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

Secondary pancreatic infections are most serious and life threatening complications of acute necrotizing pancreatitis. The risk of secondary infection is to a large extend related to duration and extension of pancreatic or peripancreatic necrosis. The combination of abdominal CT-scan with guided percutaneous needle aspiration has been demonstrated to be highly reliable on differentiating between sterile and infected pancreatic necrosis. Previous results suggest a major role of enteric pathogens in this disease. Due to the type of microorganisms and the defence capacity of the patient, the pancreatic infection might result in either elimination of the microorganism, unlimited propagation within devitalized tissue (infected necrosis) or they may remain localized (abscess formation). Though the most fulminant course of acute pancreatitis is found in patients with early infected necrosis. In these cases an operation is usually necessary within 14 days after onset of symptoms. Persistence or new development of typical symptoms two to five weeks after initial improvement should raise the suspicion of abscess. The finding of infection is an absolute indication for surgical intervention. The intention of surgical treatment in combination with antibiotic therapy is to remove devitalized pancreatic and peripancreatic tissue, evacuate all purulent material and provide continuous drainage either by lavage or "open" abdominal treatment. In this article basic procedures of diagnosis and therapy are discussed.
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PMID:Clinical significance and management of pancreatic abscess and infected necrosis complicating acute pancreatitis. 766 98

Severe pancreatitis may be associated with massive necrosis of the pancreas and/or retroperitoneal adipose tissue. Toxicity results from the dead tissue and secondary infection. A 45 year old patient, while fully immunosuppressed, developed this complication following cadaveric renal transplantation. He survived continued immunosuppression, 16 operative debridements of the retroperitoneum, and maintained a functioning renal transplant. In view of the previously reported high mortality rates from mild pancreatitis after transplantation, the current experience warrants further evaluation of the open method of treatment.
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PMID:Massive necrotizing pancreatitis in an immunosuppressed renal transplant recipient (successful therapy). 826 8

The authors draw attention to the rising incidence of acute pancreatitis, based on their own observations. They present very briefly the last version of the classification of acute pancreatitis, the so-called Atlanta classification of 1992. They summarise methods of conservative treatment of acute pancreatitis which they used as a basis for elaborating their own therapeutic pattern. In the presented group in 1995 19 patients with the diagnosis of acute pancreatitis were treated which was diagnosed based on the clinical condition, biochemical results, US and CT examination of the pancreas. CT examination is considered most important. In three instances acute non-complicated pancreatitis was involved, seven times acute accumulation of fluid in the pancreas and eight times acute necrosis of the pancreas. In 13 men and 6 women the mean age was 54.3 years. As to the aetiology, acute pancreatitis was 9 times of biliary origin, 6 times due to alcohol abuse, twice due to ERCP, once after chemotherapy and in one case the cause was not revealed. All patients with acute necrosis of the pancreas were operate by laparostomy, zip closure was used and repeated surgical revisions were made. Of 19 patients 8 died (all with acute necrosis of the pancreas). In antibiotic prevention of secondary infection of the pancreas in acute pancreatitis cefazoline proved most useful. Aprotinine administration to inhibit proteases is according to the authors effective only during the first 48 hours after the onset of the disease.
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PMID:[Acute pancreatitis--the need for an active approach. Experience in our department]. 896 39

Pancreatic infection by Candida is an infrequent entity. We report two cases and review literature. A 67 year-old woman who was admitted for severe acute pancreatitis of biliary origin developed high fever during fourth week of stay; it was secondary to a pancreatic abscess due to Candida. On the other hand, a 67 year-old man with severe acute biliary pancreatitis and renal insufficiency showed an abscess of similar characteristics that was identified during fourth week of evolution. Both of them recovered completely after surgical drainage and antifungical parenteral treatment. The use of broad spectrum antibiotics recently recommended for prophylaxis of pancreatic infection in patients with necrotizing acute pancreatitis, can favour opportunistic infection by several agents. Pancreatic abscesses by Candida often occurs in patients receiving broad spectrum antibiotics, although it isn't an essential condition. The fact that Candida could be only a contaminant may delay diagnosis and early treatment, and then it can determine a poor outcome. Adequate treatment is urgent surgical drainage associated with antifungical parenteral therapy. Usefulness of antifungic drugs in patients undergoing long term antibiotic prophylaxis for secondary infection must be evaluated.
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PMID:[Pancreatic abscess caused by Candida following wide-spectrum antibiotic treatment]. 963 80

Anecdotal and uncontrolled recommendations for programmatic surgical intervention in necrotizing pancreatitis are gradually being replaced by nonoperative approaches as prospective natural history information becomes available. In patients with sterile pancreatic necrosis, nonoperative managements has now been shown to result in a mortality rate equal or better to surgical debridement. Moreover, since surgical debridement of sterile pancreatic necrosis has not been shown to prevent or ameliorate co-existing organ failure, and given that secondary infection of sterile necrosis occurs as a result of operative debridement in 25% of cases and results in a trebling of mortality risk, it is becoming increasingly clear that surgical debridement in sterile necrotizing pancreatitis will become the exception rather than the rule. However, surgical debridement and drainage remains the preferred approach for infected pancreatic necrosis despite occasional anecdotal reports of successful management by transcutaneous or endoscopic means. While the optimal post-surgical technique of drainage remains controversial, a selective approach is reasonable, with the choice between closed drainage, lesser sac lavage, or schedule re-explorations being based upon extent of the necrotic process.
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PMID:Operative vs. Nonoperative therapy in necrotizing pancreatitis. 1002 26

Death from acute severe pancreatitis results from infection and multiple organ system failure occurring late in the course of illness. Patients with necrotizing pancreatitis involving at least one-third of the organ are at highest risk of secondary infection and death. We conducted a MEDLINE search to identify human trials of prophylactic antibiotics in acute pancreatitis. Results of early studies of prophylactic ampicillin to avoid secondary infection and death were negative, but the studies included patients with mild disease who are at low risk for infection. Antibiotics were beneficial in four recently completed studies: imipenem significantly reduced pancreatic and nonpancreatic sepsis (p< or =0.01); cefuroxime reduced all infectious complications (p<0.01) and deaths (p=0.0284); a regimen of ceftazidime, amikacin, and metronidazole reduced all infectious complications (p<0.03); and protocol use of imipenem significantly reduced pancreatic infection compared with nonprotocol antibiotics (p=0.04) and no antibiotics (p<0.001). Based on these results, we suggest early antibiotic prophylaxis in patients with necrotizing pancreatitis, but the best drug and duration of therapy are unknown.
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PMID:Prophylactic antibiotics for severe acute pancreatitis: the beginning of an era. 1033 22

In the report a new modified technique of complicated pancreatitis treatment by laparostomy was showed. In included the use of ultrasound dissector for removing necrotic tissues and locating of garamycin sponge which should protect against secondary infection. Between January and May 1998 12 patients were treated using this method. In 8 cases (66%) we obtained rapid improvement of patients' general condition. One patient died and in 6 cases postoperative complications occurred. The use of ultrasound dissector shortens time of necrotic demarcation in pancreas and peripancreatic tissues. Garamycin sponge is effective protection from late infections concerning laparostomic wound. Modified laparostomy decreases about 50% number of secondary re-laparostomies, period of hospitalization and cost of complications treatment in acute pancreatitis in comparison with conventional method.
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PMID:[The modified laparostomy with the use of ultrasound dissector and garamycin sponge in the treatment of complicated acute pancreatitis]. 1080 22

Although one third or more of pancreatic pseudocysts might resolve spontaneously, interventional therapy is required for most. Several minimally invasive management approaches are now available, including percutaneous drainage under radiologic control, endoscopic transpapillary or transmural drainage, and laparoscopic internal drainage. This paper reviews the methodology, applications, advantages, shortcomings, and results of these management approaches. A computerized search was made of the MEDLINE, PREMEDLINE, and EMBASE databases using the search words pancreatic and pseudocysts and all relevant articles in English Language or with English abstracts were retrieved. In addition, cross-references from the identified articles were reviewed. Percutaneous drainage is best applied to pseudocysts complicated with secondary infection and in critically ill patients or those unfit for surgery. Radiologic drainage, however, risks the introduction of secondary infection and the formation of an external pancreatic fistula, and is associated with high recurrence rates. Endoscopic transpapillary drainage is beneficial for pseudocysts that communicate with the pancreatic duct and when a dependent drainage could be established. Endoscopic transmural (transgastric or transduodenal) drainage offers good results in the management of suitably located pseudocysts that complicate chronic pancreatitis, but is associated with high rates of failure to drain, secondary infection, and recurrence when pseudocysts that complicate acute necrotizing pancreatitis are approached. Laparoscopic pseudocyst gastrostomy or pseudocyst jejunostomy achieves adequate internal drainage, facilitates concomitant debridement of necrotic tissue within acute pseudocysts, and achieves good results with minimal morbidity. A randomized controlled trial that compares laparoscopic and endoscopic drainage techniques of retrogastric pseudocysts of chronic pancreatitis is required.
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PMID:Minimally invasive approaches to the management of pancreatic pseudocysts: review of the literature. 1471 8

Acute pancreatitis occur after autodigestion of pancreatic tissue with pancreatic enzymes followed by necrosis and secondary infection. Two most common causes are biliary stones and alcoholism. Other causes are rare. Computerised tomography and abdominal ultrasonography are of basic diagnostic value. In early phase of pancreatitis ultrasound of biliary three is important. Urgent intervention with stone extraction can prevent severe forms of pancreatitis. Chronic pancreatitis with its etiology is related to alcohol consumption (70-80%). Other causes are common to acute pancreatitis. Long lasting papillar obstruction could cause chronic inflammatory changes on pancreas. Natural course of disease reduce tissue of gland significantly with maldigestion and malabsorption symptoms. Most common tumor of pancreas is ductal adenocarcinoma with increasing incidence of 10/100,000 per year. Risk factors are: smoking, diabetes mellitus, 65% of cancers are in the head of gland. Treatment is surgical but rarely in early phase that allows radical resectability. Endoscopic palliation is placing of biliary stents. Biliodigestive anastomoses are performed surgically.
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PMID:[Diseases of the pancreas]. 1513 43

This paper was aimed to detect Toll-like receptor 4 (TLR4) microcirculatory expression and localization in rat pancreas and intestine. Acute pancreatitis (AP) was induced by twice injections of cerulein (20 mug in total) and acute necrotizing pancreatitis (ANP) was induced by intraductal injection of 5% taurocholate (1 ml/kg.bw). Reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC) were used to detect and localize TLR4 in the pancreas and intestine. Results showed that RT-PCR of RNA isolated from pancreatic and intestinal tissue yielded the predicted amplicon for TLR4; IHC analysis localized TLR4 expression to the endothelium of pancreatic arteriole, venule, acinar capillary network and sinusoidal capillary of endocrine islet; TLR4 expression in intestine was principally in the microvascular endothelium and leucocytes within the mucosa lamina propria. TLR4 staining in intestine was more intense in taurocholate-induced pancreatitis (TIP) than that in cerulein-induced pancreatitis (CIP). In conclusion, TLR4 could be detected in the pancreatic and intestinal microcirculation, suggesting TLR4 involved in the microcirculatory impairment in AP; the more intense intestinal TLR4 expression in TIP suggests a potential risk for secondary infection.
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PMID:Microcirculatory detection of Toll-like receptor 4 in rat pancreas and intestine. 1654 39


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