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

The clinical, diagnostic, and therapeutic aspects of 27 patients with pancreatopleural fistula (PPF) reported in the literature, and two additional patients managed by the authors, form the basis of this report. The diagnosis of PPF is based on the triad of massive pleural effusions, elevated pleural fluid amylase, and protein levels. PPF is a complication of chronic fibrocalcific pancreatitis in most cases. It may develop as a consequence of disruption of a dilated obstructed pancreatic duct. Pseudocysts are involved in the process in at least half of reported cases. A substantial number of PPF will close spontaneously utilizing conservative measures including pancreatic rest, total parenteral nutrition, and repeated thoracentesis. Surgical correction of the underlying pancreatic disease, including ductal decompression and drainage or resection of associated pseudocysts, is indicated to prevent recurrence of the fistula and to avoid other complications of advanced chronic pancreatitis. Associated terminal biliary obstruction should be identified and managed with biliary-enteric bypass.
Pancreas 1986
PMID:Pancreatopleural fistula. 357 10

The value of a modified fluorescein dilaurate (FDL) serum test for the detection of pancreatic exocrine insufficiency was investigated in 89 patients with and without pancreatic disease. This test modification with fluorescein serum determination following metoclopramide (10 mg) and secretin (1 U/kg) i.v. injection appeared efficacious in a pilot study in six healthy volunteers. Individual peak fluorescein serum concentration was achieved within 180 min after the test meal in 96% of all subjects studied. Peak fluorescein serum concentration within this time period allowed the best discrimination between normal and abnormal pancreatic function. Sensitivity in detection of chronic pancreatitis was 86% (38 of 44 patients) when the lower normal fluorescein serum concentration was considered 4.5 micrograms/ml (this value corresponds to mean - 2 SD). The specificity of this test in detecting chronic pancreatitis was 100% when healthy controls were considered, but fell to 78% when patients with different gastrointestinal disorders, including those with secondary pancreatic insufficiency, were included. The correlation between serum and urinary fluorescein determination was significant (r = 0.61; p less than 0.01). Duodenal bicarbonate output/h after secretin also showed a significant correlation with peak fluorescein serum concentration (r = 0.79; p less than 0.001).
Pancreas 1987
PMID:Fluorescein dilaurate serum test: a rapid tubeless pancreatic function test. 357 14

The proliferation of pancreatic extracellular matrix, which characterizes chronic pancreatitis, has been analysed using immunohistochemistry. The relationship of matrix components to intraductal precipitates and the presence of serum proteins in precipitates were also studied to investigate the suggestion that ductal permeability increases in chronic pancreatitis. Pancreatic tissue from organ donors was compared with that from patients with chronic calcifying or chronic obstructive pancreatitis. Frozen sections were labeled with monospecific antibodies to collagen types I, III, pro-III and IV, laminin, fibronectin, IgG, IgA, and IgM and then visualized by indirect immunofluorescence. In chronic pancreatitis, interstitial collagens and fibronectin appeared increased and disorganized in both fibrous tissue and areas that appeared histologically normal. Type IV collagen distribution was abnormal and in some sites was present with interstitial collagen. In addition, intraductal precipitates were shown to contain immunoglobulins, and defects were identified in the duct basal lamina associated with precipitates. These results demonstrate that in chronic pancreatitis interstitial collagens are extensively disorganized, the fibrosis possibly being relatively labile. The presence of serum proteins in intraductal precipitates confirms an increase in ductal permeability, and associated defects in the basal lamina appear to define a route via which serum proteins may enter the intraluminal compartment.
Pancreas 1987
PMID:Pancreatic extracellular matrix alterations in chronic pancreatitis. 357 15

Scanning electron microscopy (SEM) and energy dispersive x-ray fluorescence (EDXRF) have been used in this study to investigate the morphology, nature, and arrangement of major, minor, and trace elements in human pancreatic calculi (PC) obtained from patients with alcoholic and tropical pancreatitis. The present study has confirmed previous observations that PC are rich in CaCO3 (as calcite) and many other elements. Further, we have shown for the first time that the amorphous nidus contained only iron, chromium, and nickel, whereas the outer shell contained calcium and 17 other elements. Based on our studies, we postulate the formation of PC to be taking place in multilayers and multistages. Formation of inner protein nidus in the form of a cobweb is the first stage, then calcite is deposited on this fibrous network as tiny crystals. Because of their high surface area and high surface activity, other metallic ions are incorporated onto it through co-precipitation, adsorption, and/or lattice substitution. This study has further shown that irrespective of the etiology for chronic pancreatitis, the structure and composition of PC are the same suggesting a common pathway for lithogenesis in the pancreatic duct.
Pancreas 1987
PMID:Ultrastructure and elemental composition of human pancreatic calculi. 362 20

Controversies in the literature regarding definition, diagnosis, and therapy of chronic pancreatitis may be related in part to differences in the natural history of alcoholic and idiopathic (nonalcoholic) chronic pancreatitis. In order to evaluate this problem the long-term course of 205 patients with alcoholic (85.4% with calcifications) (group A) and 82 patients with idiopathic (nonalcoholic) chronic pancreatitis (76.8% with calcifications) (group B) has been analyzed prospectively since 1963. The patients were studied at regular intervals with particular regard to pain, pancreatic exocrine, and endocrine function and calcifications. The observation time was 2 years or longer in 230 patients with a median observation time of 6.7 years from diagnosis in group A and 10.6 years in group B. In group B over 50% of the cases had primary painless chronic pancreatitis. Progressive deterioration of exocrine and endocrine function was observed in both groups. However, in group A the rate of progression of exocrine dysfunction after diagnosis was more rapid and the incidence of diabetes in relation to marked exocrine insufficiency was much higher than in group B. Steatorrhea preceded diabetes in 56% (group A) and 80% (group B), respectively. Onset of pancreatic calcifications was closely associated with pancreatic exocrine insufficiency in group A in contrast to group B. In addition lasting pain relief occurred spontaneously in about 30% of patients in group B despite a normal exocrine function for 6 years or longer which is in disaccord with the results in alcoholic chronic pancreatitis. In conclusion group A and B have many features in common, in particular the high incidence of pancreatic calcifications and the progressive pancreatic dysfunction. However, the long-term profile of both groups differs in some important aspects, particularly in the clinical pattern and in the rate of progression of pancreatic dysfunction and morphology. These differences should be appreciated in the discussion of problems regarding definition, diagnosis, and surgical therapy of chronic pancreatitis.
Pancreas 1987
PMID:Differences in the natural history of idiopathic (nonalcoholic) and alcoholic chronic pancreatitis. A comparative long-term study of 287 patients. 362 34

Course and prognosis of 125 patients with chronic pancreatitis (CP) were evaluated. Follow-up period ranged from 1-20 years with a median of 6.3 years. The following conclusions were obtained. Recent increase of CP in our clinics was ascribed to alcoholic CP and idiopathic CP in the aged. Of 106 patients with pain, 74 showed improvement or disappearance of pain. Drinking habit and observation period were the main factors determining the rate of pain relief. Serial endoscopic retrograde pancreatography (ERP) showed aggravation in 17/47 patients, cholecystokinin-pancreozymin (CCK-PZ) secretin test in 4/40 patients, and oral glucose tolerance test (OGTT) in 7/25 patients. Exocrine function showed improvement in five patients, whereas endocrine function showed none. Improvement or aggravation of exocrine function was closely related to drinking habit. Main complications included 15 cases of peptic ulcer, 19 of pancreatic pseudocyst, and 15 of bile duct stenosis. Twenty-six patients died, often due to malignant neoplasms and diabetic complications. Those who continued drinking as much showed a lower survival rate than those who discontinued or decreased alcohol intake. The socioeconomic status deteriorated often due to pain or alcoholism. Three patients had to degrade jobs and six fell into inactive social life.
Pancreas 1987
PMID:Clinical course and prognosis of chronic pancreatitis. 362 35

This paper reports on the technique and results of 20 endoscopic diversions into the duodenum of cysts complicating chronic pancreatitis in 19 patients. The procedure, performed safely on the condition of visualization of a compression of the duodenal wall by the cyst, was successful 18 times in 17 patients. Complications occurred in four patients: two with bleeding (resulting in the death of one patient), two perforations treated successfully, and one transient cholangitis. Long-term results (average = 20.7 months) in 13 patients who were followed more than 6 months were good nine times, fair three times, and bad in one case. Endoscopic cysto-digestive diversion appears as an interesting alternative to surgery in selected patients with chronic pancreatitis.
Pancreas 1987
PMID:Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases. 362 39

Pancreas divisum is a pancreatic duct anomaly that occurs due to failure of fusion of the dorsal and ventral ducts. While recognition of this anomaly is increasing due to more aggressive endoscopic retrograde cholangiopancreatography, its significance remains unclear. A patient with chronic pancreatitis and a history of alcohol abuse was noted to have pancreas divisum. At surgical exploration, intraoperative pancreatography revealed an obstructing pseudocyst of the duct of Santorini. Extended sphincteroplasty and cystduodenostomy as well as Roux-en-Y pancreatojejunostomy were necessary to insure adequate accessory duct drainage. Surgical therapy of pancreas divisum in chronic pancreatitis should be designed to correct existing pancreatic duct obstruction.
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PMID:Obstructing pseudocyst of the duct of Santorini in pancreas divisum. 382 33

Pancreas divisum is an anatomic duct variant, which may predispose to pancreatitis. Most patients are managed conservatively, but some patients justify attempts to improve drainage. The correct surgical approach is not yet established, and there has been no series published concerning pancreatic resection in this context. A 6-year experience with resection performed in 14 patients with severe pain is reported. There were no operative deaths, and 11 patients had good pain relief; steatorrhea developed in two patients and diabetes in one. The hypothesis that pancreas divisum may cause pancreatitis is supported by examination of resection specimens after pancreaticoduodenectomy; the dorsal part showed chronic pancreatitis and the ventral portion was normal.
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PMID:Resection for pancreatitis in patients with pancreas divisum. 638 80

Hereditary pancreatitis is a rare form of chronic pancreatitis inherited as an autosomal dominant. Pancreas divisum results from a developmental failure of fusion of the dorsal and ventral parts of the pancreas and is associated with an increased incidence of pancreatitis. Co-existence of the two conditions in one patient is very rare. We report a case.
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PMID:A case of hereditary pancreatitis and pancreas divisum. 672 79


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