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

The incidence of severe acute pancreatitis is about 30 cases per 100,000 inhabitants, and it carries an overall mortality rate of 10-15%. Infection of pancreatic necrosis occurs in 20-30% of patients with severe acute pancreatitis and triples the mortality rate. Therefore, early prediction and diagnosis of infection in necrotizing pancreatitis are extremely important. The aim of the studies included in this review was to investigate the potential of specific prognostic factors to predict the development of secondary pancreatic infection in severe acute pancreatitis. This is seen as an important tool allowing to perform a computed tomography- or ultrasound-guided fine needle aspiration for bacteriological sampling at the right moment, to confirm the diagnosis, and, finally, to select the subgroup of patients who would benefit from the antibiotic prophylaxis. Precise patients' selection could possibly result in more rational use of antibiotics in patients with acute necrotizing pancreatitis and reduction of multi-resistant bacteria. Recent studies show that C-reactive protein is an important prognostic marker of pancreatic necrosis with the highest sensitivity and negative prognostic value in this respect. Procalcitonin alone or in combination with interleukin-6 best identifies patients not at risk for infection. However, a review of the clinical studies suggests that we still do not have an optimal model, thus there is a need for new more reliable biochemical and/or clinical predictive systems.
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PMID:Predicting development of infected necrosis in acute necrotizing pancreatitis. 1681 37

Twenty to thirty percent patients with acute pancreatitis develop severe acute pancreatitis with high mortality and morbidity rate. Markers of severity of acute pancreatitis are clinically important for the early diagnosis of complications. We reviewed the literature for markers of acute pancreatitis. On their relevance for prediction of severe pancreatitis are given. Several markers can predict severe cases of acute pancreatitis with a different positive and negative predictive value. Useful predictors of severity may include serum procalcitonin and urinary trypsinogen activation peptide at the admission, serum interleukins-6 and -8 at 24 h, and serum C-reactive protein (CRP) in 48 hours interval. The valuable marker for daily monitoring appears to be serum procalcitonin.
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PMID:[Prediction and monitoring of severe acute pancreatitis]. 1683 94

Retrospective analysis of 99 consecutive cases of acute severe pancreatitis established presence of systemic inflammation in all patients. Magnitude of acute phase response was characterised by C-reactive protein and Interleukin-6 values. Progression to multiple organ failure raised considerably lethality. Failure developed more frequently in respiratory system, liver and kidneys. General mortality was 38,4%.
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PMID:[Sepsis in acute severe pancreatitis]. 1692 13

The aim of this study was to prospectively analyze the possible association of delayed gastric emptying and postoperative pancreatic complications after pancreaticoduodenectomy. Although hospital mortality after pancreaticoduodenectomy is minimal, morbidity is still high; delayed gastric emptying is one of the most frequent complications. Thirty-nine consecutive patients undergoing pancreaticoduodenectomy were included in this study: 14 females and 25 males (median age 65 years; range, 7-82). Delayed gastric emptying was defined as the need for a nasogastric tube or recurrent vomiting that prevented normal feeding on the 10th postoperative day. Blood analysis was performed on postoperative days 4, 6, and 10; Gastrografin examination on day 6; CT scan on days 2 and 5; and drain amylases were measured on day 5. Pancreatitis was defined as pancreatitis changes in CT scan interpreted by an experienced radiologist without knowing other data. Pancreatic fistula was defined according to the recent international recommendations. We had no mortality. Twelve patients (31%) developed delayed gastric emptying. Surgical (9/12 vs. 5/27; P = 0.001) but not medical complications occurred more often in the delayed gastric emptying group. Of the single complications, postoperative CT-detected pancreatitis (6/12 vs. 4/27; P = 0.03) and postoperative pancreatic fistula (5/12 vs. 1/27; P = 0.0007) were significantly associated with delayed gastric emptying compared with the patients without delayed gastric emptying. This pancreatitis was already detected in CT scan on day 2 in most patients (6/10, 60%). In delayed gastric emptying patients, the only parameters in blood analysis that differed significantly from patients without this complication were serum amylase activity (mean +/- SEM, 715 +/- 205 vs. 152 +/- 70 IU/L; P = 0.02), blood leukocyte count (16 +/- 2 vs. 9 +/- 0.6 x 10(9)/L; P = 0.007) and serum C-reactive protein (CRP) concentration (144 +/- 28 vs. 51 +/- 14 mg/L, P = 0.01). Postoperative pancreatic (subclinical) fistula was also associated with postoperative pancreatitis (6/10 vs. 0/29; P = 0.003). Preoperative coronary artery disease (OR = 16; 95% CI, 1.0-241; P = 0.05) and soft pancreatic texture at operation (OR = 9; 95% CI, 1.4-52; P = 0.02) were significant risk factors for the development of postoperative pancreatitis. The diagnosis of delayed gastric emptying after pancreaticoduodenectomy often follows postoperative pancreatitis. Delayed gastric emptying is also associated with postoperative pancreatic fistula, for which this pancreatitis seems to be a risk factor. Preoperative coronary artery disease and soft texture of the pancreas are significant risk factors for postoperative CT-detected pancreatitis.
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PMID:Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy. 1696 32

Acute pancreatitis is a process that continues to interest physicians and research scientists. Understanding potential factors initiating acute pancreatitis, mechanisms regulating the local and distant inflammatory response, methods for accurately predicting outcome, and possible therapeutic interventions continue to be investigated. Current interest in inflammatory response of the acute injury focuses on proinflammatory and anti-inflammatory cytokines as markers for disease severity and predictors of outcome. Recent studies confirm the utility of physical examination and existing markers such as C-reactive protein and interleukin-6 in predicting the severity of acute pancreatitis. Understanding the molecular mechanism of lung injury remains a major focus for future therapeutic targets, since pancreatitis-associated pulmonary injury results in significant morbidity and is a major indication for intensive care unit admissions.
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PMID:Acute pancreatitis. 1703 Nov 11

Severity stratification is a critical issue in acute pancreatitis that strongly influences diagnostic and therapeutic decision making. According to the widely used Atlanta classification, "severe" disease comprises various local and systemic complications that are associated with an increased risk of mortality. However, results from recent clinical studies indicate that these complications vary in their effect on outcome, and many are not necessarily life threatening on their own. Therefore, "severe," as defined by Atlanta, must be distinguished from "prognostic," aiming at nonsurvival. In the first week after disease onset, pancreatitis-related organ failure is the preferred variable for predicting severity and prognosis because it outweighs morphologic complications. Contrast-enhanced CT and MRI allow for accurate stratification of local severity beyond the first week after symptom onset. Among the biochemical markers, C-reactive protein is still the parameter of choice to assess attack severity, although prognostic estimation is not possible. Other markers, including pancreatic protease activation peptides, interleukins-6 and -8, and polymorphonuclear elastase are useful early indicators of severity. Procalcitonin is one of the most promising single markers for assessment of major complications and prognosis throughout the disease course.
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PMID:Predicting severity of acute pancreatitis. 1741 55

Acute pancreatitis is an illness of unpredictable course and in order to implement optimal treatment requires quick assessment of its probable severity and course. The development of prognostic systems was caused to determine patients of high risk of severe course of the illness, that require intensive care and proper treatment. This is the reason of development of prognostic systems based on clinical criteria, lab results and imaging procedures. Yet, none of them does fulfill all requirements. In the paper author presented and evaluated the clinical usefulness of various methods of predicting the course of pancreatitis in historical view. Although commonly used are multifactor clinical scales, current literature shows changing requirements to any scale evaluating the illness that come from better knowledge of biological mechanisms and technological development. Yet still commonly used are simple and and of practical use in any hospital ward multifactor scale with additional C-reactive protein assessment. Based on these there is high probability of correct assessment the future course of acute pancreatitis within 48 hours. Important element of evaluation of pancreatitis is current level of morphological distortion and pancreatic necrosis with use of computed tomography with contrast used in CTS index. The ultimate outcome of our assesment would be the result of the treatment of acute pancreatitis that is dependant on the skill of predicting the severity of illness course and in the end optimal treatment of the patient
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PMID:[Development of prognostic systems in acute pancreatitis]. 1767 96

We report the fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) findings of autoimmune pancreatitis (AIP) associated with idiopathic retroperitoneal fibrosis. A 69-year-old male patient was admitted to our hospital with obstructive jaundice. Six months prior to this admission, he was treated with steroid therapy for retroperitoneal fibrosis. Laboratory data showed that elevated T-bil, C-reactive protein, amylase and immunoglobulin 4, and antinuclear antibodies were positive. Clinical history, laboratory data, CT image, and magnetic resonance imaging led to a diagnosis of autoimmune pancreatitis. To investigate the inflammatory activity, FDG-PET/CT was undertaken. FDG-PET/CT demonstrated diffuse intense FDG uptake in the enlarged pancreas and diffuse mild uptake in the region of the abdominal aorta-bilateral iliac arteries. A dilated right renal pelvis and upper ureter, corresponding to hydronephrosis probably caused by retroperitoneal fibrosis, were shown. An FDG-PET/CT was useful to evaluate inflammatory activity and morphological imaging, and supported our diagnosis of AIP and retroperitoneal fibrosis.
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PMID:FDG-PET/CT findings of autoimmune pancreatitis associated with idiopathic retroperitoneal fibrosis. 1809 36

Several tools have been developed for severity stratification in acute pancreatitis. They include single biochemical markers, imaging methods, and complex scoring systems, all of which aim at an early detection of severe acute pancreatitis to optimise monitoring and treatment of patients as early as possible. Among single biochemical markers, C-reactive protein (CRP) remains the most useful. Despite its delayed increase, peaking not earlier than 72 h after the onset of symptoms, it is accurate and widely available. Many other markers have been evaluated for their usefulness, and for some of them very promising data could be shown. Among them interleukin 6 seems to be the most promising parameter for use in clinical routine. For the detection of pancreatic infection, procalcitonin is the most sensitive, and can be used as an indicator for the need for fine-needle aspiration of pancreatic necrosis. Regarding imaging, contrast-enhanced computed tomography is still the reference method for the detection of necrotising acute pancreatitis. Pancreatitis-specific scoring systems have been shown to be of value for the prediction of severity and progression of acute pancreatitis, but cannot be applied any earlier than 48 h after admission to hospital. The APACHE-II score has not been developed specifically for acute pancreatitis and is rather complex to assess, but has been proven to be an early and reliable tool. Indication, timing and consequences of the methods applied need to be carefully considered and incorporated into clinical assessments to avoid costs and harm to the patient.
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PMID:Markers for predicting severity and progression of acute pancreatitis. 1820 14

The role of homocysteine role in inflammation and malignancy has been studied experimentally. Some researchers suggest that a relationship exists between pancreatitis and homocystinuria, possibly being secondary to occlusive vascular disease of the pancreas. To date, plasma homocysteine levels in pancreatic disease have not been studied. We aimed to analyze the homocysteine status in patients with acute pancreatitis, and the changes of the plasma homocysteine level at the acute phase of the disease and six months after hospital discharge. Fourteen acute pancreatitis patients and 14 healthy subjects were studied. Plasma homocysteine, vitamin B12, folate, amylase, lipase, C-reactive protein, total, HDL and LDL cholesterol, triglycerides, blood urea nitrogen, white blood cells, and creatinine were measured in the two groups of subjects. Plasma levels of homocysteine were significantly higher in patients with acute pancreatitis as were serum creatinine, blood urea nitrogen, WBC counts, amylase, lipase, and C-reactive protein. An impaired creatinine clearance was also found in these patients but this did not reach statistical significance. Serum total, HDL, and LDL cholesterol concentrations were not significantly different between the two groups of subjects. Our data suggest that homocysteine may play a role in inflammatory diseases of the pancreas. Increased plasma homocysteine levels in acute pancreatitis may be a reason, or a marker, for the diagnosis of acute pancreatitis. In conclusion, this is the first report showing that patients with acute pancreatitis have higher plasma homocysteine levels than healthy subjects.
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PMID:Changes in plasma levels of homocysteine in patients with acute pancreatitis. 1846 55


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