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

We studied the value of contrast-enhanced CT in the detection of aneurysms in immunocompromised patients suffering from inflammatory diseases eventually complicated by hemorrhage. Contrast-enhanced spiral CT was applied in three patients with immunocompromise due to chemotherapy, alcohol abuse or HIV. They suffered from invasive aspergillosis, chronic pancreatitis with pseudocyst formation, and acute pancreatitis together with HIV-associated lymphadenopathy. Complicating hemorrhage was present in two cases. Contrast-enhanced CT showed aneurysms complicating the underlying inflammatory disease in all three cases. The feeding vessels were identified and the patients with signs of bleeding were subsequently referred for angiography and embolization. Contrast-enhanced spiral CT is suited to detect aneurysms in immunocompromised patients suffering from inflammatory disease. It is recommended in these patients prior to angiography and intervention.
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PMID:Aneurysms complicating inflammatory diseases in immunocompromised hosts: value of contrast-enhanced CT. 908 48

While alcohol abuse and biliary disease can result in the development of pancreatitis, the factors that contribute to the idiopathic form of the disease are not well understood. I propose that coxsackievirus infections account for a subset of cases of pancreatitis of unknown etiology. Evidence to support this concept is derived from serological studies, case reports and animal models. In reviewing the available data, it is obvious that the relationship between coxsackievirus infection and the development of pancreatitis is not a simple one. Many elements contribute to the development of the disease including the strain of the infecting virus, the genetic predisposition of the host and additional environmental factors that maintain the disease process. Studies that show an association between coxsackievirus infection and acute pancreatitis in humans are given additional support by the extensive data from mouse studies demonstrating that some serotypes (B4,B3) are tropic for the exocrine pancreas. Some viral strains may cause limited pancreatic tissue injury which is compatible with tissue repair followed by full restoration of pancreatic function. Other viral strains may cause more extensive tissue damage giving rise to chronic pancreatitis which, on a genetic background that predisposes to autoimmunity, may result in an autoimmune chronic pancreatitis. A multi-disciplinary approach is required to increase our understanding of the complex relationship between coxsackievirus infection and pancreatic diseases. Such studies should address the biology of viral replication, the immune response to infection, the role of viruses in the development of autoimmunity, the biology of pancreatic tissue injury and the underlying repair process.
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PMID:Coxsackieviruses and pancreatitis. 925 48

Haemorrhage via the pancreatic duct, a rare cause of upper gastrointestinal bleeding (GIB), often poses a diagnostic dilemma. We analysed our experience with 10 patients (8 men, 2 women; mean age 44 years, range 34-62) treated during a 12 year period. All had a history of alcohol abuse and presented with major upper GIB requiring a median of 8 units (range 2-40) blood transfusion. Nine had upper abdominal pain at the time of admission and nine had a history of pancreatitis. Upper gastroduodenal endoscopy (median 4; range 1-9), was diagnostic in only one. Side-viewing endoscopy showed bleeding from the pancreatic duct in 7 of 8 patients. Visceral aneurysms were demonstrated in 7 of 9 patients in whom coeliac angiography was carried out: (splenic artery 4, gastroduodenal artery 2, and pancreaticoduodenal artery 1). Two of 4 selective embolisations were successful. Six patients underwent distal pancreatectomy, 1 had gastroduodenal artery ligation and 1 died of coagulopathy following a total pancreatectomy. Pancreatic duct haemorrhage should be considered in patients with unexplained recurrent upper GIB, alcohol abuse and epigastric pain, particularly in those with established chronic pancreatitis. Selective angiography is essential for diagnosis and management. For bleeding sites in the head of the pancreas, embolisation should be attempted to avoid major resection. Distal pancreatectomy is preferred for splenic artery lesions.
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PMID:Diagnostic pitfalls and therapeutic strategies in the treatment of pancreatic duct haemorrhage. 929 83

Chronic pancreatitis is a lifelong illness for patients and a persistent medical challenge for the gastrointestinal physician. Most cases are induced by alcohol abuse. This leads to a process of recurrent injury, chronic fibrosis and subsequent pain, pancreatic ductal scarring, and dilatation. The surgical management of these associated complications as seen in the patient presented in this report will be discussed in the context of the current surgical literature.
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PMID:The surgical management of chronic pancreatitis (ductal strictures). 956 14

From 1978 to 1995, 120 patients (105 males, 15 females, mean age: 46 years) underwent pancreatico jejunostomy (PJ) for chronic pancreatitis (CP). Alcohol abuse was presented in 105 cases (87.5%). PJ was the unique procedure in 67 cases; it was associated with a biliary or a duodenal diversion in respectively 38 cases and 5 cases. In ten cases, three diversions were performed. Postoperative mortality was 1.6% (n = 2), postoperative morbidity was 10% (n = 12). Mean hospital stay was 16 days. Fifteen patients (13%) required a second operation some years subsequent to the PJ, due to the progress of the CP or alcohol abuse. In the late postoperative course 22 deaths occurred (18.5%), 8 of them were directly related to alcohol abuse. Mean follow-up was 7 years. Good and medium results for pain were evaluated to 92%, but the progression of exocrine or endocrine pancreatic insufficiency indicates that wirsung decompression was insufficient to stop the progressive sclerosis. In conclusion, PJ was our preferred surgical procedure in CP treatment, when the wirsung was dilated.
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PMID:[The role of pancreatojejunostomy in the treatment of chronic pancreatitis]. 977 91

A woman with a 20-year history of alcohol abuse and chronic pancreatitis developed an osteoarticular involvement of her right ankle in association with subcutaneous nodules. Histopathological examination of the tissue samples obtained during surgical revision of the ankle showed necrotic fat and connective tissue. Microbiological cultures remained negative. The patient was administered long-term antimicrobial treatment without any apparent benefit. Four months later, she died of pancreatic insufficiency and pneumonia. Postmortem examination showed numerous foci of intra-abdominal fat necrosis. Histopathological examination of the bone samples from the right ankle showed fat necrosis with lipophages. Based on these findings, we consider that the osteoarticular involvement in this patient was caused by intraosseous fat necrosis. This case reminds us of the importance of considering the possibility of this condition whenever a patient with chronic pancreatic disease develops sterile osteoarthritis.
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PMID:Intraosseous fat necrosis simulating septic arthritis and osteomyelitis in a patient with chronic pancreatitis. 993 96

The available morphologic data on ACP are consistent with the view that ACP evolves from acute pancreatitis. How alcohol abuse triggers pancreatic injury and which factors are responsible for the progression to chronic pancreatitis remain to be clarified, however.
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PMID:Progression from acute to chronic pancreatitis. A pathologist's view. 1047 Mar 28

Whether or not AP may progress to the chronic form is controversial. Equally debatable is whether AP caused by alcohol abuse develops in a chronically diseased gland or in a normal pancreas. As for the state of the gland, several postmortem studies have shown that AP may occur after acute alcohol abuse in the normal pancreas. As for progression from acute to chronic pancreatitis, many experimental studies have demonstrated signs of the chronic from of the disease in animals, but these signs were reversible. Some clinical studies have shown that alcohol-induced pancreatitis may progress to chronic pancreatitis. There are, however, presently no predictive parameters indicating when such a progression does or does not occur.
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PMID:Progression from acute to chronic pancreatitis: a physician's view. 1047 Mar 29

In conclusion, surgical therapy in patients with chronic pancreatitis may be characterized as follows: 1. Independently, several investigators have found intraductal and intraparenchymatous hypertension in patients with chronic pancreatitis. Decompression of the ductal system as the main principle of surgical therapy achieves clinical pain relief in most patients with chronic pancreatitis. The precondition is a consequent drainage of the main pancreatic duct and tributary ducts of second and third order up to the prepapillary region. The presence of an inflammatory tumor in the head of the pancreas or ductal abnormalities in the prepapillary region or a pancreas divisum requires performance of an extended drainage operation (LPJ-LPHE) to achieve pain relief and an improved quality of life. An extended drainage operation effectively manages complications arising from adjacent organs, such as distal common bile duct stenosis, segmental duodenal stenosis, and internal pancreatic fistulas. The extent of decompression has to be tailored to the anatomic and morphologic situation of the patient. 2. In patients with chronic pancreatitis, the main pancreatic duct is usually dilated. A small duct (3-5 mm) is only small for the surgeon. For the sclerosing entity of chronic pancreatitis with a truly small duct, that is, less than 3 mm in diameter ("small duct disease"), a longitudinal V-shaped excision of the ventral pancreas, as opposed to left resection, provides a new perspective for a sufficient drainage. 3. In the presence of segmental portal hypertension, a simple or extended drainage operation does not result in a normalization of the portal venous blood flow; however, how often relevant upper gastrointestinal hemorrhage develops from segmental portal hypertension is unclear. Therefore, the clinical relevance of this special problem needs further evaluation. 4. Postoperative morbidity of LPJ-LPHE is significantly lower in comparison to resectional procedures, such as PD, PPPD, and DPRHP. A lower perioperative mortality rate is not justified anymore as a relevant criterion in favor of drainage procedures because resectional procedures are burdened by a minimal or no mortality in experienced centers; however, PD and PPPD are greatly hampered by a significantly decreased postoperative global quality of life as opposed to the LPJ-LPHE. This is reflected by a significantly lower rate of social and professional rehabilitation. 5. The incidence of exocrine and endocrine organ dysfunction is lower after LPJ-LPHE compared with PD or PPPD, but not compared with DPRHP. Preservation of the gastroduodenal passage and the continuity of the bile duct with its associated feedback mechanisms of exocrine pancreatic secretion and glucose metabolism seem to be responsible for this phenomenon. 6. An early surgical or endoscopic interventional drainage of the hypertensive pancreatic duct system possibly offers the chance to favorably manipulate the natural course of chronic pancreatitis with regard to a delayed onset of exocrine or endocrine insufficiency. 7. Late mortality reflects continued alcohol abuse rather than the effect of an operative procedure.
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PMID:Surgical treatment of chronic pancreatitis and quality of life after operation. 1047 Mar 35

Chronic pancreatitis is characterized by progressive and irreversible loss of pancreatic exocrine and endocrine function. In the majority of cases, particularly in Western populations, the disease is associated with alcohol abuse. The major complications of chronic pancreatitis include abdominal pain, malabsorption, and diabetes. Of these, pain is the most difficult to treat and is therefore the most frustrating symptom for both the patient and the physician. While analgesics form the cornerstone of pain therapy, a number of other treatment modalities (inhibition of pancreatic secretion, antioxidants, and surgery) have also been described. Unfortunately, the efficacy of these modalities is difficult to assess, principally because of the lack of properly controlled clinical trials. Replacement of pancreatic enzymes (particularly lipase) in the gut is the mainstay of treatment for malabsorption; the recent discovery of a bacterial lipase (with high lipolytic activity and resistance to degradation in gastric and duodenal juice) represents an important advance that may significantly increase the efficacy of enzyme replacement therapy by replacing the easily degradable porcine lipase found in existing enzyme preparations. Diabetes secondary to chronic pancreatitis is difficult to control and its course is often complicated by hypoglycaemic attacks. Therefore, it is essential that caution is exercised when treating this condition with insulin. This paper reviews recent research and prevailing concepts regarding the three major complications of chronic pancreatitis noted above. A comprehensive discussion of current opinion on clinical issues relating to the other known complications of chronic pancreatitis such as pseudocysts, venous thromboses, biliary and duodenal obstruction, biliary cirrhosis, and pancreatic cancer is also presented.
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PMID:Chronic pancreatitis: complications and management. 1050 49


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