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

The results of 100 consecutive pancreatic arteriograms performed in concert with a combination of other diagnostic procedures (gray scale ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography) were evaluated to determine the value of angiography in diagnosis and management of patients with known or suspected pancreatic disease. Angiography was found to be valuable for diagnosis in 68% (68/100) of cases and was considered helpful for management in 81% (57/70) of patients with pancreatic neoplasm, pancreatitis, or a nonpancreatic abnormality.
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PMID:Impact of new diagnostic imaging methods on pancreatic angiography. 11 5

Numerous noninvasive and invasive imaging modalities are available for the study of pancreatic disease. Disappointingly, the radiographic demonstration of a pancreatic neoplasm is more successful than the treatment of the disease. The proximity of large vascular structures to the pancreas makes its study technically difficult and explains why vascular invasion is readily caused by dispersion of pancreatic secretions (as seen in pancreatitis) or by neoplastic infiltration. The latter heralds nonresectability. Needle biopsy under fluoroscopic or echographic control appears to be gaining popularity as a simple, sensitive and specific method for establishing the diagnosis of pancreatic malignancy. Angiography has its highest yield in the diagnosis of islet cell tumors because they are generally hypervascular. This technique has been complemented by selective catheterization of pancreatic veins followed by hormone bioassay determinations.
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PMID:Morphologic-radiographic correlations of the pancreas. 22 92

We did a retrospective study of 100 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), selecting those cases in which the final diagnosis was pancreatitis or pancreatic neoplasm. We analyzed the pancreatic radiographs obtained using this technique and describe the most characteristic diagnostic findings in each case. Results are compared to those published in the medical literature.
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PMID:[Chronic pancreatitis or cancer? Semeiology of pancreatic radiography]. 274 May 74

Insulinoma in patients with multiple endocrine neoplasia (MEN) is a rare condition that because of its usual multicentricity presents difficulties not encountered in sporadic patients. In contrast to gastrinoma, which is the most common pancreatic neoplasm associated with MEN I, malignancy and duodenal tumors are much less common for patients with insulinomas, and excellent palliative medication is not available. Accordingly, there is a much greater reliance on surgical therapy for this group of patients. Between 1970 and 1991 a total of 19 patients had surgical treatment of MEN I-related insulinoma. Each patient had hyperinsulinemic hypoglycemia. One patient, with extensive metastases, had unresectable disease. Of the remaining 18, there were 16 (89%) multiple pancreatic tumors. Tumors were located in the neck, body, or tail in 17 cases, 10 of whom also had tumors in the head. Pancreatic resections performed were 1 total, 12 subtotal (7 also had enucleation of tumors from the pancreatic head), and 5 limited distal resections and/or enucleation (conservative resection). There was no operative mortality. One patient developed pancreatitis, fistula, and diabetes following subtotal resection and enucleation. Postoperative cure was achieved in 17 of 18 cases. Recurrent disease occurred in 2 of 5 conservative resections compared to 0 of 12 subtotal resections, with median follow-up times of 10.4 and 10.3 years, respectively. During the follow-up period, four patients died, possibly all due to MEN I-related conditions. Hyperinsulinism in MEN I is associated with the occurrence of multiple, usually benign, pancreatic islet cell tumors, and surgery is an effective treatment modality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical management of insulinoma associated with multiple endocrine neoplasia type I. 772 33

Cystic dystrophy of heterotopic pancreas is characterized by the presence of cystic formations in the duodenal wall with or without associated pancreatitis. The mechanism by which the cystic dystrophy develops in heterotopic pancreatic pancreas is poorly understood. These lesions are found in young men (40-50 years old) with abusive alcohol intake. The patients are referred for suspected pancreatic neoplasm or for acute pancreatitis. Endoscopic ultrasonography features allow preoperative diagnosis. First line, treatment is medical with parenteral nutrition and octreotide. Then, if the lesions are complicated, surgery (pancreatoduodenectomy or bypass procedure) is indicated.
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PMID:[Cystic dystrophy of heterotopic duodenal pancreas]. 1155 98

Pancreatic cancer is the fourth leading cause of cancer death in both men and women in the United States and will be responsible for an estimated 28,900 deaths in 2001. Relatively little is known of its etiology, and the only well-established risk factor is cigarette smoking. Studies over the past 3 decades have shown that 4%-16% of patients with pancreatic cancer have a family history of the disease. A small fraction of this aggregation can be accounted for in inherited cancer syndromes, including familial atypical multiple-mole melanoma, Peutz-Jeghers syndrome, hereditary breast-ovarian cancer, hereditary pancreatitis, and hereditary nonpolyposis colorectal cancer. These syndromes arise as a result of germline mutations in the BRCA2, pl6 (familial atypical multiple-mole melanoma), mismatch repair (hereditary nonpolyposis colorectal cancer), and STK11 (Peutz-Jeghers syndrome) genes. In addition, hereditary plays a role in predisposing certain patients with apparently sporadic pancreatic cancer. Many patients with pancreatic cancers caused by a germline mutation in a cancer-causing gene do not have a pedigree that is suggestive of a familial cancer syndrome. A recent prospective analysis of the pedigrees in the National Familial Pancreatic Tumor Registry found that individuals with a family history of pancreatic cancer in multiple first-degree relatives have a high risk of pancreatic cancer themselves. The identification of such high-risk individuals will help clinicians target screening programs and develop preventive interventions with the hope of reducing the mortality of pancreatic cancer in these families.
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PMID:Familial pancreatic cancer. 1156 3

Although the clinical, radiologic, and pathologic features of cystic pancreatic lesions are well known, preoperative diagnosis is difficult. Differentiation between a pancreatic pseudocyst and a cystic pancreatic neoplasm is crucial in determining the proper treatment. Careful evaluation of the patient's clinical history is important for accurate diagnosis of a pseudocyst. Clinical scenarios include a pseudocyst developing after acute pancreatitis and a pseudocyst superimposed on chronic pancreatitis. However, a pseudocyst in a patient with no clinical history of pancreatitis poses a diagnostic problem. The differential diagnosis of a neoplastic cystic lesion of the pancreas includes serous cystadenoma, mucinous cystic neoplasms, intraductal papillary mucinous tumor, and solid and papillary epithelial neoplasm. Definitive diagnosis is often possible when the lesion has a typical radiologic appearance, but in many cases characterization with imaging alone is impossible. Thin-section computed tomography with multiplanar reformation, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography have emerged as modalities that can provide additional diagnostic information. Familiarity with the range of imaging appearances and awareness of the diagnostic strengths and limitations of each imaging modality are important for accurate diagnosis and management of cystic pancreatic lesions.
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PMID:Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst. 1588 17

Pancreatic cystic lesions comprise various entities with different histopathological characteristics and their differential diagnosis is often a challenge for clinicians. Autoimmune pancreatitis (AIP) is usually not considered in the differential diagnosis of cystic lesions, but often mimics the morphological aspects of pancreatic neoplasm. We report the case of a 64-year-old male patient with a cystic pancreatic head lesion (diameter 5 cm) and stenosis of the distal bile duct requiring repeated stenting. Because of the clinical presentation together with moderate elevation of serum CA19-9 and massive elevation of cyst fluid CA19-9 (122.695 U/L; normal range: <37.0 U/L), the patient underwent explorative laparotomy and pylorus preserving partial pancreaticoduodenectomy. Histology revealed surprisingly AIP with an inflammatory pseudocyst. In conclusion, cyst fluid analysis of tumor markers and cyst fluid cytology lack high accuracy to clearly differentiate cystic pancreatic lesions. Although AIP is rarely associated with pseudocysts, the disease has to be considered in the differential diagnosis of cystic pancreatic lesions. Early examination of serum IgG, IgG4 and auto-antibodies might save these patients from unnecessary endoscopical and surgical procedures.
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PMID:Autoimmune pancreatitis associated with a large pancreatic pseudocyst. 1700 63

Cystic dystrophy of heterotopic pancreas is characterized by the presence of cystic formations in the duodenal wall with or without associated pancreatitis. These lesions are found in young men (40-50 years old) with abusive alcohol intake. The patients are referred for suspected pancreatic neoplasm or for acute pancreatitis. IRM and endoscopic ultrasonography features allow preoperative diagnosis. First line treatment is medical with parenteral nutrition and octreotide. In complicated cases, surgery (pancreatoduodenectomy or bypass procedure) is indicated.
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PMID:[Case report: cystic dystrophy of heterotopic pancreas (CDHP)]. 1837 43

In this report, we describe a 31-year-old man in whom acute pancreatitis was the initial feature of a subsequently diagnosed pancreatic adenocarcinoma with multiple metastases. He initially presented at our hospital with acute pancreatitis. Abdominal ultrasonography revealed a mildly dilated pancreatic duct and an enlarged pancreatic head. Although a follow-up abdominal ultrasonography revealed a progressively dilated pancreatic duct and a progressively enlarged pancreatic head, he refused further investigation and was lost to follow-up. Four months later, he returned to our hospital with relapsed acute pancreatitis. Obstructive jaundice was noted and drainage was performed. Because choledochoplasty with multiple balloon catheters was not fully effective, biliary tract bypass surgery was carried out. Intraoperative biopsy confirmed pancreatic adenocarcinoma with multiple metastases. The patient died of massive gastrointestinal bleeding a few weeks later. To our knowledge, this is the youngest case of pancreatic cancer with the uncommon initial presentation of acute pancreatitis reported in the literature. For a patient with acute pancreatitis, particularly recurrent episodes, but with no known risk factors for pancreatitis, a pancreatic neoplasm should be considered as a potential underlying cause, even in a young man.
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PMID:Relapsed acute pancreatitis as the initial presentation of pancreatic cancer in a young man: a case report. 2070 57


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