Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-edematous pancreatitis and necrotizing pancreatitis. In this respect, laboratory measures like CRP, LDH, and antiproteases, and the application of contrast-enhanced CT are highly sensitive methods. Surgical decision-making should be based on clinical, bacteriological and contrast-enhanced CT data. Persistent or progressive systemic or local organ complications occurring despite ICU treatment for a minimum of three days are indicators for surgical management of necrotizing pancreatitis. Patients suffering from sepsis syndrome, cardiovascular shock, multisystemic organ failure syndrome, or surgical acute abdomen should be treated surgically early in the course of the disease. The use of a major pancreatic resection for the surgical management of necrotizing pancreatitis should be excluded from treatment protocols. Carefully performed necrosectomy or debridement, in combination with continuous or repeatedly applied surgical evacuation techniques for necrotic tissue, bacteria, and biologically active compounds, has proved to be very effective in experienced treatment centers. Necrosectomy and postoperative continuous local lavage is a well-adapted, safe, and atraumatic procedure. It results in a hospital mortality of less than 10% in patients with necrotizing pancreatitis.
 ...
PMID:Surgery in acute pancreatitis. 185 79

For a period of 14 days we carried out measurements for alpha-1-protease inhibitor, alpha-2-macroglobulin, complement C 3, complement C 4, and C-reactive protein in two different groups of patients with acute pancreatitis. Group I consisted of 13 patients with edematous-interstitial pancreatitis and group II of 22 patients with necrotizing pancreatitis. Diagnosis of acute pancreatitis was established by clinical signs and symptoms, by specific pancreatic enzymes determined in the serum, by imaging procedures, and by laparotomy in 24 cases. The overall detection rate for pancreatic necrosis was 90% for the contrast enhanced CT and 33% for ultrasonography respectively. There were significant differences as to all measured serum parameters between the two morphologically defined pancreatitis groups. The necrosis detection rate was 95% for CRP and 85% for alpha-2-macroglobulin. The combined determination of CRP and alpha-2-macroglobulin is recommended in patients with acute pancreatitis to stage the severity of the disease and to probably replace the CT investigation.
 ...
PMID:[Value of biochemical and imaging procedures for the diagnosis and prognosis of acute pancreatitis--results of a prospective clinical study]. 242 94

Known since 1930, C-reactive protein is, as serum amyloid P component its similar, part of acute phase response proteins. Its principals properties are short half-life (6-8 h), great (within 6 hours) and high (X500) rate after injury. It activates the classical complement pathway, leading further to bacterial opsonization. Different biological methods for measurement are described: both nephelometric laser method, most sensible, and agglutination-latex method, most simple and quickest, are chosen. Studies showed us that CRP value is interesting for diagnosis of bacterial infections: among them neonates infections, peri-partum infections, meningitis, pyelonephritis, pancreatitis or peritonitis. CRP value determination seems to be useful also to hold on with patients who keep infectious peril, as in post chirurgical following, neutropenic induced patients. It seemed to be no use for CRP measurement in grafts following. Its rate in inflammatory diseases or myocardial infarcts is just mentioned. The author precognize more determinations of CRP: in emergency laboratories for diagnosis of bacterial infections (agglutination latex method) and in "routine" to follow up the infectious peril.
 ...
PMID:[C-reactive protein: general review and role in the study of infections]. 307 Apr 64

Serum immunoreactive trypsin (IRT) determination has been recommended as a screening test in chronic pancreatitis. Using a commercial radioimmunoassay kit (RIA--gnost Trypsin; Behring-Werke, Marburg/Lahn, FRG) the interassay coefficient of variation was 26--44% for three different test sera. Gel filtration chromatography profiles revealed immunoreactivity in the position of 125I-trypsin and (less than 50%) in the void volume. The test was evaluated in controls (n = 90), chronic relapsing pancreatitis (CRP;n = 60) and after total pancreatectomy (n = 5). In 65% of the CRP cases decreased IRT values were found, whereas during acute attacks of CRP supranormal and normal values were found. After total pancreatectomy IRT levels were undetectable. It is concluded that the sensitivity of this IRT test is limited and that the available test system needs improvement.
 ...
PMID:Trypsin radioimmunoassay in the diagnosis of chronic pancreatitis. 739 44

Acute phase response after endoscopic retrogradic cholangiopancreaticography (ERCP) was studied in 42 patients with suspected pancreatic or biliary diseases. In uncomplicated cases acute phase response determined by serum C-reactive protein levels was rare and did not parallel the serum amylase or lipase levels. In three of the these 42 patients, post-ERCP pancreatitis developed and CRP levels elevated sharply and paralleled the degree of pancreatitis. Six additional patients outside of this prospective study with post-ERCP-pancreatitis and daily CRP determinations were used to determine the CRP-response curve in post-ERCP pancreatitis.
 ...
PMID:Acute phase response in patients with uncomplicated and complicated endoscopic retrogradic cholangiopancreaticography. 753 21

The submitted investigation deals with the value of assessment of selected reactants of the acute stage in patients with acute pancreatitis and their follow-up in the course of the disease. For the investigation C-reactive protein, alpha-1-antitrypsin and haptaglobin were selected. In addition to the prognostic impact the authors focused attention on assessment of the dynamics of individual proteins and their importance for the early detection of complications in acute pancreatitis with different etiologies. The high CRP level on admission of severe cases of pancreatitis--mean 166.9 mg/l (range from 100 to 320 mg/l)--correlated with other signs suggesting severe pancreatitis and the latter was confirmed by computed tomography (CT), surgery or post-mortem examination in 90% of the patients with a CRP level above 100 mg/l. This correlation was not confirmed for alpha-1-antitrypsin or haptaglobin.
 ...
PMID:[Acute phase proteins in acute pancreatitis]. 753 40

In the differential diagnosis of abdominal pain, acute pancreatitis may be diagnosed by its clinical features together with blood determinations and ultrasonographic findings. The primary diagnostic steps include the differentiation between biliary or non-biliary etiology of the disease. In biliary acute pancreatitis, ERCP with endoscopic sphincterotomy is recommended, although the benefit of this procedure has only been shown in patients with severe clinical courses. An early discrimination between edematous-interstitial pancreatitis [mild clinical course] and necrotizing pancreatitis [severe clinical course associated with local and systemic complications] is possible by daily CRP-monitoring. In necrotizing pancreatitis, contrast-enhanced computed tomography is the next diagnostic step, and the patient should be transferred to an intensive care unit. To differentiate between severe sterile pancreatitis and infected pancreatic necrosis, ultrasonographic or CT-guided fine needle aspiration of the pancreatic inflammatory mass is suggested. Infected pancreatic necroses are associated with systemic septic complications, which are the main mortality factor and the major reason for operative treatment of necrotizing pancreatitis.
 ...
PMID:[Acute pancreatitis: diagnosis]. 868 50

The most important diagnostic step in the management of patients with acute pancreatitis is to discriminate between interstitial edematous and necrotizing pancreatitis. Measurement of necroses indicating parameters in the serum, like CRP and PMN-elastase are useful in detecting the necrotizing course of acute pancreatitis. While patients with acute edematous pancreatitis can be treated on a regular ward, patients with a necrotizing course of disease should be treated in the intensive-care unit. Patients with biliary acute pancreatitis should be examined by ERCP with the performance of a papillotomy with stone removal in case of impacted ampullary stones within 24 hours. Surgical decision-making in patients with necrotizing pancreatitis should be based on the development of septic signs due to infected pancreatic necrosis. The information about infected pancreatic necrosis can be easily obtained by a bedside ultrasound-guided fine needle aspiration and bacteriological examination of the aspirate [gram stain plus culture]. Patients without organ complications and with focal necroses should be treated conservatively while patients with persisting organ insufficiencies or progressive multiple organ failure despite maximum intensive care measures are candidates for surgical therapy. The procedure of choice in necrotizing pancreatitis is the careful removal of necrotic tissue [necrosectomy] followed and supplemented by a postoperative regimen for the continuous evacuation of further necrotic debris. For this postoperative therapeutical concept three comparable procedures are available today, the closed continuous lavage, the 'open packing technique' and the management by planned, staged re-laparotomies. Hospital mortality in severe acute pancreatitis has been reduced to less than 15% by these procedures in experienced hands.
 ...
PMID:[Technique and outcome of surgical therapy in acute pancreatitis]. 868 52

Infectious complications are the leading cause of death in acute pancreatitis. Individual factors of immune defence could be of significance, whether or not a patient develops a severe course with infectious complications. In a prospective 5-year trial including 72 patients, we investigated 29 cellular and humoral markers of the body's defence system for their potential to indicate the severity and course of acute pancreatitis. Complement factors C3 and C4 as well as immunoglobulins IgG, IgM and IgA were normal, in general. Measurable levels of IL-1 alpha, IL-1 beta, IL-2 and sIL-2R could be detected only occasionally. Values of alpha 1-AT, TNF-alpha, TNF alpha-Rp75, neopterin, sICAM-1, IL-8, IL-1RA and sIL-6R did not correlate with a severe course. Due to the high magnitude of increase, CRP, IL-6 and granulocyte elastase were the best indicators of the inflammatory process. Delayed-type hypersensitivity response was the only early predictor of a severe course. It was superior over other cellular markers such as monocyte count or CD4+/CD8+ ratio. In vitro function of polymorphonuclear granulocytes (PMN) was not adequate to the severity of the disease already during the first week of illness. During further course, PMN motility and capacities to produce reactive oxygen species even worsened. The compromized PMN function could explain the frequent development of infectious complications in patients suffering from severe pancreatitis. These results should encourage new concepts of infection prophylaxis using stimulants of cellular defence.
 ...
PMID:[Cellular and humoral functions in acute pancreatitis]. 913

Clinically acute pancreatitis is characterized by severe abdominal pain and systemic symptoms, such as nausea, vomiting and circulatory shock. In most cases the diagnosis is verified, and differential diagnoses are excluded, by elevated serum enzyme activities as well as characteristic findings in imaging procedures. The mild form of acute pancreatitis (about 80%) is characterized by an uncomplicated course and recovery within 72 hours in response to adequate therapy. By contrast, severe pancreatitis (about 20%) shows formation of necroses and a protracted course which frequently is dominated by development of systemic complications with subsequent failure of individual or several organ systems. On this background, early discrimination between mild and severe pancreatitis is important for therapeutic management and assessment of prognosis. Several classifications have been suggested in recent years but their use has been limited because they partly depend on complicated multiscoring systems. On the other hand, it has been possible to establish simple severity markers such as serum CRP and PMN-elastase that correlate well with further clinical course and outcome.
 ...
PMID:[Clinical aspects and classification of acute pancreatitis]. 917 95


1 2 3 4 5 Next >>