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

The purpose of this study was to determine if gallstones could be safely and effectively ablated in the pig using a proprietary percutaneous rotor-tipped catheter, the Kensey-Nash Lithotrite (KNL). All gallstones in a single human gallbladder were defined as a gallstone set. Human gallstone sets not meeting current treatment criteria for extracorporeal shock wave lithotripsy (ESWL) were placed in the gallbladder (GB) of male pigs (N = 8; 80-100 kg). A percutaneous transhepatic guide wire was put into the GB and the abdomen closed. The KNL was then introduced under fluoroscopy using the Seldinger technique and activated. Gallstone ablation was monitored by tactile and auditory feedback to the operator and by fluoroscopy. Once completed the device was withdrawn, the GB irrigated, and the 9F sheath removed. Animals were sacrificed immediately (Group 1, N = 4) and at 28 +/- 5 days (Group 2, N = 4). Gallstones were ablated in 26 +/- 8 min. No pig had significant hemorrhage, GB perforation, or pancreatitis. One acute animal had stone fragments greater than 2 mm in the gallbladder. No other animals had any fragments greater than 1 mm present in the GB, cystic duct, common duct, ampulla, or duodenum. Histologic examination of the GB showed acute hemorrhagic mucosal injury in Group 1 and extensive mucosal regeneration with some stone fragment granulomata and mural fibrosis in Group 2. We conclude that percutaneous gallstone ablation with the KNL is safe and effective in this short-term pig model and appears to be a safe procedure for gallstone ablation. Long-term safety and effectiveness remain to be demonstrated. This device should be useful for treatment of symptomatic gallstones in patients not treatable by ESWL.
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PMID:Percutaneous ablation of gallstones. 238 Dec 1

Efficacy and side effects of lithotripsy of gallbladder stones with a piezoelectric lithotriptor are assessed. 16 treatments were performed in 8 patients (1-3 per patient). Patients required no premedication, analgesia, infusion or monitoring. Gallstone fragmentation was achieved with all treatments. Laboratory findings remained unchanged after treatment, with the exception of one patient with mild pancreatitis. With adjuvant oral bile acid treatment, 6 of the 8 patients were stone-free within 3 days to 3 months. Extracorporeal shockwave lithotripsy with piezoelectric shock waves provides painless and efficient gallstone fragmentation. Repeated treatments may speed complete fragment dissolution.
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PMID:[Pain-free piezoelectric extracorporeal shock wave lithotripsy in gallbladder stones. Initial experiences]. 266 25

In a 22 year study, 21 women had acute pancreatitis develop during pregnancy (11 women) or within six weeks post partum (ten women). Gallstones were the cause of the pancreatitis in all. Operation during the acute attack of pancreatitis was required in only two. Acute pancreatitis subsided in the remaining 19 patients; they were operated upon during the second trimester or the early postpartum period. During pregnancy, surgical treatment for gallstone pancreatitis should consist of cholecystectomy and exploration of the common bile duct without operative cholangiography. During the postpartum period, operative cholangiography is used to determine whether or not exploration of the common bile duct is necessary. Acute pancreatitis associated with pregnancy is "gallstone" pancreatitis; there is no evidence that pregnancy is a specific etiologic factor in pancreatitis. As opposed to nonoperative treatment of symptomatic gallstone pancreatitis in pregnancy, which is accompanied by maternal morbidity or fetal mortality, surgical treatment during the optimal time of the second trimester or early postpartum period was associated with no maternal morbidity or fetal mortality and no recurrent pancreatitis.
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PMID:Management of gallstone pancreatitis during pregnancy and the postpartum period. 271 Dec 96

The authors report on their experience with endoscopic treatment of choledocholithiasis. Out of a total of 363 successful procedures of endoscopic papillosphincterotomy (EPS), choledocholithiasis was the indication for EPS in 270 patients (74.4%). Most often, EPS and extraction were performed in patients after cholecystectomy (79.6%) and those with choledocholithiasis and an in situ gallbladder, but free of stones (13.4%). In patients with concomitant cholecystolithiasis, EPS was carried out only in those cases in which surgery was contraindicated. EPS was performed in four cases of acute biliary pancreatitis. Removal of stones from the choledochus was successful in 95.5%. Of the total of 363 successful EPS's, complications were observed in 17 cases (4.7%), with a mortality of 1.1% (4 deaths). Most frequently, the causes included bleeding (1.9%) and perforation (1.1%). Of other complications, the authors noted acute pancreatitis, acute cholangitis and impaction of stone in the hepatocholedochus in two cases each. The complications required emergency surgery in six patients (35.3%).
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PMID:Endoscopic treatment of choledocholithiasis. 312 24

This paper attempts to demonstrate the influence of gallstones, from different locations, on ultrastructural changes in pancreatic acinar cells. Forty-two gallstone patients with no record of clinical pancreatitis are the subjects of this study. Of these patients, 14 have cholecystolithiasis, 14 have choledocholithiasis, and 14 have primary hepatolithiasis. The findings reveal the following ultrastructural alterations of the pancreatic acinar cells: dilation of the rough endoplasmic reticulum, accumulation of lipid droplets, an increase of autophagic vacuoles, residual bodies and myelin figures, alteration of electron density of zymogen granules, and alteration of mitochondria. All these ultrastructural changes are similar to those of clinical acute pancreatitis. With three locations of calculi, these different kinds of gallstones have a similar affect on the fine structure of pancreatic acinar cells, and these changes occur regardless of the size of the common bile duct and the biochemical data. This suggests that irrespective of the location of the gallstones, subclinical cellular injury to acinar cells is caused.
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PMID:Effect of gallstones on pancreatic acinar cells. An ultrastructural study. 322 32

Since 1982, 38 consecutive patients with biliary pancreatitis were treated prospectively in order to prevent recurrent migration of gallstones. Removal of the stones was achieved by "early surgery" i. e. within the first week after admission or by endoscopic sphincterotomy in patients with severe pancreatitis. Gallstones were visualized by ultrasonography in 31 patients (82 p. 100). Microlithiasis was present in 14 (37 p. 100) and was missed at ultrasonography in 7 patients. According to Ranson's prognostic signs, only 4 patients had 4 or more signs. These 4 patients and 2 additional patients aged more than 85 underwent urgent retrograde cholangiography and endoscopic sphincterotomy. No complications could be attributed to this technique. Among the 4 patients with severe pancreatitis, 3 developed an abscess which required delayed surgery without further complications. The 32 other patients underwent a biliary operation within the first week after admission. Common bile duct calculi were present in 14 patients being discovered by cholangioscopy in 6. One patient died after operation and one was reoperated on for a pseudocyst on day 40. No recurrent attack of pancreatitis was observed in either group. Our study suggests that slightly delayed biliary operation with cholangioscopy during the same hospitalization can be performed safety in patients with mild pancreatitis. In patients with severe attack and/or poor general condition, endoscopic sphincterotomy is a safe technique and deserves wider consideration in the management of severe acute pancreatitis for which delayed drainage of pancreatic necrosis may occasionally be required.
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PMID:[Early treatment of biliary lithiasis in biliary pancreatitis]. 332 25

Gallstone-associated pancreatitis continues to have a mortality rate that approaches 10 percent. In a review of 132 fatal cases of acute pancreatitis, no less than a third of the gallstone-associated cases were diagnosed for the first time at autopsy. Early diagnosis of gallstones in these patients remains problematic, but clinical and biochemical factors may aid ultrasonography in defining patients who require endoscopic retrograde cholangiopancreatography. Early operation is advisable in patients with mild disease, but endoscopic papillotomy should be considered in those with severe disease who fail to stabilize after admission. Chronic pancreatitis is frequently associated with cholangiographic evidence of biliary obstruction, and serum alkaline phosphatase concentrations offer a valuable means of monitoring cholestasis. If operation is needed to deal with biliary obstruction, the options are to carry out Roux-Y hepaticojejunostomy or resection of the pancreatic head, the choice being dictated by the indications for direct pancreatic operation.
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PMID:Pancreatitis and the biliary tree: the continuing problem. 272 20

Duodenal bile crystal analysis for the detection of gallstones was assessed in 26 patients with acute pancreatitis of known aetiology (11 attributable to gallstones and 15 to alcohol) and in 37 patients without a history of acute pancreatitis (21 with gallstones and 16 without). The sensitivity was 64-67 per cent and the specificity was 94-100 per cent in these groups. Analysis of duodenal bile from 14 patients with 'idiopathic' pancreatitis revealed calcium bilirubinate crystals (but not cholesterol crystals) in 5 patients (36 per cent). Gallstones were confirmed at cholecystectomy in three of these patients and also in one other patient who had a gallstone on a 'late' ultrasound examination but was negative for crystals. Thus 29 per cent of the original 'idiopathic' group had gallstones confirmed. Gallstone analysis showed that pigment stones were present in 7 of 31 (23 per cent) non-pancreatitis controls compared with 9 of 13 (69 per cent) pancreatitis patients (P = 0.0048). These results suggest that duodenal bile crystal analysis (involving both calcium bilirubinate and cholesterol crystals) may be a useful technique for the investigation of patients with 'idiopathic' pancreatitis.
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PMID:Role of duodenal bile crystal analysis in the investigation of 'idiopathic' pancreatitis. 339 Jun 76

Benign papillary disease is an uncommon entity. For the small percentage of the population afflicted, however, it is a very real, incapacitating disease. In an attempt to alleviate the distressing pain associated with papillary disease, we performed a transampullary septectomy on 105 patients, between the years of 1972 to 1985. There were no operative deaths, and only five serious complications. The findings at exploration were almost equally distributed between stenosing papillitis (53), and septitis (45). The papilla was normal in 7. Histologic findings of inflammation were more common in the former, while fibrosis was seen more frequently with the latter. Long term follow-up (1 to 13 years) in 94 patients revealed complete pain relief in 50 per cent and improvement in 75 per cent Gallstones, pancreatitis, and peptic ulcer appeared to play a role in the pathogenesis of this obscure, rare, and disabling disease.
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PMID:Pathogenesis and treatment of inflammatory lesions of the papilla of Vater. 407 40

The charts of 55 patients with clinical and surgical evidence of pancreatitis, secondary to gallstones, were reviewed. Patients with a history of high alcoholic intake were excluded. Gallstones were retrieved from all patients, 18 (33%) of whom had choledocholithiasis. Severe pancreatitis with extensive fat necrosis was documented during surgery in 27 patients (49%). We found an inverse relationship between the preoperative serum amylase levels and the severity of pancreatitis. Cholecystectomy was performed in 53 patients (96%). The operative mortality rate was 5.5%, and severe postoperative complications developed in five patients (9%). The follow-up period ranged from two to 24 years, and 39 of the patients in the follow-up evaluation remained completely asymptomatic postoperatively.
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PMID:Gallstone pancreatitis. 619 78


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