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

Undrained necrotic tissue or septic foci contribute to continued "activation" of host processes that in turn lead to multiple organ failure and death. We hypothesized that if wide-open drainage of the abdominal cavity is provided, thus not allowing intra-abdominal collections to form, mortality in these patients can be reduced. Since 1982 we have treated 49 patients with necrotic pancreatitis and related infections and 15 patients with severe intra-abdominal sepsis from intestinal perforations. The surgical treatment was based on the provision for daily laparotomies in the intensive care unit with the patient under epidural anesthesia by using an "open-abdomen" technique (zipper alone or a zipper-mesh combination). The APACHE II score and the functional classification were used to derive expected mortalities. The patients with intraabdominal sepsis had a mean APACHE II score of 25 and an expected mortality of 45%, vs the 26.5% mortality that we observed. The lowest mortality in the necrotic pancreatitis group was associated with noninfected pancreatic necrosis (6%) and single abscess (9%) vs 22% mortality rate in the patients with infected pancreatic necrosis. The mean expected mortality in this group was 47%, vs the observed 22%. We attributed this result to the daily abdominal explorations that achieved a complete excision of infected or necrotic tissue.
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PMID:Treatment of severe intra-abdominal sepsis and/or necrotic foci by an 'open-abdomen' approach. Zipper and zipper-mesh techniques. 327 82

This paper reports on the technique and results of cystogastric catheter drainage, as described by Hancke, in eight patients with post-acute pseudocysts, and in one patient with acute necrotising pancreatitis. With this procedure, the catheter is passed, under gastroscopic and ultrasonographic control, percutaneously through the stomach into the pseudocyst in such a manner that the contents of the cyst drain into the stomach. Too small a residual stomach following surgery, and too small, or immature, cysts, represent the limitations of the technique. In five patients, complete, lasting emptying of the cyst was accomplished without any complications. The intervention can be carried out under local anesthesia.
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PMID:Catheter drainage of pancreatic pseudocysts into the stomach. 338 97

We describe a new method for the insertion of an indwelling catheter into the region of the celiac ganglion in order to achieve long-lasting pain relief. A simple nylon catheter, of the type usually used for performing epidural catheter techniques, is placed into the prevertebral space opposite the first lumbar vertebra. The applications of the catheter were tested in a prospective study. Catheter insertion was performed in five patients suffering from carcinoma or pancreatitis. The catheter remained in place for an average of 5.8 days. The new technic was found to be successful not only for pain therapy but also to be a useful supplement for anaesthesia during laparotomy.
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PMID:[Continuous block of the celiac plexus]. 357 13

The hemodynamic effect of pancreatic ascitic fluid was studied in a porcine model. Pancreatitis was induced by a low-pressure infusion of trypsin and taurocholate sodium into the pancreatic duct. The ascitic fluid that accumulated was then injected into the inferior vena cava of five pigs, with each pig receiving five infusions at 40-minute intervals. Mean arterial blood pressure and peripheral vascular resistance fell with each infusion, while pulmonary artery pressure increased. The magnitude of the drop in arterial blood pressure decreased with subsequent infusions, suggesting tachyphylaxis. The rise in pulmonary artery pressure increased with successive infusions. Anesthesia artifact and decay of the pancreatic ascitic fluid were ruled out as causes of the tachyphylaxis. Filtration separated the substances producing pulmonary effects and systemic blood pressure effects (0.2 to 11 microns vs 10,000 daltons to 0.2 micron). These data suggest that two mediators may produce the hemodynamic effects of pancreatic ascitic fluid.
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PMID:The vasoactive properties of ascitic fluid in acute pancreatitis in a porcine model. 370 41

We treated nine patients with functioning gallbladders containing one to three symptomatic radiolucent stones not larger than 25 mm in diameter, as well as five patients with stones in the common bile duct that were not removable by endoscopic procedures, by means of extracorporeally generated shock waves during general anesthesia. The patients with gallbladder stones received adjuvant treatment with a combination of ursodeoxycholic acid and chenodeoxycholic acid. All gallbladder stones were disintegrated into sludge or fragments with diameters of no more than 8 mm. In six of the nine patients the fragments disappeared completely within 1 to 25 weeks. No adverse effects were detected during a follow-up period of 10 to 34 weeks, except transient biliary pain in two patients, with mild pancreatitis in one. In four of the five patients with common-bile-duct stones, shock-wave treatment permitted stone disintegration and successful endoscopic extraction or spontaneous passage of fragments. We conclude that gallstone disease may be treated successfully and without serious adverse effects by extracorporeally generated shock waves in selected patients.
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PMID:Fragmentation of gallstones by extracorporeal shock waves. 395 14

ERCP was carried out in 8 children under 14 years age. The indications of examinations were in 7 cases obstructive jaundice caused in 3 patients by congenital anomalies of the biliary tract. In one case the ERCP was performed because of acute relapsing pancreatitis. The examinations were carried out under general anesthesia in 5 children and after sedative premedication in 3 cases. No complications of the procedures were recorded. ERCP is a useful method also in children for diagnosing bilio-pancreatic anomalies.
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PMID:[Endoscopy of the bile ducts and pancreas in children]. 408 90

The histological features of 24 pancreases obtained from patients who died of causes other than hepatitis, pancreatitis or pancreatic tumors, included a variable degree of autolysis, rare foci of inflammatory reaction but no hemorrhagic fat necrosis or destruction of elastic tissue in vessel walls (elastolysis). Assays of elastase in extracts of these pancreases showed no free enzyme, but varying amounts of proelastase.A review of autopsy findings in 33 patients with fatal liver necrosis attributed to halothane anesthesia, demonstrated changes of acute pancreatitis only in two. On the other hand, a review of 16 cases of fulminant viral hepatitis revealed changes characteristic of acute pancreatitis in seven - interstitial edema, hemorrhagic fat necrosis, inflammatory reaction and frequently elastolysis in vessel walls. Determination of elastase in extracts of one pancreas showed the bulk of the enzyme in free form. Furthermore, assays of urinary amylase in 44 patients with viral hepatitis showed increased levels of this enzyme (2583 +/- 398 mean value +/- standard error, Somogyi units per 100 ml in 13, or 29.5 percent). The evidence suggests that acute pancreatitis may at times complicate viral hepatitis. Although direct proof of viral pancreatic involvement is not feasible at present, a rational hypothesis is advanced which underlines similar mechanisms of tissue involvement in both liver and pancreas that may be brought about by the hepatitis viruses.
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PMID:The association of viral hepatitis and acute pancreatitis. 507 Jun 94

The aetiological associations and proposed pathogenesis of acute pancreatitis have been reviewed. Although 80 per cent of patients have underlying alcohol abuse or gallstones, the precise mechanism of induction and of progression of pancreatic injury remains uncertain. Our current approach to management is summarized in Table 8. At present, no measure designed to limit the severity of pancreatitis or to interrupt the genesis of complications has been of proven benefit. Treatment is therefore primarily supportive. Peritoneal lavage by catheters introduced under local anaesthesia appears to be a valuable adjunct to the treatment of the early cardiovascular and respiratory complications of severe pancreatitis and we continue to recommend this measure. The major unsolved problem in treatment of this disease is the prevention and treatment of infected peripancreatic abscesses.
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PMID:Acute pancreatitis: pathogenesis, outcome and treatment. 638 41

We have performed coeliac plexus block by standard percutaneous technique for disabling pain in 36 patients (13 with cancer and 23 with chronic pancreatitis). Eleven of the 13 cancer patients had complete pain relief initially and 7 remained pain free at the time of death. By contrast, only 12 of the 23 patients with pancreatitis had complete pain relief, 6 had partial relief and there was no effect in 5. The mean pain-free period in the chronic pancreatitis patients was only 2 months, and the longest 4 months. Benefit was least in patients with previous pancreatic surgery and repeat blocks were unhelpful. Transient postural hypotension occurred in most patients; two had nerve root pain and one developed persistent weakness and anaesthesia of the left leg, with bladder disturbance. These results warrant the continuing use of coeliac plexus block in pancreatic cancer, but rarely in chronic pancreatitis.
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PMID:Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis. 664 Feb 55

Male Sprague-Dawley rats were treated ip for 30 d with either 3.0 mg Mn/kg or an equal volume of 0.9% NaCl, then sacrificed by exsanguination through the aorta under pentobarbital anesthesia. The pancreas was removed immediately, fixed in 10% buffered formalin, and subsequently processed for light microscopy. Significant pathological changes were observed in pancreatic tissue from Mn-exposed rats. These changes were characterized by a pancreatitis-like reaction consisting of expanded interacinar spaces, a thickened connective tissue capsule with invaginations of fibrotic connective tissue septa extending into the body of the gland, the presence of an inflammatory infiltrate of neutrophils, lymphocytes, and macrophages, and the separation of groups of acini from the body of the pancreas with occasional destruction of acinar cells. Since other peritoneal organs did not exhibit pathological changes, this study suggests that intraperitoneally injected Mn2+ exerts a selective toxicity on pancreatic tissue and that, therefore, intraperitoneal injection is not recommended as the route of administration of choice for chronic Mn neurotoxicity studies.
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PMID:Chronic manganese exposure in rats: histological changes in the pancreas. 665 39


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