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

134 patients with necrotizing pancreatitis were operated. Preoperative organ insufficiency (pulmonary or renal), the presence of shock or sepsis and the intraoperative morbidity factors: parenchymal necroses greater than 30%, extrapancreatic necroses, ascites and in particular bacterial contamination were directly correlated with prognosis and mortality. The occurrence of these morbidity factors consequently signifies an urgent indication for operation.
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PMID:[Data on surgical indications in necrotizing pancreatitis--results of a validation study]. 292 70

Following laparotomy for severe intra-abdominal sepsis, the abdominal cavity was left open to heal by granulation in 18 patients. In 14 patients, operation was required because of recurrent gastrointestinal perforation or anastomotic dehiscence. In three, the indication for this procedure was recurrent pancreatic abscess. Of the 17, 13 had previously undergone multiple operations which had failed to control sepsis. Laparostomy was performed as a primary procedure in only one case, a patient with fulminating pancreatitis requiring pancreatic necrosectomy. All patients received parenteral nutrition. The overall mortality was 28 per cent. However, there was only one death among the last 9 patients treated compared with 4 in the previous 9. The median sepsis score in the first 9 (19, range 10-26) was not significantly different (P greater than 0.05) from that in the subsequent 9 patients (17, range 8-21). Three of the four who had initially presented with severe acute pancreatitis died. No patient eviscerated and only 9 (50 per cent) required mechanical ventilation for a median duration of 5 days. The median time for wound healing was 10 weeks and 6 patients have subsequently undergone definitive surgery with satisfactory results. Laparostomy is a valuable technique in the management of severe, intractable intra-abdominal sepsis.
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PMID:'Laparostomy': a technique for the management of intractable intra-abdominal sepsis. 293 61

Pancreatic necrosis and sepsis are the major causes of death in instances of acute pancreatitis. No widely accepted definition of these conditions in individuals exists, and, yet, accurate differentiation is mandatory for effective therapy. A series of operational definitions conforming to known clinopathologic factors are proposed for the necrotizing septic complications of acute pancreatitis. These complications, as distinguished from acute interstitial pancreatitis, are fat sequestra, pancreatic necrosis, infected pancreatic necrosis, pancreatic abscess and acute pseudocyst. Imprecise definitions of these complications of necrotizing pancreatitis make inter-institutional comparisons of previously identified data dubious.
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PMID:Progress in acute pancreatitis. 304 92

To determine the effect of early aggressive parenteral support in pancreatitis, 54 patients with acute pancreatitis were randomized to receive either conventional therapy (control group) or conventional therapy plus the institution of total parenteral nutrition within 24 hours. The two groups were similar demographically. The total parenteral nutrition group had a significantly higher rate of catheter-related sepsis than did an additional group of contemporaneous patients without pancreatitis who received total parental nutrition (10.5 percent and 1.47 percent, respectively; p less than 0.01). There was no advantage to the use of early total parenteral nutrition; that is, there was no difference in the number of days to oral intake, total hospital stay, or number of complications of pancreatitis. Patients with zero or one Ranson's criterion on admission were more likely to be eating by the seventh hospital day than were those with two or more Ranson's criteria (80 percent and 54 percent, respectively; p less than 0.05). The early institution of total parenteral nutrition in patients with acute pancreatitis did not appear to improve the outcome. Its use should be limited to prolonged periods of no oral intake or treatment of a specific complication, such as a pseudocyst.
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PMID:Early total parenteral nutrition in acute pancreatitis: lack of beneficial effects. 309 88

The treatment of acute pancreatitis is primary conservative independent of the degree of severeness. The aim of our multimodal concept of therapy (stomach tube, catheterisation of urinary bladder, closed peritoneal dialysis, analgetics--peridural catheter-, substitution of volume-electrolytes, colloides, protein, plasma, blood-, antibiotics, heparin H2-receptor blocker, early artificial respiration, insulin, parenteral nutrition-glucose, amino acids, fat-, hemofiltration/-dialysis, percutaneous drainage of liquid formations) is to postpone or to avoid an operation. Only the erosion bleeding or a locally conditioned sepsis ask for an emergency operation. The lethality of the degrees II (n = 30) and III (n = 39) could be decreased to 20.3% in the last 7 years. The follow-up of 55 patients with severe pancreatitis was free of clinical symptoms in 80% with normal exocrine and endocrine function of pancreas. This confirms that the organ itself is mostly intact even in severe cases of pancreatitis, in hemorrhagic-necrotic pancreatitis.
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PMID:[Pancreatitis: conservative therapy]. 310 Aug 87

A method, devised in the authors' laboratories, for the determination of C3b receptors on normal and patient neutrophils using C3b-coated fluorescent microspheres, was applied to the quantitation of C3b receptors on the neutrophils of several patients suffering from burns and trauma and a patient with pancreatitis. From three to 11 days in the clinical course the relative number of C3b receptors was, or rose to, two to ten times the number of receptors present at later times in the clinical course and, in most of the cases studied, the increase in C3b receptor number coincided with enhanced neutrophil bactericidal function. The rise in C3b receptor number was ascribed to up-regulation by C3a and C5a des Arg from complement activation and also, in the cases where sepsis occurred, to the presence of bacterial chemotactic peptides. Preliminary experiments with zymosan-activated serum and the chemotactic peptide N-formyl-methionyl-leucyl-phenylalanine confirmed this explanation.
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PMID:Determination of C3b receptors on normal and patient polymorphonuclear neutrophils with C3b-coated fluorescent microspheres. 315 8

In the 41st week of her first pregnancy, a 25-year-old woman presented abdominal complaints. After the Caesarean delivery of an healthy child, the mother developed a severe hypoglycaemia and septic shock. Although normal serum and urine amylase values were obtained, an exploratory laparotomy disclosed acute haemorrhagic pancreatitis. Clinical treatment was complicated by repeated sepsis, multiple organ failure and ARDS, requiring the patient to receive intensive care for 3.5 months. To control abdominal sepsis and bleeding complications, an additional ten laparotomies were carried out. During this period the abdomen was kept closed by means of a nylon mesh. Although according to present day criteria the prognosis was fatal, the patient ultimately fully recovered. By exclusion, the cause of the pancreatitis was ascribed to the pregnancy itself. The medical, obstetric and surgical aspects of the management of acute pancreatitis complicating pregnancy and puerperium are reviewed.
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PMID:Maternal survival after acute haemorrhagic pancreatitis complicating late pregnancy. 322 42

Pancreatic resection for acute necrotising pancreatitis was followed by abscess of the remnant in 14 out of 83 cases. Not even extensive pancreatic resection could prevent pancreatic remnant infection. The 14 cases of abscess are reviewed. Seven were fatal. Enterocutaneous fistula, commonly accompanied by sepsis and major bleeding, was identified in five patients, four of whom died.
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PMID:Pancreatic remnant abscess after resection for acute necrotising pancreatitis. 322 17

Undrained necrotic tissue or septic foci contribute to continued "activation" of host processes that in turn lead to multiple organ failure and death. We hypothesized that if wide-open drainage of the abdominal cavity is provided, thus not allowing intra-abdominal collections to form, mortality in these patients can be reduced. Since 1982 we have treated 49 patients with necrotic pancreatitis and related infections and 15 patients with severe intra-abdominal sepsis from intestinal perforations. The surgical treatment was based on the provision for daily laparotomies in the intensive care unit with the patient under epidural anesthesia by using an "open-abdomen" technique (zipper alone or a zipper-mesh combination). The APACHE II score and the functional classification were used to derive expected mortalities. The patients with intraabdominal sepsis had a mean APACHE II score of 25 and an expected mortality of 45%, vs the 26.5% mortality that we observed. The lowest mortality in the necrotic pancreatitis group was associated with noninfected pancreatic necrosis (6%) and single abscess (9%) vs 22% mortality rate in the patients with infected pancreatic necrosis. The mean expected mortality in this group was 47%, vs the observed 22%. We attributed this result to the daily abdominal explorations that achieved a complete excision of infected or necrotic tissue.
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PMID:Treatment of severe intra-abdominal sepsis and/or necrotic foci by an 'open-abdomen' approach. Zipper and zipper-mesh techniques. 327 82

Local septic complications in acute pancreatitis need to be exactly characterized and defined in order to develop improved concepts for their prevention, early diagnosis, and therapy. While up to now all local septic complications have been termed abscesses, the present study for the first time delineates the morphologic, clinical, and laboratory criteria needed to distinguish between two separate clinical entities: the infected necrosis (IN) and the pancreatic abscess (PA). IN is defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue, but without any significant pus collections. On the other hand, the morphologic substrate of PA is a localized collection of pus surrounded by a more or less distinct capsula. IN becomes clinically evident during the early phase of acute pancreatitis (AP). The patients with IN present both the signs of sepsis and the laboratory findings of AP. Thus in these patients the most fulminant course of AP is observed; 51.8% and 35.7% of them have pulmonary or renal insufficiency, respectively. The mortality of the patients with IN is high and amounts to 32.1%. Pancreatic abscess, on the other hand, does not develop before the fifth week after onset of symptoms and after subsidence of the acute phase of pancreatitis. In these patients laboratory signs of AP-like amylasemia, hypocalcemia, hyperglycemia, and rise of LDH are rarely observed. Corresponding to the lack of pathophysiologic effects of AP per se, pulmonary and renal insufficiencies occur in only 33.3% and 16.7%, respectively, and mortality in these patients is 22.2%. While an abscess may readily be identified by computed tomography, the differentiation between IN and non-IN can be very difficult.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pancreatic abscess and infected pancreatic necrosis. Different local septic complications in acute pancreatitis. 330 74


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