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

Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). In addition, serum pancreatic enzymes increase without clinical symptoms in about 40-50% of patients undergoing these endoscopic procedures. We evaluated the potential of octreotide, a long-acting somatostatin analogue, to prevent these complications in patients who underwent EST for choledocholithiasis. 151 patients were randomly allocated to two groups (A and B). Group A was given 0.1 mg of octreotide subcutaneously 120 and 30 min before EST and four hours after; group B was given a placebo. Serum amylases (normal range 20-220 IU/l) were measured before premedication and 4, 24, and 48 hours after the end of endoscopy. After EST, the increase in the mean serum amylase was greater in the control group, but the difference was statistically significant only at the 48-hour measurement. There were five cases of acute pancreatitis in each group, with a trend (but not statistically significant) toward less severe pancreatitis in the treated group. In the control group, one patient with acute pancreatitis died. In conclusion, octreotide does not seem to prevent acute post-EST pancreatitis.
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PMID:The use of a long-acting somatostatin analogue (octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy. 753 55

Pancreatic reaction after endoscopic papillosphincterotomy (EPT) is a common event occurring in about 70% of cases. Acute pancreatitis may also develop in 1%-6% of cases. Previous attempts to prevent this reaction with an inhibitor of exocrine pancreatic secretion such as somatostatin provided conflicting results. The somatostatin long-acting analogue octreotide has recently proposed for the prevention of ERCP/EPT-induced pancreatic reaction. Therefore we tested the prophylactic effect of a subcutaneous administration of octreotide in two different dosages in 60 consecutive patients undergoing EPT for common bile duct stones and benign papillary stenosis. They were given either octreotide 0.2 mg (20 cases), or octreotide 0.1 mg (20 cases), or placebo (20 cases) before the procedure. Serum amylase levels were determined at baseline and 2, 4, 8 and 24 hours thereafter. The differences were statistically significant at 2 hours between subjects pretreated with octreotide 0.2 mg and control subjects (p = 0.01); at 4 and 8 hours after the procedure between both octreotide-treated groups and control subjects (octreotide 0.1 mg: p < 0.05, at 4 and 8 hrs; octreotide 0.2 mg: p = 0.01, at 4 hrs, and p < 0.01, at 8 hrs). In patients with previous episodes of relapsing pancreatitis, the increase in serum amylase was significantly reduced in the octreotide 0.2 mg group vs control group, at 4 hrs (p < 0.05) and 8 hrs (p < 0.05). Our data suggest that octreotide 0.2 mg has a greater prophylactic efficacy than 0.1 mg in reducing pancreatic reaction after EPT.
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PMID:Controlled trial of different dosages of octreotide in the prevention of hyperamylasemia induced by endoscopic papillosphincterotomy. 754 Dec 58

During the last 15 years, a total of 26 patients were treated for pancreatic pseudocysts, at the 2nd Department of Propaedeutic Surgery, University of Athens. There were 16 (61.5%) men and 10 (38.5%) women aged between 19 and 82 years old (mean age 61 years). Dominating symptoms in most patients were epigastric mass and pain, nausea, vomiting, mild fever and leucocytosis, and persistent elevation of serum amylase. Imaging studies, such as ultrasound, CT scan, and ERCP, were mostly helpful in establishing diagnosis. In most cases, attack of acute pancreatitis preceded with the exception of two cases where there was chronic pancreatitis and another which was post-traumatic. Rapid progression of underlying pancreatitis led to urgent laparotomy in two patients (7.7%). Elective surgery was performed in 22 patients (84.6%), 1-7 months after onset of pancreatitis (median 2 months). Selection of operative procedure depended on the patient and cyst condition. Cystogastrostomy was performed in 18 patients (69.2%), cystojejunostomy in three patients (11.5%), and external drainage in three patients (11.5%). There were three postoperative deaths (11.5%). Haemorrhage and infection were the main complications. Percutaneous drainage was performed in two cases (7.7%) (one for a cyst remnant after an operative procedure), and medical treatment with somatostatin in another case (3.8%) with excellent clinical results. In conclusion, conservative treatment of pancreatic pseudocysts has good clinical results, but it is not always indicated. Surgical drainage remains the preferred method of treatment.
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PMID:Therapeutic strategies for pancreatic pseudocysts. 761 75

1. The present study was designed to determine the changes in renal function in two models of experimental pancreatitis in rats, in an attempt to assess the possible pathogenic role of reactive oxygen species and to elucidate a possible therapeutic role for somatostatin. 2. Mild pancreatitis was induced by low blockade of the biliary duct and severe pancreatitis was evoked by retrograde infusion of bile salts. Renal function was studied by clearance techniques in rats with pancreatitis, treated or not treated with somatostatin. Plasma and glomerular malonyldialdehyde levels were measured by the thiobarbituric acid method. 3. Renal function did not change in rats with low blockade of the biliary duct, but animals receiving a retrograde infusion of bile salts showed a significant decrease in glomerular filtration rate and renal plasma flow with respect to sham-operated animals. 4. Plasma malonyldialdehyde levels increased significantly in rats treated with bile salts with respect to control animals, whereas no changes were detected in glomerular malonyldialdehyde levels. Thus, the renal dysfunction does not seem to be related to an increased production of reactive oxygen metabolites at the glomerular level. 5. Somatostatin infusion significantly improved renal function in rats with severe pancreatitis (retrograde infusion of bile salts) by increasing glomerular filtration rate, renal plasma flow and filtration fraction. These results support a possible therapeutic role for somatostatin in the renal dysfunction associated with the severe forms of pancreatitis.
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PMID:Changes in renal function in acute experimental pancreatitis in rats: a therapeutic role for somatostatin. 790 48

L-Asparaginase-induced pancreatitis is an uncommon but potentially lethal complication. An 8-year-old girl with acute lymphoblastic leukaemia developed acute pancreatitis following treatment with asparaginase. Clinical and laboratory improvements were evident after treatment with somatostatin, with no complications of pancreatitis. Induction therapy for the leukaemia was able to be continued and complete remission was documented during the course of pancreatitis and somatostatin treatment, suggesting a beneficial role of somatostatin in the management of asparaginase-induced pancreatitis.
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PMID:Somatostatin therapy in L-asparaginase-induced pancreatitis. 790 15

The aim of this study was to determine the hemodynamic effect of somatostatin, either prophylactically or therapeutically, in shock caused by acute necrohemorragic pancreatitis in conscious rats. For this purpose, radioactive microspheres were used in 3 groups (control pancreatitis, therapeutic somatostatin and prophylactic somatostatin), performing a basal and final hemodynamic study. In the control group, acute necrohemorragic pancreatitis resulted in overwhelming shock with decrease of 55% in cardiac output, 58% in renal blood flow, increase in total peripheral resistances of 342%, and death after 70 min. Therapeutic somatostatin decreased cardiac output by 42%, renal blood flow by 47%, and increased total peripheral resistances by 153%. Prophylactic somatostatin decreased cardiac output by 24%, and renal blooded flow by 28%; it increased peripheral resistances by 146%, and improved survival up to 97 min. In conclusion, therapeutic somatostatin, and particularly prophylactic somatostatin, improved hemodynamic shock after acute necrohemorragic pancreatitis in conscious rats.
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PMID:[Effect of somatostatin on the hemodynamic changes induced by acute experimental pancreatitis in the conscious rat]. 791 12

Obstruction-induced acute pancreatitis in rats is associated with increased plasma cholecystokinin (CCK) levels. Duodenal replacement of bile reduces severity of pancreatitis and limits CCK increase. We investigated the role of CCK in the pathogenesis of obstruction-induced acute pancreatitis by pretreating rats with the somatostatin analog octreotide and the CCK antagonist L-364,718. Octreotide inhibits duodenal CCK release, and L-364,718 competitively blocks CCK receptors. We studied 31 rats after (1) sham operation (n = 7), (2) bile and pancreatic duct obstruction (BPDO) (n = 12), (3) BPDO plus octreotide (20 micrograms/kg IP and then 5 micrograms/kg/hr IV) (n = 6), and (4) BPDO plus L-364,718 (1 mg/kg IP and then 0.25 mg/kg/hr IV) (n = 6). Rats were killed after 18 hours. Pancreas weight, acute pancreatitis histology score, and plasma amylase and CCK levels were determined. Octreotide and L-364,718 limited the increase in pancreas weight. Octreotide also limited the rise in plasma CCK levels. These findings suggest that CCK may play a role in the pathogenesis of obstruction-induced acute pancreatitis.
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PMID:Octreotide and cholecystokinin antagonist reduce edema in obstruction-induced acute pancreatitis. 822 60

We report an autopsy case of acute-onset insulin-dependent diabetes mellitus, type I, that occurred in an adult. The patient died 3 days after the clinical onset of diabetes. Hyperglycemia, ketonuria, and hyperamylasemia were observed at admission. The pathologic examination of the pancreas showed a markedly decreased number of islets, and residual islets were small and shrunken. Diffuse inflammatory cell infiltrates, which were found in islets and also in acini, were mainly T lymphocytes. Shrunken islets were composed of insulin cells, glucagon cells, somatostatin cells, and pancreatic polypeptide cells. A decreased number of zymogen granules in acini were prominent [corrected]. This case suggested that pan-pancreatitis, destroying whole islets and acini, can initiate insulin-dependent diabetes mellitus.
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PMID:Vanished islets with pancreatitis in acute-onset insulin-dependent diabetes mellitus in an adult. 828 38

The innervation of the sphincter of Oddi (SO) has been extensively studied experimentally, but human studies have not been published, which is why this study was undertaken. Biopsies, taken by gastroscopy-biopsy forceps from duodenal epithelium of the papilla of Vater and from ampullary epithelium after sphincterotomy, did not demonstrate nerves and could not be used for studying SO innervation. Therefore SO specimens were obtained from brain-dead organ donors (N = 5) and from autopsies (N = 14). By staining with a myelin marker S-100, a rich network of nerves was demonstrated in SO. The occurrence of vasoactive intestinal polypeptide (VIP), peptide histidine-isoleucine (PHI) (or its immunologically similar human equivalent peptide histidine methioninamide, PHM), neuropeptide Y, calcitonin gene-related peptide (CGRP), galanin, substance P, enkephalin, bombesin, and somatostatin were studied by immunohistochemical technique. SO demonstrated immunoreactivity for VIP, PHI (PHM), neuropeptide Y, CGRP, galanin, somatostatin, substance P, and enkephalin, but no immunoreactivity was observed for bombesin. The SO immunoreactivity was similar in specimens from organ donors and from autopsies of victims of violence without pancreatobiliary diseases (N = 3) when the specimens were taken within 48 hr of death. Autopsy specimens of SO from subjects with gallstone disease (N = 5), recurrent pancreatitis (N = 3) or periampullary carcinoma (N = 3) also demonstrated similar immunoreactivity. We conclude that VIP-, PHI- (PHM-), neuropeptide Y-, CGRP-, galanin-, substance P-, somatostatin-, and enkephalin-like immunoreactivity occur in human SO. These neuropeptides may have role in the neural control of human SO function.
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PMID:Peptidergic innervation of human sphincter of Oddi. 831 11

The inflammatory pancreatic diseases are usually hardly governable; special problems are arosen with the treatment of pancreatic fluid collections. The focal pericystic pancreatitis, the reactive inflammation developing in the course of the injury of the gland as well as draining pancreatic duct filling the cyst up may result in pitfalls. Thus subcutaneous administration of Sandostatin was added to the usual therapeutic regimen in 12 patients. It was applied with external and internal drainage of pseudocysts in 10 patients and in one of them the complication was reduced in an unsuccessful attempt, respectively. The pseudocyst of one patient disappeared by sole somatostatin administration. One cystic formation did not respond to this kind of treatment thus a drainage procedure had to be performed. Based on our initial experiences we seem to find a rather promising tool that may influence the basic process beneficially and makes our instrumental interventions safer and more successful.
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PMID:[The use of a somatostatin analog (Sandostatin) in percutaneous drainage of pancreatic pseudocysts]. 836 49


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