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

The value of endoscopic retrograde cholangiopancreatography (ERCP) in a surgical unit was established by analysing 200 consecutive studies. The selective success rate was 80%. The groups of indications were jaundice (27%), postcholecystectomy pain (22%), recurrent acute pancreatitis (19%), complicated attack of acute pancreatitis (14%), and other (18%). A normal ERC was found and operation thus avoided in 26% of cases with persistent jaundice. In patients with postcholecystectomy pain pathological findings were found in 50% and half of them were operated upon. In pancreatitis demonstration of the pancreatic ducts and grading of the disease facilitated selection of the treatment and enabled preoperative planning of the surgical procedure. The pancreas was resected in 13 of 59 cases with diagnostic ERP. In pancreatic carcinoma ERCP led directly to diagnosis, but only two (ampullary carcinomas) out of ten were operable. The overall complication rate was 4%, including one case of fatal haemorrhagic pancreatitis.
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PMID:Endoscopic retrograde cholangiopancreatography in a surgical unit. 67 99

The results of ERP carried out in a series of cases of established and suspected chronic and acute relapsing pancreatitis are presented. Radiological findings are divided into major and minor alterations of the pancreatic secretory system. X-ray findings are easy to interprete in chronic pancreatitis with major alterations. Minor anomalies of the pancreas are difficult to interprete in the absence of supporting evidence. Biliary tract involvement is useful for diagnosis of chronic pancreatitis.
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PMID:An evaluation of endoscopic retrograde pancreatography (ERP) in chronic and relapsing acute pancreatitis. 86 74

Functional tests and ERP were performed in patients with chronic and acute pancreatitis and papillary stenosis; both diseases differ considerably as can be shown by both, pancreatography and degree of functional impairment. The different classification types of pancreatitis are based upon the Marseille Symposium. The ERP is the only x-ray procedure which allows the diagnosis of intrapapillar pancreatic duct stenosis. The ERP significantly improves diagnosis of the early stages of papillary stenosis of the pancreas. Neither secretin-pancreozymin test nor ERP are indicated in cases of primary chronic calcifying pancreatitis; in chronic relapsing calcifying pancreatitis they should be used for preoperative diagnostic purposes.
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PMID:[Pancreatitis and papillary stenosis: endoscopic retrograde pancreatography (ERP) vs. exocrine functional tests (author's transl)]. 102 76

In a nonblind nonrandomized clinical trial two groups of patients who were undergoing ERCP - A (n = 182) with antibiotic prophylaxis and B (n = 220) without an antibiotic--were compared on a prospective basis. The efficacy of properly timed prophylaxis with a therapeutically effective antibiotic had previously been established by a pilot study and a definitive trial based on HPLC assays of endoscopic biopsy specimens taken from the duodenal papilla. In Group A (n = 182) there was hyperamylasaemia without a leucocytic reaction in only 18 (14.75%) of the ERP patients and two (3.33%) of the ERC patients, but in Group B (no antibiotic - n = 220) this change was detected in 48 (35.29%) of the ERP patients and 12 (14.28%) of the ERC patients (P = 0.00018 and 0.043 respectively). Hyperamylasaemia with a leucocytic reaction occurred in only one patient with ERP from Group A (0.82%) as compared with 15 patients (11.02%) from the untreated group (P = 0.00047). These results were highly significant. There were three cases of subclinical pancreatitis and two of acute pancreatitis--all of them in the control group. Although these results were not statistically significant (because the number of cases was too small), they are clearly consistent with the growing tendency towards using antibiotic cover. On the basis of these results we regard antibiotic prophylaxis during ERCP as a sensible precaution, and in patients with any concurrent disease which heightens the risk it is essential.
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PMID:[Comparative studies of preventive antibiotic administration in ERCP]. 162 7

Serum and urinary amylase level are different between in cases with carcinoma of the pancreas head and in those with carcinoma of body or tail of the pancreas. In this study the relationship between elevation in serum and urinary amylase level and the portion of obstructed pancreatic duct by tumor was analysed in cases with pancreatic carcinoma was analysed and also this was investigated in experimental model of pancreatic duct ligated dog. In patients with carcinoma of the pancreas and periampullary region, the site of obstruction of the main pancreatic duct was estimated by ERP and serum and urinary amylase level were measured. The values of serum amylase level were different according to the site of obstruction of the pancreatic duct by the tumor and in cases with highly elevated serum amylase levels the main pancreatic duct was obstructed within 5cm from the duodenal papilla. Pathology of these cases revealed pancreatic fibrosis derived from pancreatitis accompanied by tumor was closely related to serum and urinary amylase level. In pancreatic ligated dogs similar findings were observed. These data suggested that elevated serum amylase level is due to the pancreatic duct obstruction in cases with carcinoma of the periampullary duodenum.
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PMID:[Clinical and experimental studies on serum and urine amylase levels in carcinoma of the pancreas and periampullary region]. 241 41

Cases of pancreas divisum (PD) were reviewed in our patients and 19 Japanese and 14 English series during the past 10 yr to see any significant association of PD with certain diseases. PD was diagnosed in 20 (0.64%) among our 3121 patients with successful endoscopic pancreatograms (ERP). Of 20 PD patients, acute pancreatitis in one, chronic pancreatitis in two, ampullary cancer in one, and cholelithiasis in five were diagnosed. Incidences of PD were 2.6% (1/38) in acute pancreatitis, 0.8% (2/248) in chronic pancreatitis, 0% (0/100) in pancreatic cancer, 20% (1/5) in ampullary cancer, and 0.8% (5/615) in cholelithiasis. The incidences were similar to overall incidences of ours and other Japanese series (0.69% of 36,171 patients). Higher incidences of acute pancreatitis (12.9% of 559) and pancreatic cancer (5.5% in 448) may result from the higher overall incidence (4.6% in 16,257) in English series. The relationship between pancreatitis and PD has been controversial, but our present data suggest that PD is a coincidental finding and not a predisposing factor to pancreatitis in Japan.
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PMID:Pancreas divisum. A predisposing factor to pancreatitis? 269 89

The practical implications of the new Marseilles classification (1984) of pancreatitis are discussed and the present-day diagnostic methods critically reviewed. The new classification distinguishes between two typical long-term profiles, i.e. acute (reversible) and chronic (progressive) pancreatitis. Modern diagnostic tests such as sonography, CT, ERCP and the secretin-CCK test do not provide a "gold standard" for early chronic pancreatitis. Thus, long-term studies of function and morphology are needed to differentiate chronic pancreatitis (progressive dysfunction, calcification, ERP changes) from acute (reversible) pancreatitis. The etiology is a helpful prognostic guide since gallstone pancreatitis virtually never becomes chronic. However, alcoholic "acute" pancreatitis may not always progress to chronic pancreatitis. Drug or surgical treatment of pain is symptomatic and empirical, since the pathomechanisms of pain are poorly understood. A prerequisite for optimum therapy is exact staging of the disease into: uncomplicated early stages with short, self-limiting episodes of pancreatitis: conservative therapy, persistent pain, mainly due to pseudocysts (diagnosis by morphological tests): surgical therapy, advanced painless forms of chronic pancreatitis associated with diabetes and/or steatorrhea: diet and substitution therapy. After successful surgical drainage persistent pain subsides, but postoperative episodic recurrences of pancreatitis are common in the early stages of the disease and in association with continued alcohol intake. However, spontaneous pain relief occurs in all cases in the late stages of the disease and with progressive pancreatic dysfunction (despite continued alcohol abuse).
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PMID:[Diagnosis and therapy of chronic alcoholic pancreatitis. A critical review of the status]. 390 86

ERP was analyzed in 87 patients with chronic pancreatitis with special reference to its clinical value in management of pain, the dominating symptom in uncomplicated chronic pancreatitis. A significant correlation was found between ductal changes due to pancreatitis and decrease in pancreatic function. However, no association was found between severe pancreatic pain and pancreatic function or pancreatic morphology. The significance of ERP in management of patients with persistent severe pancreatic pain is discussed.
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PMID:ERP in chronic pancreatitis--ductal morphology, relation to exocrine function and pain--clinical value. 405 12

In order to detect early pancreatic changes in chronic alcoholism, we reviewed pancreatograms (ERP) in 35 patients with alcoholic chronic liver disease who had no clinical evidence of pancreatitis. The patients were grouped by the length of history of alcohol intake (group 1: 5-15 years; group 2: more than 15 years), and on the basis of daily alcohol intake (group 1: 100-150 g/day; group 2: 150-200 g/day; group 3: more than 200 g/day). Pancreatic changes were present at ERP in 48.6% of patients, suggesting mild pancreatitis in 15 patients and advanced pancreatitis in two. Pancreatic lesions were significantly more frequent (p less than 0.01) in those who took more than 200 g of alcohol each day. There was no correlation with the length of history of alcoholism or with hepatic lesions. Our data confirm that asymptomatic pancreatitis is frequent in chronic alcoholism and that ERP can detect pancreatic lesions not otherwise demonstrable.
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PMID:Early detection of pancreatic lesions in chronic alcoholism: diagnostic accuracy of ERP. 651 28

In patients with haemorrhagic necrotizing pancreatitis who are scheduled for surgery we have been carrying out a preoperative retrograde investigation of the pancreatic duct system for the past months. The results in, to date, ten patients revealed four different morphological findings of importance for the surgical tactic: 1. A normal pancreatic duct system with no signs of fistulae: only peripancreatic necrosectomy is required. - 2. Contrast medium leaks via a ductal fistula: left resection including the removal of the fistulous area must be done. - 3. Normal duct system with complete segmental parenchymal staining, representing total necrosis in this region: left resection of the pancreas. - 4. Duodenoscopically demonstrable perforation into the duodenum of a necrotic cavity in the head of the pancreas: conservative management only, no surgery, since this lesion resulting in drainage of the necrotic cavity into the bowel permits self-healing, while the site of the perforation within the necrotic wall cannot be dealt with by surgery. - The experience gained so far indicates that the surgical tactic can be determined with greater selectivity by the use of ERP.
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PMID:[Retrograde pancreatic duct imaging and surgical tactics in hemorrhagic necrotizing pancreatitis. Preliminary report]. 666 66


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