomy.
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PMID:Evolution of pain in chronic relapsing pancreatitis: a study of operated and nonoperated patients. 619 9

Eighty-seven patients underwent distal subtotal or near-total (80% to 95%) pancreatectomy (NTP) during a 25-year period for management of intractable pain resulting from chronic pancreatitis. Alcoholism affected the majority of patients and 20% of cases were idiopathic in origin. Ten patients (12%) exhibited insulin-requiring diabetes before operation. The perioperative mortality rate was 3.4%. Significant improvement or complete pain relief was achieved in 75% of patients while 14% remained narcotic dependent. Forty-four patients (51%) required insulin postoperatively, with an average insulin requirement of 35 U per day. Thirty late deaths occurred 2 to 15 years after operation, 12 (40%) of which were related to complications of pancreatic insufficiency or persistent alcoholism. Five patients (8.5%) required completion pancreatectomy 6 months to 4 years after NTP for complications relating to persistent pancreatitis. NTP provides effective pain relief in the majority of patients with chronic pancreatitis. While this procedure can be performed with a low operative mortality rate, the high incidence of endocrine and exocrine insufficiency after operation may contribute to late deaths. Consequently, this procedure should be performed only when the underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief.
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PMID:Near-total pancreatectomy for chronic pancreatitis. 648 4

A new radioimmunoassay to serum trypsinogen (Cis Trypsik) was tested in several patient populations. A low serum trypsinogen level (less than 10 ng/ml) was found in 69.2% of 13 patients with chronic pancreatic insufficiency (CPI), in 100% of 10 patients with 95-100% pancreatectomy but only in 14% of 14 patients with cancer of the pancreas. A low trypsinogen level was not found in any of 68 control subjects or 10 patients with nonpancreatic steatorrhea. Nine patients with CPI or 95% pancreatectomy were retested a mean of six months after initial testing. Four of these nine (44.4%) had a significant variation in serum trypsinogen which would have led to a different diagnostic interpretation (two went from low to normal levels and two from normal to low levels). A mixed meal had little effect on serum trypsinogen levels in five of six patients with CPI, and pancreatic enzyme replacement therapy had no consistent effect on the serum trypsinogen level in seven patients with CPI or 95% pancreatectomy. It is speculated that minor subclinical episodes of focal pancreatitis may effect the serum trypsinogen level. Although there can be considerable variability using this assay, it still offers important clinical utility. A low trypsinogen level points to a chronic pancreatic process with excellent specificity. A normal trypsinogen level is of no help and should be repeated if clinical suspicion of chronic pancreatitis remains high.
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PMID:Serum trypsinogen in diagnosis of chronic pancreatitis. 648 92

The effect of high nitrogen Criticare and Vivonex on nutritional repletion was evaluated in 12 patients with malnutrition secondary to pancreatic insufficiency. The patients were randomized to receive either Criticare HN or Vivonex HN for a total period of 9 days. Each patient received 3000 kcal/day of either preparation, in addition to 1000 kcal of solid food. A significant weight gain was encountered in the group of patients receiving Criticare HN. Increased blood urea nitrogen was encountered in both groups of patients. All patients tolerated both diets well without evidence of relapse of their pancreatitis. No significant complications were encountered. Our results indicate that Criticare HN is of superior nutritional value, but both preparations resulted in increased blood urea nitrogen retention.
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PMID:Comparative effects of Criticare HN and Vivonex HN in the treatment of malnutrition due to pancreatic insufficiency. 669 26

Lactoferrin and albumin concentrations in pure pancreatic juice were studied by radial immunodiffusion in 81 patients. Lactoferrin concentration (% of total protein) was specifically increased in patients suffering from chronic calcifying pancreatitis (mean +/- SE: 0.169 +/- 0.024) and no overlap was observed with patients suffering from other pancreatic diseases (0.008 +/- 0.001), organic nonpancreatic diseases (0.011 +/- 0.001) and without organic disease (0.01 +/- 0.001). Lactoferrin concentration was not found to be correlated with chronic alcohol consumption or pancreatic insufficiency. Albumin concentration (% of total protein) was increased in patients suffering from chronic calcifying pancreatitis (5.55 +/- 0.49) and other pancreatic diseases (5.45 +/- 1.02). These values were significantly higher (P less than 0.001) than the corresponding values in patients with organic nonpancreatic diseases (1.66 +/- 0.16) and patients without organic diseases (1.46 +/- 0.22). Measuring lactoferrin and albumin in pancreatic juice may aid in the diagnosis of pancreatic disease and in the differentiation of chronic calcifying pancreatitis, even in the earliest stage, from other pancreatic diseases such as pancreatic carcinoma or acute pancreatitis.
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PMID:Lactoferrin and albumin in human pancreatic juice: a valuable test for diagnosis of pancreatic diseases. 676 33

The comparative sensitivity of 4 tubeless pancreatic function tests was evaluated in 125 patients with proved chronic pancreatitis associated with various degrees of pancreatic insufficiency. NBT-PABA, immunoreactive trypsin (IRT), and pancreatic isoamylase (P-iso) were studied in relation to the fecal chymotrypsin test (FCT) and steatorrhea. In advanced insufficiency (steatorrhea or FCT less than 20 micrograms/g) PABA, IRT, and P-iso were pathologically low in only 70-85% of patients. In less severe pancreatic insufficiency (FCT 21-120 micrograms/g) these tests yielded pathological results in 35-53% of patients. Thus the sensitivity of the three tests was comparable and rather low. IRT values (and P-iso) were constantly low or progressively decreasing in 64% of patients (30/47) studied repeatedly over an average of 17 months. The serum enzyme tests seem, therefore, to be valuable for monitoring pancreatic insufficiency, like the FCT. This is particularly important for the differential diagnosis of acute (reversible) and chronic (progressive) pancreatitis.
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PMID:Comparative diagnostic accuracy of four tubeless pancreatic function tests in chronic pancreatitis. 698 71

Three typical clinical patterns can be distinguished based upon the experience with the long-term course in 258 cases of chronic relapsing pancreatitis. In chronic pancreatitis without local complications there is 1. an early phase, characterized by recurrent episodes of pancreatitis; 2. a late phase, characterized by the triad: absence of pain, severe global pancreatic insufficiency (diabetes/steatorrhea), and pancreatic calcifications (if any). 3. Local complications (e.g. pseudocysts) produce a different pattern characterized by persistent pain and the symptoms of the "pancreatitis tumor", which may cause many different complications such as cholostasis, gastrointestinal bleeding, duodenal obstruction etc. Local complications are observed mainly in the early phase of the disease. Late symptoms such as diabetes, steatorrhea and calcifications indicate that the pancreatitis is virtually "burned out". The occurrence of late symptoms in the course of the disease varies individually.
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PMID:[Clinical aspects and differential diagnosis of chronic pancreatitis. Emphasis on the long term course in 258 patients]. 700 6

Hereditary pancreatitis is an autosomal dominant disease with no other known cause. It usually begins in childhood and is characterized by recurrent attacks of abdominal pain of variable intensity and duration, followed by symptom-free periods. The diagnosis is usually made in early adult life, when pancreatic insufficiency and calcifications appear. Complications are less frequent than in nonhereditary chronic pancreatitis. There are also differences between the two forms of chronic pancreatitis in sex incidence, etiologic factors and life expectancy. In a Canadian kindred three generations are affected with hereditary pancreatitis; there are four definite and four suspected cases. More than 40 affected kindreds, including 195 proven cases and 190 suspected cases, have now been reported in the literature. Thus, hereditary pancreatitis should be considered in the differential diagnosis of chronic relapsing pancreatitis of unknown cause as well as recurrent abdominal pain in childhood.
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PMID:Hereditary pancreatitis: report of an affected Canadian kindred and review of the disease. 702 15

A 19-yr-old woman developed pancreatic insufficiency and pericholangitis associated with ulcerative colitis. Recognized causes of pancreatic insufficiency were excluded. Pancreatic insufficiency has not previously been reported in patients with ulcerative colitis, although interstitial pancreatitis at postmortem examination and pancreatic duct abnormalities by endoscopic pancreatography have been described. Pancreatic insufficiency and ulcerative colitis may have occurred together by chance in this patient, but the time sequence and exclusion of known causes of pancreatitis suggest an association between these two conditions. The literature concerning pancreatic disease in ulcerative colitis is reviewed.
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PMID:Pancreatic insufficiency associated with ulcerative colitis and pericholangitis. 705 51

From March 1980 to December 1981 partial duodenopancreatectomy and occlusion of the pancreatic duct of the remaining tail of the pancreas was carried out in 22 patients. Indication was severe chronic pancreatitis in 17 cases, cancer of the ampulla of Vater in 4 cases and cancer of the duodenum in 1 case. 1 patient (duodenal cancer) died because of necrosis of the residual pancreas. The treatment of exocrine pancreatic insufficiency does not create problems. Only patients presenting with preoperative latent diabetic metabolism seem to develop postoperatively a manifest Insulin dependent diabetes mellitus. The obtained results are very satisfactory and justify to conclude that this operative procedure gives real help to patients with severe chronic relapsing pancreatitis.
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PMID:[Partial duodenopancreatectomy and intraoperative occlusion of the pancreatic duct: preliminary results]. 715 5


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