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)

The epidemiological patterns for pancreatic and biliary cancers reveal more differences than similarities. Pancreatic carcinoma is common in western countries, although 2 Polynesian groups (New Zealand Maoris and native Hawaiians) have the highest rates internationally. In the United States the disease is rising in frequency, predominating in males and in blacks. The rates are elevated in urban areas, but geographic analysis uncovered no clustering of contiguous counties except in southern Louisiana. The origin of pancreatic cancer is obsure, but a twofold increased risk has been documented for cigarette smokers and diabetic patients. Alcohol, occupational agents, and dietary fat have been suspected, but not proven to be risk factors. Except for the rare hereditary form of pancreatitis, there are few clues to genetic predisposition. In contrast, the reported incidence of biliary tract cancer is highest in Latin American populations and American Indians. The tumor predominates in females around the world, except for Chinese and Japanese who show a male excess. In the United States the rates are higher in whites than blacks, and clusters of high-risk counties have been found in the north central region, the southwest, and Appalachia. The distribution of biliary tumors parallels that of cholesterol gallstones, the major risk factor for biliary cancer. Insights into biliary carcinogenesis depend upon clarification of lithogenic influences, such as pregnancy, obesity, and hyperlipoproteinemia, exogenous estrogens, familial tendencies, and ethnic-geographic factors that may reflect dietary habits. Noncalculous risk factors for biliary cancer include ulcerative colitis, clonorchiasis, Gardner's syndrome, and probably certain industrial exposures. Within the biliary tract, tumors of the gallbladder and bile duct show epidemiological distinctions. In contrast to gallbladder cancer, bile duct neoplasms predominate in males; they are less often associated with stones and more often with other risk factors. In some respects, bile duct and pancreatic tumors are alike. The male predominance of both tumors, an association between cholecystectomy and pancreatic cancer, and other considerations have prompted the notion that the same biliary carcinogens may affect the bile duct, ampulla of Vater, or, by reflux, the pancreatic duct. Various epidemiological and interdisciplinary approaches are needed to further clarify the origins of biliary tract and pancreatic cancers, but nutritional studies hold special promise in laying the groundwork for prevention of these tumors.
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PMID:Cancers of the pancreas and biliary tract: epidemiological considerations. 110 53

We measured urinary levels of free L-fucose in healthy subjects, patients with benign diseases, and patients with cancer using an automated analyzer and a newly isolated L-fucose dehydrogenase, and evaluated the clinical usefulness of the results. The values obtained were corrected for urinary creatinine as micromoles per gram of creatinine. The cutoff value, set at the mean + 2SD for the healthy subjects, was 250 mumol/g.Cr. Patients with gallbladder cancer, bile-duct cancer, liver cancer, pancreatic cancer, or cirrhosis of the liver had significantly higher levels of L-fucose than the healthy subjects. The diagnostic sensitivity for these five diseases, taken together, was 68% (144/213). Specificity for the detection of cancer was calculated by use of false positives for patients with cholelithiasis, hepatitis, and pancreatitis: it was 73% (76/104). Diagnostic accuracy for these seven diseases taken together was therefore 69% (220/317). We compared the positive ratio of the L-fucose level with that of the tumor markers AFD and CA19-9. The positive ratio of an L-fucose value above the cutoff was higher than the positive ratio of either marker in bile-duct cancer, gallbladder cancer, liver cancer, and pancreatic cancer. The results suggested that the urinary levels of free L-fucose reflected the metabolism of sugar chains of glycoconjugates, and may be usefully clinically as a tumor marker.
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PMID:[Clinical assessment of urinary free L-fucose levels]. 140 61

The most certain symptomatic manifestation of gallstones is episodic upper abdominal pain. Characteristically, this pain is severe and located in the epigastrium and/or the right upper quadrant. The onset is relatively abrupt and often awakens the patient from sleep. The pain is steady in intensity, may radiate to the upper back, be associated with nausea and lasts for hours to up to a day. Dyspeptic symptoms of indigestion, belching, bloating, abdominal discomfort, heartburn and specific food intolerance are common in persons with gallstones, but are probably unrelated to the stones themselves and frequently persist after surgery. Many, if not most, persons with gallstones have no history of pain attacks. Persons discovered to have gallstones in the absence of typical symptoms appear to have an annual incidence of biliary pain of 2-5% during the initial years of follow-up, with perhaps a declining rate thereafter. Gallstone-related complications occur at a rate of less than 1% annually. Those whose stones are symptomatic at discovery have a more severe course, with approximately 6-10% suffering recurrent symptoms each year and 2% biliary complications. The far higher rates of symptom development reported in a few studies raise the possibility that these incidence estimates may be too low. The best predictors of future biliary pain are a history of pain at the time of diagnosis, female gender and possibly obesity. The risk of acute cholecystitis appears to be greater in those with large solitary stones, that of biliary pancreatitis in those with multiple small stones, and that of gallbladder cancer in those with large stones of any number. Drugs that inhibit the synthesis of prostaglandins may now be the treatment of choice in patients with gallstones who are suffering acute pain attacks. Persistent dyspeptic symptoms occur frequently following cholecystectomy. A prolonged history of such symptoms prior to surgery and evidence of significant psychological distress appear to be the best predictors of unsatisfactory outcome.
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PMID:Symptoms of gallstone disease. 148 6

24 patients (median age 71.5 years) with inoperable proximal malignant biliary obstruction were treated by insertion of endoscopic endoprostheses from January 1991 to August 1994. 10 patients had gallbladder cancer, 6 cancer of body or tail of pancreas, 5 cholangiocarcinoma and 3 other metastatic malignancy, respectively. 13 patients had type I, 10 had type II and 1 had type III proximal biliary stenosis (Bismuth classification). Stent occlusion or dislocation required a secondary stent insertion in 9 patients. In all cases there was adequate biliary drainage after stent insertion. Complications were: early cholangitis developed in 2 patients, late cholangitis in 5, stent dislocation in 3. One patient underwent an operation because of necrotising cholecystitis and subhepatic abscess. There was no bleeding, retroperitoneal perforation or pancreatitis. 18 patients died (median survival time 28 weeks) and 6 have been alive at the time of review for 15 weeks in average. Endoscopic stent insertion can be applied effectively also in the palliative treatment of proximal malignant biliary obstruction.
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PMID:[Palliative endoscopic treatment of proximal malignant biliary stenosis]. 754 51

Recent studies have indicated that solitary or multiple gallstones may differ with respect to the conditions favoring their formation, such as nucleation time. We examined the clinical, histological and laboratory characteristics of symptomatic gallstone disease in a series of 125 consecutive patients with either solitary (n = 33) or multiple (n = 92) cholesterol gallstones undergoing cholecystectomy. The nature of biliary pain was found to differ in the two groups. Histological diagnoses of acute cholecystitis and gallbladder cancer was more frequent in the patients with multiple stones, and cholesterolosis in those with solitary stones. Furthermore, the stone cholesterol content was higher in the solitary stone group than in the multiple stone group. Morbid complications such as cholangitis and pancreatitis were rare and occurred only in the multiple stone group. The results support the view that gallbladder disease presents histological evidence of biliary complications more often in patients with multiple cholesterol stones than in those with solitary stones.
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PMID:Characteristics of symptomatic gallbladder disease in patients with either solitary or multiple cholesterol gallstones. 795 50

The disruption of malignant biliary strictures by dilation could enhance the results of bile cytology. To test this hypothesis, we studied the results of bile cytology in 64 consecutive patients undergoing endoscopic biliary drainage for malignant biliary strictures. Patients included 36 men and 28 women, ages 29 to 79 years. In the control group (n = 15), bile was obtained by aspiration without dilating the biliary stricture. In the dilated group (n = 49), bile was aspirated after dilating the biliary stricture to 10F gauge. The bile was centrifuged, and smears were prepared, stained, and interpreted as malignant, suggestive of malignancy, or not malignant. The biliary obstruction was caused by gallbladder cancer in 33, primary bile duct cancer in 14, pancreatic cancer in 11, and metastasis in 6 patients. Forty patients had obstruction at the bifurcation of the hepatic duct. Malignancy was confirmed by surgery in 14, fine-needle aspiration cytology in 9, presence of metastasis in 19, and a combination of clinical and radiologic studies, endoscopic cholangiopancreatography findings, elevated tumor markers, and follow-up in 22 patients. Bile cytology was positive for malignancy in 4 (26.6%) and 31 (63.3%), suggestive in 1 (6.7%) and 6 (12.2%), and negative in 10 (66.7%) and 12 (24.5%) patients in the control group and the dilated group, respectively (p = 0.028, 95% CI 1.15 and 21.03). Cytology was positive in 73% of gallbladder cancers, 62.5% of bile duct cancers, 40% of pancreatic cancers, and 60% of metastasized cancers after dilation. Two patients had hemobilia, 8 had cholangitis, and 2 had pancreatitis after biliary drainage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosis of malignant obstructive jaundice by bile cytology: results improved by dilating the bile duct strictures. 801 38

The relationship between family history of selected neoplasms in first-degree relatives and the risk of pancreatic, liver, and gallbladder cancer was investigated using data from a case-control study conducted in northern Italy on 320 histologically confirmed incident cases of liver cancer, 58 of gallbladder cancer, 362 of pancreatic cancer, and 1408 controls admitted to the hospital for acute, nonneoplastic, nondigestive tract disorders. Significant associations were observed between family history of hepatocellular carcinoma and primary liver cancer [relative risk (RR) = 2.4; 95% confidence interval (CI), 1.3 to 4.4], between family history of pancreatic cancer and pancreatic cancer (RR = 3.0; 95% CI, 1.4 to 6.6), and between family history of gallbladder cancer and gallbladder cancer (RR = 13.9; 95% CI, 1.2 to 163.9). The elevated risk of liver cancer associated with family history was not materially modified by adjustment for tobacco, alcohol, and personal history of cirrhosis and hepatitis (RR = 2.9; 95% CI, 1.5 to 5.3). Similarly, the risk for pancreatic cancer did not appreciably change after allowance for tobacco, alcohol, dietary factors, and medical history of diabetes and pancreatitis (RR = 2.8; 95% CI, 1.3 to 6.3). This pattern of risk would support the existence of a genetic component in the familial aggregation of liver and pancreatic cancer. In terms of population attributable risk, approximately 3% of the newly diagnosed liver and pancreatic cancers would be related to this familial component.
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PMID:Family history and the risk of liver, gallbladder, and pancreatic cancer. 801 68

The point of the junction of the cystic duct with the common hepatic duct was studied by means of various preoperative and intraoperative cholangiographic procedures and by gross intraoperative examinations in 468 surgical patients with biliary diseases. The cystic duct entered the hepatic duct at a very low position and was consequently long in 39 patients. The clinical significance of this abnormally low junction of the cystic duct was studied in comparison with 358 patients with gallstones with a normal cystic duct-hepatic duct junction. In the low-junction group with a short common bile duct several complications, including gallstone pancreatitis (7 patients), the Mirizzi syndrome (7), confluence stones (2), gallbladder cancer (3), and congenital dilation of the cystic duct (1), were demonstrated preoperatively. The anomalous junction of the cystic duct with the common bile duct may cause stagnation of bile and/or reflux of pancreatic juice into the bile duct, producing a choledochopancreatic ductal junction and posing difficulties at surgery.
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PMID:Clinical evaluation of a low junction of the cystic duct. 843 Feb 77

Pancreatic cancer is a leading cause of cancer-related deaths in developed countries. Gall bladder cancer is very common in South American countries, around the Mediterranean and in Japan. A majority of patients with these cancers receive only palliative therapy in spite of recent advances in investigation and surgery. Their poor prognosis and increasing incidence in India necessitate a better epidemiologic approach towards their control. This review is based on epidemiological data, publications and abstracts from India. Population-based data reveal that the incidence of gall bladder cancer is very high in northern Indian cities (5-7 per 100,000 women) and low (0-0.7 per 100,000 women) in southern India. The distribution suggests a high-incidence region comprising Uttar Pradesh, Bihar, Orissa, West Bengal and Assam. The cancer is twice more common in women and is the leading cancer among digestive cancers in women in the northern Indian cities of Delhi and Bhopal. There are few analytical data to hypothesize why this geographical predisposition. The high incidence is also observed in north Indian immigrants to the United Kingdom. The incidence of pancreatic cancer is low (0.5-2.4 per 100,000 men and 0.2-1.8 per 100,000 women) in most parts of India. Somewhat higher rates are seen in the male urban populations of western and northern India. Studies from Kerala support an association between tropical pancreatitis and pancreatic cancer. Time trends reveal an increase in the incidence of gall bladder and pancreas cancers; the increase in the former is alarming. We estimate that the approximate annual cancer burden of India in 2001 would include 17,730 cases of gallbladder cancer and 14,230 of pancreatic cancer. Multi-center studies are needed to identify potentially preventable risk factors associated with gall bladder and pancreatic cancer in India.
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PMID:Epidemiology of digestive tract cancers in India IV. Gall bladder and pancreas. 1006 43

Biliopancreatic carcinoma has a poor prognosis since the diagnosis of the tumor occurs late when advanced disease is present. The identification of potential causes and earlier diagnosis are needed to prevent the disease or identify it early enough to improve survival. The main risk factors for pancreatic cancer include advanced age, cigarette smoking, high-fat diet, diabetes mellitus, chronic pancreatitis (especially hereditary pancreatitis) and a positive family history of pancreatic cancer. The most important etiologic factor for the development of gallbladder cancer is gallstone disease. Patients with anatomic abnormalities and chronic inflammatory conditions (primary sclerosing cholangitis, infections with parasites) have an increased incidence of bile duct cancers. Several new and promising imaging techniques have recently become available and our understanding of the mechanisms of carcinogenesis are growing rapidly. However, there is currently no effective screening strategy applicable and it is unknown when to begin screening. For pancreatic cancer, reduction of risk is likely to occur with avoidance of smoking and promotion of healthful diets. Cholecystectomy rates have increased since the introduction of new laparoscopic techniques and will eventually reduce the incidence of gallbladder cancer. Improved imaging techniques, the identification of new genes and a better definition of genetic alterations that characterize preinvasive lesions will hopefully allow to develop sensitive and specific technologies to screen and to detect early biliopancreatic cancer for even premalignant lesions to improve the mostly fatal prognosis if this tumor.
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PMID:[Risk groups for pancreatic and bile duct carcinomas]. 1101 30


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