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Query: UMLS:C0149521 (chronic pancreatitis)
 7,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The work analyses 141 patients who were operated on for primary chronic pancreatitis which was caused by alcohol abuse in 84.4% of cases. The patients were divided into 2 subgroups according to the damage to the pancreas: 1--with dilatation of the pancreatic duct (49.6%), 2--without dilatation of the pancreatic duct (50.4%). Internal drainage of the duct system and their associated cysts was the main method of management of patients of the first group (52 patients). Patients of the second group were subjected to various resections of the pancreas (24) and occlusion of the ducts with a polymeric composition (19). In 38 cases the operation on the pancreas was complemented by operations on the biliary tract, stomach, and duodenum. Various postoperative complications were encountered in 27 (19.1%) patients, mortality was 5.7%. The results were most favorable after operations for internal drainage, resection of the organ, and external drainage of the cysts. Irrespective of the type of the operation, progressive fibrous degenerative changes of the gland with a statistically significant (p < 0.05) reduction of its size was noted in the late-term period. The method of occlusion of the duct system was marked by the greatest number of poor results. Strict argumentation of the indications for the use of each type of operation makes it possible to obtain good and satisfactory late-term results in 85.6% of cases.
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PMID:[Long-term results in surgical treatment of chronic pancreatitis]. 790 68

Bleeding pseudocysts respectively pseudoaneurysms represents a seldom complication of chronic pancreatitis in owing to erosion of pancreatic or peripancreatic arteries. The potential rupture into neighbouring organs or in the peritoneal cavity is accompanied with paramount life-threatening risks. During the last years we observed 3 patients with acute intestinal bleeding caused by pseudocysts converted to pseudoaneurysms. The goal of our report is to analyze the diagnostic tools and the management of patients with bleeding pancreatic pseudocysts, also well establish the clinical constellation, which is typical for this complication, the best diagnostic tool and the modalities to immediate control of the acute bleeding situation. All three patients suffered from chronic pancreatitis and alcohol abuse. The first patient had a known pancreatic pseudocyst, which penetrated through the gastric wall and caused a life-threatening bleeding. The second patient was admitted in owing to melena. The examinations yielded a pancreatic pseudocyst with hematosuccus pancreatis. The third patient suffered from abdominal pain and vertigo caused by anemia. With endoscopy, Cat and celiacography a pancreatic pseudocyst with cysto-colic fistula has been identified. The color-doppler ultrasound revealed a pseudoaneurysm supplied from a splenic artery branch. With management of these patients with hemorrhagic complications of pancreatic pseudocysts we acquired the following findings: 1. Patients with known chronic pancreatitis and abdominal tumor, especially when accompanied by epigastric pain and anemia, are highly suspicious for pancreatic pseudoaneurysms. 2. The color-doppler ultrasound is the best diagnostic tool, since this investigation can establish the pseudoaneurysm and identify the source.
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PMID:[Hemorrhage from pseudocysts caused by pseudoaneurysms in chronic pancreatitis. Diagnosis and management]. 837 41

Major arterial hemorrhage associated with pancreatic pseudocysts represents a formidable complication with high mortality rates. This study was undertaken to analyze presentation and outcome and to assess the role of angiography in diagnosis and management of this complication. A retrospective review of 180 patients referred for surgical management of pancreatic pseudocysts from 1964 to 1991 identified 13 patients (7.2%) with arterial hemorrhage. Eight patients presented with intracystic hemorrhage, 4 with upper gastrointestinal bleeding, and 1 with intra-abdominal bleeding. Six patients had gastroduodenal artery bleeding, 4 splenic, and 1 each left gastric, right colic, and left gastroepiploic. The site of bleeding was identified with selective visceral angiography in 9 patients; evidence of pseudocyst bleeding was seen in 5 of 7 patients who had contrast-enhanced computerized tomography (CT) scans. Angiographic embolization for control of hemorrhage was used in 6 patients and operative control in 7. Over the past decade, bleeding has been controlled with angiographic embolization in all patients except 1 with massive bleeding due to splenic artery erosion. Average blood loss was less in patients treated with angiographic embolization (6.8 vs 17.5 units, packed red cells, P < .05, Wilcoxon rank sum test). The sole mortality was a patient with cirrhosis treated in 1969. Clinical presentation of pseudocyst bleeding is variable; the underlying cause is usually related to chronic pancreatitis due to alcohol abuse. The dynamic contrast-enhanced CT scan is valuable in demonstrating evidence of pseudocyst bleeding. Accurate diagnosis with dynamic CT scan and angiography and control of bleeding with angiographic embolization has improved the outcome in patients with this complication.
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PMID:Arterial hemorrhage complicating pancreatic pseudocysts: role of angiography. 847 74

The natural history of alcoholic chronic pancreatitis is well-known. Patients who are the most frequently involved by the disease are 40-50 year old men. About 15,000 patients have chronic pancreatitis in France. The first symptoms occur after 10-20 years of alcohol abuse. Pain is the first symptom in 80% of patients and acute pancreatitis in one third of them. During the 5 first years of the course, pseudocyst or common bile duct compression may occur. Between the 5th-10th years of the course, acute bouts are rare but the risk of pseudocyst and extrahepatic cholestasis remains high. Therefore, patients may still undergo surgery. On the other hand, the proportion of pain free patients increases. After the 10th year of the disease, pancreatic calcifications are frequent and exocrine and endocrine pancreatic insufficiency occurs in the majority of patients.
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PMID:[Natural history of chronic pancreatitis]. 873 38

Most cases of diabetes mellitus result from decreased insulin secretion (type I, insulin-dependent) or altered insulin action (type II, insulin-independent). Another category, namely, "other" diabetes mellitus-associated conditions, is usually mentioned to distinguish this type of diabetes from the other two categories; this category includes drugs, genetic and endocrine syndromes, and pancreatic disorders. The most common pancreatic disease that causes diabetes mellitus is chronic pancreatitis that results from alcohol abuse. The clinical observation of patients at our institution with long histories of heavy alcohol intake and diabetes mellitus prompted us to review the impact of alcohol on carbohydrate metabolism. In many of these patients, it was notable that they were not obese and they had no immediate family members with diabetes mellitus, raising the possibility that alcohol-associated diabetes mellitus may be a distinct subset of non-insulin-dependent diabetes mellitus that is distinct from type II diabetes mellitus.
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PMID:Alcohol-associated diabetes mellitus. A review of the impact of alcohol consumption on carbohydrate metabolism. 876 12

Chronic pancreatitis is characterized by inflammation and fibrosis leading to tissue destruction; in industrialized nations, alcohol abuse is the cause of 70-80% of cases of pancreatitis in adults. The purpose of the current work was to determine whether free radical adducts are produced by the pancreas during the early phases of chronic exposure to ethanol. Accordingly, rats were chronically fed ethanol using the model of continuous enteral infusion developed by Tsukamoto et al.[Am. J. Physiol. 247: R595-R599 (1984)]. Histological evaluation revealed only mild acinar steatosis and spotty necrosis after 4 weeks of alcohol treatment; the pancreatic enzymes lipase and amylase were not elevated. Furthermore, no fibrosis was detected, nor were there differences in pancreatic collagen alpha 1(l) mRNA levels between the dietary control and ethanol-treated groups. After 4 weeks, rats were injected with the spin trap alpha-(4-pyridyl-1-oxide)-N-tert-butylnitrone (1 g/kg intravenously), and pancreatic secretions were collected over a 4-hr period. A six-line free radical adduct spectrum indicative of a carboncentered free radical was detected in pancreatic secretions and in Folch extracts of pancreatic tissue by electron spin resonance spectroscopy. Control experiments ruled out ex vivo radical formation. This study represents the first detection of radical adducts in pancreatic secretions. When [13C]ethanol (3 g/kg intragastrically) was administered, a definitive 12-line spectrum was detected in pancreatic secretions, demonstrating that the alpha-hydroxyethyl radical adduct was formed in the pancreas from [13C]ethanol. Interestingly, only a six-line signal was detected in tissue extracts under these conditions. Free radicals, therefore, are formed in the pancreas during the early phases of chronic alcohol intake in rats before the development of overt pathology.
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PMID:Detection of alpha-hydroxyethyl free radical adducts in the pancreas after chronic exposure to alcohol in the rat. 879 7

A 40-year-old man with diabetes mellitus, congestive heart failure, alcoholic cirrhosis, and chronic pancreatitis had an exacerbation of pancreatitis due to alcohol abuse. His condition deteriorated rapidly with development of apparent sepsis; cultures were negative. He slowly improved with multiple antibiotic therapy and total parenteral nutrition. Serial imaging of the pancreas revealed edematous pancreatitis that evolved initially into a phlegmon and later into multiple pseudocysts. Intermittent fever prompted computed-tomography-directed percutaneous aspiration of the largest pancreatic fluid collection, yielding purulent material that grew only Candida albicans. Subsequently, disseminated candidiasis developed. Despite therapy with amphotericin B and aggressive supportive care, the patient died from multiple organ system failure.
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PMID:Infection of a pancreatic pseudocyst due to Candida albicans. 890 99

Normal pancreatic ageing is characterized by functional and morphological changes of the pancreatic parenchyma and of the ductal system, which, however, do not interfere with normal exocrine pancreatic function. It can be speculated that 'pancreatic lithiasis in the aged' as well as the 'senile idiopathic chronic pancreatitis', two conditions of chronic pancreatitis in the elderly, may represent more extreme forms of these normal age-related changes in pancreatic structure and function. In elderly people, acute and chronic pancreatitis are only rarely related to alcohol abuse, in contrast to the situation in a younger patient population. The presence of gallstones represents the most frequent cause of acute pancreatitis in the elderly. In most aged patients with acute biliary pancreatitis, endoscopic sphincterotomy is the treatment of choice, even when bile duct stones cannot clearly be demonstrated at ERCP. Endoscopic sphincterotomy has been shown to reduce morbidity as well as mortality rates in acute biliary pancreatitis. This technique can even be considered as treatment of choice in elderly patients with an increased operative risk. An elective laparoscopic cholecystectomy should be performed in elderly patients with an acceptable operative risk.
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PMID:[Acute and chronic pancreatitis in the elderly patient]. 896 46

15 to 30% of the patients with chronic pancreatitis develop an inflammatory mass in the pancreatic head. The leading symptoms of these patients are severe upper abdominal pain and complications of the surrounding organs. From 1969 to 1995, 380 patients were treated with a duodenumpreserving pancreatic head resection. The cause of the disease was alcohol abuse in 81%. 93% of the patients suffered from severe pain with recurrent pain attacks. CT-scan revealed enlargement of the pancreatic head (> 4 cm in diameter) in 79% of the patients. 83% of the patients had an impaired exocrine pancreatic function; 48% of the patients had an impaired glucose tolerance or were diabetic. The hospital mortality was 0.8%; 5% of all patients had to be reoperated. The mean duration of the hospitalization was 13.9 days. 89% of the patients showed an unchanged endocrine function in the early postoperative course. The glucose metabolism was improved in 9%, 2% had a deteriorated function. The duodenum-preserving pancreatic head resection is a procedure with a low postoperative mortality and morbidity without deterioration of the endocrine pancreatic function.
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PMID:[Duodenum preserving pancreatic head resection in chronic pancreatitis with inflammatory tumor in the pancreas head]. 904 35

Chronic pancreatitis resulting from alcohol abuse might in some rare cases require a total surgical resection of the pancreas to treat severe local complications. We have learned from the new techniques developed for islet isolation that it is now possible to obtain a sufficient number of good quality islets from one single pancreas to be transplanted into one recipient. We present a case of total surgical pancreatectomy for chronic pancreatitis in a previously non-diabetic patient with immediate islet isolation and autotransplantation. At operation, a cirrhotic liver was found, but no portal hypertension. We still decided to embolize a non purified preparation of endocrine tissue into the liver without alteration of liver function or durable modification of the portal pressure. One year after this procedure, the patient remains insulin-independent with a close to normal glycemic regulation as demonstrated by stimulation tests. Islet autotransplantation does not appear to be generally contra-indicated in the presence of a cirrhotic liver; provided the portal pressure is within normal limits. Under these circumstances, satisfactory glycemic control is achieved.
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PMID:Islet autotransplantation in a cirrhotic liver. 904 22


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