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

A survey is given of the present state of the ERCP in the diagnostics of the chronic pancreatitis. The ERCP is not suited for the proof of early changes in the chronic pancreatitis; it does not allow an exclusion diagnosis. The value of the ERCP in the chronic pancreatitis consists in the fact to render the indication to operation by the proof changes which should be operated on, or to precise it, respectively, and to prevent unnecessary test laparotomies. For this reason the ERCP is indicated above all in the ascertained chronically relapsing pancreatitis and in the persistence of symptoms after an acute inflammatory attack. The most comprehensive information about the morphologic state of the pancreas is got by the combination of the ERCP with methods which reflect the size and the external form of the organ and give evidence concerning the structural changes (sonography, computer tomography).
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PMID:[The contribution of ERCP to the diagnosis of chronic pancreatitis]. 48 22

The acute haemorrhagically necrotizing pancreatitis demands, as a rule, an operative sanation of the local complications. The partial or total pancreatectomy during the first days for preventing the late local complications is loaded with an operation mortality from 35 to 60%. If the early operation is limited to the removal of recognizable and demarkated necroses, the mortality decreases to 30 or 35%. In principal preference of a retarded date of operation and in consequent sanation of local changes, if necessary in repeated interventions, the mortality is between 20 and 33%. The surgical treatment of the chronic pancreatitis shall concerning indication to operation, tactics and kind of intervention always take into consideration an existing abuse of alcohol. Long-term controls revealed that the most essential life-limiting factor is a further existing alcoholism. The more parenchyma is removed in operation the higher is the late mortality.
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PMID:[Surgical treatment of acute and chronic pancreatitis]. 48 23

Seventy-four patients underwent operation for chronic pancreatitis during a 22 year period at UCLA Hospital. Follow-up data obtained for 60% of these patients an average of 3.2 years postoperation were analyzed by computer for statistically significant benefit between paired operation combinations and the variables of pain relief, stool habits, alcohol use, readmission for pancreatitis, and narcotic use. The combined group of total and cephalic pancreaticoduodenectomy proved more effective with respect to pain relief and readmission (p less than 0.05) than the group that had pseudocyst drainage. The comparison of groups that underwent resection or ductal drainage showed no statistical differences for the above variables. Regardless of type of operation, if the patient had evidence of pancreatic calcifications and had abstained from alcohol postoperatively, the likelihood of a return to normal activity was more favorable (p less than 0.05).
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PMID:Surgical treatment of chronic pancreatitis. Twenty-two years' experience. 48 5

Clinical, radiological and histopathological features of 31 duodenopancreatectomies for chronic pancreatitis with lithiasis are analysed in relation to whether or not there was dilatation of the duct of Wirsung. Two groups of patients may be defined in the basis of this criterion: -- the first, without dilatation of the duct of Wirsung, with lithiasis predominantly affecting the head of the pancreas and irregular fibrosis, corresponding patients aged approximately 30 years, suffering from the disease for about 10 years, often already operated upon for pancreatitis; gastrointestinal bleeding is common; -- the second, with dilatation of the duct of Wirsung, with disseminated lithiasis, and very marked fibrosis, affecting patients aged over 50 years, suffering from the disease for less than 5 years and not yet operated upon for their pancreatitis. The problem of the independance of the two groups or of the possibility of progression of forms without dilatation of the duct of Wirsung to dilated forms remains.
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PMID:[Clinicopathological profile of pancreatic lithiasis (author's transl)]. 49 88

Seventy-two patients were examined by ultrasonography and endoscopic pancreaticography (ERCP) because of clinical suspicion of pancreatic disease. The following final diagnoses were obtained. Carcinoma of the pancreas: 20 patients; pancreatitis: 27 patients; other diseases: 17 patients; no organic disease: 8 patients. In this series, carcinoma of the pancreas was demonstrated with almost equal efficacy by the two methods used. Cysts in the pancreas were better demonstrated by ultrasonography, while ERCP was superior in demonstrating chronic pancreatitis. The diagnostic results with the exclusive use of one method was not satisfactory, but by combining the two methods an adequate diagnostic accuracy was obtained. Thus in the 47 patients with pancreatic disease, organic abnormalities were demonstrated by the two combined methods in 46 (98%). In 41 of the 47 patients (87%) the exact nature of the lesion could be assessed by combining the two methods.
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PMID:Gray scale ultrasound and endoscopic ductography in the diagnosis of pancreatic disease. 49 71

The clinical, biochemical and radiological findings in 16 patients with carcinoma of the head of the pancreas were compared with that of 13 with cholestatic jaundice due to chronic pancreatitis. Patients presenting with malignancy had more severe hyperbilirubinemia (18.5 +/- 2.1 vs 5.6 +/- 1.6 p to ten days of hospital admission was the single most accurate test distinguishing carcinoma from pancreatitis. The mean bilirubin rose in carcinoma but fell in pancreatitis (mean net change 15.1 +/- 2.9 vs 3.9 +/- 0.6, p less than 0.001). Calcification in the pancreatic region was identified on a flat plate of the abdomen in 8/13 with pancreatitis but 0/16 with malignancy. Preoperative percutaneous transhepatic cholangiography was helpful in defining the site of biliary obstruction but the radiologist was unable to clearly predict the definitive diagnosis in five of the 29 patients. A point score based upon the major significant differences noted, predicted the presence or absence of malignancy in all patients (16/16 vs 0/13, p less than 0.01).
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PMID:Mass in the head of the pancreas in cholestatic jaundice: carcinoma or pancreatitis? 50 68

The chronic pancreatitis population of Wadsworth VA Hospital over the past five years was screened for two-fold or greater alkaline phosphatase elevation at any time during their course, as a marker for either distal common bile duct stenosis or other hepatobiliary disease. Forty-seven of 207 patients screened met this criterion and are reviewed in detail. Of the 16 patients with persistent alkaline phosphatase elevation (group B), 15 had proven common bile duct stenosis, demonstrating a clear pathophysiologic role of partial bile duct obstruction in their liver disease. Three had developed secondary biliary cirrhosis, marking this entity the commonest cause of secondary biliary cirrhosis at our hospital. Of the remaining 31 patients with transient alkaline phosphatase elevation (group A), only 4 had proven duct abnormalities which may resolve during recovery. Alcoholic liver disease was demonstrated with normal extrahepatic ducts in the remainder in group A adequately studies. Persistent greater than two-fold alkaline phosphatase elevation in pancreatitis thus represents a reliable marker of distal common bile duct stenosis, whose sequelae may include cholangitis and secondary biliary cirrhosis and which requires operative intervention in these cases. When a persistent alkaline phosphatase elevation greater than two-fold is encountered in a chronic pancreatitis patient, adequate cholangiography and liver histology are both necessary to confirm and grade this frequent and treatable complication.
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PMID:Common bile duct stenosis from chronic pancreatitis: a clinical and pathologic spectrum. 51 65

Important experiences are reported from an analysis of 500 examinations. The ERCP gives eminent possibilities for the improvement of the pre- and postoperative diagnostics of the bile ducts, particularly in unclear cholestasis and in conditions after operations of the bile ducts. The ERCP is little suited for the early diagnosis of the carcinoma of the pancreas and for the ascertainment of the diagnosis in easy and moderate forms of chronic pancreatitis. Of particular value is the possibility to clear the causes of recidivations of pancreatitis as well as of complications of the severe chronic pancreatitis with regard to operative consequences.
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PMID:[Possibilities and limitations of endoscopic retrograde cholangiopancreaticography (ERCP)]. 51 32

We studied the plasma pancreatic polypeptide (PP) response to a meal in patients with pancreatitis and attempted to correlate the PP increment with the degree of pancreatic exocrine insufficiency. Control subjects and patients with recurrent pancreatitis showed significant mean increase (P less than 0.05) in plasma PP concentration in response to food. By contrast chronic pancreatitis patients had no significant increase in plasma PP. However, some subjects with normal pancreatic had no response and some patients with chronic pancreatitis did show a response. In addition, no correlation was observed between the PP response and pancreatic exocrine secretion. We conclude that the PP response to a meal has only limited value in the detection of pancreatic destruction.
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PMID:Pancreatic polypeptide response in patients with chronic pancreatitis. 52 Jan 7

Three-dimensional reconstruction of pancreatic ducts were made from specimens of pancreases from chronic pancreatic injury dogs following adjuvant injection, one patient with chronic non-alcoholic pancreatitis, and 2 patients with chronic alcoholic pancreatitis. The ductal alterations of alcoholic pancreatitis showed more apparent changes than those of non-alcoholic pancreatitis. The lesions in experiment such as uneven surface, irregular dilatation, tortuosity, and anastomosis, resembled to those of alocholic calcifying pancreatitis. Although gross appearance of the reconstructed ducts in advanced cases of experimental pancreatic injury revealed some resemblance to that of alcoholic calcifying pancreatitis, histologically, the epithelial changes of the former were different from those of the latter. Thus we concluded that more complicated factors than those considered in experiment play a role in combination in the pathogenesis of bead-like dilatation of the pancreatic ducts of chronic pancreatitis.
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PMID:Studies on pancreatic duct system. II Comparative study of histological features, and three-dimensional reconstruction of pancreatic ducts. 52 Jul 72


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