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

Pulmonary edema, cardiac enlargement, and respiratory insufficiency may occur in patients with acute pancreatitis. The mechanisms are complex and incompletely understood, but probable etiologic factors include fluid overload, left ventricular failure, impaired respiratory excursion and microatelectasis, and a nonspecific response of the lung to various types of pulmonary injury including hypotension, intravenous crystalloids, and the effects of circulating pancreatic enzymes. Recognition of the association of pulmonary edema and respiratory insufficiency with pancreatitis is importance because early treatment with positive pressure breathing, careful fluid management and diuretics, and corticosteroids may prevent the development of irreversible respiratory failure.
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PMID:Pulmonary edema and respiratory insufficiency in acute pancreatitis. 12 91

Acute pancreatitis may present as the mild edematous type or the more rare and dangerous hemorrhagic form. The effects of the latter are believed to be due to the activation of pancreatic enzymes, notably trypsin. Therefore attempts are being directed towards suppression of pancreatic enzyme activation in the management of the condition. Aprotinin and glucagon are the agents for this purpose that have received most attention. Patients with acute hemorrhagic pancreatitis are subject to respiratory failure, which is not detectable early by clinical evidence, so that early monitoring of pulmonary function by the determination of arterial blood-gas pressures is desirable. This is borne out by the findings in six fatal cases.
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PMID:Symposium on pancreatitis: 1. Conservative management of acute pancreatitis. 30 73

Clinical and pathological information from forty patients who died with pathologically severe acute pancreatitis was correlated. Patients were classified into four etiologic groups: those with biliary pancreatitis (11 patients), alcoholic pancreatitis (13 patients), idiopathic pancreatitis (10 patients), and renal failure (6 patients). Antemortem diagnosis was made in only 57 per cent of the patients studied. The diagnosis was determined before death in 91 per cent of the biliary patients but in none of the renal patients. Thirty-seven patients died from their first clinical attack of pancreatitis. Operation in patients with biliary pancreatitis failed when biliary decompression was not provided. Peripancreatic sepsis was a frequent lethal mechanism in patients with biliary pancreatitis, but renal and respiratory failure were more common in patients with alcoholic pancreatitis.
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PMID:Lethal pancreatitis: a diagnostic dilemma. 42 98

A case of severe multiple trauma sustained in a road accident is reported. The aim of the report is to show the determing role played by diagnostic and surgical methods and therapeutic possibilities available in the intensive care unit (shock treatment, controlled respiration, parenteral feeding, haemodialysis) in winning the five-months' battle for the life of the patient. Early haemodyalisis as supporting therapy in respiratory failure and conservation treatment of intestinal fistulae are important. Post-traumatic pancreatitis which is a not infrequent complicating feature of severe multiple trauma may present diagnostic difficulties.
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PMID:[A case of severe multiple trauma (author's transl)]. 46 Dec 93

Encouraged by reports of the therapeutic efficacy of peritoneal lavage in small series of five or six patients with acute pancreatitis, we have evaluated this treatment in 24 patients with "severe" pancreatitis. One hundred and three patients with "severe" pancreatitis (28% mortality) were separated from 347 with "mild" pancreatitis (0.9% mortality) by previously described early objective signs. Early treatment (Day 0-7) of "severe" pancreatitis included peritoneal lavage through catheters placed nonoperatively in 18 (Group A) and by catheters placed at laparotomy in six (Group C). Early treatment of nonlavaged patients with "severe" pancreatitis was by standard nonoperative measures in 61 (Group B) and included early operation in 18 (Group D). Lavage was continued for 48-96 hours, usually using 36-48 L/24 hours of balanced isotonic dialysate fluid, and was uncomplicated. Lavage led to striking immediate clinical improvement and no lavaged patient (Groups A and C) died during the first 10 days of treatment of pancreatitis. By contrast, 45% of deaths in nonlavaged patients (Group B and D) occurred during this early period, usually from cardiovascular or respiratory failure. Although lavage reduced mortality in subgroups of patients, ultimate overall survival was no affected (Group A, 83%; B, 84%; C, 33%; D,33%). Late peripancreatic abscesses caused most deaths in lavaged patients. These data show that peritoneal complications of severe acute pancreatitis and dramatically reduces early mortality. Lavage does not prevent the late local sequelae of peripancreatic necrosis.
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PMID:The role of peritoneal lavage in severe acute pancreatitis. 64 97

Lethal nosocomial mucormycosis developed in three previously well individuals while they were receiving intensive care for acute hemorrhagic pancreatitis, for cardiogenic shock, and for a ruptured intra-abdominal aortic aneurysm. In two cases, the condition was first seen as progressive cavitary pneumonia refractory to antibacterial therapy; Mucoraceae was identified in all three patients only at autopsy. Each patient had received large doses of corticosteroids and broad-spectrum antibiotics, and all had suffered from respiratory failure, acute renal failure with acidosis, and severe hyperglycemia in association with total parenteral nutrition. Mucoraceae should be regarded as an additional nosocomial pathogen in the setting of advanced life-support care.
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PMID:Mucormycosis. A complication of critical care. 64 64

A 23-year-old black man survived a life-threatening multisystem disturbance resulting from a large single dose of colchicine administered intraurethrally for condyloma acuminata. Gastroenteritis and probable pancreatitis rapidly evolved into severe respiratory failure, marked neuromuscular problems, alopecia, and complete bone marrow aplasia. Within two months he had completely recovered. This patient demonstrates that colchicine should be used with extreme caution, if at all, for the therapy of condyloma acuminata.
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PMID:Colchicine toxicity: a multisystem disease. 84 57

Fifty-two cases of acute renal failure at Livingstone Hospital were studied. Twenty-two cases were obstetric, 10 surgical and 20 medical. The aetiological factors are tabulated and the pathophysiology is reported. Clinical features and biochemical abnormalities are presented. Infection was the commonest associated factor, followed by hypotension and volume problems, coagulation disorders, jaundice and hepatic failure, respiratory failure, pancreatitis and typhoid fever. In 7 of the medical cases the aetiology was unknown and was assumed to be toxic. A case history of a patient with leptospirosis, acute renal failure, liver failure and pancreatitis is presented. The mortality in this series was 32%.
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PMID:Acute renal failure. Experience with 52 patients treated at Livingstone Hospital. 125 Dec 80

Extracorporeal shock-wave lithotripsy (ESWL) was undertaken in 36 patients (12 men, 24 women; mean age 70.9 +/- 2.4 years) with extra- or intrahepatic bile duct stones which could not be removed endoscopically. Stone fragmentation was successful in 32 patients with stones in the choledochal duct and in one with stones in the left hepatic duct. Fragmentation failed in two patients with stones in the left hepatic duct and one with stones in the cystic duct. 26 of the 36 patients were free of stone after spontaneous passage (n = 3) or after endoscopic removal of the residual concrements (n = 23). Complications occurred in only five patients during or after ESWL (cardiac arrhythmias, respiratory failure, pancreatitis, cholangitis).--These data point to ESWL being clearly preferable to surgical intervention in bile duct stones refractory to endoscopic treatment, especially in the elderly with an increased perioperative risk.
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PMID:[Extracorporeal shockwave therapy in endoscopic therapy-refractory gallstones]. 147 69

The correlation of endotoxin (ET), tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), and cellular immune parameters with multiple organ failure and lethal outcome in intraabdominal infections was studied in a group of 18 patients with peritonitis, abscess or pancreatitis. Of these patients, 7 developed respiratory failure and 5 died due to multiple septic organ failure. The peak levels of ET (2.7 +/- 1.3 ng/ml) in the course of the disease were followed by moderate increases of TNF-alpha (mean 147 +/- 41 pg/ml) and IL-6 (170 +/- 61 pg/ml) within 2 days. Analysis of the parameters for the last 12 days prior to death or discharge showed, that the patient group with lethal outcome was characterized by significant lower mean plasma levels of TNF-alpha (less than 75 pg/ml versus greater than 160 pg/ml) and IL-6 (less than 130 pg/ml versus greater than 270 pg/ml), as well as high rates of unstimulated thymidine uptake into peripheral mononuclear blood cells (greater than 44000 cpm/8 x 10(6) PMBC/18 h versus less than 24000 cmp), T-lymphocyte depression (CD3; approximately greater than 40% reduction) with lower T-helper/inducer subset cell numbers (mean CD:CD8 ratio 1.0 +/- 0.55 versus 1.8 +/- 0.2) and lower lectin (PHA) stimulation values (1.9 +/- 1.4 versus 4.1 +/- 1.0). These data demonstrate an anergic immune status with low mediator levels and depressed T-lymphocyte function in patients with poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Endotoxin, TNF-alpha, interleukin-6 and parameters of the cellular immune system in patients with intraabdominal sepsis. 150 42


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