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)

Tumour-associated antigens CA 50 and CA 19-9 were determined in serum of 208 patients. Specificity of both neo-antigens as tumour markers was equally good, at 100% and 95%, in patients without malignancy or gastrointestinal disease, respectively, using an upper limit of normal of 17 U/ml for CA 50 and 37 U/ml for CA 19-9. Benign diseases of the upper gastrointestinal tract, such as pancreatitis, cholestasis or cirrhosis of the liver, reduce the specificity of CA 50 more than of CA 19-9. For example, specificity of CA 50 is only 33% for choledocholithiasis, but 74% with CA 19-9. The sensitivity of both closely related sialogangliosides in malignancies of the upper GI tract is similar, with the usual normal limits: in pancreas carcinoma 77% for CA 50, 81% for CA 19-9; in biliary tract carcinoma 80% for CA 50, 90% for CA 19-9; in gastric carcinoma 40% for CA 50, 50% for CA 19-9. But if one equalizes the upper limits of normal for both markers to a common 95% specificity, the tumour-indicating sensitivity of CA 19-9 clearly surpasses that of CA 50. Malignant tumours not recognized by increased levels of CA 19-9 also escape serological diagnosis with CA 50.
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PMID:[Comparison of CA 50 and CA 19-9 tumor markers in benign and malignant diseases of the upper gastrointestinal tract]. 241 74

Pancreatitis associated with biliary tract operations continues to be an important clinical problem. The results of biliary tract operations performed on 1256 patients were carefully scrutinized for the presence of postoperative hyperamylasemia and pancreatitis persisting after 48 hours. Patients were evaluated in the context of the presence or absence of preoperative pancreatic dysfunction. Similarly, various operative risk factors were evaluated, including cholangiography, choledocholithiasis, common duct exploration, choledochoscopy, choledochoduodenostomy, and sphincteroplasty. Operative cholangiography did not induce postoperative pancreatitis. The incidence of postoperative pancreatitis following cholecystectomy was 0.6%, which was significantly greater than the incidence following common duct exploration (8.4%). Pancreatitis following biliary tract surgery seemed to be not directly related to the performance of choledochoscopy, sphincteroplasty, or choledochoduodenostomy, as it developed with similar frequency in patients undergoing common duct exploration alone. The timing of operative therapy in patients with biliary tract pancreatitis did not significantly alter the frequency with which pancreatitis persisted in the postoperative period. In 970 patients undergoing cholecystectomy, one patient who had preoperative pancreatitis died of postoperative pancreatitis. Of 286 patients undergoing common duct exploration, seven patients died with pancreatitis. In three of these patients there was no active preoperative pancreatitis, and in one of these patients pancreatitis was the cause of death. Four patients with preoperative pancreatitis eventually died of pancreatitis in the postoperative period. Pancreatitis is an important complication of biliary tract disease and operations, and all efforts should be extended to suppress its occurrence and development.
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PMID:Pancreatitis after biliary tract surgery. 243 80

One hundred four consecutive patients with acute gallstone pancreatitis underwent biliary surgery. The relationships between the timing of surgery, the severity of pancreatitis, and the surgical outcome were examined. Patients were divided into three groups according to the timing of surgery and into four groups according to the gross pancreatic pathologic characteristics observed at operation. Patients who underwent surgery early tended to have a higher incidence of common bile duct stones and more severe forms of pancreatitis; however, neither the timing of surgery nor the severity of pancreatitis had a significant impact on surgical outcome. Other factors, such as the level of serum amylase on admission and presence or absence of choledocholithiasis, did not significantly influence the natural history of the disease or the outcome of surgical therapy, whereas advanced age was associated with higher morbidity. Hemodynamic status and the overall condition of the patients were more important than either the timing of surgery or the gross pathologic characteristics of the pancreas in determining surgical outcome. We conclude that the timing of surgery is not a critical factor in the outcome of surgery for acute gallstone pancreatitis. Provided that the patient is stable and has no medical contraindications, surgery on the biliary tract can be performed safely at any time after initial resuscitation of the patient and confirmation of diagnosis.
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PMID:Timing of surgery for acute gallstone pancreatitis. 234 51

Among the patients with acute cholecystitis, those at the age of 20-45 years account for 12.6%. Of them, 50.9% develop complications: choledocholithiasis, obstructive jaundice, cholangitis, pancreatitis etc. The main method for treatment of the patients is the operation within 24-48 hr from the moment of their admission with intraoperative diagnosis of pathology of the extrahepatic bile ducts. There were no lethality, postoperative complications were noted in 9.3% of the patients.
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PMID:[Diagnosis, surgical treatment procedure and results in acute cholecystitis in young patients]. 259 7

An investigation of specific course of the disease in 911 patients operated upon for acute cholecystitis with bilirubinemia has shown that mechanical jaundice resulting from choledocholithiasis takes place in a third of the patients. Obstruction of the bile duct was confirmed in 27.1% of the patients during cholangiography. Prevalence of a number of factors was noted indicating of a toxic lesion of the liver (destructive forms of acute cholecystitis in 81.0% of the patients, higher level of bilirubinemia in long terms of the disease, the presence of coexistent pancreatitis in 30.5%, cholangitis--in 39.3%). An investigation of 207 bioptates of the liver in acute cholecystitis has revealed fatty degeneration of hepatocytes in 56.5%, pericholangitis--in 43.0%, cholestasis--in 21.3% of the cases. The cause of jaundice in acute cholecystitis mainly is an alteration of the hepatic cells due to pyo-resorptive intoxication manifested as cholestasis and hepatitis.
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PMID:[Pathogenesis of jaundice in acute cholecystitis]. 259 23

Based upon 129 endoscopic operations in 98 patients with choledocholithiasis and stenosis of the major duodenal papilla the authors came to a conclusion on an increasing significance of endoscopic papillosphincterotomy (EPST) in the surgery of bile ducts. EPST was shown to be followed by less amount of complications and less lethality as compared with surgical papillosphincterotomy. The intrahospital lethality after EPST was 1%. EPST allowed to elevate efficiency of the treatment in elderly and senile patients. It may be considered as an alternative surgical intervention after preceding cholecystectomy and can be used as an emergency procedure for acute obstructive purulent cholangitis and pancreatitis. In patients with little operative risk and preserved bile duct the indications for EPST must be restricted.
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PMID:[The importance of endoscopic papillosphincterotomy in biliary tract surgery]. 263 48

Endoscopic sphincterotomy is the procedure of choice for choledocholithiasis in patients who have had a cholecystectomy. The bile duct is cleared of stones in about 80 to 90 percent of patients. Available data, largely retrospective, suggest that surgery and endoscopic sphincterotomy are about equal with respect to removal of stones, morbidity, and mortality. Certain technical problems are discussed, including inability to insert the papillotome, the large stone, and problems relating to anatomy such as peripapillary diverticulum and prior gastrectomy. The treatment of patients with bile duct stones who have not had a cholecystectomy, with and without cholelithiasis, is controversial. Endoscopic sphincterotomy without subsequent cholecystectomy is adequate treatment for the majority of patients who are unfit for surgery, even if there are stones in the gallbladder, provided they are asymptomatic after endoscopic removal of stones from the bile ducts. Endoscopic sphincterotomy has been performed in the treatment of gallstone-induced pancreatitis, acute obstructive cholangitis, and sump syndrome. The complication rate for endoscopic sphincterotomy ranges from 6.5 to 8.7 percent, with a mortality rate of 0 to 1.3 percent. The most common serious complications are perforation, hemorrhage, acute pancreatitis, and sepsis.
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PMID:Endoscopic management of bile duct stones. 267 45

The results of a study from 25 centers (= Series I: 1974-1980) covering 9041 endoscopic sphincterotomies (EST) were compared with those of a second study from 20 centers (= Series II: 1981-1986) covering 10177 cases. A change was seen in the indications during the past 5 years: While choledocholithiasis after cholecystectomy remained the main indication, EST is performed with increasing frequency in patients with common bile duct stones having their gallbladder in situ as a definitive method with low complications (only 0.61% emergency cholecystectomies): Circumscript papillary stenosis became quite a rare indication. The success rate of EST because of choledocholithiasis was not improved in spite of new techniques (stone-free common bile ducts in I: 84.06%, in II: 83.97%). The complication rate decreased from 7.55% to 5.04%. Types of complications did not change. Only perforations decreased, the rates of bleeding, cholangitis and pancreatitis remained the same. The mortality diminished from 1.12% to 0.60% (the figures remained twice as high in papillary stenosis than in choledocholithiasis). There was no change in the results of EST during the past 5 years. Follow-up studies using radiological methods show worse results (recurrent stones in II: 21.2%, in I: 5.8%, stenosis of EST in II: 6.1%, in I: 3.1%): Late results of EST because of papillary stenosis are still worse compared to those of choledocholithiasis. Therefore, in spite of increasing experience and introduction of new techniques the method became safer, but the therapeutic results did not appreciably improve.
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PMID:[Quo vadis endoscopic sphincterotomy?]. 272 64

Endoscopic sphincterotomy is the treatment of choice for choledocholithiasis after cholecystectomy. Its role has been expanded to treat choledocholithiasis in patients with gallbladders still in place. The authors report their experience with endoscopic sphincterotomy, with emphasis on the safety of the procedure, in high-operative-risk patients with choledocholithiasis and gallbladder in situ. Stones were successfully removed in 72 of 75 patients (96%); 1 required an emergency operation and 2 an elective one. Complications included bleeding, pancreatitis and cholangitis; there were no associated deaths. Follow-up of 54 of the patients, who had associated cholelithiasis at the time of endoscopic sphincterotomy, showed that 14 died of causes unrelated to the biliary tract. Of the others, 14 underwent cholecystectomy for failure of endoscopic sphincterotomy (2), acute cholecystitis (4) or persistent biliary tract symptoms (8). The other 26 patients were well after a mean follow-up of 30.4 months; 1 had mild biliary tract symptoms. Ultrasonography in 16 of the 26 patients showed persistent cholelithiasis in 12. Life-table analysis revealed a 15% probability of acute cholecystitis within 5 years of endoscopic sphincterotomy.
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PMID:Fate of the gallbladder with cholelithiasis after endoscopic sphincterotomy for choledocholithiasis. 291 Mar 74

The relative indications for operative common duct exploration (CDE) and endoscopic sphincterotomy (ES) in treating common duct stones are often unclear. This prospective study compared CDE and ES in treating choledocholithiasis after excluding patients with acute cholecystitis, idiopathic pancreatitis, sphincter of Oddi dysfunction and malignant disease. One hundred and two patients had 105 CDE and a further 50 patients had 57 ES. Of the patients having CDE, 76 also had cholecystectomy for gall-bladder (GB) disease while 26 had prior cholecystectomy. With ES, in 16 the GB was present and not removed while 34 patients had had prior cholecystectomy. Hospitalization was significantly less following ES. There was one peri-operative death after CDE and none after ES. There were two late biliary-related deaths, 3 and 27 months after ES, in patients who developed acute cholecystitis. In post-cholecystectomy patients having ES, complications were fewer and less severe after ES (15%) than CDE (41%). In patients with an intact GB, peri-operative complications occurred in 30% after cholecystectomy and CDE. Following ES alone, complications occurred in 33% with the majority of these complications arising from the diseased GB. It is concluded that the optimal treatment for post-cholecystectomy patients with bile-duct stones is ES. In elderly patients with an intact GB, the bile-duct stones can be treated by ES; whether subsequent cholecystectomy is necessary should be assessed on the likelihood of future GB complications.
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PMID:Common duct exploration or endoscopic sphincterotomy for choledocholithiasis? 293 Mar 74


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