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

A follow-up investigation of 20 patients, surgically treated for acute haemorrhagic necrotising pancreatitis, was performed in an average of 2 3/4 years after the operation. Twelve patients showed manifest diabetes mellitus, four further cases had a suspicious oral glucose tolerance test. Only one patient was insulin dependent. A secretin-pancreozymin test performed in 15 patients showed a dissociated or global pancreatic insufficiency in 13 cases. The extent of the endocrine and exocrine functional disturbance did not correlate with the extent of surgery. Postoperative functional defects were readily improved therapeutically in most cases. Only in patients who continued to consume alcohol were there digestive disturbances. The results indicate that the functional state of the remaining pancreas does not only depend on the extent of surgery but also on the extent of already existing or persisting toxic inflammatory damage and on the regenerative capacity of the remaining parenchyma.
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PMID:[Long-term results after operative treatment of acute haemorrhagic necrotising pancreatitis (author's transl)]. 51 Jan 95

22 patients with bioptically found severe fibrou inflammatory changes of the pancreas underwent an after examination in order to exclude endocrine disturbances of the pancreas. The biopsy of the pancreas was carried out during an operation of the bile-duct. A restriction of the glucose tolerance was to be proved the more frequently the more distinct were the histological changes of the pancreas and the older were the patients. Post-operative increases of the fasting blood sugar appeared above all transitorily and rarely led to a manifestation of diabetes. It is recommended to exclude an endocrine functional disturbance of the pancreas not only when a typical symptomatology of pancreatitis is present, but also when there are possibly clinically not expected bioptical findings of a severe fibrous inflammatory change of the pancreas.
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PMID:[Disorders of carbohydrate metabolism in severe fibrou-inflammatory pancreatic changes]. 60 17

Jejunal perfusion studies were performed to assess water, electrolyte, d-xylose, and d-glucose transport in 16 patients with chronic calcific pancreatitis (eight with and eight without steatorrhoea) and in 10 control subjects. The patients with steatorrhoea demonstrated significantly less xylose, water, and electrolyte absorption than patients without steatorrhoea and control subjects, when an isosmotic slaine-xylose solution was perfused. On the other hand, when an isosmotic saline-glucose solution was perfused, the patients with steatorrhoea absorbed significantly more glucose, water, and electrolytes than control subjects. Significant correlation was demonstrated between the absorption of xylose as measured by the segmental perfusion technique and the peak serum xylose level during perfusion as well as the five-hour urinary xylose excretion after a 25 g oral dose of xylose. The xylose absorption measured by small bowel perfusion also correlated significantly with pancreatic juice amylase and trypsin concentrations obtained during a standard pancreatic function test.
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PMID:Jejunal monosaccharide, water, and electrolyte transport in patients with chronic pancreatitis. 62 5

The prevalence of diabetes due to chronic pancreatitis would appear to be increasing. In western countries this is associated with the known increase in alcohol consumption and AIP. Malnutrition may be etiologic in tropical areas. The incidence of diabetes in chronic pancreatitis is dependent on a number of factors. It is more common in alcohol-induced pancreatitis, rarely occurs after the first attack but tends to increase with time and rises markedly in calcific pancreatitis. Abnormal glucose tolerance occurred in 91% of patients with calcific pancreatitis and 70% of patients with noncalific AIP in our follow up of five to 12 years. This stresses the importance of serial regular glucose tolerance tests in these patients (Table I). The insulin-reserve is severely depleted in most patients who do not yet demonstrate abnormal glucose tolerance, indicating that pancreatitis regularly affects the islets and that nearly all patients are potential diabetics. The beta cells appear to respond better to oral glucose, glucagon or secretin than to i.v. glucose suggesting a selective glucose receptor loss or block to hyperglycemia in chronic pancreatitis. The alpha cells seem to be more resistant to the effects of chronic pancreatitis but true hypoglucagonemia was found in 16% of patients. In addition, stimulated growth hormone secretion may be deficient in pancreatic diabetes. These last two factors, among others, may be responsible for the protracted and even fatal hypoglycemia to which some patients with AIP on insulin therapy are liable. The danger of drug-induced hypoglycemia, coupled with the infrequency of vasculopathy, retinopathy and nephropathy in pancreatic diabetes has induced us to keep these patients hyperglycemic and glycosuric rather than in a sugar-free state, as long as symptoms are contained. Recurrent abdominal pain, marked weight loss and associated steatorrhea often raise special problems in the management of the pancreatic diabetic.
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PMID:Clinical and hormonal aspects of pancreatic diabetes. 80 21

Diazoxide was given orally to nine hypertensive patients with renal failure and its effect on blood pressure and on glucose metabolism was studied. There was no long-term antihypertensive effect. During treatment insulin release and glucose assimilation after an intravenous glucose load were frankly impaired, but this impairment was reversible after stopping the treatment. Two major complications (diabetic ketoacidosis and pancreatitis) were observed. In view of these observations, the authors are of the opinion that oral diazoxide is contraindicated in the treatment of hypertension in patients with renal failure.
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PMID:Oral diazoxide contraindicated in severe hypertension with renal failure. 81 Feb 87

Unmodified synthetic somatostatin, given as a 200-microgram intravenous bolus, plus 200 microgram infused over 3 hours, had no effect on basal plasma insulin and pancreatic glucagon-like immunoreactivity (GLI) levels, both in controls and in patients with chronic pancreatitis. Somatostatin inhibited insulin-hypoglycaemia-induced pancreatic GLI release in controls and in patients with pancreatitis, and prolonged the insulin-induced fall in blood glucose in the patients. Arginine, presumably via insulin release, caused a fall in free fatty acids (FFA) in controls, which was inhibited by somatostatin. Somatostatin abolished the rebound rise in plasma FFA in patients with pancreatitis after insulin-hypoglycaemia. This effect may be related to inhibition of pancreatic GLI release or may be a direct action of somatostatin on lipolysis.
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PMID:The effects of somatostatin on hormonal and metabolic responses in chronic pancreatitis. 89 37

A report is presented on the results of the follow-up examination of 43 patients who had been previously operated on chronic pancreatitis. Clinical data such as the patients' well being, their ability to work were collected and specific tests for the function of the pancreas such as fat-content in faeces and glucose-tolerance-test were made. It was shown, that the pancreas-resected patients felt better in themselves. Moreover, their clinical picture was superior to that of non-resected patients although they had initially required a longer postoperative rehabilitation phase. Pseudocysts, which had been drained, showed no diminution of the pancreas function, nor any tendency to rest-pancreatitis.
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PMID:[Long term results following surgical therapy for chronic pancreatitis (author's transl)]. 90 95

Three hundred patients with acute pancreatitis have been studied. Pancreatitis was associated with alcoholism in 207, biliary tract disease in 51 and other conditions in 42. Twenty-two patients died, and an additional 34 patients required more than one week of treatment in the intensive care unit. Retrospective analysis of the first 100 patients identified 11 objective findings which correlated with the occurrence of serious illness or death. They were, on admission, age over 55 years, blood glucose level over 200 milligrams per cent, white blood count over 16,000 per cubic millimeter, serum lactic dehydrogenase level over 350 International units per liter and serum glutamic-oxalacetic transaminase level over 250 Sigma Frankel units per cent. During the initial 48 hours of therapy, the findings were hematocrit value decrease over 10 percentage points, serum calcium level below 8 milligrams per cent, base deficit over 4 milli-equivalents per liter, a blood urea nitrogen level increase over 5 milligrams per cent, estimated fluid sequestration over 6 liters and arterial oxygen tension less than 60 millimeters of mercury. Prospective application of these signs in the latter 200 patients permitted the accurate early identification of those with severe pancreatitis. Only one of 162 patients with fewer than three of these early features was seriously ill or died, while 24 of 38 patients with three or more early positive findings were seriously ill or died. The objective early identification of patients with severe pancreatitis permits more vigorous management of this group and also provides a basis for the selection of patients for the evaluation of proposed improved therapies. Percutaneous peritoneal dialysis in severe pancreatitis was evaluated in ten patients, with three or more positive early signs, who were randomly assigned to dialysis or continued conventional care. Morbidity was strikingly reduced in patients who underwent dialysis, and while death or more than nine days of intensive care occurred in two of five patients who did not receive dialysis, all five patients having dialysis recovered after fewer than nine days of intensive care treatment. Serious illness or death occurred in 31 of the first 100 patients but in only 26 of the more recent 200 patients. There has been a similar fall in mortality from 15.0 to 3.5 per cent. Factors which may contribute to this improvment include the objective early identification of patients with severe disease, the avoidance of early laparotomy whenever practical, the prolongation of nasogastric suction until all evidence of pancreatic inflammation has resolved, careful monitoring of respiratory function and early treatment of pulmonary complications and peritoneal dialysis in patients with severe disease.
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PMID:Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. 94 Oct 75

Acute pancreatitis was experimentally produced in dogs to study the effect of the disease on glucose tolerance. The k value (glucose disappearance coefficient measured in percentage decrease of glucose/min) calculated from the high-dose intravenous glucose-tolerance test was used to evaluate the glucose tolerance of each dog. Thirty dogs were allotted to 3 groups of 10 dogs each as follows: group I--nonsurgical control dogs; group II--surgical control dogs; and group III--pancreatitis-affected dogs. To increase their susceptibility to diabetes, 50% partial pancreatectomies and ductal catheterizations were performed on group II and III dogs. Saline solution was infused into the ductal systems of group II dogs, and staphylococcal alphatoxin was infused into the ductal systems of group III dogs to produce pancreatitis. The results indicated that (1) high-dose intravenous glucose-tolerance test was an effective tool for determining decreased glucose tolerance in dogs; (2) glucose tolerance of group III dogs was markedly decreased compared with that of group I and II dogs; (3) staphylococcal alpha-toxin produced signs of moderately severe pancreatitis; and (4) 50% partial pancreatectomy and saline solution infusion produced clinical and clinicopathologic signs of mild pancreatitis. To determine if a simplified k value (calculated using 2 or 3 blood samples) could closely approximate the standard k value (calculated using 6 blood samples), simplified k values were derived from the 5- and 60-minute blood sample values. These values closely approximated the standard k values, indicating the simplified value may be used in the clinical situation. The standard k value, however, is preferred for investigative work.
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PMID:Effect of staphylococcal alpha-toxin pancreatitis on glucose tolerance in the dog. 94 22

The effect of insulin treatment in acute pancreatitis was studied in a double-blind investigation. Fifteen patients with clinical signs of acute pancreatitis were treated with intravenous infusion of glucose and insulin only. Twelve patients were free from pain within four hours of commencement of treatment. Within eight hours all fifteen were free from abdominal pain. Fourteen patients with pancreatitis established by the same criteria were treated with glucose infusions without insulin. Only four of the patients in this group became free from pain within four hours. The role of intravenously infused insulin with respect to the more beneficial effect in the first group is discussed.
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PMID:Role of intravenously infused insulin in treatment of acute pancreatitis. A double-blind study. 109 32


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