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)

A total of 144 gray-scale sonograms were obtained in 110 children to evaluate the pancreas. The entire gland was adequately visualized in just over 86% of cases. The size, contour, echo pattern, and echo intensity were assessed. Either diffuse or focal enlargement of the pancreas was the most consistent finding in the 25 children with pancreatitis. In contrast to previous reports, decreased echo intensity was not a reliable indicator of inflammation. Numerous complications were detected on the 54 sonograms of these 25 patients. These complications included pseudocysts, lesser sac fluid collections, ascites, biliary obstruction, and hemorrhage. It is recommended that ultrasound be the initial imaging procedure in the evaluation of children with suspected pancreatic disease, and that it be used in conjunction with clinical and biochemical data.
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PMID:Gray-scale sonographic assessment of pancreatitis in children. 684 36

A total of 40 patients with pancreatitis had associated extrahepatic biliary obstruction. Eighteen had biliary-induced pancreatitis. Comprehensive correction of the biliary tract disease, including cholecystectomy, common duct exploration and, when indicated, transduodenal sphincteroplasty, resulted in a high recovery rate (83%) with no recurrence of pancreatitis. Twenty-two patients had chronic pancreatitis with involvement of the terminal biliary tract by a long tapering stenosis. Nineteen of these patients had chronic fibrocalcific pancreatitis secondary to chronic alcohol abuse. In five patients, the stenosis produced a high grade obstruction which required biliary bypass with choledochoduodenostomy (four) or cholecystoduodenostomy (one). The remaining 14 patients maintained patency of the biliary tract following correction of the underlying pancreatic pathology. The latter consisted of drainage (nine) or resection (five) of 14 associated pseudocysts (present in 64% of the 22 patients), combined with side-to-side pancreaticojejunostomy to decompress an obstruction of the major pancreatic duct. In assessing the degree of terminal bile duct stenosis, calibration of the duct with Bakes dilators or rubber catheters was a useful aid. Two of the 22 patients ultimately proved to have carcinomas, producing obstruction of the pancreatic duct in the head of the gland. Both were treated initially with choledochoduodenostomy. This possibility must be considered in the management of these patients.
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PMID:Extrahepatic biliary obstruction associated with pancreatitis. 685 77

Despite the careful observance of standard precautions during endoscopic sphincterotomy, serious complications are sometimes unavoidable and these may require various forms of treatment. Surgical intervention is necessary for fulminating pancreatitis, acute arterial hemorrhage, and retroperitoneal abscess. The endoscopic insertion of a drainage tube into the common bile duct can serve to overcome biliary obstruction due to cholangitis secondary to stone impaction, Dormia basket impaction or blood clot. The obstruction can be removed electively either endoscopically or surgically in a symptom-free interval. Uncomplicated perforation can be treated by parenteral feeding and naso-gastric suction. Acute pancreatitis may require further intensive care procedures such as peritoneal or hemodialysis and early intermittent positive pressure respiration. By using these means the mortality rate due to ES is reduced to 0.5%.
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PMID:Complications of endoscopic sphinecterotomy and their treatment. 727 68

Although obstructive jaundice in pancreatic inflammatory disease is being recognized with increased frequency, duodenal obstruction is thought to be unusual. The occurrence of both duodenal and biliary obstruction suggests pancreatic cancer, and has seldom been described in pancreatitis. We report three patients with combined duodenal and biliary obstruction occurring as a complication of chronic pancreatitis. Distinction from carcinoma by barium study or laboratory results alone was not possible; instead, it depended on studies of the common bile duct, exploratory laparotomy in two patients, and follow-up in all three.
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PMID:Duodenal and common bile duct obstruction in pancreatitis simulating carcinoma. 727 92

Common bile duct stricture secondary to chronic pancreatitis is difficult to detect clinically. Surgical bypass is necessary if complications from biliary obstruction develop. In 21 patients operated on between 1968 and 1979, the earliest typical biochemical finding was a persistently elevated serum alkaline phosphatase level. The SGOT level was minimally elevated in seven patients, but did not correlate with changes in the stricture. An increased bilirubin level was noted either during an acute exacerbation of pancreatitis or late in the course of the stricture development, when obstruction was almost complete. Operative cholangiograms taken in 12 of these patients and transhepatic cholangiograms taken in nine demonstrated a stricture of the intrapancreatic bile duct more than 2 cm long. Operations were performed for treatment of obstructive jaundice (11), ascending cholangitis (three), suspected pancreatic cancer (three), and progressive biliary cirrhosis (two). Sphincteroplasty, initially attempted in four patients, uniformly failed to relieve the obstruction due to the length of strictured duct. Satisfactory drainage was obtained for up to ten years with choledochoduodenostomy (12), choledochojejunostomy (three), and cholecystojejunostomy (six).
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PMID:Common duct stricture from chronic pancreatitis. 737 60

Choledochoduodenostomy, choledochojejunostomy, or sphincteroplasty are used in the treatment of selected patients with retained, recurrent, and impacted bile duct stones; strictures of the bile ducts; stenosis of the sphincter of Oddi; pancreatitis associated with biliary disease; choledochal cysts; fistulas of the bile duct; and biliary obstruction, either benign or malignant. From a group of approximately 1600 patients operated on for biliary and pancreatic disease during the 17-year period, 1962 to 1979, 153 patients who had choledochoduodenostomy, choledochojejunostomy or sphincteroplasty were identified. Follow-up information was available for 146 patients (95%). Overall, 84% of the patients had good results, 10% had fair results, and 3% had poor results. A 3% postoperative mortality rate was found, all in patients with unresectable malignancies. Treatment of bile duct obstruction, benign or malignant, was equally effective by choledochoduodenostomy or choledochojejunostomy. Jaundice resolved in all patients; three patients with benign strictures required reoperations for recurrent stricture formation, two after choledochoduodenostomy, and one after choledochojejunostomy. Recurrent cholangitis heralded the development of another stricture. Both choledochoduodenostomy and sphincteroplasty were used for patients with retained, recurrent or impacted duct stones. Pancreatitis did not occur in any patient after sphincteroplasty; the sump syndrome was not seen after choledochoduodenostomy. This review supports the view that choledochoduodenostomy is a safe and effective procedure. All three operative procedures were effective for the problems for which they were used; each procedure has a place in the treatment of recurrent or complicated biliary and pancreatic diseases. The procedures are complementary, not competitive. For certain problems, the operation performed depends upon the surgeon's preference and experience. The indications for and results of these operative procedures are discussed.
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PMID:Choledochoduodenostomy, choledochojejunostomy or sphincteroplasty for biliary and pancreatic disease. 746 51

We investigated the diagnostic utility of frequent serial determinations of aspartate aminotransferase, alanine aminotransferase (ALT), lipase, amylase, and the lipase/amylase (L/A) ratio for distinguishing patients with acute pancreatitis due to biliary obstruction from those with acute pancreatitis due to other pathogenesis. Analyzed were enzyme activities obtained at admission and peak enzyme activities identified retrospectively from serial measurements in 53 patients with acute pancreatitis due to various causes. We evaluated the data with multiple statistical tools. Discriminant analysis and logistic regression revealed the diagnostic significance of ALT at initial and peak values, and the maximum information provided by peak ALT was confirmed by both logistic regression and stratum-specific likelihood ratios. Stratum-specific likelihood ratios showed peak ALT > 150 U/L was highly diagnostic of biliary pancreatitis. The L/A ratio, either at admission or at peak, was the only other significant variable for identifying patients with acute pancreatitis due to biliary obstruction. A multivariate logistic discriminant function including ALT and the L/A ratio significantly discriminated biliary acute pancreatitis from pancreatitis due to other causes. Evaluation of initial and peak enzyme data by information theory revealed that the optimal test depended on disease prevalence. Initial ALT activities were the test of choice for identifying biliary pancreatitis, up to a disease prevalence of approximately 0.75. At disease prevalence > 0.75, the initial L/A ratio provided the greatest amount of diagnostic information.
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PMID:Enzymatic markers of gallstone-induced pancreatitis identified by ROC curve analysis, discriminant analysis, logistic regression, likelihood ratios, and information theory. 753 44

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

During a 48 month period to December 1990, 367 patients, median age 75 years, with obstructive jaundice caused by common bile duct stones (201), malignant biliary obstruction (148), and benign biliary strictures (18), underwent therapeutic endoscopic retrograde cholangiopancreatography. Endoscopic biliary stenting and drainage was achieved in 343 of 367 patients attempted (93%), seven patients requiring a combined percutaneous endoscopic approach. Endoscopic stenting failed in 24 patients because of malignant duodenal infiltration (10), Billroth 2 gastrectomy (6), tight and extensive biliary strictures (6), peripapillary diverticulum (1), and technical failure (1). Prolonged follow up was available in 91% (311 of 343). The 30 day mortality was 5% (17 of 343), which included two procedure related deaths (0.6%) from fulminant pancreatitis and major sphincterotomy site bleeding. Early complications occurred in 14% (48 of 343) and late complications occurred in 11.9% (35 of 294) patients, as of the original 343, 17 had died within 30 days and another 32 were lost to follow up. Eighty patients with incomplete bile duct clearance and eight patients with benign biliary strictures had biliary stents inserted for 12-48 months (median 30). Endoscopic biliary stenting services are necessary in a district general hospital with technical success, death and morbidity rates comparable to other studies.
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PMID:Endoscopic biliary stenting in a district general hospital. 755 82

A prospective randomized trial was undertaken to determine if selective peroperative cholangiography resulted in greater morbidity and mortality from missed common bile duct (CBD) stones. Five hundred and thirty-nine consecutive cholecystectomies were performed over a 3-year period. Two hundred and fifty-four had indications for mandatory peroperative cholangiography and were excluded from the trial. The remaining 285 patients, without a history of jaundice, pancreatitis or abnormal liver function tests, were randomized blindly into two groups. Group 1 underwent peroperative cholangiography (PC) and group 2 did not. If the surgeon found a dilated CBD at surgery then these patients were also excluded from the trial. Selective peroperative cholangiography revealed an unsuspected CBD calculus in 16 of the 132 patients (12%). Up to the time of review no patient from group 2 presented with symptoms or complications from retained CBD stones. One patient in group 1 had endoscopic removal of a retained CBD calculus 16 months after cholecystectomy. All patients were sent a questionnaire at least three years after surgery and 210 responded (74%). One hundred and thirty (62%) of the respondents had peroperative cholangiography. There were 11 deaths from unrelated causes. No difference between the two groups was found for postoperative dietary habit, dyspepsia, pain, flatulence, diarrhoea or signs of biliary obstruction. It seems from these results that a policy of selective cholangiography in our hands may miss a 12% incidence of unsuspected stones but, importantly, this does not appear to influence postoperative morbidity or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Does selective peroperative cholangiography result in missed common bile duct stones? 769 32


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