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A Pap

Publications and source records attributed to A Pap.

At least 37 records · Page 2Linked to original sources
PubMed1998

[The role of jejunal feeding in the treatment of acute necrotizing pancreatitis and in recurrence of chronic pancreatitis with severe necrosis].

Acute necrotising is the most serious form of pancreatic inflammatory diseases leading to multiorgan failure and high (15-20%) mortality. The poor nutritional and metabolic condition of the patient and secondary bacterial translocation further rise the mortality. A recently introduced method of continuous nasojejunal feeding putting the pancreas into rest with basal pattern of secretion resulted in lower mortality rate by using adequate nutrition into the second loop of jejunum bypassing duodenopancreatic stimulations via an endoscopically placed feeding tube. The better nutritional and immunological states of the patients, the restored absorption and intestinal motility promote the recovery of pancreatitis, prevent bacterial translocation, resulting in time and in financial spares. Although surgery is occasionally inevitable because of progression of pancreatitis, nasojejunal feeding improves the general condition of patients more efficiently than parenteral nutrition and makes the scheduling of the operation optimal. The authors retrospectively analyse the results of treatment in 56 patients suffering from acute necrotising pancreatitis, as well as in 30 patients with chronic pancreatitis accompanied with more than 20% of necrosis in the pancreas and admitted to their gastroenterological medical department during 5 years. The effect of parenteral nutrition were less beneficial than that of jejunal feeding regarding the mortality and the necessity of operative interventions. Chronic pancreatitis with severe necrosis behaved similarly to the acute necrotising pancreatitis. The continuous nasojejunal feeding seems to be a promising new method for acute necrotising pancreatitis preventing complications and severe catabolic state of the disease by a cost--effective manner.

Chronic Disease↗
PubMed1998

Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies).

BACKGROUND: The efficacy of H2-receptor antagonists in functional dyspepsia is equivocal and the therapeutic place of proton pump inhibitors in functional dyspepsia is unknown. AIM: To evaluate the efficacy of proton pump inhibitor therapy in functional dyspepsia. METHODS: Patients (n = 1262) with a clinical diagnosis of functional dyspepsia (persistent or recurrent epigastric pain or discomfort for at least 1 month and a normal upper gastrointestinal endoscopy) were randomized to receive omeprazole 20 mg, 10 mg or identical placebo, for 4 weeks. Symptoms were assessed using validated measures. Helicobacter pylori status was determined pre-entry by a 13C-urea breath test. RESULTS: On an intention-to-treat analysis (n=1248), complete symptom relief was observed in 38% on omeprazole 20 mg, compared with 36% on omeprazole 10 mg and 28% on placebo (P = 0.002 and 0.02, respectively). Among those with ulcer-like and reflux-like dyspepsia, complete symptom relief was achieved in 40% and 54% on omeprazole 20 mg, and 35% and 45% on omeprazole 10 mg, respectively, compared with 27% and 23% on placebo (all P < 0.05, except omeprazole 10 mg in ulcer-like dyspepsia, P = 0.08). There was no significant benefit of omeprazole over placebo in dysmotility-like dyspepsia. Symptom relief was similar in H. pylori-positive and negative cases. CONCLUSIONS: Omeprazole is modestly superior to placebo in functional dyspepsia at standard (20 mg) and low doses (10 mg) but not in patients with dysmotility-like dyspepsia.

Adenosine Triphosphatases↗
PubMed1998

Pain relief and functional recovery after endoscopic interventions for chronic pancreatitis.

BACKGROUND: Pain and functional deterioration in chronic pancreatitis is multifactorial. Early surgery in non-alcoholic patients with mild to moderate chronic pancreatitis can relieve pain and prevent progression of pancreatic insufficiency for some time, but the good results are only short term. Endoscopic intervention can relieve pain and recover pancreatic function without surgery. METHODS AND RESULTS: To achieve the burned out state of chronic pancreatitis, occlusion of the pancreatic duct was first attempted by our team with Ethibloc at ERCP. Temporary obstruction of the pancreatic duct did not result in a long-lasting symptom and relapse-free situation because of early recovery of pancreatic function. On the contrary, endoscopic simple and double papillotomy, pancreatic drainage with citrate lavage, biliary endoprosthesis with multiple stents and endoscopic decompression of pseudocysts with or without jejunal feeding resulted in pain-free patients for a considerable time and in several cases significant functional recovery occurred. In cases where pain remained, percutaneous celiac plexus block with long-lasting steroids can be applied and only if all of these treatments fail should surgery be recommended. CONCLUSION: Endoscopic intervention can successfully substitute for surgery for chronic pancreatitis in individual cases.

Adult↗
PubMed1997

[Management of diabetes induced by nearly total (95%) pancreatectomy with autologous transplantation of Langerhans cells].

The present report concerns a patient who had undergone nearly total pancreatectomy (95%) with pancreatic islet autotransplantation for intractable pain caused by obstructive chronic pancreatitis. Islets were prepared by a modified collagenase digestion and were cultured in vitro in Eagel's medium in 5% CO2 in air at 37 degrees C for 5 days. The resultant preparation, containing about 150,000 islets, was injected into the recipient's liver via the umbilical vein. No complication occurred from the pancreatectomy or transplant. Postoperatively, the patient had complete relief of the abdominal pain, and the insulin-independent condition remained with normal fasting blood glucose, and hemoglobin A1c for 11 months. Subsequently the fasting hyperglycemia was evident, and the patient began oral antidiabetic medication, but 2 year after transplantation the insulin-dependent condition demanded exogenous insulin (24 U). At present the fasting serum C-peptide level is 0.6 ng/ml and the HbA1c of 5.8% confirms the normoglycemic condition at the same insulin dose. Islet auto-transplantation should be considered as an adjunct procedure to prevent or ameliorate diabetes after total or nearly total pancreatic resection.

Adult↗
PubMed1997

[Tumors of the papilla of Vater--diagnostic and therapeutic dilemmas].

Benign and malignant tumors of papilla Vateri are rare diagnoses in the endoscopic practice. Sixteen patients with benign and 22 cases of malignant tumors are presented. In all of them endoscopic cholangiopancreatography with or without papillotomy followed by biopsy and operation in 13 cases was performed. Biopsy confirmed the endoscopy in 71%. Adenomyosis, supposed by endoscopy was proved by repeated histology in only 2/9 cases although invasive component of the tumor was found in 3/9 patients at operation underlying precancerous nature of this entity. Among 5 cases of villous adenoma one developed malignant alterations during 4 years of follow-up. Biopsy was not more effective after papillotomy than without it, and 5-7 days of delay for recovery of thermic lesion did not ameliorate success rate of histology. For malignant diseases surgical therapy should be considered if staging of tumor and general condition of the patient permits. In unresectable cases endoscopic palliation (papillotomy or polypectomy with or without drainage) can increase survival. In patients with benign tumors operative endoscopy followed by regular ultra-sonography and endoscopy seems to be necessary.

Adenocarcinoma↗
PubMed1997

[Treatment of pancreatic insufficiency with a preparation containing high lipase activity].

In vitro testing of lipase survival of Panzytrat 25,000 homogenized in Tris HCl buffer and Lundh meal stimulated gastric or duodenal contents demonstrated favorable stability of lipase of this new preparation in the protein and fat containing gastric and duodenal juices of patients with chronic pancreatitis. Later an open, intra-individually controlled study with two doses of Panzytrat 25000 (5 x 1 and 5 x 2 capsules/day) was performed in 10 patients with severe pancreatic steatorrhoea. A diet containing 70 g of fat/day was offered and the 3-day fat loss of collected stools was measured in the last 3 days of 5-day equilibration periods with and without replacement therapy. After these short-term periods, patients were treated with 5 x 1 capsules of the drug for one month and body weight increases as well as patient's appraisals were registered. Stool weight and fat loss maximally decreased already in response to the 5-day treatment with 5 x 1 capsules of drug and double dose of the preparation did not further decrease steatorrhoea in most cases except 2 patient. Disappearance of fat loss was achieved in 3 out of ten patients. Body weight of patients increased in most cases and their subjective evaluation was also favorable.

Adult↗
PubMed1997

Effect of endotoxin administration on the severity of acute pancreatitis in two experimental models.

CONCLUSIONS: Endotoxemia can transform acute pancreatitis (AP) into a more severe form of the disease in models of AP provoked by common pancreatico-biliary duct ligation or L-arginine injection. BACKGROUND: It has been shown that systemic endotoxemia is a common feature in severe AP. The effect of endotoxemia on the course of experimental pancreatitis is unknown. METHODS: AP was induced by common pancreatico-biliary duct ligation (experiment 1) and i.p. injection of 250 mg/100 g body wt of L-arginine (experiment 2). Test animals of both experiments received i.p. injections of 0.5 and 1.0 mg/100 g body wt of endotoxin at the induction of AP. Saline-treated and only endotoxin-dosed animals served as controls for both experiments. Mortality rates and pancreatic histology were investigated at 48 h. RESULTS: The mortality rate was significantly elevated (60%, p < 0.05) in experiment 1 when 1.0 mg/100 g of endotoxin was given. In experiment 2, the mortality rate was also increased (30%) at this dose of endotoxin without reaching significance. Histologic changes were more severe in both groups of AP treated by the two doses of endotoxin than without it. Acinar necrosis and hemorrhage were highly elevated (p < 0.01) in both experiments when AP was combined with 1.0 mg/100 g body wt of endotoxin. The animals receiving only endotoxin showed only slight inflammatory and necrotic changes.

Acute Disease↗
PubMed1996

[Experience with insertion of an endoscopic endoprosthesis in a case of inoperable bile duct calculi].

UNLABELLED: Endoscopic sphincterotomy for removal of stones from the common bile duct is an established procedure. Large stones, however, can be unavailable for basket trapping and/or extraction in some cases. In these patients, which are at high risk for surgery, endoscopic insertion of biliary endoprosthesis seems to be an alternative approach to dissolution therapy or ESWL. During the last 5 year, among 4081 ERCP-s 879 examinations demonstrated common bile duct (CBD) stones in our institutions. In 81 of these cases, an endoprosthesis was inserted into the CBD after extended endoscopic sphincterotomy because of failure of extraction of the large stones. Also ursodeoxycholic-acid treatment was initiated thereafter. Mean age of patients was 76 yrs (range 46-95 yrs), 51 females and 30 males. Acute complications after procedure were: mild bleeding not requiring transfusion, and 1 perforation treated surgically some days after prosthesis placement. Late complications until now included: peritonitis in 1 case, and recurrent jaundice due to drain clogging in 12 patients. These patient were treated with replacement of endoprosthesis. Remaining patients are well since the procedure and in 26 cases controlled about 17 months after endoprosthesis placement endoscopy verified significantly smaller or no stones in the common bile duct and in 4 cases even the endoprosthesis has disappeared. CONCLUSION: endoscopic insertion of a biliary endoprosthesis is a safe and effective treatment for the huge CBD stones in high risk patients in whom endoscopic sphincterotomy and attempts to remove the stones are not successful. In more than 30% of cases dissolution of stones with ursodeoxycholic acid may be expected.

Aged↗
PubMed1996

Biphasic effect of prostaglandin E1 on the severity of acute pancreatitis induced by a closed duodenal loop in rats.

The effect of prostaglandin E1 (PGE1) on the severity of acute pancreatitis induced by a closed duodenal loop in the rat was tested. PGE1 was administered subcutaneously at various doses (3, 6, 12, and 24 microgram/kg) at hourly intervals, from the induction of acute pancreatitis up to the 24th hour. A saline-treated group served as the control. The mortality rate was recorded, and pancreatic histology was evaluated by a scoring system. Serum amylase activity and pancreatic amylase, trypsin, protein, and desoxyribonucleic acid (DNA) contents were determined at 24 h. Administration of PGE1 influenced the severity of acute pancreatitis biphasically. Serum amylase was reduced significantly (p < 0.01) at a dose of 12 microgram/kg/h, but less at 24 microgram/kg/h. Pancreatic weights did not differ in the groups. Pancreatic amylase, trypsin, and protein contents showed significant elevations (p < 0.01), yet the mortality rate was reduced using 6 and 12 microgram/kg/h doses of PGE1 compared to controls, but not at higher and lower doses. The DNA content was significantly higher at the 6 microgram/kg/h dose, compared to the control. The extent of necrosis and the severity of hemorrhage were reduced significantly (p < 0.05) at doses of 6 and 12 microgram/kg/h of PGE1, but less at 24 microgram/kg/h. Leukocyte infiltration was not affected. In conclusion, optimal doses of PGE1 can ameliorate, but higher doses increase, the severity of acute pancreatitis in this experimental model.

Acute Disease↗
PubMed1995

Excitatory amino acid antagonists attenuate the effects of cocaine on extracellular dopamine in the nucleus accumbens.

The effect of N-methyl-D-aspartate and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate/kainate excitatory amino acid antagonists on systemic cocaine-induced increases in extracellular dopamine was examined. The alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate/kainate receptor subtype antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), and N-methyl-D-aspartate receptor antagonists, 2-amino-5-phosphonovalerate and dizocilpine, were infused via a microdialysis probe placed in the nucleus accumbens. The local infusion of 2-amino-5-phosphonovalerate (500 microM), dizocilpine (50 microM) and CNQX (100 microM), started 80 min before cocaine injection, significantly inhibited the cocaine-induced increase in extracellular dopamine. The CNQX blockade was dose-dependent with respect to both CNQX concentration infused and dose of cocaine administered. Simultaneous infusion of the two antagonists (500 microM 2-amino-5-phosphonovalerate and 100 microM CNQX) did not lead to further reductions in the effects of cocaine when compared to either antagonist alone. Our results suggest that both N-methyl-Daspartate and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate/kainate subtypes of excitatory amino acid antagonist receptors may contribute to the stimulatory effect of cocaine on extracellular dopamine in the nucleus accumbens.

2-Amino-5-phosphonovalerate↗
PubMed1994

[Annular pancreas in an adult].

Annular pancreas is a rare congenital anomaly which can remain symptom free for a long time and be manifested mainly in adults. 1130 endoscopic retrograde pancreatographies were performed in the author's laboratory during 3.5 years, and annular pancreas was seen in 2 cases. Duodenal obstruction with consecutive ulcers was the clinical manifestation in a young woman requiring duodeno-jejunostomy. Annular pancreas was an accidental finding in an other old woman presenting obstructive jaundice caused by several big stones in the main bile duct. A short review of the literature is given concerning the diagnostic possibilities, eventual complications and treatment modalities of this rare anomaly. It is emphasised that the diagnosis became possible due to the modern radiologic and endoscopic methods.

Adult↗
PubMed1994

[Treatment of empyema of the gallbladder by endoscopic drainage].

Medical history of an old female patient is described. Gallstones were extracted from the main bile duct after endoscopic papillotomy when she was 83 ys old. Eighteen months later, she presented an obstruction of the cystic duct with a consecutive empyema of gallbladder. The obstruction was relieved mechanically by inserting a catheter through guide-wire in the cystic duct and moving the impacted stone into the gallbladder. A naso-cholecystic drain was placed and kept in the gallbladder for six days to assure free passage of bile and to administer local antibiotic treatment. The patient quickly recovered, she has not presented any repeated cholecystitis or cholangitis in the last year. It was pointed out, that the endoscopic access to the gallbladder became possible. This technique offers an alternative way in the treatment of patients with high operative risk.

Aged↗
PubMed1994

Time-course changes in pancreatic laboratory and morphologic parameters in two different acute pancreatitis models in rats.

The aim of this work was to study in rats the temporal course of laboratory parameters and morphologic features in acute pancreatitis induced by cholecystokinin octapeptide (CCK-8) or by a closed duodenal loop. Pancreatitis was induced either with an overdose of CCK-8 (3 x 75 micrograms/kg at 1 h intervals) or by ligation of the duodenum on both sides of the bilio-pancreatic duct. The animals were examined at 0, 2, 4, 8, 16 and 24 h after AP induction. In CCK-8-induced acute pancreatitis, the pancreatic weight/body weight ratio (8.2 +/- 1.1 mg/g) and the amylase level (44.8 +/- 7.5 x 10(3) U/ml) were significantly increased vs. the controls (4.5 +/- 0.8 mg/g and 3.3 +/- 0.2 x 10(3) U/ml, respectively) 2 h after the intervention. The plasma CCK was significantly increased at 4 h (4.55 +/- 1.7 pM) and remained elevated thereafter. The tissue malonyldialdehyde concentration was significantly elevated at 8 h (0.28 +/- 0.07 mumol/mg pancreas) vs. the controls (0.20 +/- 0.02 mumol/mg pancreas). In closed duodenal loop-induced acute pancreatitis, the ratio pancreatic weight/body weight steadily increased during the study; it reached its maximum level at 24 h (7.1 +/- 0.5 mg/g) vs. the sham-operated control (4.8 +/- 0.9 mg/g). The serum amylase level was significantly elevated at 2 h (47.1 +/- 9.3 x 10(3) U/ml), and then decreased steadily. Plasma CCK values were significantly higher than the controls throughout the study. A significant increase in the tissue malonyldialdehyde concentration (0.94 +/- 0.15 mumol/mg vs. 0.20 +/- 0.01 mumol/mg pancreas) appeared at 4 h. Our data indicate that in CCK-8-induced acute pancreatitis the laboratory signs of pancreatitis are most expressed at 4 h, whereas the morphologic changes culminate 8 h, following the last CCK injection. In closed duodenal loop-induced acute pancreatitis, the histologic findings showed a progressive deterioration. Endogenous CCK and oxygen-derived free radicals seem to play a role in the pathogenesis of both types of acute pancreatitis.

Acute Disease↗
PubMed1993

Pancreatic trophism in experimental liver cirrhosis.

Pancreatic trophism and pancreatic enzyme composition, and plasma levels of cholecystokinin, insulin, glucagon, and glucose in liver cirrhosis induced by chronic thioacetamide administration (0.02% in the drinking water for 12 mo) were studied in rats. Advanced liver cirrhosis was evident in all thioacetamide-treated rats. The weight of the pancreas and its contents of DNA, protein, trypsinogen, chymotrypsinogen, proelastase, secretory trypsin inhibitor, and amylase were significantly increased as compared to the controls. The pancreatic secretory enzyme content changes showed a nonparallelism, characteristic of a cholecystokinin effect. Light and electron microscopy revealed a normal pancreatic architecture. Bioassayed plasma cholecystokinin levels in both fed and 24-h-fasted cirrhotic rats were significantly higher than in the corresponding controls. The plasma glucose, insulin, and glucagon levels demonstrated hypoglycemic tendencies with a glucagon predominance. These findings indicate that advanced liver cirrhosis in the rat is accompanied by pancreatic hypertrophy and hyperplasia, which might be attributed, at least in part, to elevated circulating cholecystokinin levels.

Animals↗
PubMed1993

The role of nitroglycerin preparations in the treatment of post-acute and chronic pancreatitis.

The role of nitrate compounds in the therapy of pancreatic diseases is discussed in this review. A short overview is given about the physiological background of the treatment: the regulation of Oddi's sphincter function and its pharmacology. An adjuvant role is attributed to the free outflow of pancreatic secretion in the treatment of pancreatic pain and in the prevention of relapses. The authors describe their clinical practice during the last 15 years: nitrates with short half-life in the treatment of acute pancreatitis (amylnitrit or nitroglycerin spray) which have a low risk of developing nitrate tolerance; chronic administration of retard nitroglycerin in chronic pancreatitis and Oddi's sphincter hypertonic dyskinesia. For preventing the induction of nitrate tolerance, Nitromint retard is recommended twice a day combined with a calcium antagonist or with theophylline during the nitrate-free period.

Acute Disease↗
PubMed1992

[New trends in the treatment of exocrine pancreas deficiency].

Economic function of the exocrine pancreas is based on non-parallel synthesis, transport and secretion of pancreatic enzymes during basal state and postprandially. Reserve capacity of acinar cells is also augmented by adaptation to the diet as well as by regeneration. In mild pancreatic insufficiency complex dietetic considerations help to maintain the necessary secretory capacity of the pancreas. In severe cases effective substitution therapy is mandatory and increasing lipase survival by dietetic maneuvers, by optimizing trypsin and chymotrypsin levels as well as acid and bile secretion can significantly ameliorate results of replacement therapy of steatorrhea. However, in painful chronic pancreatitis high protease activities seem to be beneficial. Individual replacement therapy with pancreatin preparations adapted to the requirements of the patient has to be chosen in difficult cases.

Chymotrypsin↗
PubMed1992

Possible role of Coxsackie-B virus infection in pancreatitis.

Coxsackie-B antibodies were examined in a study of 118 patients with acute and relapsing chronic pancreatitis. The rise in antibody titers was significant in 40 cases. Fourteen had acute, five relapsing acute, and 21 chronic pancreatitis. Among patients with acute pancreatitis, we detected infectious hepatitis in six cases. Two patients with persisting acute pancreatitis received levamisole as an immune adjuvant, which promoted their recovery. It seems that Coxsackie-B virus can cause acute pancreatitis, and it can also worsen chronic pancreatitis.

Acute Disease↗