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

Autoimmune pancreatitis is a rare type of pancreatitis that is characterized by diffuse swelling of the pancreas and irregular stenosis of the pancreatic ductal system ("sclerosing" pantreatitis), caused by autoimmune processes. Previous reports have shown the complete form of the disease, but very few have presented follow-up imagings from the beginning to the complete form. We, herein, report a case of autoimmune pancreatitis starting as a localized form. A-56-year-old Japanese man developed obstructive jaundice. Ultrasonography showed a hypoechoic mass in the head of the pancreas, and endoscopic retrograde pancreatography (ERP) showed localized stenosis of the pancreatic duct in the head of the pancreas. Computed tomography (CT) showed enlargement, with a capsule-like rim, in the head of the pancreas. Internal biliary tube drainage was performed to relieve the obstructive jaundice. The patient was followed-up under the tentative diagnosis of localized "mass-forming" pancreatitis. Four months after the drainage, CT showed diffuse swelling of the pancreas, with a capsule-like rim, and ERP demonstrated diffuse irregular narrowing of the pancreatic duct. Glucose intolerance was noted for the first time. Steroid was given as a diagnostic treatment for autoimmune pancreatitis. Two months after initiation of the steroid treatment, the ERP findings were normal, and CT showed a normal pancreas. The biliary tube was removed, and the glucose intolerance was subsequently alleviated. To summarize, we report a case of autoimmune pancreatitis starting as localized "mass-forming" pancreatitis with a peripheral rim on imagings. It is very important to be well aware of the presence of the localized form of autoimmune pancreatitis.
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PMID:Autoimmune pancreatitis starting as a localized form. 1187 65

Tropical pancreatitis is an uncommon cause of acute, and often chronic, relapsing pancreatitis. Patients present with abdominal pain, weight loss, pancreatic calcifications, and glucose intolerance or diabetes mellitus. Etiologies include a protein-calorie malnourished state, a variety of exogenous food toxins, pancreatic duct anomalies, and a possible genetic predisposition. Chronic cyanide exposure from the diet may contribute to this disease, seen often in India, Asia, and Africa. The pancreatic duct of these patients often is markedly dilated, and may contain stones, with or without strictures. The risk of ductal carcinoma with this disease is accentuated. Treatment may be frustrating, and may include pancreatic enzymes, duct manipulations at endoscopic retrograde cholangiopancreatography, octreotide, celiac axis blocks for pain control, or surgery via drainage and/or resection.
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PMID:Tropical pancreatitis. 1208 Feb 28

As an example of iatrogenic diabetes, we discuss the problem of diabetes mellitus in patients receiving atypical antipsychotics. The risk of diabetes mellitus appears to be different according to various molecules with, by decreasing order, clozapine, olanzapine, risperidone and quetiapine, and finally amisulpride, aripiprazole and ziprasidone. A careful analysis of published case reports and series indicates the existence of two different problems: 1) the rather common development of impaired glucose tolerance or diabetes mellitus (often associated with metabolic syndrome) related to weight gain in individuals at risk for type 2 diabetes; and 2) the occurrence of rare cases of acute metabolic episodes with severe ketoacidosis and/or pancreatitis whose pathophysiological mechanisms remain largely unknown. Generally speaking, the pathophysiology involves both increased insulin resistance and deficient insulin secretion. Cautious metabolic monitoring of patients receiving atypical antipsychotics is recommended, and the selection of the appropriate drug should be influenced by the metabolic profile of the various molecules and the metabolic risk of the patients who should be treated with atypical antipsychotics.
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PMID:[Drug-induced diabetes mellitus: the exemple of atypical antipsychotics]. 1603 11

Diabetes mellitus (DM) as part of chronic pancreatitis (ChP) belongs into the group of secondary DM with typical insulin deficiency. The prevalence and incidence of DM in ChP depends on the selected diagnostic criteria, geographical conditions and duration and grade of pancreatitis. Based on our findings during a 15-year investigation of impaired glucose tolerance and insulin secretion in patients with ChP the authors submit some partial (published and unpublished) results. The largest investigated group were 122 patients with ChP diagnosed according to the morphological appearance during ERCP. The authors detected a mutual close relationship between the extent of morphological damage of the efferent system of the pancreas on one hand and impaired glucose metabolism and endogenous insulin secretion on the other hand. It was revealed that values of C-peptide are in patients with ChP and normal glucose tolerance significantly lower as compared with the healthy population, and in patients with ChP and DM they are significantly lower as compared with non-obese type 2 diabetics. With the persistence of ChP the C-peptide levels decline gradually and the incidence of diabetes increases but even when DM persists in ChP C-peptide does not reach zero values as in type 1 DM. For detection of diabetes in ChP assessment of the fasting blood sugar level does not suffice and an oral glucose tolerance test must be made.
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PMID:[Diabetes mellitus associated with chronic pancreatitis]. 1673 34

On July 24, 2006, the U.S. Food and Drug Administration granted approval to pegaspargase (Oncaspar; Enzon Pharmaceuticals, Inc., Bridgewater, NJ; hereafter, O) for the first-line treatment of patients with acute lymphoblastic leukemia (ALL) as a component of a multiagent chemotherapy regimen. O was previously approved in February 1994 for the treatment of patients with ALL who were hypersensitive to native forms of L-asparaginase. The trial supporting this new indication was an open label, randomized, multicenter clinical trial that enrolled 118 children (age, 1-9 years) with previously untreated, standard risk ALL. Patients received either native Escherichia coli asparaginase (Elspar; Merck, Whitehouse Station, NJ; hereafter, E) or O along with multiagent chemotherapy during remission induction and delayed intensification (DI) phases of treatment. O, at a dose of 2,500 IU/m(2), was administered i.m. on day 3 of the 4-week induction phase and on day 3 of each of two 8-week DI phases. E, at a dose of 6,000 IU/m(2), was administered i.m. three times weekly for nine doses during induction and for six doses during each DI phase. This study allowed direct comparison of O and E for asparagine depletion, asparaginase activity, and development of asparaginase antibodies. An unplanned comparison of event-free survival (EFS) was conducted to rule out a deleterious O efficacy effect. Following induction and DI treatment there was complete (</=1 microM) or moderate (1-10 microM) depletion of serum asparagine levels in the large majority of samples tested over the 4-week period in both O-treated and E-treated subjects. Similarly, depletion of cerebrospinal fluid asparagine levels during induction was similar between O-treated and E-treated subjects. The number of days asparaginase activity exceeded >0.03 IU/ml in O-treated subjects was greater than the number of days in E-treated subjects during both the induction and DI phases of treatment. There was no correlation, however, between asparaginase activity and serum asparagine levels, making the former determination less clinically relevant. Using the protocol-prespecified threshold for a positive result of >2.5 times the control, 7 of 56 (12%) O subjects tested at any time during the study demonstrated antiasparaginase antibodies and 16 of 57 (28%) E subjects tested at any time during the study had antiasparaginase antibodies. In both study arms EFS was in the range of 80% at 3 years. The most serious, sometimes fatal, O toxicities were anaphylaxis, other serious allergic reactions, thrombosis (including sagittal sinus thrombosis), pancreatitis, glucose intolerance, and coagulopathy. The most common adverse events were allergic reactions (including anaphylaxis), hyperglycemia, pancreatitis, central nervous system thrombosis, coagulopathy, hyperbilirubinemia, and elevated transaminases. Disclosure of potential conflicts of interest is found at the end of this article.
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PMID:FDA drug approval summary: pegaspargase (oncaspar) for the first-line treatment of children with acute lymphoblastic leukemia (ALL). 1776 59

Research into the clinical management of acute pancreatitis has primarily focused on the immediate complications of the disease, whereas its late consequences have received less attention. These late sequelae of acute pancreatitis refer to complications that arise after the convalescence period, which lasts for 3-6 months after the initial episode. In patients who do not undergo necrosectomy that involves removal of the exocrine gland, pancreatic exocrine function usually improves rather than deteriorates during follow-up. By contrast, glucose intolerance is likely to worsen over time in all patients with acute pancreatitis. Despite the risk of late complications for patients with acute pancreatitis, their long-term quality of life is usually good. The number of pancreatitis episodes a patient has experienced is an important factor that determines the severity of late complications of acute pancreatitis. Risk factors for the recurrence of acute pancreatitis episodes have now been identified. This Review focuses on data from studies that investigated the risk factors for recurrent attacks of acute pancreatitis, and discusses the late consequences of this disease.
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PMID:Acute pancreatitis: risk of recurrence and late consequences of the disease. 1958 5

A 65-year-old man with myelodysplastic syndrome (MDS) was admitted for progressive jaundice. Diffuse pancreatic swelling and stricture of the main pancreatic duct were observed with elevated serum levels of direct bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, gammaGTP and amylase, and impaired glucose tolerance. Serum IgG and IgG4 levels were highly elevated, and both the direct antiglobulin test and platelet-associated IgG were positive. He was diagnosed with autoimmune pancreatitis associated with MDS, and biliary drainage followed by immunosuppressive therapy ameliorated the jaundice and laboratory findings. In addition to diffuse pancreatic FDG accumulation, fine incorporations of FDG to the lachrymal and submandibular glands were demonstrated, suggesting the recently proposed IgG4+ multiorgan lymphoproliferative syndrome (MOLPS). The etiology of IgG4+ MOLPS is still unknown; however, autoantibodies to blood cells in this case suggested that the autoimmune mechanism, which is caused by abnormal immune functions in MDS patients, might be involved in the pathogenesis of IgG4+ MOLPS.
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PMID:Autoimmune pancreatitis associated with myelodysplastic syndrome. 1975 71

Total pancreatectomy may be the only treatment option that relieves pain and tissue destruction for patients with chronic pancreatitis, but this procedure causes surgically induced diabetes, which is difficult to manage because of the absence of insulin-producing beta cells. Some patients may benefit from autologous islet cell reimplantation, a procedure that involves collecting and purifying the islets of Langerhans from the patient's own resected pancreas and reinfusing them into the patient via the portal vein. Typically, candidates for this procedure are younger adults with nondilated pancreatitis that has yet to develop into glucose intolerance. Islet cell transplantation success varies and is directly related to the quality and quantity of the patient's pancreas and the damage caused by the chronic pancreatitis.
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PMID:Preventing surgically induced diabetes after total pancreatectomy via autologous islet cell reimplantation. 2067 6

Pancreatic cancer, although infrequent, has a very poor prognosis, making it one of the 4 or 5 most common causes of cancer mortality in developed countries. Its incidence varies greatly across regions, which suggests that lifestyle factors such as diet, and environmental factors, such as vitamin D exposure, play a role. Because pancreatic cancer is strongly age-dependent, increasing population longevity and ageing will lead to an increase of the global burden of pancreatic cancer in the coming decades. Smoking is the most common known risk factor, causing 20-25% of all pancreatic tumors. Although a common cause of pancreatitis, heavy alcohol intake is associated only with a modest increased risk of pancreatic cancer. While viruses do not represent a major risk factor, people infected with Helicobacter pylori appeared to be at high risk of pancreatic cancer. Many factors associated with the metabolic syndrome, including overweight and obesity, impaired glucose tolerance, and long-standing diabetes also increase the risk disease, while atopic allergy and use of metformin as a treatment for diabetes have been associated with a reduced risk of pancreatic cancer. A family history of pancreatic cancer is associated with an increased risk of pancreatic cancer and it is estimated that 5-10% of patients with pancreatic cancer have an underlying germline disorder. Having a non-O blood group, another inherited characteristic, has also been steadily associated with an increased risk of pancreatic cancer. While many risk factors for pancreatic cancer are not modifiable, adopting a healthy lifestyle could substantially reduce pancreatic cancer risk.
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PMID:Epidemiology of pancreatic cancer: an update. 2108 17

Cystic dystrophy of duodenal wall and duodenal dystrophy (DD)--is a rare disease which is based on chronic inflammation of the pancreas tissue (PT), malrelated in the wall of the duodenum (DU). The principal method of surgical treatment of this disease is Pancreaticoduodenectomy (PRD), although it was presented several reports of successful use sandostatin or endoscopic treatment in some patients. Analysis of demographic, clinical and instrumental data, methods of surgical treatment of DD showed that all patients with persistent or recurrent abdominal pain was noted in all patients, weight loss--51%, vomiting--at 26%, jaundice--in 20% of patients. The most accurate diagnostic methods were CT, endo-ultrasound and MRI. The diagnosis of duodenal dystrophy installed in 35 patients. Operations were performed on 22 patients: Implemented PRD (10), removal of pancreatic head resection with a vertical branch of the PT and duodenoduodenoanastomosis (2), pancreatic head resection with excision of the cyst wall of the first portion of duodenum (2), gastric resection (1), resection of the vertical branch of the duodenum with duodenoduodenoanastomosus (2), duodenectomia (1) and resection of the vertical branch of the duodenum with reconstruction of the intestinal insert (2). Four patients fulfilled draining intervention on pancreatic ductal system--pankreatico and cystoenteroanastomoses. Postoperative and late mortality--0.77% of patients the disappearance of pain and 23%--a decrease in its intensity. In two cases, after the PRD against the background of pronounced chronic pancreatitis observed impaired glucose tolerance. Cystic dystrophy of duodenal wall without the expressed "orthotopic" pancreatitis clearly shows pathogenetic, clinical, diagnostic and therapeutic aspects of this disease, causing the possibility of an effective surgical treatment, only limited intervention by the KDP, without resection of the pancreas.
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PMID:[Diagnosis and treatment of cystic forms of duodenal dystrophia]. 2126 28


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