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

Extracorporeal CO2 removal combined with low-frequency positive pressure ventilation (ECCO2-R LFPPV) is a new therapeutic approach in treatment of ARDS. The main problem during long-term extracorporeal support is anticoagulation and related bleeding problems. We conducted a prospective, randomized and controlled clinical trial in 18 patients to compare the effect of the non-heparin-coated (Scimed = group 1) with the heparin-coated (Carmeda = group 2) extracorporeal circuit on clinical course and complication rate. In group 2 the daily blood loss, the amount of substituted red cells and the i.v. heparin dose were significantly lower than in group 1. Bleeding complications were less and more patients survived in group 2. The disadvantage of the hollow fiber oxygenators in the heparin-coated system was plasma leakage, which was more frequent in patients with pancreatitis and hyperbilirubinemia.
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PMID:Progress in veno-venous long-term bypass techniques for the treatment of ARDS. Controlled clinical trial with the heparin-coated bypass circuit. 155 73

Laparoscopic cholecystectomy (LC) has rapidly gained wide acceptance in the United States. The applicability, safety and efficacy of this new procedure for the treatment of cholelithiasis in Taiwan, however, needs evaluation. We performed LC in 50 out of 98 cases of cholelithiasis at Cathay General Hospital from 28 December 1990 to 28 April 1991. We found that the applicability rate was 51%. The reasons for not selecting LC in the 48 open cases were: acute and gangrenous cholecystitis (13), common bile duct stones (11), concomitant intra-abdominal malignancy (5), intrahepatic stones (5), multiple upper abdominal incisions (4), pancreatitis or pancreatic abscesses (3) and other causes (7). In the LC group, there were 44 patients with symptomatic chronic calculus cholecystitis, 3 patients with acute calculus cholecystitis and 3 patients with gall bladder polyps. The age of the patients ranged from 27 to 79. There were 14 males and 36 females. All of the patients had a detailed preoperative workup including complete liver function test and sonographic examination of the hepatobiliary system. Additional pre-operative endoscopic retrograde cholangiopancreatographies were done in 3 and operative cholangiograms were done in another 3 to confirm the absence of common bile duct stones or to delineate anatomy. Although we encountered a few problems during the operations, such as severe adhesion, bleeding, difficult dissection, CO2 leakage, difficult insufflation, or large stones, all of the 50 patients completed the LC successfully without conversion to open cholecystectomy. The average operation time was 60 minutes, ranging from 30 to 135 minutes. Drain tubes were used in 7 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Laparoscopic cholecystectomy: the first 50 patients]. 168 93

The techniques of papillosphincterotomy were improved on the basis of CO2 laser and special laser tools. The results of 212 routine and 114 laser papillosphincterotomies were appraised. With the laser techniques, the incidence of postoperative complications reduced to 14% as compared to 23.6% with the routine method. The incidence of postoperative pancreatitis decreased from 7.5% to 4.3%, the destructive pancreatitis mortality, from 4.7% to 0.9%. The long-term results provide evidence for laser papillosphincterotomy.
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PMID:[Comparative evaluation of the results of traditional and laser papillosphincterotomy]. 233 86

This study quantifies lung water in acute hemorrhagic pancreatitis to determine the degree to which pulmonary dysfunction occurs subclinically, before alterations in the arterial blood gases can be measured. Pancreatitis was induced in ten dogs by injecting 0.5 ml/kg of bile into the pancreatic ducts, which had been surgically cannulated. Pulmonary and systemic blood gases and blood pressures, heart rate, extravascular lung water, and lung blood flows were studied over 5 hours while cardiac output and mean arterial pressure were maintained at control values by Ringer's lactate infusion. The percentage of water in lung tissue was determined at the time of sacrifice using gravimetric measurements. Mean arterial pressure, cardiac output, and pulmonary capillary wedge pressure, reflecting intravascular volume status, did not change through at the experiment. By contrast, major disturbances were measured in the pulmonary bed with pulmonary artery pressures rising from 15.6 +/- 1.8/8.1 +/- 1.3 mmHg to 22.0 +/- 1.2/15.6 +/- 1.7 mmHg over 5 hours (p less than 0.01). Peripheral vascular resistance rose from 3.6 +/- 0.6 units to 6.6 +/- 0.4 units (p less than 0.05), whereas bronchial blood flow to the lung fell significantly. These changes in pulmonary hemodynamics were not reflected by changes in the arterial blood gases. Arterial oxygenation was maintained during 5 hours of pancreatitis. The partial pressure of carbon dioxide and the serum pH did not change significantly. There was, however, a progressive rise in extravascular lung water measured by the double-dilution technique from 10.2 +/- 0.8 ml/kg at control to 18.1 +/- 2.8 ml/kg (p less than 0.01) at 5 hours. This was confirmed by direct gravimetric measurements, which revealed an increase in the water content of the lung from 78.1 +/- 0.3% to 86.4 +/- 2.4% over the course of the experiment. Arterial blood gases, therefore, do not necessarily reflect the pulmonary deterioration in acute pancreatitis. These data supported a mechanism of lung dysfunction independent of the circulatory compromise, which often accompanies the disease in the clinical setting.
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PMID:Extravascular lung water as an indicator of pulmonary dysfunction in acute hemorrhagic pancreatitis. 244 44

Acute pancreatitis often results in a hyperdynamic, consumptive state. Hallmarks of this condition are decreased peripheral resistance with increased cardiac output. Hemodynamic and cardiovascular changes are accompanied by metabolic alterations. Increased protein catabolism, increased ureagenesis, glucose intolerance, increased lipolysis, and reduced servoregulation are metabolic changes commonly seen in this syndrome. To preserve organ structure and function, biochemical processes must be metabolically supported. Substrate needs change as stress level increases. The per cent of total calories provided as protein must increase. Branched-chain-enriched amino acid solutions have been shown to improve nitrogen utilization in hypermetabolic patients and may therefore be beneficial for the patient with acute pancreatitis. Glucose utilization decreases and free fatty oxidation increases. A mixed fuel system that provides fat, protein, and glucose is suggested for these patients. IV fat has been shown to be a safe energy substrate for patients with pancreatitis in the absence of hyperlipidemia. Failure to use fat as an energy substrate in conjunction with TPN may result in hepatic steatosis and excess carbon dioxide production. The decision of whether to use the parenteral or enteral route to nutritionally support the patient with pancreatitis remains controversial. TPN may allow maintenance of pancreatic rest. The role of enteral feedings is less clear. However, it has been shown that the further down the alimentary tract the feeding is infused, the less pancreatic stimulation occurs. Therefore, it seems wise to support the patient with TPN during severe acute pancreatitis. Jejunal enteral feedings should be initiated as a transitional feeding when the acute inflammatory episode begins to subside.
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PMID:Nutritional support in acute pancreatitis. 250 54

The trend in recent years for treatment of pancreatic carcinoma and occasionally for pancreatitis has been towards total pancreatectomy. The pancreas is also now being harvested for transplantation. Any operative technique that can reduce operating time, blood loss, and associated morbidity and mortality would be of tremendous advantage. The aim of this study was to undertake a total pancreatectomy using the Nd:YAG laser (wavelength 1,060 nm) with a helium neon laser (wavelength 628 nm) incorporated to provide a marker beam. The laser beam was passed into a 400 micron flexible glass fiber enclosed in a 2.5 mm polyethylene cannula, which also served as a conduit for coaxial CO2. The laser was operated in a continuous wave mode, and the fiber exit beam had a divergence of 10 degrees. For photocoagulation and tissue vaporization, peak powers of 50 W were used with 0.5-1 sec pulses. The total pancreatectomy using the Nd:YAG laser was performed in eight dogs, and ten dogs undergoing the conventional operative procedure served as controls. The findings indicate that the Nd:YAG laser could be used effectively and safely. The operating time was considerably diminished (P less than 0.01); the number of ligatures used was smaller; blood loss, graft survival, and duodenal viability were similar. The Nd:YAG laser offers a new therapeutic modality in the performance of tedious and often difficult pancreatic surgery.
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PMID:Use of Nd:YAG laser in pancreatic resections with duodenal preservation in the dog. 390 27

Laparoscopic cholecystectomy has been performed in the United States since 1989 and currently is the procedure of choice for the management of symptomatic cholelithiasis. Its utility in the pregnant patient has been controversial. Concerns have been expressed for a number of potential problems, including trocar injury to uterus and fetus, effect of pneumoperitoneum on both mother and fetus, induction of preterm labor, teratogenic effects on the fetus, and long-term effects on fetal and neonatal development. We describe the Greenville Hospital System experience with laparoscopic cholecystectomy in pregnancy. From 1992 to 1996, eight laparoscopic cholecystectomies were performed in pregnant females, one during the first trimester and seven during the second trimester. Mean maternal age was 23.8 years (range, 18-31). All procedures were performed for recurrent and intractable symptoms with the average length of symptoms 3.5 weeks (range, 2-4 weeks). Two patients were diagnosed preoperatively with gallstone pancreatitis, two had acute cholecystitis, and four patients were felt to have hyperemesis gravidarum before their diagnosis of gallstones. All procedures were performed under general endotracheal anesthesia with CO2 insufflation pressures of 12 mm Hg. Postoperatively, all patients had uneventful recoveries with complete resolution of their symptoms and were discharged home in an average of 3 days (range, 1-7 days). No postoperative complications to mother or fetus were documented. Eight patients have delivered full-term healthy fetuses with no documented neonatal morbidity or mortality. Long-term follow-up of the infants at a mean of 23 months (range, 2.5-47 months) reveals that all eight infants have progressed to normal healthy children. Our experience and the current world literature demonstrate that laparoscopic cholecystectomy in pregnancy can be performed safely and effectively for symptomatic cholelithiasis, especially when symptoms are recurrent and persistent and may endanger fetal and maternal livelihood. The diagnosis of symptomatic cholelithiasis should be considered in the pregnant patient with recurrent episodes of nausea and vomiting.
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PMID:Laparoscopic cholecystectomy in pregnancy. 945 45

Laparoscopic transperitoneal fusion of the L5-S1 spinal interspace has become a common procedure. Retroperitoneal retraction and laparoscopic instrumentation without insufflation also allows visualization of the upper lumbar spaces, but this procedure is much more difficult to accomplish. We review and compare our results using each of these techniques for the treatment of mechanical instability and chronic back pain. A total of 35 selected patients underwent intervertebral fusion between February 1996 and August 1998. Their mean age was 48 years. There were 22 female and 13 male patients. Standard CO2 insufflation was used in 10 patients with L5-S1 fusions. Retractional gasless technique was used in nine patients with fusions at L5-S1, 16 patients at L4-L5, one patient at L3-L4, three patients at L2-3, and one patient at L1-L2. Thus, we performed a total of 40 lumbar fusions in 35 patients. In the 19 patients with the gasless technique, a balloon dissector and retractor facilitated the retroperitoneal exposure. Seven of these 19 patients were converted to open procedures, most commonly due to lacerations of the peritoneal lining that prohibited visualization. None of the L5-S1 patients with insufflation were converted to open. Mean operative time in the insufflated patients was 152 min vs. 181 min for the retractional technique. There were seven complications in the transperitoneal group: one fusion device migration, one postoperative UTI, one intracerebral hemorrhage, one severe postoperative pancreatitis, and three iliac vein lacerations. There were 16 complications in the retroperitoneal group: one deep vein thromboses, one serosal bowel injury, one small tear in the spleen, one cage migration, one postoperative pulmonary atelectasis, one postoperative hydrocele, four postoperative ileus, and six peritoneal tears. The mean postoperative stay was three days for both groups. There were no deaths. The L5-S1 interspace is best approached transperitoneally for anterior fusion. Although the retroperitoneal retractional technique is much more difficult and has a longer and steeper learning curve, it does allow laparoscopic anterior fusion of the upper lumbar spine.
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PMID:Comparison of insufflation vs. retractional technique for laparoscopic-assisted intervertebral fusion of the lumbar spine. 1074 54

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.
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PMID:Gallstones in elderly patients: impact of laparoscopic cholecystectomy. 1112 83

Sphincter of Oddi (SO) dysfunction as a potential cause of chronic acalculous cholecystitis (CAC) has not been studied in cases for which intraoperative SO manometry was used during laparoscopic cholecystectomy. In this study, we evaluated the effects of carbon dioxide pneumoperitoneum on laparoscopic transcystic SO manometry. In 27 patients with CAC, transcystic SO manometry had been attempted during laparoscopic cholecystectomy. The mean age of the patients was 46 years (range, 22-71). Complete manometric data sets were obtained in 18 patients. The mean SO pressure, phasic SO pressure, and phasic frequency were 35.4 +/- 29.1 mm/Hg versus 30.8 +/- 23.8 mm/Hg, 104.8 +/- 63.0 mm/Hg versus 73.6 +/- 34.6 mm/Hg, and 2.1 +/- 1.8 contractions/min versus 2.8 +/- 3.4 contractions/min with and without pneumoperitoneum, respectively. All differences were nonsignificant (P > 0.05). Two complications (7.4%) were observed: pancreatitis and jaundice. SO manometry is not affected by CO2 pneumoperitoneum. It may be used to study SO motility in patients with CAC.
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PMID:Laparoscopic transcystic sphincter of Oddi manometry is not affected by carbon dioxide pneumoperitoneum. 1144 49


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