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

A prospective study was carried out to evaluate the efficacy of somatostatin in the treatment of acute pancreatitis. Seventy one patients were randomised to control (h = 36), or to the somatostatin group (h = 35) who received somatostatin 100 micrograms/h after a 250 microgram bolus for the first two days. The following were compared in the two groups on admission and two days later: laboratory tests of prognostic significance, severity of pancreatitis, and also morbidity and mortality. Of the nine laboratory tests compared, the white blood cell count, lactate dehydrogenase, and urea concentrations were significantly lower in the somatostatin group two days after admission. Severity of pancreatitis after hospitalisation increased in fewer patients given somatostatin (NS). There was a trend toward fewer complications, especially local, in the somatostatin group. Mortality in both groups was low. Somatostatin appeared to reduce the local complications of acute pancreatitis. A larger trial is necessary to show its beneficial effect conclusively.
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PMID:Somatostatin in the treatment of acute pancreatitis: a prospective randomised controlled trial. 256 34

The most important diagnostic step in the management of patients with severe acute pancreatitis is the discrimination between acute interstitial and necrotizing pancreatitis. Measurement of C-reactive protein, lactic acid dehydrogenase, alpha-1-antitrypsin, and alpha-2-macroglobulin and contrast-enhanced CT are useful in detecting the necrotizing course of acute pancreatitis. C-reactive protein, lactic acid dehydrogenase, and contrast-enhanced CT offer detection rates of 85 per cent to more than 90 per cent for pancreatic necrosis. Surgical decision-making in necrotizing pancreatitis should be based on clinical, morphologic, and bacteriologic data. Patients with focal pancreatic necrosis, in general, respond well to medical treatment and do not need surgery. Extended (50 per cent or more) pancreatic necroses, infected necroses, and intrapancreatic parenchymal necroses plus extrapancreatic fatty tissue necroses are indicators for surgical management. The decision for the timing of operation in patients with proved necrotizing pancreatitis should be based on clinical criteria: the development of an acute surgical abdomen, generalized sepsis, shock, persisting or increasing organ dysfunction, or some combination thereof despite maximum intensive care treatment for at least 3 days. Major pancreatic resection for the treatment of necrotizing pancreatitis appears disadvantageous. Necrosectomy and continuous local lavage allow debridement of devitalized tissue and preservation of vital pancreatic tissue. Postoperative local lavage thus results in an atraumatic evacuation of necrotic tissue, the bacterial material, and biologically active substances. The hospital mortality rate of patients treated with necrosectomy and continuous local lavage (the Ulm protocol) is below 10 per cent. Nevertheless, controlled prospective clinical trials should be performed in order to bring more precision to our clinical decisions in respect to the role of surgery for this disease.
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PMID:Surgical management of necrotizing pancreatitis. 265 62

Experimental study had been conducted on 18 healthy adult mongral dogs of both sex, weighting from 7.5-11 kg, randomly divided into four groups. Experimental models of acute hemorrhagic necrotizing pancreatitis (AHNP) were established by retrograde injecting 1 ml/kg of sodium taurocholate directly into the pancreatic duct. The dogs were treated respectively with intravenous infusion of Salviae miltiorrhizae (5 g/kg), 654-2(5 mg/kg) or normal saline. The results showed that PaO2, PaCO2 and pH did not change in early stage of AHNP. The contents of lactic acid dehydrogenase (LDH), albumin and lipid peroxide (LPO) of bronchoalveolar lavage fluid in the AHNP group were significantly higher than that of Salviae miltiorrhizae group (P less than 0.05). The necrosis and disruption of conjunction of endothelial cells resulting from the defects of vascular wall were noted under transmission electron microscope. Both pulmonary vascular and type II pneumocyte were normal in the Salviae miltiorrhizae group. These results suggested that Salviae miltiorrhizae possess the effect of protecting endothelial cells of pulmonary vascular and type II pneumocyte, which could function as scavenger of oxygen-derived free radicals.
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PMID:[Protective effects of Salviae miltiorrhizae and anisodamine (654-2) against early lung injury in acute hemorrhagic necrotizing pancreatitis in the dog]. 273 1

The liver affection in acute experimental pancreatitis (AEP) could be reflected by changes of enzymatic activity in the liver and in serum. The histoenzymatic studies of the liver of dogs with AEP of different severity and time of duration induced according to Elliott's method were performed and the constellation of serum enzymatic activities considering treatment with prostacyclin was estimated. The histoenzymatic reactions on succinic dehydrogenase, lactic dehydrogenase and alkaline phosphatase were depressed with progression of time and severity of AEP. In contrast, the reaction on acid phosphatase was augmented at the same time. Serum AspAT, AlAT and alkaline phosphatase were augmented in the later phase of AEP, but acid phosphatase and beta-glucuronidase were not significantly changed. The treatment with PGI2 limited both histoenzymatic reactions and alterations of serum enzymatic activities. These results support the significance of changes in enzymatic activities in the course of liver reaction on pancreatogenic noxa during acute pancreatitis, and suggest the protective effect of PGI2 against liver injury in this disease.
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PMID:The enzymatic studies of the liver in acute experimental pancreatitis in dogs treated with prostacyclin (PGI2). 329 21

In an attempt to reduce the current morbidity and mortality from acute pancreatitis, a prospective randomized multicentre trial was begun in August 1982. Part of this study involved an attempt to develop a set of prognostic indices which would identify patients with severe pancreatitis on the day of admission to hospital. An analysis of a predetermined set of 10 indices (age, blood pressure, white cell count, blood urea, serum calcium, aspartate aminotransferase, lactate dehydrogenase, blood glucose, arterial blood pH and PO2) on admission to hospital, in 100 patients, is presented. The positive predictive value of these indices (excluding age) is 90%. These indices are readily available in most hospitals, and allow the early identification of the high risk patient with an accuracy equal to or better than that previously reported.
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PMID:Predictors of severity of attacks of acute pancreatitis. 346 82

Twenty-one routine clinical and laboratory data in 161 patients with necrotizing pancreatitis (NP) undergoing surgical treatment were analyzed. The necrotic tissue at operation was bacterially infected in 41% of the patients. The goal of the study was to evaluate whether there was any special clinical feature in cases of an infection. The parameters were recorded during 48 h after admission as well as during 48 h before operation, and the frequencies submitted to both a univariate and a multivariate analysis (logistic regression model). In the period after admission, patients with infected necrosis significantly more often had a rectal temperature greater than 38.5 degrees C (p = 0.001). Before operation (i.e., after maximum conservative treatment), four findings were significantly related to an infection: rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, hematocrit less than 35% (all p = 0.0001), and paO2 less than 60 mm Hg (p = 0.001). The multivariate analysis, which calculates and quantifies the mutual influence of factors, showed a combination of three findings (rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, and hematocrit less than 35%) to be related to necrosis infection before operation. All three criteria in a patient imply a probability of infection of 83%. It is noteworthy that the sepsis indicators were equally distributed in patients with focal, extended, or subtotal/total infected necrosis, but correlated with the necrosis extent in sterile necrotizing pancreatitis. Moreover, all parameters not related to the pancreatic infection [e.g., hyperglycemia, hypocalcemia, rise of lactic dehydrogenase (LDH), and the white blood cell count] correlated with the three necrosis categories.
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PMID:Sepsis indicators in acute pancreatitis. 367 46

During the past 3.5 years the authors have evaluated 191 patients, both retrospectively and prospectively, to establish factors which might help to identify those patients at higher risk of developing pancreatic abscesses. Those factors included etiology of pancreatitis, number of severity indices present, and specific indices present. Once an abscess developed, severity indices, etiology, and bacteriology were examined as factors in mortality. Six specific severity indices occurred more often (P less than 0.05) in patients developing abscesses. These indices were lactate dehydrogenase evaluation, leukocytosis, metabolic acidosis, hypoxemia, hypocalcemia, and fluid sequestration. In addition, seven of 18 abscess patients had six or more indices present as opposed to five of 161 pancreatitis patients. This was significant at P less than 0.05 level. The etiology of the pancreatitis was not a significant factor. Once an abscess developed, gram-negative infections were polymicrobial (8 of 9 patients) and were associated with a 56 per cent mortality. The gram-positive abscesses (6 patients) were all monomicrobial and none of these patients died. In addition, age greater than 55 years, serum glucose greater than 200 mg%, hematocrit decrease of 10 per cent, and fluid sequestration greater than 6 L were associated with a 50 per cent or greater mortality. The authors believe that patients presenting initially with six or more severity indices, especially the six mentioned above, are at significantly increased risk for developing a pancreatic abscess and those abscess patients with gram-negative abscesses, as well as having any of the four severity indices previously mentioned, have a much worse prognosis.
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PMID:Early diagnosis and outcome of pancreatic abscesses in pancreatitis. 380 Jan 61

The purpose of this study is to elucidate the pathophysiology of the acute pancreatitis and set up the criteria for assessing the severity of this disease. One hundred and fifty seven cases of acute pancreatitis were treated at the First Surgical Department of Tokyo University Hospital and its affiliated hospitals. They consisted of 24 severe cases, 76 moderate cases, and 57 mild cases according to our classification. In early stage ten parameters, namely, abnormalities of white cell count, platelet count, hematocrit, lactic acid dehydrogenase, blood urea nitrogen, serum calcium, base excess, PaCO2 and fasting blood glucose and age within 24 hours after admission and X-ray CT scan within 48 hours as early prognostic signs, enabled us to predict severe, moderate, or mild pancreatitis. More than 4 weeks later than the onset of acute pancreatitis, X-ray CT scan, white blood cell count, elevation of serum FDP level, endotoxemia and fall of plasma opsonic index served as good indicators to evaluate the severity of abdominal sepsis. In experimental pancreatitis, CH50 and opsonic index were remarkably decreased at 6 and 12 hours after induction of acute pancreatitis. As the above results, determination of early prognostic signs immediately after onset and late prognostic signs 3-4 weeks after onset is very important to evaluate and manage the acute pancreatitis patients.
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PMID:[Pathophysiology and prognosis of acute pancreatitis--early and late prognostic signs]. 408 48

Macroamylase is a circulating complex of immunoglobulin linked to normal amylase in most cases. Its physical properties are heterogeneous, but its large size impairs renal filtration. Macroamylasemia usually causes hyperamylasemia and an amylase clearance:creatinine clearance (C(AM):C(CR)) ratio of less than 1 percent. Macroamylasemia occurs in 2.5 percent of hyperamylasemic patients, and 1 percent of apparently healthy subjects with normal amylase levels. It often accompanies diseases of aberrant immunity or conditions in which pancreatitis must be ruled out. This disorder should be considered in a patient with asymptomatic hyperamylasemia because its detection can obviate a prolonged diagnostic workup. The condition requires no treatment and may be transient. Macroamylasemia is one of several immunoglobulin-complexed enzyme (ICE) disorders. MacroLDemia, an ICE disorder of lactate dehydrogenase (LD), shares features with macroamylasemia. These and other ICE disorders appear to represent nonspecific dysproteinemic responses to disease.
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PMID:Macroamylasemia and other immunoglobulin-complexed enzyme disorders. 616 78

The activity of elastase, elastase inhibitor and isozymes of lactate dehydrogenase (LDH) was studied in 11 dogs with experimental pancreatitis and 5 control dogs. All dogs with experimental pancreatitis died 6--14 hours after the induction of pancreatitis. Morbid anatomy studies proved severe pancreonecrosis. The results obtained show that after the induction of pancreatitis the elastase blood activity increased 3-fold as compared with the initial level, and remained unchanged up to the animals' death. At the same time the activity of elastase inhibitor fell, correlating with the rise in elastase activity. Also there was a disproportion between LDH 1 and LDH 2 which became more conspicuous to the 3d hour, and an increase in LDH 5 by the end of the experiment. A conclusion is made that dysfunction of the liver may be one of the causes of the decreased inhibitory activity of elastase in pancreonecrosis.
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PMID:[Elastase activity in experimental pancreatitis]. 690 51


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