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

Information from 72 patients from 7 families in England and Wales confirms that hereditary pancreatitis is inherited as an autosomal dominant conditions with limited penetrance. The degree of penetrance is approximately 80%. These patients have had recurrent attacks of abdominal pain starting from childhood or young adult life. The mean age of onset in the 7 families studied was 13.6 years. There were two peaks, with maximum numbers at 5 years and 17 years. The second peak was thought to represent genetically susceptible individuals having pain brought on by alcohol rather than representing evidence of genetic heterogeneity. Five of the 7 families had members with both childhood and adult ages of onset. Only 4 patients out of 72 had life-threatening disease and in the majority of cases the attacks of pain were of nuisance value only. Hereditary pancreatitis was implicated in only 1 patient's death and this was not definite. Patients appear to get better after a period of symptoms usually as they approach middle age, or after a severe attack. In older patients alcohol, emotional upsets, and fatty food appear to precipitate attacks. Pancreatic insufficiency (5.5%), diabetes mellitus (12.5%), pseudocysts (5.5%), and haemorrhagic pleural effusion are uncommon complications. Portal vein thrombosis occurred definitely in 2 patients and was suspected in 3 others. Carcinoma of the pancreas was not found in any of 72 patients studied in detail; however, 2 members from a family not visited personally had chronic pancreatitis and malabsorption going on to carcinoma. They may have suffered from a different disease. Genetic linkage information was too slight for many definite conclusions. However, there was no suggestion of linkage with any of the markers tested.
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PMID:Hereditary pancreatitis in England and Wales. 67 83

The value of endoscopic retrograde cholangiopancreatography (ERCP) in a surgical unit was established by analysing 200 consecutive studies. The selective success rate was 80%. The groups of indications were jaundice (27%), postcholecystectomy pain (22%), recurrent acute pancreatitis (19%), complicated attack of acute pancreatitis (14%), and other (18%). A normal ERC was found and operation thus avoided in 26% of cases with persistent jaundice. In patients with postcholecystectomy pain pathological findings were found in 50% and half of them were operated upon. In pancreatitis demonstration of the pancreatic ducts and grading of the disease facilitated selection of the treatment and enabled preoperative planning of the surgical procedure. The pancreas was resected in 13 of 59 cases with diagnostic ERP. In pancreatic carcinoma ERCP led directly to diagnosis, but only two (ampullary carcinomas) out of ten were operable. The overall complication rate was 4%, including one case of fatal haemorrhagic pancreatitis.
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PMID:Endoscopic retrograde cholangiopancreatography in a surgical unit. 67 99

Grey-scale ultrasound scanning (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) were performed in a series of 50 patients with known or suspected pancreatic disease. The impact of the individual tests were assessed in the relevant clinical context. With a maximum of 100, the overall clinical impact score of ERCP (75) exceeded that of CT(63) and US (36). In patients with obscure pain, and in those with relapsing pancreatitis, a combination of US and ERCP provides good clinical guidance. Computed tomography scanning can currently be reserved for documentation of patients with a major mass lesion. None of the techniques can detect early pancreatic cancer, except of the papilla of Vater, where ERCP is diagnostic. Recommendations for future diagnostic strategies may alter as grey-scale ultrasonography and computed tomography develop, and, in any case, depend on many factors including local expertise, availability, and cost.
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PMID:Comparative clinical impact of endoscopic pancreatography, grey-scale ultrasonography, and computed tomography (EMI scanning) in pancreatic disease: preliminary report. 68 May 99

We report the use of a new surgical procedure following pancreaticoduodenectomy in nine patients with chronic relapsing pancreatitis and its complications. The modification of the Whipple reconstruction following resection of the head of the pancreas consists in selective proximal vagotomy, transposition of a jejunal loop for bile duct, and pancreatic anastomosis. The longest follow up period has been 18 months. In agreement with reports on other procedures for resection of the head of pancreas, the patients who had been operated on suffered few symptoms. With one exception they had no pain at all; they all gained weight. The results of early follow-up examinations of the patients treated by to these procedures encourage continued use of duodenopancreatectomy.
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PMID:[Transposition of the jejunum and selective proximal vagotomy following duodenopancreatectomy]. 68 36

Indications for endoscopic retrograde cholangiography (ERCP) have been poorly defined. We studied the symptoms in 161 patients who underwent ERCP and evaluated the results from four groups of indications: cholestasis, pancreatitis, suspected carcinoma of the pancreas, and pain of unknown etiology. The likelihood of finding abnormalities is discussed.
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PMID:Endoscopic retrograde cholangiopancreatography. A review of the rewards and indications. 70 Mar 14

We have analysed retrospectively the pancreatic ultrasound scans (using a bistable machine) in 138 consecutive patients, and have related the results to the clinical status and the final diagnosis in each case. The scans were read without knowledge of the patient's clinical state. When technically unsatisfactory scans were excluded from consideration, the overall diagnostic accuracy of ultrasonography proved to be 82%, with a false positive rate of 8%. The scan was abnormal in all 10 patients with cancer of the pancreas: a positive diagnosis of cancer was made in six. All patients with chronic pancreatitis in relapse had abnormal scans, but in 53% the scans were normal in patients in whom the disease was in clinical remission. In seven patients with chronic pancreatitis who suffered relentless pain, the head of the pancreas was swollen and contained cystic areas or emitted abnormal echoes. In acute pancreatitis ultrasonic scanning proved useful in following the progression of the disease to final resolution, or to development of complicating pseudocyst, abscess, or ascites. Random echoes in the early stages of acute pancreatitis are features of haemorrhagic necrosis. In alcoholic relapsing pancreatitis the persistence of abnormal echoes, disposed linearly along the axis of major ducts, suggests the presence of chronic pancreatitis.
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PMID:Ultrasonic scanning in pancreatic disease. 73 69

Of 22 patients treated surgically for intractable pain from chronic alcoholic pancreatitis, eight did not show notable dilation of the main pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP), operative pancreatography, and/or operative and microscopical studies of the pancreas after subtotal pancreatectomy. In all patients, far advanced parenchymal pancreatitis was evident at operation and by microscopical study of the removed portion of the pancreas. These findings indicate that the basic problem in a considerable number of patients with symptomatic alcoholic chronic pancreatitis is not related primarily to obstruction with dilation of the major pancreatic duct, but to intrinsic changes in the parenchymal pancreas. The preoperative use of ERCP and individualization of operative procedures with a preference for subtotal or partial pancreatectomy for symptomatic chronic alcoholic pancreatitis are supported.
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PMID:Absence of pancreatic duct dilation in chronic pancreatitis: surgical significance. 84 51

Patients with abdominal pain resulting from pancreatitis are often misdiagnosed initially. There are no pathognomonic physical signs to implicate the pancreas as a source of chronic abdominal discomfort. Four patients seen consecutively (and one studied retrospectively) illustrate that erythema ab igne of the abdomen or low back may be a sign of pancreatitis. These patients had used heat on their abdomens or backs in attempts to relieve the pain. Using heat in this manner is common among patients with undiagnosed pancreatitis; the heat enhances the appearance of the erythema ab igne. The presence of pigmentation is a sign of organicity which should lead the physician to investigate the pancreas as a source of the patient's pain.
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PMID:Erythema ab igne, a sign of pancreatic disease. 85 Nov 10

In a follow-up-series on 37 patients, who had been operated on for pancreatitis, the effect of pancreas insufficiency on the well-being of resected and non-resected patients was examined. Analyses of fatcontent in feces, collected over a three day-period, revealed that all patients with chronic pancreatitis now had a maldigestion, in particular patients with duodenopancreatectomie. Pseudocyst-patients showed no maldigestion. Increased in the bodyweight in most cases could not only be explained by drug-substituion of encymes but was also due to the resection of the pain-producing area of the pancreas.
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PMID:[The loss of exocrine pancreas-function following operation for pancreatitis (author's transl)]. 85 72

Normal serum amylase values were established for the pediatric age group (47.7 +/- 28.6 mg/dl); these are higher than previously stated. Average serum amylase values increased with increasing age (r = 0.55). The three commonest causes of pancreatitis in 54 patients studied were drug induced (16), idiopathic (10), and traumatic (7). Prednisone was the most frequently implicated drug. Midepigastric pain and vomiting were the presenting symptoms in 75% of the patients. Serum amylase values were more than three times normal in 63.8% of patients; 17% of patients presented with normal serum amylase values. The typical patient received intravenous therapy for 5.4 days and was hospitalized for 9.4 days. Treatment with antibiotic and anticholinergic drugs did not alter mortality or morbidity rates. Mortality rate for acute interstitial pancreatitis was 17.5%, and for acute hemorrhagic pancreatitis was 86%.
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PMID:Pancreatitis in children and adolescents. 87 77


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