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

Acute pancreatitis, reported in 17% of pediatric patients with acquired immune deficiency syndrome (AIDS), is said to have a poor prognosis. We describe the pancreatic changes observed at autopsy from 71 children with human immunodeficiency virus (HIV) infection and document their nature, extent, and clinical relevance. The median age at autopsy of the children was 17 months (range, 2 months to 19 years); 38 were boys and 33 were girls. Parental intravenous drug use was the most frequent risk factor for AIDS, followed by blood transfusions. Respiratory failure and sepsis constituted the predominant causes of death. Nonspecific changes, such as edema, inflammation, fibrosis, inspissated material in acini and ducts, and enlarged Langerhans' islet predominated. Acute and chronic pancreatitis were mild except in one instance of a fatal acute probably dideoxyinosine-associated pancreatitis. Pancreatic involvement by opportunistic infections, such as cytomegalovirus (CMV), Mycobacterium avium intracellulare (MAI), and Candida, was focal and rare despite the high prevalence of these infections at autopsy. Focal lymphoplasmacytic infiltration and vascular calcifications were also observed. We conclude that pancreatic changes were frequently noted at autopsy in children with AIDS. They were usually mild, reflected systemic disease states, and were usually not life threatening. The incidence of opportunistic infections of the pancreas was low.
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PMID:Pancreatic disorders in pediatric acquired immune deficiency syndrome. 762 49

The authors report a case of massive intestinal hemorrhage caused by rupture of a splenic artery pseudoaneurysm into a pseudocystojejunostomy. The pathologic and clinical features of this unusual complication of pancreatitis are discussed. One hundred and seventy one cases of major bleeding associated with pseudocysts and/or pseudoaneurysms have been reported in the literature during the period 1989-May 1991. Acute and chronic pancreatitis may be the underlying etiologies and the overall mortality rate of this complication is 35.1%. According to the authors experience, angiographic localization of the bleeding sources and steel coil embolization play a key role in the diagnostic and therapeutic approach to what is generally regarded as the most rapidly lethal sequelae of pancreatitis.
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PMID:[Massive pseudocysto-jejunal hemorrhage caused by rupture of pseudoaneurysm of the splenic artery]. 787 70

Acute and chronic pancreatitis present challenging problems for the physician. In acute pancreatitis, initial efforts should be directed toward supporting the patient hemodynamically. Recognition and early treatment of complications such as shock, renal failure, respiratory failure, hypocalcemia, abscess, hemorrhage, or unremitting symptoms caused by an impacted stone in the common bile duct are necessary. The cause of the pancreatitis must be identified, possibly for acute therapy, but certainly to prevent recurrences and progression of disease. In chronic pancreatitis, insufficiencies of pancreatic function must be identified and consequent malabsorption and diabetes treated appropriately. The major challenge is the relief of chronic pain. It is hoped that this can be accomplished medically, but in carefully selected cases, specific types of surgery may be required.
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PMID:Pancreatitis. Evaluation and treatment. 888 42

Acute and chronic pancreatitis remain among the most recalcitrant of all diseases to investigation and intervention. In the majority of patients, excessive alcohol consumption is associated with development of the disease. Therefore, several theories have been proposed seeking to explain the relationship between alcohol and the development of acute and chronic pancreatitis. However, recent investigations in hereditary pancreatitis provided important insights into chronic pancreatitis pathogenesis and offer an important model for understanding pancreatic inflammation. This article highlights several advances gained from investigating hereditary pancreatitis kindreds, and reviews the TIGAR-O risk/aetiology classification system. Finally, the major independent theories on development of chronic pancreatitis are reviewed with respect to the SAPE hypothesis of chronic pancreatitis pathogenesis.
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PMID:Hereditary pancreatitis: a model for inflammatory diseases of the pancreas. 1207 62

Acute and chronic pancreatitis is associated with alcohol abuse, but symptomatic pancreatitis develops in only a small proportion of persons (10-20%) who abuse alcohol. This apparent paradox has led to the notion that additional cofactors are involved in the development of alcoholic pancreatitis. Potential cofactors, such as diet and smoking, have been suggested, but there are no compelling epidemiologic data to support this idea. A number of viruses and some bacteria have been shown to infect the pancreas and produce pancreatitis. One important mediator of pancreatitis in persons with a compromised immune system is a viral infection. The increased susceptibility of immunocompromised persons to viral pancreatitis led to the hypothesis, described in this paper, that the well-known immunosuppression associated with alcohol abuse would result in a more severe viral pancreatitis in mice, which are provided ethanol, than in control animals. To test this hypothesis, C57BL/6 mice were infected with a virulent strain of coxsackievirus B3, which preferentially induces pancreatitis, or with a strain that is naturally avirulent. The study findings presented in this paper show that ethanol consumption alone does not produce pancreas damage but results in a more severe and prolonged pancreatitis after infection with a virulent virus and interestingly, after infection with the avirulent strain of virus. This was associated with an increased number of viruses in the pancreas and spleen, which correlated with decreased humoral immune responses to the virus.
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PMID:Alcoholic pancreatitis: mechanisms of viral infections as cofactors in the development of acute and chronic pancreatitis and fibrosis. 1709 12

Acute and chronic pancreatitis are most frequently caused by a high consumption of alcohol and tobacco but often the aetiology is unknown. The diseases have a high risk of complications, but the long-term prognosis and the natural course of the diseases are only sparsely described. The aims of the study were to investigate the long-term prognosis of acute pancreatitis (AP) and chronic pancreatitis (CP), the risk of progression to CP, and the natural course of progressive acute pancreatitis. Hereby, describe the prognostic factors associated with mortality and the causes of death in these patients. The study was based on the large prospective cohort study - Copenhagen Pancreatitis Study - of patients in the Copenhagen Municipality admitted with either AP or CP fulfilling specific diagnostic criteria and enrolled in the study during 1977 to 1982 and in 2008 followed up by linkage to the Danish registries. Factors associated with mortality in AP patients were high age, alcohol and diabetes, whereas female gender, employment, and co-living were associated with better survival. Level of S-amylase had no impact on the mortality. AP can progress to CP not only from alcoholic but also from idiopathic AP within a mean interval of 3.5 years. The mortality of progressive AP was 5-7 times higher compared with the background population. Patients with definite CP had a 4-fold higher mortality than the background population and patients with a suspicion of CP had twice the mortality compared with the background population. Unlike alcohol and smoking, both non-employment and being underweight had a significant impact on survival in CP patients. In the future, when diagnosing AP, we suggest focusing more on the elimination of differential diagnosis than on the level of S-amylase. The high mortality in progressive AP indicates that patients with risk factors for CP should be followed up. As both AP and CP are multifaceted, treatment for smoking dependency, alcohol dependency, and social and nutritional support is encouraged. More knowledge could be provided by interventional treatment of these four focus areas in patients with AP and CP.
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PMID:Prognosis of acute and chronic pancreatitis - a 30-year follow-up of a Danish cohort. 2112 67

Acute and chronic pancreatitis may lead to complications that prior the recent advancement of therapeutic endoscopy had to be treated with conventional surgery. The current techniques in interventional endoscopy allow us to access the pancreas and treat some of the complications in a minimally invasive way leading to less morbidity in our patients. Approximately 90% of acute pancreatitis episodes are edematous with early resolution of clinical symptoms and rarely leading to major complications. Patients with necrotizing pancreatitis are susceptible to local and systemic complications particularly in the setting of organ failure. On the other hand chronic pancreatitis is as a chronic inflammatory process that leads to fibrosis of the gland and in occasions to exocrine and/or endocrine insufficiency. The main objective of therapeutic endoscopy in chronic pancreatitis is to relief the obstruction and decreases the pressure in the pancreatic duct with the intention to alleviate abdominal pain. In this review we will address the indications and endoscopic techniques to treat the different complications of pancreatitis such as pseudo cyst drainage, walled off necrosis debridement, disconnected duct syndrome and different options for endoscopic therapy in chronic pancreatitis.
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PMID:[Endoscopic management of the complications of pancreatitis]. 2410 77

Acute and chronic pancreatitis carry a significant disease burden and there is no definite treatment that exists for either. They are associated with local and systemic inflammation and lead to numerous complications. Stem cell therapy has been explored for other disease processes and is a topic of research that has gained momentum with regards to implications for acute and chronic pancreatitis. They not only carry the potential to aid in regeneration but also prevent pancreatic injury as well as injury of other organs and hence the resultant complications. Stem cells appear to have immunomodulatory properties and clinical potential as evidenced by numerous studies in animal models. This review article discusses the types of stem cells commonly used and the properties that show promise in the field of pancreatitis.
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PMID:Stem cell therapy: a potential for the perils of pancreatitis. 3272 12