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

Surgical procedures can be accomplished successfully in patients with uremia provided certain principles of perioperative management are observed. Preoperative dialysis minimizes the biochemical derangements and improves fluid balance, hypertension and hemostasis. Drug schedules are adjusted in consideration of abnormal metabolism in renal disease. Anesthetic management is modified in recognition of potentially adverse or altered activity of anesthetic agents and neuromuscular relaxants. The lightest plane of anesthesia consistent with expeditious operative technique is maintained, since adequate tissue oxygenation is dependent upon increased cardiac output in these invariably anemic patients. Intraoperative hyperventilation sustains the usual compensatory mechanism for uremic metabolic acidosis in the conscious patient, thereby averting increments in serum potassium levels associated with increasing acidosis. Postoperative morbidity may include shunt thrombosis, infection, impaired wound healing, bleeding, pericarditis, pleuritis and pancreatitis. Hypervolemia and hyperkalemia are best managed by early postoperative dialysis. A period of nutritional support using intravenous essential L-amino acids and hypertonic glucose appears promising, especially when gastrointestinal dysfunction exists.
 ...
PMID:Renal failure and the surgeon. 40 28

Uremia results in complex metabolic disturbances of exocrine pancreatic function which increase with the severity of renal insufficiency. This uremic pancreopathy is not identical with the pancreatitis of classical type. Its important clinical indicator is an elevation of serum lipase activity (more than 60% in nondialyzed renal insufficiency; hyperlipasemia was also detectable in chronic hemodialyzed patients (45%). The pathogenesis is heterogenous, its concept based on clinical and experimental studies involves several components: hormonal alterations (calcitonin etc.), catabolic protein metabolism in uremia, systemic disturbances (hemodynamics, hypoxia, acidosis etc.), direct impairment of the pancreatic cells induced by uremic toxins.
 ...
PMID:[Uremic pancreopathy. Clinical and experimental studies of its pathogenesis]. 45 76

The pancreases of 77 uremic rats of a Wistar strain were investigated light-microscopically in groups of 5 animals at 11 different times between one day and ten weeks after 5/6-nephrectomy. The serum concentration of urea reached a maximum mean value of 375 mg% after three days; during the stage of chronic uremia the mean value was found to be 175 mg%. The blood pressure increased in the third week after 5/6-nephrectomy and reached in the course of the experiment values of up to 200 mm Hg and more. Histologically, after an initial acute interstitial pancreatitis with focal dystrophies of the exocrine parenchyma which was virtually cured by the 14th day of the experiment, an increasing proliferative-exudative and granulomatous vasculopathy appeared at the end of the third week. This was followed by a perivascular transmitted chronic-fibrosing pancreatitis which may be regarded as a model of vascularly induced pancreatitis. Early damage by uremia and initial pancreatitis, the rapidly developing hypertension and allergical and autoallergical reactions are discussed as aetiological complex for the vascular alterations. The typical findings of the uremic pancreatopathy, well-known in human pathology, are not reproducible.
 ...
PMID:Vascular chronic-fibrosing pancreatitis of the rat after 5/6-nephrectomy. 59 Apr 15

Authors have studied in autopsy samples of 80 patients having suffered from rheumatoid arthritis the incidence and types of pancreatitis. There were 6 acute, 4 chronic-recurrent and 11 chronic severe or moderately severe pancreatitis observed. In the ethiology of pancreatites the ductal origin, cholelithiasis and uraemia were not found to be of exclusively significance. In 3 cases a pancreatitis was found accompanied by vasculitis and a typical histological pattern characterized by the vasculitis-thrombovasculitis of arterioles and small arteries with simultaneously occurring necrotic foci. In one case a pancreatitis due to severe amyloidosis could be verified. Authors draw attention to the frequent occurrence of pancreatitis in patients suffering from rheumatoid arthritis and the difficulties of a clinical diagnosis.
 ...
PMID:[Pancreatitis in rheumatoid arthritis found in autopsy material]. 267 91

Of a total of 780 patients with abdominal aortic aneurysms, 37 patients (4.7%) had inflammatory aneurysms. Presenting symptoms included back and abdominal pain (76%), leg edema, melena, uremia, claudication and pancreatitis. Mean erythrocyte sedimentation rate was 45 mm/hr. Weight loss and anorexia were common. Elevated urea and creatinine were seen on 11 patients, nine of whom had obstructive uropathy. Average aneurysm size was 9.3 cm. Thirty-six patients were treated surgically and one was observed. Involvement of the suprarenal (nine cases) or thoracic (three cases) aorta was common. Elective operations included resection and grafting in 21 patients and axillofemoral bypass in four patients. Patients with ureteral entrapment underwent simultaneous ureterolysis. Among the elective operations four deaths were noted (15%). Ten emergency operations were done for posterior rupture (four cases), aortoduodenal fistula (one case), inferior vena cava obstruction or fistula (two cases), hemorrhage into the aneurysmal wall (two cases), or presumed rupture (one case). There were seven deaths (70%) in this group. The operation of choice for inflammatory aneurysm is a bifurcation graft combined with ureterolysis.
 ...
PMID:Inflammatory abdominal aortic aneurysms: a report of thirty-seven cases. 322 67

An analysis is presented of 64 fatal cases of acute pancreatitis in the decade 1972-1981. In the same period altogether 2842 episodes of acute or relapsing pancreatitis were treated. The male/female ratio in the fatal cases was 49/15, with mean age 46.9/61.4 years. The mortality rate was 22% among patients with acute hemorrhagic pancreatitis and 2.3% among all patients. Of the patients who died, 23% had fewer than 3 Ranson signs, suggesting mild pancreatitis. The etiology of the disease was alcohol in 48% of the fatal cases, biliary disease in 16% and postoperative state in 17%. The study indicated two groups with high mortality rate--young men with a first attack of alcohol-induced pancreatitis and elderly patients with pancreatitis of biliary origin. Systemic complications arose in all patients, the most common being respiratory dysfunction (51%), anuria/uremia (33%) and intra-abdominal complications (31%). The most important causes of death were anuria (27%), respiratory dysfunction (22%) and gastric bleeding (13%).
 ...
PMID:Fatal pancreatitis. A study of 64 consecutive cases. 373 48

Continuous arterio-venous haemofiltration (CAVH), a simple technique not employing pumps, was used for treatment of acute renal failure in 25 intensive care patients (mean age 52 +/- 16 [SD] years). Acute renal failure was due to trauma in 9 patients, occurred after surgery in 7 patients and was related to septicaemia in 5 patients, peritonitis in 2 patients and pancreatitis in one patient; in one patient acute renal failure developed during pregnancy after preexisting renal disease. Seventeen patients were oliguric and 8 patients were non-oliguric, with a mean daily urine output of 507 +/- 407 ml. At the start of CAVH the serum creatinine level was 511 +/- 198 mumol/l. The duration of treatment with CAVH was 1 to 36 days (average 9.3 days). Access to the circulation was by cannulation of the femoral artery and vein in 23 patients and by Scribner shunt in 2 patients. After an initial systemic dose of 2000 IU heparin, a continuous infusion of 250-1000 IU/hr into the arterial blood line was administered, adjusted to a partial thrombin time of 58 +/- 28 sec. With this heparin regimen a single haemofilter could be used for an average time of 2.6 +/- 1.2 days. The mean spontaneous filtration rate was 6 +/- 2 ml/min, resulting in the following serum levels: creatinine 490 +/- 187 mumol/l; urea 39 +/- 12.5 mmol/l; potassium 4.5 +/- 0.5 mmol/l. Nine catheter-associated complications occurred in 5 patients. The most important aspect of CAVH was its simplicity, optimal control of fluid balance and the possibility of unlimited parenteral nutrition. Uremia was adequately and continuously controlled. Prognosis of ARF was related to the patients' underlying illness.
 ...
PMID:[Continuous arteriovenous hemofiltration for the treatment of acute kidney failure]. 398 93

Pure amylase was isolated from pancreata and parotid glands of the baboon, an animal which has a serum amylase level and renal clearance of amylase (C(Am)) similar to man. After bolus injection, both pancreatic and salivary amylase rapidly disappeared from the serum in a monoexponential fashion with a mean serum half-time of approximately 83 min. Only about 24% of the amylase cleared from the serum appeared in the urine indicating that the majority of amylase was removed from the serum by an extraurinary mechanism. The C(Am) by the kidney was constant over a wide range of serum amylase levels and the ratio of C(Am)/C(In), which averaged 3.0%, was not influenced by mannitol diuresis. This suggests that the renal excretion of amylase results from glomerular filtration without appreciable tubular reabsorption. Pancreatic amylase was consistently cleared more rapidly by the kidney than was the baboon's endogenous amylase while salivary amylase was consistently cleared less rapidly than endogenous amylase. THE FINDINGS IN THIS STUDY PROVIDE INSIGHT INTO SEVERAL OF THE FOLLOWING CLINICALLY OBSERVED PHENOMENA: (a) the short serum half-time of amylase accounts for the transient nature of serum amylase elevations in pancreatitis; (b) the extra-urinary removal of amylase accounts for the maintenance of relatively normal amylase levels in uremia; and (c) the more rapid renal clearance of pancreatic amylase compared to salivary amylase may explain the disproportionate elevation of the urinary amylase excretion rate relative to the serum amylase level in acute pancreatitis.
 ...
PMID:Distribution, turnover, and mechanism of renal excretion of amylase in the baboon. 554 73

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insights into the underlying mechanisms the lysosomal factors of polymorphonuclear (PMN) leukocytes and the plasma elastase-alpha 1-proteinase inhibitor complex were investigated in patients with acute and chronic renal failure. Lysosomal activity was evaluated in peripheral blood smears by the lysis of erythrocytes and plasma (halo formation) around each neutrophil induced by 0.25 M NaC1 borate buffer. In about half of the patients with chronic renal insufficiency on dietary treatment lysosomal activity of PMN leukocytes was reduced. The plasma concentration of elastase-alpha 1-proteinase inhibitor complex was normal in most subjects, but increased in three patients with the highest serum creatinine levels (greater than 13 mg/d1). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis, or dye-induced) halo formation was either reduced or absent. The plasma elastase-alpha 1-proteinase inhibitor complex was increased in 5/6 of the patients by a factor of two to four. Also in the patients on regular hemodialysis treatment halo formation of PMN leukocytes was substantially reduced, whereas the plasma levels of elastase-alpha 1-proteinase inhibitor complex was slightly increased. The finding of reduced lysosomal activity of PMN neutrophils in uremia may be partly due to an enhanced release of neutral proteinases into the circulation as indicated by the elevated plasma levels of elastase-alpha 1-proteinase inhibitor complex in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Granulocyte lysosomal factors and plasma elastase in uremia: a potential factor of catabolism. 620 47

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insight into the underlying mechanisms the neutral proteinases of polymorphonuclear (PMN) leukocytes were investigated in patients with acute and chronic renal failure. The following studies were performed: 1. Neutral proteolytic activity of PMN neutrophils in blood smears (according to Klessen, 1978). 2. Serum levels of elastase alpha 1 proteinase inhibitor complex (Neumann et al., 1981). In about half of the patients with chronic renal insufficiency on dietary treatment the proteolytic activity of PMN leukocytes (halo formation are due to digestion of erythrocytes and plasma) was reduced. The serum concentration of elastase alpha 1 proteinase inhibitor complex was normal in most subjects, but increased in 3 patients with the highest serum creatinine levels (greater than 13 mg/dl). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis or dye induced) halo formation was either reduced or absent. Serum elastase alpha 1 proteinase inhibitor was increased in 5/6 patients by a factor of two to four. Also in the 15 patients on regular hemodialysis treatment halo formation was substantially reduced, while the serum levels of elastase alpha 1 proteinase inhibitor complex was slightly increased. The finding of reduced proteolytic activity of PMN neutrophils in uremia is probably due to an enhanced release of proteinases into the circulation as indicated by the elevated serum levels of elastase alpha 1 proteinase inhibitor complex in some patients. The release of proteinases might be in part due to the effect of "uremic toxins". In the RDT patients the contact of the blood with the dialyzer (cuprophane) membrane might be an additional factor. In the patients with ARF the underlying disease (infection, shock, trauma) contributes to the release of proteinases. These disturbances may be harmful for the patient, if the blood concentration or function of the most important proteinase inhibitors (alpha 1 proteinase inhibitor, alpha 2 macroglobulin) is reduced.
 ...
PMID:Release of granulocyte neutral proteinases in patients with acute and chronic renal failure. 636 15


1 2 3 Next >>