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

Studies of coagulation were performed prospectively in 41 patients with mild to moderately severe acute pancreatitis. Six patients (15%) presented with coagulation data suggestive of defibrination; two of them had clinical signs of bleeding. No other cause than pancreatitis was found in these 6 patients to account for coagulation abnormalities. Comparing the patients who presented defibrination to those who did not, no difference was observed in clinical course and admission values of serum amylase, fibrinogen, urea, calcium, glucose, transaminase levels, white blood cell count and arterial partial pressure of oxygen. Platelets counts and serum creatinine levels were respectively lower and higher in the first group of patients.
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PMID:[Defibrination syndrome during acute pancreatitis: 6 cases. Prospective studies of coagulation in 41 patients (author's transl)]. 46 Nov 54

The pancreases of 77 uremic rats of a Wistar strain were investigated light-microscopically in groups of 5 animals at 11 different times between one day and ten weeks after 5/6-nephrectomy. The serum concentration of urea reached a maximum mean value of 375 mg% after three days; during the stage of chronic uremia the mean value was found to be 175 mg%. The blood pressure increased in the third week after 5/6-nephrectomy and reached in the course of the experiment values of up to 200 mm Hg and more. Histologically, after an initial acute interstitial pancreatitis with focal dystrophies of the exocrine parenchyma which was virtually cured by the 14th day of the experiment, an increasing proliferative-exudative and granulomatous vasculopathy appeared at the end of the third week. This was followed by a perivascular transmitted chronic-fibrosing pancreatitis which may be regarded as a model of vascularly induced pancreatitis. Early damage by uremia and initial pancreatitis, the rapidly developing hypertension and allergical and autoallergical reactions are discussed as aetiological complex for the vascular alterations. The typical findings of the uremic pancreatopathy, well-known in human pathology, are not reproducible.
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PMID:Vascular chronic-fibrosing pancreatitis of the rat after 5/6-nephrectomy. 59 Apr 15

Pancreatitis was induced in 11 miniature pigs by infusing a bile salt-trypsin solution into the pancreatic duct. Seven animals served as sham-operated controls. Serum ionized calcium, total calcium, albumin, total protein, inorganic phosphorus, urea nitrogen, magnesium, insulin, glucagon, and hematocrit were determined every six to 12 h over a period of one week in both test and control animals. We observed significant decreases in ionized and total calcium, modest decreases in albumin, and significant increases in the inorganic phosphorus, urea nitrogen, and hematocrit in the pancreatitic pigs. The latter two findings were consistent with early acute hypovolemia. Glucagon and insulin appeared to play no role in the hypocalcemia. Glucagon concentrations increased to the same degree in both test and control animals, probably as a result of the stress of being handled and operated on. The highest concentrations of inorganic phosphorus and the lowest concentrations of both ionized and total calcium were seen 18 h after the induction of pancreatitis in the test animals. These findings suggest that parathyrin (parathormone) was not being secreted in adequate amounts, or that the target organs were unresponsive to parathyrin.
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PMID:Biochemical changes in a porcine model of acute pancreatitis. 65 76

The value of conservative treatment in a case of chronic advanced renal failure was investigated in a 5-year-old girl with congenital hypoplastic kidneys. Before treatment the patient was severely anorexic and her plasma urea nitrogen was 180 mg/100 ml. Protein restriction alone was fruitless. After a transitional period on total parenteral therapy the patient was put on a maintenance oral diet, where an energy-rich diet was supplemented with essential amino acids including histidine. Plasma urea nitrogen dropped and stayed at about 50 mg/100 ml during the whole treatment in spite of a rising plasma creatinine from 10 to 24 mg/100 ml. The general condition of the patient normalized as she went into an anabolic state with weight gain and growth in height. The nitrogen balance studied in two different periods was positive. An acute attack of pancreatitis, secondary to hyperparathyroidism, ended the patient's life after 22 months of treatment.
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PMID:Essential amino acids in the treatment of advanced uremia: twenty-two months' experience in a 5-year-old girl. 81 Jul 64

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

Total serum amylase activity, its isoenzymes and pancreatic to salivary amylase (P/S) ratio were studied in 40 normal subjects and 47 patients with renal failure, 32 with benign and 15 with malignant conditions. Amylase to creatinine clearance (Cam/Ccr) was studied in 17 normals and 14 patients with renal failure, 10 benign and 4 with malignant diseases. Total amylase activity, and pancreatic and salivary fractions were found to be increased by about 3.4 times the normal in both benign and malignant conditions producing renal failure though the P/S ratio was within the normal range. However, the increase in the urea and creatinine levels in patients could not be related to the increase in serum total amylase. Besides the Cam/Ccr ratio was elevated in patients with both benign and malignant conditions producing renal insufficiency whereas the Cam and Ccr were individually found to be decreased. Why patients with chronic renal failure in both conditions without clinical evidence of pancreatitis should have elevated Cam/Ccr ratio is not clear.
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PMID:Hyperamylasaemia & related enzyme factors in renal failure associated with benign & malignant conditions. 172 Apr 21

In spite of continuous progress in intensive care during the past two decades, there is no definite proof that the prognosis of critically ill patients with acute renal failure has actually improved. Nevertheless, the development of hemofiltration and hemodiafiltration and of the continuous methods has extended the therapeutic spectrum and allows therapy to be adapted to the specific cardiovascular and metabolic situation of the individual patient. Detoxification is carried out intracorporeally in peritoneal dialysis or extracorporeally by means of filters and membranes with different filtration properties. Peritoneal dialysis is seldom indicated in operative patients, because of its low efficiency and the hypercatabolism that is often observed, except in situations where continuous abdominal lavage is desired, as in peritonitis or necrotizing pancreatitis. The standard detoxification method is hemodialysis in which the filter is perfused in the opposite direction to blood flow. Solute transport is the result of diffusion, osmosis and, to a minor extent, convection, and the elimination of small molecules is favored. As huge amounts of dialysate have to be used, a central water regeneration unit is the technical prerequisite for hemodialysis. In critically ill patients bicarbonate dialysis should be preferred, because it is hemodynamically better tolerated. Hemofiltration relies on convection rather than diffusion through a membrane with a cut-off between 20,000 and 50,000 daltons. The ultrafiltrate largely resembles plasma water. Fluid loss is substituted by appropriate electrolyte solutions allowing space for negative balances and hypercaloric parenteral nutrition. Hemofiltration is better tolerated than hemodialysis and was introduced to improve the elimination of toxic middle molecules. In intensive care units without access to hemodialysis or intermittent hemofiltration continuous arteriovenous hemofiltration (CAVH), first proposed by P. Kramer, has become an alternative, mainly because of its simplicity and the absence of hemodynamic side effects. The drawback of this method is its limited efficiency. In hypercatabolic patients daily ultrafiltration rates of 10-15 l will not reduce blood urea sufficiently. The same holds true for severe hyperkalemia. One attempt to increase efficiency is predilution, which involves adding part of the substitution fluid before the filter, to enhance blood flow and to increase the effective filtration pressure by lowering the oncotic pressure of the plasma. Predilution will increase the net urea clearance by some 20%. Another way to enhance filtration is to apply negative pressure to the membrane with the aid of an infusion pump at the filtrate side. The development of better filters with smaller resistances may further increase filtration rates.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Extrarenal elimination procedures in acute kidney failure]. 228 6

Normothermic ischemia tolerance is an important aspect of organ procurement and transplantation. The function of pancreas and kidney autografts was investigated in totally pancreatectomized or nephrectomized canine recipients. In 30 dogs the left limb (tail) of the pancreas was removed but left in the abdominal cavity after cessation of blood flow to produce warm ischemia for 30, 60, and 120 min (10 dogs at each time point), and then was flushed with cold Ringers' lactate and transplanted to the iliac vessels. Twenty dogs with fresh pancreatic transplants were controls. The success rate of pancreas transplants with warm ischemia of 1/2 and 1 hr was the same as that of controls (80%); however, after 1 hr normothermia 5/10 dogs had episodes of hyperglycemia for 1 week before glucose levels came back to normal. All but one graft with 2 hr warm ischemia failed. Intravenous glucose tolerance test (IVGTT) mean (+/- SEM) K values were not different in the successful groups, i.e., no warm ischemia: -1.55 +/- 0.15%; 1/2 hr warm ischemia: -1.81 +/- 0.18%; 1 hr warm ischemia: -1.64 +/- 0.09%. Amylase levels increased after transplant with maximum values at Day 2, then returned to normal, but the levels remained elevated in recipients of grafts subjected to longer normothermia with evidence of pancreatitis after 1 hr warm ischemia. Fifteen kidney grafts were treated similarly with warm ischemia exposure of 1/2 hr (n = 9) and 1 hr (n = 6) before being flushed and autotransplanted, and were compared to 16 fresh kidney transplants. After 1/2 hr warm ischemia none of the kidney grafts failed but 78% of the recipients had elevated serum creatinine and urea nitrogen levels which returned slowly to normal after 3 to 4 weeks. There was only one long-term survivor after 1 hr warm ischemia. Thus the pancreas seems to be more resistant to warm ischemia damage than is the kidney. This difference should be taken into consideration in regard to organ procurement for clinical transplantation.
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PMID:Definition of normothermic ischemia limits for kidney and pancreas grafts. 242 97

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

Rates of glucose turnover and oxidation in normal volunteers (N = 16) and in severely ill patients with pancreatitis (N = 9) were isotopically determined. Glucose turnover was determined using primed constant infusions of either 6-3H-glucose or 6-d2-glucose, and glucose oxidation with either U-14C-glucose or U-13C-glucose after appropriate priming of the bicarbonate pool. Urea kinetics were determined using primed constant infusions of either (15N2)-urea or U-14C-urea, whereas free fatty acid (FFA) kinetics were determined by the constant infusion of 1,2-13C palmitate. Basal rates of glucose production and plasma glucose clearance were significantly higher in the patients than in the volunteers. During glucose infusion (4 mg/kg/min) endogenous glucose production was virtually totally suppressed in the volunteers (94 +/- 4%). There was significantly less suppression in the patients, however (44 +/- 1%). In addition, the percentage of available glucose oxidized (i.e., percentage of uptake oxidized) was significantly less in the patients than in the volunteers. The basal rate of urea production was significantly higher in the patients; however, in both patients and volunteers, glucose infusion resulted in a significant decrease. The rate of FFA turnover was similar in the patients and volunteers, and the patients and volunteers were equally sensitive to the suppressive effects of glucose infusion. When the patients were studied during total parenteral nutrition (TPN), there was no further suppression of endogenous glucose turnover than that seen during 2 hours of glucose infusion, and the mean rate of urea turnover measured during TPN (7.0 +/- 1.9 mumol/kg/min) was also not significantly different than the value determined during glucose infusion (8.9 +/- 1.8 mumol/kg/min). It was concluded from these studies that patients with pancreatitis are metabolically similar to septic patients, have an impairment in their ability to oxidize infused glucose when compared with normal volunteers, have an elevated rate of net protein catabolism, and have FFA kinetics similar to those seen in normal humans.
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PMID:Glucose, fatty acid, and urea kinetics in patients with severe pancreatitis. The response to substrate infusion and total parenteral nutrition. 309 98


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