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

Microvascular permeability was studied in the isolated perfused rat pancreas using a rapid multiple indicator-dilution technique. Capillary extractions, permeability-surface area products (PS), and extravascular volumes of distribution (EVV) were determined for 22Na+, 51Cr-labeled EDTA, [57Co]-cyanocobalamin (B12), and 125I-labeled insulin at various perfusion flows. Permeability to albumin was negligible. PS for Na+ and EDTA increased with increasing flow, whereas PS for cyanocobalamin and insulin approached diffusion-limited exchange at flows greater than 3 ml.min-1.g-1. Permeability coefficients for Na+, EDTA, B12, and insulin were 36, 22, 11, and 3.48 x 10(-5) cm/s, respectively, and the permeability ratio for B12/insulin (3.16) indicated restricted diffusion to insulin. In the presence of unlabeled B12 and insulin EVV (0.15-0.19 ml/g) for EDTA, B12 and insulin approximated the interstitial volume. Caerulein-induced pancreatitis or treatment with the synthetic protease inhibitor camostate had no significant effects on permeability. In caerulein-treated rats, EVV for B12 was elevated (0.17 +/- 0.01 vs. 0.28 +/- 0.06; P less than 0.01), reflecting the interstitial edema associated with this model of pancreatitis. Permeability of the rat pancreatic microvasculature is similar to that of other fenestrated tissues, but it is 10- to 20-fold greater than that of continuous capillaries. Contrary to previous assumptions, permeability does not appear to be increased after induction of acute interstitial pancreatitis.
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PMID:Pancreatic microvascular permeability in caerulein-induced acute pancreatitis. 192 54

In a prospective study, several parameters of small intestinal function have been assessed in 20 patients with chronic relapsing pancreatitis with and without steatorrhoea. By and large all routine parameters of small intestinal function were found to be normal. In particular, neither a previously reported high incidence of lactase deficiency, nor D-xylose malabsorption or vitamin B12 depletion was observed. However, there was a high incidence of abnormal 14C-cholylglycine breath tests (40%), suggesting the presence of mild bacterial overgrowth. Occasionally, this condition was associated with diarrhoea and steatorrhoea, thus indicating that steatorrhoea remaining after high-dosage pancreatin supplementation might sometimes be due to bacterial overgrowth.
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PMID:Small intestinal function in chronic relapsing pancreatitis. 401 10

A new inherited neuromuscular disease was identified in 4 patients (1 male, 3 females), offspring of consanguineous marriages, belonging to the same kindred. The proband was a 24-year-old female with history of ptosis and ophthalmoplegia since childhood and progressive intestinal pseudo-obstruction for the last 4 years of her life. A sural nerve biopsy showed axonal and demyelinating neuropathy. Muscle biopsies of pectoral and gastrocnemius revealed myopathic alterations with marked variation in muscle fiber size, atrophy of both fiber types and normal mitochondria. An upper gastrointestinal study showed barium in the stomach after 8 h and jejunal diverticula. Tests for absorption of fat, protein, carbohydrate, folic acid and vitamin B12 were normal. Serum levels of vitamin A and lipoproteins were also normal. The patient underwent partial gastrectomy and gastrojejunostomy. Postoperatively, she developed severe pancreatitis, sepsis, peritonitis and expired. Tissue samples from the proband and from her brother, revealed normal mucosa, but degeneration of smooth muscle of the stomach and small intestine. The myenteric plexus and vagus nerves were normal. The biochemical studies of contractile proteins (myosin, actin, tropomyosin) in the fresh and cultured smooth muscle cells of the proband obtained at the time of gastrectomy showed a 50-75% decrease in the synthesis of different contractile proteins. Turnover of contractile proteins and synthesis and turnover of collagen showed normal values. The reduction in synthesis of contractile proteins may account for the weak peristalsis and be a factor in the pathogenesis of the intestinal pseudo-obstruction.
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PMID:Inherited ophthalmoplegia with intestinal pseudo-obstruction. 668 98

Seven cases of Crohn's disease of the duodenum are presented. They made up 2% of 350 cases of Crohn's disease seen over a period of 15 years. Mean age at onset of Crohn's disease was 22 years (range, 13--47). All patients had other, and most patients severe, lesions elsewhere in the alimentary tract. In three patients the duodenal lesion appeared simultaneously with or within a year of lesions elsewhere, in four cases not until 4 to 15 years later. The period of observation after detection of regional duodenitis was 2 to 14 years; mean, 8 years. The commonest complaint due to duodenitis was epigastric pain. It was present in everyone. Gastrointestinal bleeding rarely occurred. Complicating pancreatitis was not seen. Pathophysiologic abnormalities (decreased vitamin B12 and iron absorption, abnormal protein loss) depended more on the extraduodenal extension of Crohn's disease than on the duodenal lesion. In three patients duodenal obstruction required a bypass operation (gastrojejunostomy or duodenojejunostomy). The same three patients and three other of the series were subjected to other surgical treatment, including ileal resection and, in four cases, subtotal colectomy. Two patients died, one of pneumonia in his home and one in her home town of, probably, acute gastroenteritis complicating a severe short-bowel syndrome. The prognosis in this series seemed to be worse than in Crohn's disease in general, not because of the duodenal lesion but because of its association with severe lesions elsewhere in the gastrointestinal tract.
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PMID:Crohn's disease of the duodenum. 720 78

The serum levels of 6 vitamins were prospectively evaluated in 20 patients with acute biliary pancreatitis and in 20 patients with acute alcoholic pancreatitis. Twenty healthy subjects acted as controls. There were no statistically significant differences in the levels of vitamin B12 and D among the groups. Patients with alcoholic pancreatitis had significantly lower levels of vitamins A, E (p < 0.01) and C (p < 0.001) than those of the control group. Plasma levels of vitamin K were decreased or undetectable in 6 patients with biliary and 3 with alcoholic pancreatitis. The pathophysiological and clinical implications of this abnormal vitamin status in patients with acute pancreatitis are unknown. Nevertheless, multi-vitamin supplementation seems justified, especially in patients affected by alcoholic pancreatitis. Vitamin K should be administered in both types of pancreatitis when blood coagulation tests are disturbed.
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PMID:Vitamin status in patients with acute pancreatitis. 1683 77

The role of homocysteine role in inflammation and malignancy has been studied experimentally. Some researchers suggest that a relationship exists between pancreatitis and homocystinuria, possibly being secondary to occlusive vascular disease of the pancreas. To date, plasma homocysteine levels in pancreatic disease have not been studied. We aimed to analyze the homocysteine status in patients with acute pancreatitis, and the changes of the plasma homocysteine level at the acute phase of the disease and six months after hospital discharge. Fourteen acute pancreatitis patients and 14 healthy subjects were studied. Plasma homocysteine, vitamin B12, folate, amylase, lipase, C-reactive protein, total, HDL and LDL cholesterol, triglycerides, blood urea nitrogen, white blood cells, and creatinine were measured in the two groups of subjects. Plasma levels of homocysteine were significantly higher in patients with acute pancreatitis as were serum creatinine, blood urea nitrogen, WBC counts, amylase, lipase, and C-reactive protein. An impaired creatinine clearance was also found in these patients but this did not reach statistical significance. Serum total, HDL, and LDL cholesterol concentrations were not significantly different between the two groups of subjects. Our data suggest that homocysteine may play a role in inflammatory diseases of the pancreas. Increased plasma homocysteine levels in acute pancreatitis may be a reason, or a marker, for the diagnosis of acute pancreatitis. In conclusion, this is the first report showing that patients with acute pancreatitis have higher plasma homocysteine levels than healthy subjects.
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PMID:Changes in plasma levels of homocysteine in patients with acute pancreatitis. 1846 55

Intestinal microflora can be considered as a ''dynamic system'' that actively interacts with the intestinal epithelium and the local immune system. It synthesizes antimicrobial substances (bacteriocins), vitamins (PP, B1, B6, B12), it produces a major intestinal nutrient (butyric acid) and interacts in a competitive fashion with the pathogens. Lactobacilli concentration (Gram+, Gram variable, facultative anaerobes) is generally decreased in irritable bowel syndrome (IBS) patients. This syndrome has, until recently been considered to be ''functional'', whereas, in fact, it may result from previous enteritis (in up to 31% of patients), featuring a persistent low-grade intestinal inflammation and a reduction in interleukin-10 (IL-10) concentration. Some Lactobacilli strains (e.g. L. paracasei subsp. paracasei) in vitro lead to normalisation of the hypercontractility of the smooth muscle cells. A growing body of clinical findings indicates that some ''genetically stable'' strains of Lactobacilli may be useful in the treatment, even long term, of IBS, and reduce the postoperative infection rate, especially in critically ill patients (orthotopic liver transplant, severe pancreatitis). However, some Lactobacilli, ''not genetically stable'', used in the treatment of neutropenic patients during chemotherapy and in pediatric patients submitted to gastrojejunostomy, have been reported to lead to bacteremia and endocarditis. These effects may be due to transfer of bacteria and genetic material. Therefore, the confirmed genetic stability and the fact that no antibiotic resistance occurs are fundamental requisites for the use of Lactobacilli in certain disorders of the gastrointestinal tract, such as, for instance, IBS. In conclusion, ''genetically stable'' Lactobacilli (L. paracasei subsp. Paracasei F19) have recently become available, representing an exiting new field in clinical studies and for treatment purposes, offering guarantees of safety also for long-term use. Careful personalized evaluation, as always in medical practice, is necessary in order to gain further insight into, and to validate with additional studies, the role of ''genetically stable'' Lactobacilli in the treatment of IBS.
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PMID:New insights into Lactobacillus and functional intestinal disorders. 1861 77

In patients with Crohn's disease and ulcerative colitis parenteral nutrition (PN) is indicated when enteral nutrition is not possible or should be avoided for medical reasons. In Crohn's patients PN is indicated when there are signs/symptoms of ileus or subileus in the small intestine, scars or intestinal fistulae. PN requires no specific compounding for chronic inflammatory bowel diseases. In both diseases it should be composed of 55-60% carbohydrates, 25-30% lipids and 10-15% amino acids. PN helps in the correction of malnutrition, particularly the intake of energy, minerals, trace elements, deficiency of calcium, vitamin D, folic acid, vitamin B12, and zinc. Enteral nutrition is clearly superior to PN in severe, acute pancreatitis. An intolerance to enteral nutrition results in an indication for total PN in complications such as pseudocysts, intestinal and pancreatic fistulae, and pancreatic abscesses or pancreatic ascites. If enteral nutrition is not possible, PN is recommended, at the earliest, 5 days after admission to the hospital. TPN should not be routinely administered in mild acute pancreatitis or nil by moth status <7 days, due to high costs and an increased risk of infection. The energy requirements are between 25 and 35 kcal/kg body weight/day. A standard solution including lipids (monitoring triglyceride levels!) can be administered in acute pancreatitis. Glucose (max. 4-5 g/kg body weight/day) and amino acids (about 1.2-1.5 g/kg body weight/day) should be administered and the additional enrichment of TPN with glutamine should be considered in severe, progressive forms of pancreatitis.
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PMID:Gastroenterology - Guidelines on Parenteral Nutrition, Chapter 15. 2004 77

Organic acidemias (OAs) are rare inborn errors of metabolism. The clinical presentations of methylmalonic acidemia (MMA) and propionic acidemia (PA) in Japan have not yet been examined in detail. We aimed to investigate the clinical presentations of OAs in Japan and evaluate current therapies for improving long-term outcomes, especially in MMA and PA cases. Questionnaires were sent to 928 institutions in 2009 inquiring about OAs, and secondary questionnaires were sent to those who confirmed that they had diagnosed and/or treated such cases; 119 cases were eventually included for analysis. In Japan, the majority of OAs was MMA, which was associated with a high mortality rate. The survival rates at 20 years of age in vitamin B12-unresponsive MMA, vitamin B12-responsive MMA and PA patients were 69.8%, 94.4% and 95.8%, respectively. Factors associated with mortality in MMA were failure to thrive, hypoglycemia and pancreatitis. Factors associated with mental retardation in vitamin B12-unresponsive MMA, vitamin B12-responsive MMA, and PA were seizure and liver dysfunction, seizure and failure to thrive, and failure to thrive, respectively. We advocated that avoiding failure to thrive due to too restricted protein diet, hypoglycemia and pancreatitis associated with mortality lead to improve outcome, especially in vitamin B12-unresponsive MMA patients.
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PMID:Clinical features and management of organic acidemias in Japan. 2406 94

A 27-year-old woman with vitamin B12 responsive form of methylmalonic acidaemia (MMA) was pregnant with her first child. Treatment was unaltered during pregnancy: a low-protein diet and supplements. Her pregnancy was uncomplicated. She had a spontaneous delivery of a healthy girl with no MMA. The postpartum period was uneventful. MMA is a rare autosomal recessive metabolic disorder caused by a deficiency of methylmalonyl coenzyme A mutase or its vitamin B12-dependent cofactor, leading to a toxic accumulation of methylmalonyl acid in plasma and urine. Clinical presentation involves otherwise unexplained deterioration and neurological dysfunction, recurrent vomiting, dehydration, lethargy, respiratory distress and muscular hypotonia. Long-term sequelae are neurological problems, renal failure, pancreatitis and cardiomyopathy. This is the 11th reported case of pregnancy in a woman with MMA.
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PMID:Methylmalonic acidaemia in pregnancy. 2468 5


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