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

A prospective, comparative study is made of 262 patients (195 males, 67 females) subjected to laparoscopic cholecystectomy. Two groups were considered: simple cholelithiasis (SC) (187 cases), and complicated cholelithiasis (CC) (75 cases: 63 acute cholecystitis, 8 hydrocholecystitis, 4 pancreatitis). Mean age was 51 among the SC cases, and 57 in the CC patients. Mean operating time was 67 and 96 minutes for the SC and groups, respectively. Preoperative complications were more frequent in the CC group (51.4%) than in the SC patients (24%)--immediate laparotomies being performed in 2 and 25% of the SC and CC patients, respectively. Mortality was zero, with similar morbidity in both groups. Mean hospitalization time was 4.9 and 3.4 days for the CC and SC groups, respectively.
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PMID:[A prospective and comparative study of 262 laparoscopic cholecystectomies]. 183 85

The authors performed 20 laparoscopies in patients previously submitted to abdominal surgery, in whom after clinical evaluation by the medical staff, the existence of intra-abdominal affection was still questioned. In this study group 14 patients exhibited more than 19 days old former abdominal incisions while in six patients they were recent ones. The incisions were median and para-median, McBurney incisions and Pfannenstiel incisions; one patient had been previously submitted to laparoscopy. The laparoscopic findings were hemoperitoneum, encapsulating peritonitis, ascites, subphrenic abscess, acute adnexitis, acute traumatic pancreatitis, genital tuberculosis, acute cholecystitis and one case of peritonitis due to a hollow viscus perforation by a fish bone. In one patient presenting encapsulating peritonitis the laparoscopic examination was complicated by a hollow viscus perforation.
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PMID:Emergency laparoscopy in patients submitted previously to abdominal surgery: a study of 20 cases. 184 26

Gallstone disease occurs in 20% to 30% of the elderly, is usually silent, and is rarely fatal. Silent GSD requires no treatment. Symptomatic GSD can be treated surgically, nonsurgically, or, if there are minimal symptoms, expectantly. The decision is based largely on physician experience and informed patient preference. Nonsurgical treatment is evolving and has particular appeal for the elderly but does have restricting eligibility requirements and limited efficacy. For acute cholecystitis, early surgery is advisable, except for high-risk patients, in whom conservative treatment or cholecystostomy may be preferable. For choledocholithiasis with persistent obstruction or cholangitis and for severe biliary pancreatitis, ERCP with sphincterotomy and stone removal is usually advisable. Benign biliary strictures are infrequent, usually iatrogenic, and a diagnostic consideration whenever biliary obstruction develops within a year after cholecystectomy. Treatment is usually surgical and not always successful. Biliary strictures in patients with ulcerative colitis suggest PSC. Malignant biliary obstruction is common in the elderly and with a few exceptions is rarely curable. Palliation is often achieved by endoscopic stenting.
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PMID:Biliary tract disease in the aged. 185 63

A prospective study of 397 patients with primary biliary operations performed for benign disease included a perioperative culture of the bile. Two main groups of patients in whom bacteria in the bile and, thus, probably increased risk postoperative infection was common, are patients undergoing emergency operation (60 per cent bacteria in the bile, as compared with 22 per cent in those with elective operations) and patients with a history of acute cholecystitis or pancreatitis, or both, or jaundice (49 per cent bacteria in the bile with a positive history as compared with 11 per cent without). The rate of infection was 2.8 per cent in high-risk groups, as compared with 0.6 per cent in patients undergoing elective operative procedures with no history of acute cholecystitis, pancreatitis or jaundice. Thus, antibiotics can probably be reserved for those patients who had emergency surgical treatment and for those with elective operations and a history of acute cholecystitis, pancreatitis or jaundice. In addition, antibiotic prophylaxis might be indicated for all patients who are 75 years of age or older, as bacteria in the bile seems to be common in this age group even without a history of the aforementioned complications.
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PMID:Selective antibiotic prophylaxis in biliary tract operations. 186 65

Ultrasound examinations of 563 patients with right upper quadrant pain and a clinical suspicion of acute cholecystitis were reviewed. In 31 patients, a tender, dilated gall-bladder with a thick (more than 4 mm) partly hypoechoic wall without any detectable calculi was found on the emergency examination. This was interpreted as due to acute acalculous cholecystitis. None of the patients was critically ill. Twenty-one of the patients had follow-up studies with either oral cholecystography, cholangiography, or ultrasound. Fourteen of the 21 had gall-bladder calculi while seven did not. These seven patients presumably represent the true frequency (1.2%) of acute acalculous cholecystitis in this clinical setting. In five other patients with an initial diagnosis of acute acalculous cholecystitis the gall-bladder wall thickening probably was secondary to concomitant pancreatitis, appendicitis, hepatitis or peptic ulcer disease. A meticulous and careful search for gall-bladder calculi should be performed in the presence of a dilated, tender thick-walled gall-bladder.
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PMID:The clinical importance of a thick-walled, tender gall-bladder without stones on ultrasonography. 187 51

Ceftriaxone, a third-generation cephalosporin, has been associated with the development of sludge or stones in the gallbladders of some patients treated with this medication. Such precipitates, which are usually reversible upon discontinuation of the drug, sometimes cause symptoms, have simulated acute cholecystitis, and have even led to cholecystectomy in some cases. We report the first known instance of biliary obstruction and secondary pancreatitis in association with reversible ceftriaxone-induced pseudolithiasis.
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PMID:Reversible symptomatic biliary obstruction associated with ceftriaxone pseudolithiasis. 188 6

The clinical manifestations, management and outcome of gallstone disease in 100 elderly patients are described. A total of 65 patients presented with a complication, acute cholecystitis (43), gallstone pancreatitis (8) and obstructive jaundice (6) being the commonest manifestations. The clinical picture was often misleadingly mild. Associated disease occurred in 70 patients but precluded surgery in only 3. Emergency surgery was indicated in 18 patients. Surgery was performed on 96 patients (cholecystostomy 2, cholecystectomy 94); 35 explorations of the common bile duct were done, with stones present in 33. Four patients died, 1 following an endoscopic retrograde cholangiopancreatography (ERCP) and 3 postoperatively (2 patients with gallstone pancreatitis); no death occurred following an elective operation. Alternative modalities of treatment of gallstone are expected to play a minor role in the management of gallstone disease in the elderly.
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PMID:[Gallstone disease in the elderly]. 192 8

The efficacy of the combination of piezoelectric lithotripsy and oral bile acids in the treatment of gallbladder stones was assessed. Three hundred and sixty-three patients with symptomatic radiolucent gallstones in functioning gallbladder were treated in five medical centers using the same protocol with the EDAP LT 01 lithotripter. No anesthesia, analgesia or sedation was used. After one session of lithotripsy, fragmentation was observed in 89% of the patients, and satisfactory fragmentation (fragments less than or equal to 5 mm) in 29%. The satisfactory fragmentation rate was higher in patients with solitary stones less than or equal to 20 mm than in patients with solitary stones 21-35 mm or multiple stones (p less than 0.001). After multiple sessions (mean 1.6 session/patient, range 1-5) the overall rate of satisfactory fragmentation was 50%. After 12 months on oral bile acid therapy, complete clearance of the gallbladder was observed in 69% of patients with solitary stones less than or equal to 20 mm, 25% of patients with solitary stones 21-35 mm and 37% of patients with multiple stones. No complication was observed during the lithotripsy. During follow-up under bile acid therapy, there were five complications (1.4%): four patients had acute cholecystitis and one had mild, self-limited pancreatitis. We conclude that piezoelectric lithotripsy with the EDAP lithotripter is a safe and effective treatment which can be performed in outpatients. Satisfactory fragmentation and rapid disappearance of stones are obtained mainly in patients with solitary stones less than or equal to 20 mm.
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PMID:Treatment of gallstones with piezoelectric lithotripsy and oral bile acids. A multicenter study. 194 Feb 62

To evaluate the likelihood that patients can be discharged from the hospital the day after open cholecystectomy, a prospective study of 500 consecutive patients undergoing cholecystectomy was undertaken. The study group included patients with associated acute and gangrenous cholecystitis, biliary pancreatitis and choledocholithiasis as well as those with diabetes, hypertension and obesity. Approximately one-fourth of the total group were discharged within 24 hours and over one-half in 48 hours. There was a significant correlation between advancing age and increasing length of stay. Almost one-half of the patients less than 35 years of age without acute or complicated disease were discharged within 24 hours, more than 80 per cent within 48 hours, and the mean length of postoperative stay (MLS) for these patients was 1.9 days. The presence of choledocholithiasis and fever greater than 101 degrees F. increased MLS, while acute cholecystitis, hyperamylasemia and leukocytosis did not. Early discharge from the hospital after open cholecystectomy, even in sick patients, is safe and cost-effective.
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PMID:Twenty-four hour hospitalization after cholecystectomy. 194 86

Sonographic identification of thickening of the gallbladder wall that consists of multiple striations (alternate hypoechoic and hyperechoic layers) has been considered strong evidence of the presence of acute cholecystitis. We studied 27 patients in whom sonograms showed striated thickening of the gallbladder wall to determine the diagnostic significance of this finding. Striations were classified as focal or diffuse. Sonograms were correlated with pathologic findings in 16 patients and with clinical diagnoses and laboratory findings in 11. Patients were categorized as having cholecystitis with or without gangrene or edema of the gallbladder wall unrelated to gallbladder disease. Striated thickening of the gallbladder wall was due to cholecystitis in 10 patients, and all 10 had gangrenous changes at surgery or at pathologic examination. Striations were focal in eight of these patients and diffuse in two. Striated thickening of the gallbladder wall was due to edema of the wall unrelated to gallbladder disease in 17 patients. Causes included congestive heart failure (n = 4), renal failure (n = 5), liver disease (hepatic failure [n = 1], hepatitis [n = 6]), ascites (n = 2), hypoalbuminemia (n = 3), pancreatitis (n = 1), blockage of the lymphatic/venous drainage of the gallbladder (n = 2), and prominent Rokitansky-Aschoff sinuses (n = 1). More than one abnormality was present in five patients. Striations were focal in 11 of these patients and diffuse in six. The sonographic finding of striated gallbladder wall thickening is no more specific for cholecystitis than the observation of gallbladder wall thickening by itself, and it may occur in a variety of diseases. However, in the clinical setting of acute cholecystitis, the presence of striations suggests gangrenous changes in the gallbladder. The extent of the striations (focal or diffuse) is not useful in predicting the cause of the striated gallbladder wall thickening.
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PMID:Sonography of the gallbladder: significance of striated (layered) thickening of the gallbladder wall. 201 56


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