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)

An EDAP LT-01 lithotripter was used to treat 245 patients with functioning gallbladders containing one to three radiolucent stones of less than 20 mm in diameter. Ursodeoxycholic acid was administrated as adjuvant litholytic therapy. The gallbladder stones disintegrated in 98.8% of patients and disappeared completely in 21.2% within 1 month after lithotripsy, in 26.5% within 2 months, in 33.9, 40, 46.5, 48.6 and 53.9% within 3, 4, 6, 9, and 12 months, respectively. Adverse effects after lithotripsy were dull abdominal pain (49.4%), biliary colic (13.1%), jaundice (1.2%), and pancreatitis (0.4%). Extracorporeal shock wave lithotripsy combined with litholytic therapy is a non-invasive, painless, safe, and effective treatment in selected patients. Patients with solitary radiolucent stone less than 20 mm in diameter are considered candidates for extracorporeal shock wave lithotripsy (ESWL). The key to success of ESWL lies in the strict selection of patients, careful monitoring throughout the lithotriptic procedure, and enough litholytic therapy. The disadvantages of this method include strict selection of patients and high costs, poor curative effect, and recurrence of stones (11.4% of patients).
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PMID:Extracorporeal shock wave lithotripsy. Experience in treating 245 patients with gallbladder stones. 211 55

Twenty-three of 229 symptomatic patients undergoing cholecystlithotripsy underwent surgical intervention: 22 of the patients had cholecystectomy performed (five also undergoing choledochotomy) and one patient had a cholecystostomy. Of these 23 patients, five were lithotripsy failures, five developed acute pancreatitis, one had acute cholecystitis, and one had cholangitis. One patient had her gallbladder removed incidentally at the time of surgery for a bleeding gastric ulcer. Ten patients underwent surgery for recurrent biliary pain, probably related to fragment passage via the cystic duct. We suggest that up to 16 of these 23 patients did not necessarily require cholecystectomy, i.e. five patients with pancreatitis, one patient with cholangitis and ten patients with recurrent biliary colic. Conservative and/or endoscopic management may be successful in the first instance to allow further treatment with lithotripsy in the majority of patients. If, however, the expertise to perform endoscopic sphincterotomy is not available or the patient declines further lithotripsy, then resort to surgery may be necessary. We propose that it is the responsibility of the management team in charge of the lithotripsy unit to inform both the patient and the referring clinicians of the possible side-effects and outcome of treatment in an attempt to avoid unnecessary surgical procedures.
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PMID:Gallbladder surgery following cholecystlithotripsy: suggested guidelines for treatment. 203 21

Passage of stone fragments after extracorporeal shock wave lithotripsy (ESWL) of gallstones has resulted in biliary colic, duct obstruction, and pancreatitis in some patients. Rapid dissolution of these fragments with methyl tert-butyl ether (MTBE) may prevent such side effects and achieve complete clearance of gallstones within hours rather than several months to a year or longer. This study examines the safety of same-day ESWL fragmentation and MTBE dissolution of surgically implanted human gallstones in 15 dogs. The animals were randomly assigned to one of four treatment groups to assess MTBE absorption from the gallbladder and to observe hematology and chemistry profiles after 0, 400, and 1,200 shock waves from a lithotriptor followed by MTBE dissolution therapy. They were sacrificed either immediately after treatment (12 dogs) or 2 weeks later (3 dogs). The results demonstrated that although ESWL causes moderate trauma to the gallbladder, this did not result in increased MTBE absorption or histologic evidence of mucosal disruption. Blood profiles demonstrated an increase in only the level of aspartate aminotransferase. The three dogs that were sacrificed 2 weeks after the combined treatment had no residual evidence of gallbladder injury or remaining stone material. In all animals, severe injury occurred where shock waves passed through lung or air-filled colon. This study suggests that same-day sequential fragmentation of gallstones by ESWL followed by dissolution of stone fragments with use of MTBE may be associated with only mild to moderate and reversible gallbladder trauma and can rapidly achieve clearance of gallstones.
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PMID:Safety of same-day sequential extracorporeal shock wave lithotripsy and dissolution of gallstones by methyl tert-butyl ether in dogs. 225 18

Choledochocele or type III choledochal cyst is a rare abnormality of obscure etiology that consists of cystic or diverticular dilatation of the terminal intramural portion of the common bile duct protruding into the duodenum. It should be considered in the differential diagnosis of otherwise unexplained biliary colic or recurrent pancreatitis--particularly after cholecystectomy. An intraluminal duodenal filling defect on barium study that opacifies during cholangiography or endoscopic retrograde cholangiopancreatography is diagnostic. We present one case of choledochocele in which the first use of the biliary scintigraphic (HIDA) scan for diagnosis is demonstrated. An additional 47 cases found in the literature are reviewed and a new anatomic classification of choledochoceles is proposed as a guide for treatment. Treatment options are partial excision of the cyst, sphincterotomy, or both.
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PMID:Choledochocele: case report, literature review, and a proposed classification. 264 45

We examined 29 patients without stone disease or pancreatic ductal ectasia who underwent transduodenal sphincteroplasty and transampullary septotomy for symptoms of biliary colic or pancreatitis. The combination of biliary symptoms and a fibrotic ampulla of Vater portends a favorable surgical outcome in virtually all such patients. Patients with pancreatitis did worse overall, perhaps due to the existence of unappreciated subclinical parenchymal disease not related to sphincter dysfunction. Although endoscopic retrograde cholangiography was sensitive in demonstrating abnormalities of the pancreaticobiliary system, its specificity as a predictor of good results was poor. It seems prudent to temper one's enthusiasm for sphincteroplasty in the patient with pancreatitis, whereas patients with biliary symptoms, the postcholecystectomy syndrome, or both will usually benefit significantly from this procedure.
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PMID:Transduodenal sphincteroplasty and transampullary septotomy for primary sphincter of Oddi dysfunction. 291 Jan 25

To substantiate the early results of extracorporeal shock-wave fragmentation of gallstones, we used this nonsurgical procedure to treat 175 patients with radiolucent gallbladder calculi. Chenodeoxycholic acid and ursodeoxycholic acid were administered as adjuvant litholytic therapy. The gallstones disintegrated in all patients except one and completely disappeared in 30 percent of all patients within 2 months after lithotripsy, in 48 percent at 2 to 4 months, in 63 percent at 4 to 8 months, in 78 percent at 8 to 12 months, and in 91 percent at 12 to 18 months. In patients with solitary stones up to 20 mm in diameter, the corresponding values were 45, 69, 78, 86, and 95 percent, respectively. Shock-wave therapy had no adverse effects except cutaneous petechiae (14 percent) and transient gross hematuria (3 percent). One third of the patients had one or more episodes of biliary colic before all the fragments disappeared. Two patients had mild pancreatitis, which necessitated endoscopic sphincterotomy in one. The patient with insufficient stone fragmentation underwent elective cholecystectomy; no additional operations were necessary. Extracorporeal shock-wave lithotripsy combined with medical therapy for stone dissolution is a safe and effective treatment in selected patients with radiolucent gallbladder calculi.
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PMID:Shock-wave lithotripsy of gallbladder stones. The first 175 patients. 334 Jan 16

It has been suggested that gallstone disease is rare in Africa. The 118 cholecystectomies for this condition performed at Baragwanath Hospital over the 3-year period 1983-1985 were reviewed; 100 records were available. The male: female ratio was 1:4, the mean age 51 years. Fifty-one per cent of patients presented with acute cholecystitis, 18% with obstructive jaundice, 9% with pancreatitis and only 22% with biliary colic. The incidence of complicated presentation was higher in the over 60-year-old age group (P less than 0.05). The correct diagnosis was made on admission in only 41% of cases. The mean delay in diagnosis was 5 days; however, the delay was 8 days for patients admitted to the medical wards compared with 2 days in the surgical wards (P less than 0.001). Elective operations were performed on 82% of patients and 18% had urgent surgery. The incidence of common bile duct stones was 22%. The overall mortality rate was 10%; however, the mortality rate was 3.2% for the under-60-year-old group compared with 21% for patients 60 years and older (P = 0.006). This series, which is probably the largest reported in black patients, suggests that greater awareness of acute cholecystitis is necessary in the black patient since there is a rising in-hospital incidence.
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PMID:Gallstone disease among black South Africans. A review of the Baragwanath Hospital experience. 360 87

Thirty-one patients with radiolucent common bile duct stones received medical treatment. Nineteen had Rowachol, a terpene preparation, eight (42%) achieving complete stone disappearance within 3 to 48 months. Fifteen (including 3 of the above) took Rowachol with bile acid (chenodeoxycholic in 11, ursodeoxycholic in 4) for 3 to 60 months: 11 (73%) achieved complete dissolution within 18 months. Persistent symptoms and complications settled on conservative management: 8 (25%) patients required admission (2 biliary colic, 1 obstructive jaundice, 4 cholangitis, 1 pancreatitis). One patient died of a myocardial infarction during recovery from pancreatitis; the other continued treatment, 2 achieving complete dissolution/disappearance. Oral dissolution therapy with Rowachol and bile acids should be considered when endoscopic sphincterotomy or surgery is not feasible, but careful attention to potential complications is required while stones persist.
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PMID:Stones in the common bile duct: experience with medical dissolution therapy. 402 60

It was felt that the apparent specificity of the amylase-to-creatine clearance ratio (ACCR) in several previous studies of pancreatitis might reflect a failure to utilize adequately ill control subjects. The ACCR and the renal clearances of beta 2-microglobulin (B2-m), similarly related to creatinine (BCCR) as well as the urinary concentration of albumin, were compared in 27 patients with acute pancreatitis, 8 with a perforated peptic ulcer and 7 with mild biliary colic, during the first 5 days in hospital. Acute pancreatitis was graded as mild (6), moderate (14) or severe (7), using a combination of clinical data, diagnostic peritoneal lavage and multiple criteria. Further assessment of the severity of the acute illness was obtained from measurement of C-reactive protein (C-RP). Lowest C-RP levels were found in the patients with mild pancreatitis and biliary colic, and highest levels in the patients with severe pancreatitis and perforated ulcer (P less than 0.002). Similarly, ACCR and BCCR levels were significantly lower in the two mild groups than in the two severe ones (P less than 0.01 and less than 0.002 respectively), although plasma amylase was raised only in patients with pancreatitis and plasma B2-m was similar in all groups. Electrophoresis of urine showed dense bands of tubuloprotein in patients from both severe groups. Urine albumin was higher in severe pancreatitis than in perforated ulcer (P less than 0.1), perhaps indicating a more specific glomerular lesion in pancreatitis. Thus a rise in amylase clearance appeared to be related to the severity of the acute illness, and may be a component of a non-specific tubuloproteinuria. In this study patients with a perforated peptic ulcer had increases in ACCR similar to those seen in patients with severe pancreatitis, and we are therefore doubtful whether ACCR has any role in the clinical diagnosis of pancreatic disease.
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PMID:The amylase-to-creatinine clearance ratio--a non-specific response to acute illness? 617 75

The functional activity of the sphincter of Oddi complex has been examined by ceruletide manometry in patients undergoing cholecystectomy with a normal peroperative cholangiogram. In Group I (n = 14), which included patients with previous acute cholecystitis/biliary colic, the sphincter activity appeared to be normal and responded to intravenous ceruletide by a marked relaxation with a significant fall in both the infusion and postinfusion pressures. In patients undergoing cholecystectomy for gallstone-associated pancreatitis (n = 8), the sphincter exhibited manometric features of hypotonia with low infusion and postinfusion pressures which were not significantly altered by intravenous ceruletide.
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PMID:Evidence for sphincter dysfunction in patients with gallstone associated pancreatitis: effect of ceruletide in patients undergoing cholecystectomy for gallbladder disease and gallstone associated pancreatitis. 649 60


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