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

We describe here a 71-year-old man who had herpes zoster encephalitis. He developed high fever, headache and disturbance of consciousness on 1st, May, 1998. On admission, neurological examination revealed disturbance of consciousness with restlessness and meningeal signs. Brain MRI (T 1 and T 2 weighted images) demonstrated high signal lesions in the left temporal lobe and cerebellar vermis. VSV encephalitis was diagnosed based on CSF pleocytosis, high serum and CSF titers of VZV antibody and EEG abnormality. During hospitalization, Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis developed. To our knowledge, the characteristic combination of the clinical signs in this case is very rare. We discussed the pathogenic mechanisms of these conditions, and this case was considered to have VZV encephalitis, and to be associated with right facial nerve palsy and pancreatitis, in spite of the absence of immunological deficiency.
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PMID:[A case of herpes zoster encephalitis with Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis]. 1068 90

The purpose of this study was to compare prospectively computed tomography (CT) and magnetic resonance (MR) imaging before and after mangafodipir trisodium infusion for the detection and staging of focal pancreatic lesions. From November 1996 to October 1997, 43 consecutive patients suspected to have a focal pancreatic lesion were included in a phase III study. Triphasic helical CT was performed, as well as MRI at 1.5 T, as follows: axial T1-weighted (T1w) turbo spin echo (TSE), spectral presaturation with inversion recovery (SPIR) T1w TSE, T1w turbo field echo (TFE), and SPIR T2w TSE before and after mangafodipir trisodium (0.01 mmol/ml, 0.5 ml/kg) infusion. Imaging results were correlated with surgery, laparoscopy, laparoscopic ultrasound, and biopsy. Objective measurements were performed by measuring signal intensities (SIs) of lesion and parenchyma and calculating contrast indexes (CIs) and contrast-to-noise-ratios (CNRs) to assess the delineation of the tumor. SIs were correlated with four phantom standards with a known SI. Thirty-eight pancreatic adenocarcinomas were present, as well as one cystadenoma, two papillomas, and two cases of focal pancreatitis. SI measurements revealed significant increases in CIs for the lesion compared with the parenchyma in T1w TSE (69.7 vs 152.7; P = 0. 0003) and T1w TFE (107.8 vs 194.2; P = 0.0002). These series also revealed significant increases in CNRs (for T1w TSE: 9.7 vs 13.0; P = 0.0407 and for T1w TFE: 14.5 vs 26.1; P = 0.0001). In the other series, there was no significant increase. CT detected 38 lesions, MRI without mangafodipir trisodium detected 39 lesions, and MRI with mangafodipir trisodium detected 40 lesions, giving detection accuracy rates of 88%, 91%, and 93%, respectively. Staging accuracy rates for vascular ingrowth were 81%, 75%, and 81%, respectively. Overall staging accuracy rates were 57%, 54%, and 54%, respectively, mostly due to undetected small metastases in the peritoneum, omentum, or liver (< 1 cm). This study indicates that a) MRI after mangafodipir trisodium gives a better delineation of the tumor in T1w series, but b) does not significantly improve the detection rate and staging accuracy of focal pancreatic lesions over MRI without this contrast medium.
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PMID:MRI with mangafodipir trisodium in the detection and staging of pancreatic cancer. 1093 89

Retroperitoneal collections in the absence of pancreatitis are rare. Imaging plays an important role in determining the aetiology of these collections and in allowing percutaneous drainage to be performed safely. A review of the imaging characteristics on both CT and MRI is presented, highlighting the advantages and disadvantages of these two modalities and their complimentary roles.
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PMID:MRI of retroperitoneal collections: a comparison with CT. 1102 72

The incidence of acute pancreatitis within 100,000 inhabitants a year differs between 5 (Bristol) and 80 (USA). Even though the diagnosis of pancreatitis has become easier by the measurement of specific pancreatic enzymes there are still 30-40% of the fatal cases which are first diagnosed at autopsy. It is of utmost importance to assess the diagnosis and the severity of acute pancreatitis in the beginning to identify those patients with severe or necrotising disease who benefit from an early initiated intensive care therapy. Additionally, in view of new therapeutical concepts (e.g. antibiotic therapy in severe forms) and for the evaluation of new drugs, patients should be staged into mild and severe disease as early as possible. In most cases it is not possible to assess the severity clinically on hospital admission. Up to now the "gold standard" are imaging procedures (contrast-enhanced CT and MRI) which should be reserved for the severe cases to estimate the extent of pancreatic necrosis. The ideal predictor in blood or in urine should be objective, reliable, inexpensive, easy to measure, widely available, sensitive and specific. There are a variety of mediators of the "systemic inflammatory response syndrome" which are elevated in this disease (C-reactive protein, antiproteases, enzyme activation peptides like trypsinogen activation peptide (TAP) and carboxypeptidase B activation peptide (CAPAP), PMN-elastase, complement factors, chemokines and interleukins and others). Among all these mediators, C-reactive protein is the parameter best analysed. It has to be taken into account that it is not specific for AP and it's highest efficacy is reached after > 48 hours after the onset of disease. However, because usually a certain time elapses (approximately 24-48 hours) until patients are hospitalised the time delay seems not to a major disadvantage.
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PMID:[Acute pancreatitis--clinical and technical laboratory diagnostic and prognostic assessment]. 1107 88

Pancreatic masses are common in daily imaging practice. The advent of helical CT and breathold MRI has provided a new impetus to the study of the pancreas not only for the potential of characterizing pancreatic masses and pancreatitis but also because of the more accurate staging of pancreatic neoplasms using this technique. Pancreatic tumors are classified according to its histologic origin. Ductal adenocarcinoma is the most common. Regarding ductal adenocarcinoma, despite the fast evolving imaging techniques promising an earlier diagnosis and an accurate staging, still the prognosis is extremely poor. However, new surgical data indicate that long-term survival although rare, occurs on resected tumors less than 2 cm, without vascular encasement or adenopathy. Logically, early detection and accurate staging of tumors has become the main focussing in pancreatic imaging since it may result in an increase in the survival of these patients. In this context, the role of imaging to identify, characterize and stage pancreatic neoplasms will be described. Furthermore, the key radiological features of a gamut of more uncommon pancreatic neoplasms will be illustrated. These include other exocrine epithelial tumors (anaplastic carcinoma, pancreatoblastoma, acinar cell carcinoma serous cystic pancreatic adenoma, mucinous cystic tumors, intraductal mucinous papillary tumor, and solid pseudopapillary neoplasm), endocrine tumors or islet cell tumors (insulinoma, gastrinoma, gluconoma, vipoma, non-functioning tumors), rare non-epithelial tumors (lymphoma, teratoma) and metastases to the pancreas.
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PMID:Imaging features of pancreatic neoplasms. 1181 75

Pancreatitis is one of the most complex and clinically challenging of all abdominal disorders. It is classified according to clinical, morphologic and histologic criteria. The primary role of radiologic imaging in patients with suspected pancreatitis is to confirm or exclude the clinical diagnosis of pancreatitis. Second, if possible, the cause of the disease is established with the assessment of disease severity and detection of complications. Imaging can also provide guidance for percutaneous therapy. Sonography in acute pancreatitis is a good screening test in patients with suspected biliary pancreatitis and a mild clinical course. Contrast-enhanced CT is preferred for patients with acute pancreatitis because it can accurately diagnose and stage the disease and the necessary information for percutaneous management is provided. The diagnosis of acute pancreatitis on MRI relies on the presence of morphologic and peripancreatic changes. Pancreatic necrosis and complications of acute pancreatitis such as hemorrhage, pseudocysts or abscesses are well-examined by MRI.
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PMID:Imaging of acute pancreatitis. 1192 84

In this paper we will try to compile briefly the most important historical facts on the pancreas, and how the concepts and classification about its major disorder, pancreatitis, has evolved. In older times, the pancreas was ignored, both as an organ and as a focus of disease. The first description of the pancreas is attributed to Herophilus. It was in the 18th century that the main duct of Wirsung was described as well as its first cannulations to perform studies on pancreatic secretion. In 1889, Fitz established pancreatitis as a nosdogic disease. In 1901, Opie proposed his "common channel" hypothesis. In 1927, Elman described the serum amylase test. In 1963, the first Marseilles Symposium favored a clinic pathologic classification of pancreatitis. In 1984 the second Marseilles Symposium revised that classification. Finally, in 1992, the Atlanta Symposium established a clinically based classification system for acute pancreatitis. In the years to come, we expect further refinements in the classifications, as MRI and innovative technologies become increasingly sophisticated.
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PMID:[History of the pancreas and the evolution of concepts and classification of pancreatitis]. 1237 19

We report the cases of three patients who fulfilled the criteria for sphincter of Oddi dysfunction of biliary type II and underwent needle-knife suprapapillary sphincterotomy. These patients presented with episodes of biliary-type pain after cholecystectomy and significant elevation of liver enzymes. Ultrasonography and MRI cholangiography revealed dilatation of the common bile duct, without visible stones. The patients all underwent needle-knife suprapapillary sphincterotomy because free cannulation of the common bile duct could not be achieved. Needle-knife suprapapillary sphincterotomy enabled catheterization of the common bile duct. After clearing of the common bile duct with a balloon catheter, no stones, fragments of stones, or sludge were observed to exit from the sphincterotomy. None of our patients developed postprocedure pancreatitis. When needle-knife suprapillary sphincterotomy is performed by an experienced biliary endoscopist, it is a safe and effective procedure for patients with sphincter of Oddi dysfunction of biliary type II, who otherwise constitute a high-risk group for the development of postsphincterotomy pancreatitis.
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PMID:Needle-knife suprapapillary sphincterotomy avoids postprocedure pancreatitis in patients with sphincter of Oddi dysfunction of biliary type II: a report of three cases. 1497 27

A 66-year-old patient developed episodes of severe pain due to recurrent cholangitis and pancreatitis. 2 years prior to this referral the patient had undergone an end-to-side hepaticoduodenostomy and a cholecystectomy because of choledocholithiasis and obstructive jaundice. 20 years previously a Billroth II operation had been carried out for the treatment of ulcer disease. Since the hepaticoduodenostomy the patient has suffered from recurrent epigastric pain, nausea and postprandial vomiting. An oedematous pancreatitis following a recurrent chronic cholangitis was assumed. As the intrahepatic biliary ducts appeared to be normal on radiological studies and hepatobiliary scintigraphy showed a downright transit of the tracer, recurrent cholangitis appeared at first to be a rather unlikely explanation. However, follow-up MRI and MRCP showed large calculi at the lower end of the common duct, which was also enlarged up to 1 cm. For this reason an open duodenotomy with subsequent papillosphincterotomy and retrograde choledochoscopy was carried out. The diagnosis was confirmed hereby and all calculi were removed during the operation. Since then the patient has been free of symptoms and complaints. This case shows that remaining calculi at the lower end of the common bile duct can cause severe clinical problems. Therefore the bile ducts should be inspected endoscopically and stones removed prior to, or during the primary operation.
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PMID:[Symptomatic biliary stones at the lower end of the common duct following hepaticoduodenostomy]. 1555 41

Autoimmune pancreatitis is a recently recognized clinical entity characterized by narrow strictured main pancreatic duct on ERCP, diffusely enlarged sausage-shaped pancreas on CT scan and MRI, seropositivity for antinuclear antibodies, hypergammaglobulinemia, and excellent response to steroids. We report a 25-year-old man and a 53-year-old man with this condition.
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PMID:Autoimmune pancreatitis--an uncommon type of chronic pancreatitis. 1587 69


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