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

Grey-scale ultrasound scanning (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) were performed in a series of 50 patients with known or suspected pancreatic disease. The impact of the individual tests were assessed in the relevant clinical context. With a maximum of 100, the overall clinical impact score of ERCP (75) exceeded that of CT(63) and US (36). In patients with obscure pain, and in those with relapsing pancreatitis, a combination of US and ERCP provides good clinical guidance. Computed tomography scanning can currently be reserved for documentation of patients with a major mass lesion. None of the techniques can detect early pancreatic cancer, except of the papilla of Vater, where ERCP is diagnostic. Recommendations for future diagnostic strategies may alter as grey-scale ultrasonography and computed tomography develop, and, in any case, depend on many factors including local expertise, availability, and cost.
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PMID:Comparative clinical impact of endoscopic pancreatography, grey-scale ultrasonography, and computed tomography (EMI scanning) in pancreatic disease: preliminary report. 68 May 99

In 260 cytologic examinations of pancreatic juice and gall we were able to make a reliable diagnosis in 75%. 90% of the samples were taken before an ERCP. In the cytogram the cells of the gall passages, of the duodenum, and of the pancreas are easily distinguishable. Degenerative pancreas epithelia appear not only in pancreatitis but also in pancreatic carcinoma. 78% of the cases of pancreatic cancer were cytologically positive. By combining cytological examination with ERCP we can attain a large degree of reliability in the detection of cancer.
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PMID:[Cytodiagnosis of pancreatic juice and gall (author's transl)]. 70 69

Secretory flow rates were measured inside the main pancreatic duct during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer and in controls after intravenous administration of secretin. Peak secretory flow rates in these groups were 5.04 +/- 1.74, 0.71 +/-1.28, 0.60 +/- 1.37, and 4.13 +/- 0.88 ml/min, respectively. Peak secretory pressures were also measured intraductally in patients with acute relapsing pancreatitis and pancreatic cancer and in controls and were 402 +/- 69, 75 +/- 161, and 403 +/- 99 mm pancreatic juice, respectively. Peak secretory flow rates and pressures measured in controls during constant administration of secretin were similar to those measured when secretin was administered as a bolus.
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PMID:Endoscopic measurement of pancreatic juice secretory flow rates and pancreatic secretory pressures after secretin administration in human controls and in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer. 70 39

One hundred thirty-four patients suspected of having pancreas cancer successfully underwent gray scale ultrasound examination of the pancreas. The prospective ultrasound findings were correlated with the final diagnoses, laparotomy findings, and pathology findings. Fifty-four patients had pancreas cancer, confirmed by resection or biopsy in all cases. On ultrasonography, the pancreas was correctly reported to have abnormalities in sixty-one of seventy-eight patients (78 per cent) and correctly reported to have no abnornalities in thirty-eight of fifty-six patients (68 per cent). A correct ultrasound diagnosis of pancreas cancer was made for forty-four of fifty-six patients (81 per cent), and there were thirteen false-positive reports. Ninety-four percent of cancers confined to the head of the pancreas and 70 per cent of cancers at other locations within the gland were detected by ultrasound examination. The correct ultrasound diagnosis was given for fifteen of seventeen patients with resectable pancreas cancer, the degree of associated pancreatitis ranging from minimal to severe. Analysis of the predictive values of positive and negative ultrasound examinations suggests that this test could be used to screen a population of patients with symptoms mildly suggestive of pancreas cancer. The importance of preselecting the level of confidence of a positive test result, a,ove which further investigation is indicated, is emphasized.
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PMID:Prospective evaluation of gray scale ultrasonography in the diagnosis of pancreas cancer. 70 40

A critical "blind" evaluation of 129 randomly selected angiographic examinations was carried out including 37 control patients, 58 patients affected by proven chronic relapsing pancreatitis and 34 patients with cancer of the pancreas. In 48.5% of the control patients a completely normal angiographic picture was found. The false positives were found in 10.8% of chronic pancreatitis and in pancreatic carcinoma in 5.5% of the cases. Equivocal signs were found in 35.2%. The percentage of the false negative results in chronic pancreatitis was 34.4% (of which 8.6% were suggestive of pancreatic cancer). In pancreatic cancer positive results were seen in 70.6% of the cases. The percentage of the false negatives was 26.5% (suggestive of chronic pancreatitis); equivocal signs were found in 2.9% of these patients. Notwithstanding the not-negligible percentage of errors, angiography can be usefully employed in diagnosis of pancreatic disorders.
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PMID:Angiography in chronic pancreatitis and pancreatic cancer. A critical evaluation. 74 14

We undertook to test the recent suggestion that measurement of immunoreactive carcinoembryonic antigen (CEA) in pancreatic secretion may be useful in diagnosis of pancreatic cancer. Using duodenal intubation and a perfusion method in 57 cases, we measured the rate of pancreatic CEA secretion into the duodenum under basal saline perfusion, alone and with continuous intravenous infusion of secretin (2 clinical units per kg per hr) and of cholecystokinin-pancreozymin (CCK, 15 Crick-Harper-Raper units per kg per hr); and we compared the CEA output with secretion of trypsin, lipase, and bicarbonate under the same conditions. Subsequent laparotomy revealed pancreatic carcinoma in 25 patients, pancreatitis in 7, other intraabdominal malignancies in 6, and benign nonpancreatic disorders in 19. CEA output rates did not differentiate all pancreatic-cancer patients from other patients in any test condition. However, pancreatic enzyme outputs were abnormal with almost 90% of cancers of the pancreatic head and with 75% of cancers of the pancreatic body and tail. For detection of pancreatic cancer, enzyme and bicarbonate outputs in response to CCK are more accurate than pancreatic CEA or bicarbonate outputs in response to secretin. Since CCK-stimulated enzyme outputs can be related accurately to malabsorption (not reported here), we prefer them to bicarbonate output for assessment of pancreatic function.
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PMID:Prospective evaluation of the pancreatic secretion of immunoreactive carcinoembryonic antigen, enzyme, and bicarbonate in patients suspected of having pancreatic cancer. 89 42

In 70 patients suspected of having pancreatic cancer, we prospectively compared results of seven diagnostic tests. Subsequent exploration (of 68) and liver biopsy (of two) demonstrated pancreatic cancer in 30, pancreatitis in seven, nonpancreatic neoplasms in nine and nonpancreatic non-neoplastic disease (or no disease) in 24. For detection of pancreatic disease, the best tests were the pancreatic-function test (cholecystokinin-stimulated enzyme outputs) and ultrasonography. The pancreatic scan was nonspecific (P less than 0.001), and thermography was insensitive (P less than 0.001). Endoscopic retrograde pancreatography and arteriography were significantly more sensitive than cytologic study in diagnosis of pancreatic cancer (P less than 0.001). Therefore, when pancreatic cancer is suspected, abdominal ultrasound should be performed first, and if it is negative, a pancreatic-function test next. A positive result from either test warrants an endoscopic retrograde pancreatography for definitive diagnosis. This sequence identified 88 per cent of patients without pancreatic disease and 89 per cent with pancreatic cancer.
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PMID:A prospective comparison of current diagnostic tests for pancreatic cancer. 89 3

We have developed a canine model which allows simultaneous quantification of pancreatic enzyme outputs, duodenal volume flow, and pancreatic and duodenal pressures under physiological circumstances. Twelve studies on 4 conscious healthy dogs demonstrated that mean fasting pancreatic pressure was 5 to 10 cm H2O higher than mean fasting duodenal pressure. Furthermore, 8 min after ingestion of a meal, both the pancreatic and the duodenal pressure increased. Surprisingly, the mean duodenal pressure was higher than the mean pancreatic pressure 20 min after feeding. This relationship lasted for 30 min. Lastly, elevation of postprandial pancreatic pressure occurred concomitantly with increased pancreatic enzyme output, and duodenal pressure increased with increased duodenal volume flow. The observed large postprandial duodenal volume flows associated with duodenal pressures greater than pancreatic duct pressures may favor reflux of duodenal contents into the pancreatic duct. These relationships may be important in the pathogenesis of postprandial pancreatitis and in the induction of pancreatic cancer.
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PMID:Relationships between fasting and postprandial pancreaticoduodenal pressures, pancreatic secretion, and duodenal volume flow in the dog. 90 81

Thirty-three patients with pancreas divisum studied by endoscopic retrograde cholangiopancreatography (ERCP) are described. Documented pancreatitis was present in fifteen patients, and another eleven had recurrent episodes of pain typical of pancreatitis. The major papilla was cannulated in all patients, but the duct of Wirsung was opacified in only twenty-eight and showed changes of pancreatitis in one. Attempts were made to cannulate the minor papilla in fifteen of the thirty-three patients and were successful in four. The duct of Santorini showed typical changes of pancreatitis in one. One patient had pancreatic cancer, and the duct of Wirsung demonstrated only nonspecific abnormalities. In only two cases was pancreatitis due to alcohol abuse. The high incidence of pancreatitis and pancreatic-like pain in patients with pancreas divisum, may be due to the very small ampulla of the duct of Santorini which in these patients drains the majority of the pancreas, creating a marked relative stenosis of the ampulla. Surgery for relief of pain was required in five patients. The operation of choice, when pancreatitis involves the dorsal pancreas, appears to be distal resection with drainage.
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PMID:Pancreas divisum: its association with pancreatitis. 92 Aug 76

In a prospective study for the diagnosis of pancreatic cancer, ultrasonography, radionuclide scanning, selective arteriography, and endoscopic retrograde cholangiopancreatography (ERCP) were compared. Eighty-nine consecutive patients were investigated; 58 underwent laparotomy, and 36 were found to have periampullary cancer; seven had other malignant tumors within the abdomen, and nine had pancreatitis on biopsy. Five had other benign disease, and there was one negative laparotomy. Thirty-one patients who did not have laparotomy have shown no evidence of cancer at one year follow-up. Ultrasonography was found to be more reliable than scan or arteriography in the detection and diagnosis of a mass in the pancreas. ERCP achieved the highest rate of correct definitive diagnosis.
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PMID:Comparative value of four methods of investigating the pancreas. 96 35


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