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

Elevated serum amylase activity, in the absence of clinically apparent pancreatic or salivary gland disease, has been observed in many seemingly unrelated conditions. In a search for common etiological factors to account for hyperamylasemia in these conditions, a retrospective analysis was performed. Eighty-four episodes of hyperamylasemia (greater than 300 I.U./l. Phadebas method) occurring in 75 patients over a one-year period ending in June, 1975 were assigned to one of two groups. Group 1 consisted of 56 (67%) episodes of hyperamylasemia with clinical pancreatitis. Group 2 consisted of 28 (33%) episodes of hyperamylasemia in the absence of clinical pancreatitis. Hypoxemia (pO2 less than 75 mm. Hg.) was found in 9/15 patients in Group 2 who had arterial blood gases measured. To assess the possible relationship between acute hypoxemia and amylase activity, a prospective study was initiated. Patients with known causes of pancreatitis or renal failure were eliminated. Hyperamylasemia was found in 3/8 hypoxemic patients. This raises the possibility that acute hypoxemia alone or in combination with other factors may raise serum amylase activity, possibly through ischemic injury to the pancreas or salivary glands or other amylase containing tissues.
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PMID:Elevated serum amylase activity in the absence of clinical pancreatic or salivary gland disease: possible role of acute hypoxemia. 74 4

This investigation was designed to determine whether serum isoamylase measurements can aid in establishing the diagnosis of acute pancreatitis in renal failure patients. Twenty-two hemodialysis patients were studied, four of whom had documented acute pancreatitis. Total serum amylase and pancreatic isoamylase concentrations were significantly higher (p less than 0.02) in the pancreatitis patients than in the 18 patients without pancreatitis, but there was appreciable overlap between these two groups. In each of the four patients with pancreatitis, the percentage of serum amylase derived from the pancreas (range, 80% to 90%) was well above the highest value (67%) observed in the patients without pancreatitis. These results suggest that determination of the percentage of serum amylase represented by pancreatic isoamylase is of assistance in establishing the diagnosis of acute pancreatitis in renal failure patients.
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PMID:Serum isoamylase measurements in pancreatitis complicating chronic renal failure. 75 28

Diazoxide was given orally to nine hypertensive patients with renal failure and its effect on blood pressure and on glucose metabolism was studied. There was no long-term antihypertensive effect. During treatment insulin release and glucose assimilation after an intravenous glucose load were frankly impaired, but this impairment was reversible after stopping the treatment. Two major complications (diabetic ketoacidosis and pancreatitis) were observed. In view of these observations, the authors are of the opinion that oral diazoxide is contraindicated in the treatment of hypertension in patients with renal failure.
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PMID:Oral diazoxide contraindicated in severe hypertension with renal failure. 81 Feb 87

The value of conservative treatment in a case of chronic advanced renal failure was investigated in a 5-year-old girl with congenital hypoplastic kidneys. Before treatment the patient was severely anorexic and her plasma urea nitrogen was 180 mg/100 ml. Protein restriction alone was fruitless. After a transitional period on total parenteral therapy the patient was put on a maintenance oral diet, where an energy-rich diet was supplemented with essential amino acids including histidine. Plasma urea nitrogen dropped and stayed at about 50 mg/100 ml during the whole treatment in spite of a rising plasma creatinine from 10 to 24 mg/100 ml. The general condition of the patient normalized as she went into an anabolic state with weight gain and growth in height. The nitrogen balance studied in two different periods was positive. An acute attack of pancreatitis, secondary to hyperparathyroidism, ended the patient's life after 22 months of treatment.
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PMID:Essential amino acids in the treatment of advanced uremia: twenty-two months' experience in a 5-year-old girl. 81 Jul 64

The history of the technique of promoting dissolution of retained gallstones in the biliary tree is briefly reviewed. Present methods are described in detail and our own experience recorded. We have treated six patients with retained calculi by means of heparinized saline and sodium cholate infusions of the common bile duct. Successful dissolution of calculi was achieved in five cases, but one patient developed severe pancreatitis and renal failure which responded to peritoneal dialysis. We believe that the method is a valuable alternative to re-exploration of the common bile duct, particularly when calculi are situated in the distal part of the duct.
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PMID:Dissolution of retained choledochal calculi. 84 50

Involvement of the spleen or its vasculature in inflammatory disease of the pancreas may result in life-threatening hemorrhage. Retrospective analysis of six patients having direct splenic involvement and/or occlusion of the splenic vein secondary to pancreatitis or pseudocyst showed that removal of the spleen as a portion of an appropriately timed operation for complications of pancreatitis uniformly resulted in an uncomplicated course and survival (3 patients). Leaving the spleen in place when it was directly involved in a pseudocyst and/or when the splenic vein was occluded resulted in postoperative bleeding, the requirement for reoperation, and death from septic sequelae (2 patients). One patient died of progressive respiratory and renal failure because initial operation was inappropriately delayed. We recommend splenectomy as a portion of an appropriately timed operation for complications of pancreatitis when the splenic vessels are involved and/or when the spleen is directly involved in a pseudocyst or lesser sac collection.
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PMID:Splenectomy: its place in operations for inflammatory disease of the pancreas. 92 Aug 79

Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.
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PMID:Splenic hematoma in acute pancreatitis. Role of coagulation disorders. 141 37

Sixty-six consecutive patients with unresectable hepatocellular carcinoma (HCC) were treated with transcatheter arterial chemoembolization (TACE) using aclarubicin microspheres (ACRms) in combination with cisplatin suspended in iodized oil (Lipiodol, Laboratoire Guerbert, Paris, France) (CSL). The stages of the disease were as follows: Stage I (n = 1), Stage II (n = 10), Stage III (n = 26), and Stage IV (n = 29). The effectiveness of TACE was assessed by comparing ACRms with CSL with ACRms without CSL. Of 66 patients treated with ACRms and CSL, 62 (93.9%) could be examined for response. According to response criteria, there were 31 (50.0%) partial responses and 17 (27.4%) minor responses. In 13 cases (21.0%) there was no change and in 1 case (1.6%) there was progressive disease. The cumulative survival rate was 80.7% at 1 year, 64.2% at 2 years, and 50.6% at 3 years. The rates were significantly higher than those of the group treated with ACRms. Eleven patients in the ACRms and CSL group experienced clinical complications: cholecystitis (4.5%), pancreatitis (3.0%), liver abscess (3.0%), hepatic failure (3.0%), gastrointestinal bleeding (1.5%), and renal failure (1.5%). No lethal side effects related to the therapy were observed. TACE using ACRms in combination with CSL prolongs the survival of patients with unresectable HCC.
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PMID:A new approach to chemoembolization for unresectable hepatocellular carcinoma using aclarubicin microspheres in combination with cisplatin suspended in iodized oil. 165 61

The serum amylase concentration reflects the balance between the rates of amylase entry into and removal from the blood. Hyperamylasemia can result either from an increased rate of entry of amylase into the circulation and/or a decreased metabolic clearance of this enzyme. The pancreas and salivary glands have amylase concentrations that are several orders of magnitude greater than that of any other normal tissue, and these two organs probably account for almost all of the serum amylase activity in normal persons. A variety of techniques are now available to distinguish pancreatic from salivary-type isoamylase. Pancreatic hyperamylasemia results from an insult to the pancreas, ranging from trivial (cannulation of the pancreatic duct) to severe (pancreatitis). In addition, loss of bowel integrity (infarction or perforation) causes pancreatic hyperamylasemia due to absorption of amylase from the intestinal lumen. Hyperamylasemia due to salivary-type isoamylase is observed in conditions involving the salivary glands. In addition, this type of hyperamylasemia occurs in conditions in which there is no clinical evidence of salivary gland disease, such as chronic alcoholism, postoperative states (particularly postcoronary bypass), lactic acidosis, anorexia nervosa or bulimia, and malignant neoplasms that secrete amylase. Hyperamylasemia can also result from decreased metabolic clearance of amylase due to renal failure or macroamylasemia (a condition in which an abnormally high-molecular-weight amylase is present in the serum). Patients with abdominal pain and a markedly elevated serum amylase (more than three times the upper limit of normal) usually have acute pancreatitis, and additional serum enzyme testing is not helpful. Patients with smaller elevations of serum amylase often have conditions other than pancreatitis, and measurement of a serum enzyme more specific for the pancreas (pancreatitic isoamylase, lipase or trypsin) is frequently of diagnostic value in such patients.
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PMID:Where does serum amylase come from and where does it go? 170 56

Advances in medical technology and knowledge have influenced morbidity and mortality in surgically treated diseases. The authors have compiled four consecutive retrospective studies of demography, morbidity and mortality of patients with acute pancreatitis to summarize the experience from 1956 to 1985 at the Montreal General Hospital with 629 patients. The death rate has remained unchanged. Hypotension, gastrointestinal bleeding and respiratory failure have assumed lesser roles as major complicating factors. Renal failure and gram-negative aerobic pancreatic sepsis are the common causes of death. The last two reviews revealed that surgical debridement and drainage combined with appropriate biliary procedures salvaged two-thirds of the patients with sepsis. Deteriorating nutritional status, heralded by a fall of serum albumin level below 30 g/L, is associated with a poor prognosis. Interval cholecystectomy in patients with mild biliary tract pancreatitis is associated with a low death rate (0.01%).
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PMID:Acute pancreatitis--30 years' experience at a teaching hospital. 202 95


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