PubMed Health⌕ Search

Biomedical subjects

P G Lankisch

Publications and source records attributed to P G Lankisch.

At least 19 recordsLinked to original sources
PubMed1995

Recovery of the pancreas after acute pancreatitis is not necessarily complete.

In 38 patients, exocrine pancreatic function was tested by means of the secretin-pancreozymin test (SPT) and pancreatic duct system with endoscopic retrograde cholangiopancreatography (ERCP) 34 +/- 36 mo (mean +/- SD, range 1-156 mo) following acute pancreatitis. SPT and ERCP results were both normal in 19 (50%). They were both abnormal in four (11%) patients (group 1). Fourteen (37%) patients with normal SPT had abnormal ERCP test results (group 2), and one (3%) patient with normal ERCP had abnormal SPT (group 3). All patients except one of group 2 could be followed up within a mean observation time of 105 +/- 46 mo (range 24-168 mo): Chronic pancreatitis developed in all four patients of group 1, in one patient of group 2, and in the single patient of group 3, and suspected chronic pancreatitis in another patient of group 2. Eleven of the remaining 12 patients with abnormal ERCP results, but normal exocrine pancreatic function (group 2), showed no signs or symptoms of acute or chronic pancreatitis. It is concluded that (1) recovery to normal does not necessarily occur after acute pancreatitis, (2) progression to chronic pancreatitis is possible at a considerable percentage, and (3) duct changes demonstrated by ERCP may persist without any later signs and symptoms of acute or chronic pancreatitis.

Acute Disease↗
PubMed1995

The course of pain is the same in alcohol- and nonalcohol-induced chronic pancreatitis.

The natural course of pain in chronic pancreatitis was followed up in 318 patients over 10.6 +/- 8.0 years (median, 9.0 years). By the end of our follow-up, a significant decline in pain in alcoholics (n = 228) and nonalcoholics (n = 90) (p < 0.001 and p < 0.03) was marred by the fact that, even after more than 10 years, 50% of alcoholics and 62% of nonalcoholics still reported pain attacks (difference insignificant). Only alcoholics had pain relief with increasing exocrine pancreatic insufficiency (p < 0.02), but 54% of alcoholics and 73% of nonalcoholics still had pain attacks despite severe, enzyme substitution-requiring exocrine pancreatic insufficiency. The development of severe endocrine pancreatic insufficiency did not significantly influence the course of pain. It is concluded that no clinically relevant differences exist in the course of pain in alcoholic and nonalcoholic chronic pancreatitis.

Alcoholism↗
PubMed1995

Painless acute pancreatitis mimicking pancreatic carcinoma.

Painful acute pancreatitis masking pancreatic carcinoma and painless acute pancreatitis with shock or coma as leading symptoms have been described before. We report a first case of almost-painless pancreatitis mimicking pancreatic carcinoma with spontaneous normalization of symptoms and biochemical as well as imaging procedure findings.

Acute Disease↗
PubMed1995

Drug induced acute pancreatitis: incidence and severity.

To determine the incidence and severity of drug induced acute pancreatitis, data from 45 German centres of gastroenterology were evaluated. Among 1613 patients treated for acute pancreatitis in 1993, drug induced acute pancreatitis was diagnosed in 22 patients (incidence 1.4%). Drugs held responsible were azathioprine, mesalazine/sulfasalazine, 2',3'-dideoxyinosine (ddI), oestrogens, frusemide, hydrochlorothiazide, and rifampicin. Pancreatic necrosis not exceeding 33% of the organ was found on ultrasonography or computed tomography, or both, in three patients (14%). Pancreatic pseudocysts did not occur. A decrease of arterial PO2 reflecting respiratory insufficiency, and an increase of serum creatinine, reflecting renal insufficiency as complications of acute pancreatitis were seen in two (9%) and four (18%) patients, respectively. Artificial ventilation was not needed, and dialysis was necessary in only one (5%) case. Two patients (9%) died of AIDS and tuberculosis, respectively; pancreatitis did not seem to have contributed materially to their death. In conclusion, drugs rarely cause acute pancreatitis, and drug induced acute pancreatitis usually runs a benign course.

Acute Disease↗
PubMed1995

Acute abdominal pain in chronic pancreatitis: hemorrhage from a pseudoaneurysm?

An alcoholic, 67-year old retired male nurse complained of abdominal pain, loss of appetite and weight loss of 10 kg within one year. Based on elevated serum enzyme levels, ultrasonography and computed tomography examinations, an acute attack of chronic pancreatitis with several pancreatic pseudocysts was diagnosed. Ultrasonographically, an 1.8 cm phi, echo-free, pulsatile, space-occupying lesion, suggestive of a pancreatic pseudoaneurysm, was found at the right lateral margin of an almost echo-free pseudocyst measuring 6.8 x 5.6 x 5.0 cm in the head of the pancreas. Shortly before the planned discharge when the patient felt well, he developed acute abdominal pain. An immediate ultrasound examination showed an inhomogenous and echo-dense pseudocyst, in short, an acute hemorrhage. Rupture of the pseudoaneurysm of the Arteria gastroduodenalis was suspected and later confirmed by angiography and laparotomy. After proximal an distal ligation of the vessel and fibrin sealing of the inner surface of the cyst, the patient recovered and, under alcohol abstinence, has been free of symptoms since one year.

Abdomen, Acute↗
PubMed1995

[The natural course of chronic pancreatitis--pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease].

The natural course of the classical symptoms of chronic pancreatitis, i.e. pain, exocrine and endocrine pancreatic insufficiency, was followed up in 335 patients over a median of 9.8 years (mean 11.3 +/- 8.3 years). Pain relief was not obtained in the majority of patients, even after a longterm observation of > 10 years, and severe exocrine and/or endocrine insufficiency, severe duct abnormalities and pancreatic calcifications developed. Alcohol abstinence failed to have a significant beneficial effect on pain. Pancreatic surgery led to pain relief immediately after operation, but later on the pain course between operated and nonoperated patients was not significantly different. Repeated exocrine pancreatic function tests in 143 patients showed that functional exocrine impairment came to a standstill (46%), or improved (11%). At the end of the observation, 22% of 335 patients still had normal endocrine function and only 40% required insulin treatment. Alcohol abstinence had a significant beneficial effect on endocrine, but not on exocrine pancreatic insufficiency. Chronic pancreatitis led to a sharp increase in unemployment and retirement. Pancreatic carcinoma occurred in 3% and extrapancreatic carcinoma in 4%. The mortality rate within the observation period was 22%, pancreatitis-induced complications accounted for 13% of these deaths.

Adult↗
PubMed1994

No parallel between the biochemical course of acute pancreatitis and morphologic findings.

The clinical, biochemical (serum enzymes), and morphologic course of acute pancreatitis was studied in 83 consecutive patients from time of admission until 3 months after discharge. At discharge, all 75 surviving patients had no more symptoms of acute pancreatitis, even though amylase (in 11%) and lipase (in 25%) were still elevated, computed tomography (CT) findings still abnormal (in 81%), and necrosis amounting up to 50% of the gland still present (in 24%). There was no significant correlation between serum enzymes and CT findings at discharge. Three months later, with the exception of one patient with an acute relapse of the disease, all followed-up patients were free of symptoms and had normal serum amylase, whereas lipase was still elevated in 10%, and CT findings abnormal in 23%. Subsiding symptoms provided a more accurate picture of the patients' recovery than the biochemical markers, and even more so that the morphologic findings.

Acute Disease↗
PubMed1994

Natural course of operated pseudocysts in chronic pancreatitis.

A longterm review (median follow up 11 years) of the postoperative course of pancreatic pseudocysts was undertaken in 55 patients with chronic pancreatitis. While 96% of the patients were free of pain immediately after the operation this figure fell to 53% subsequently. Alcohol abstinence did not significantly reduce pain. Endocrine pancreatic deterioration (60%) was significantly (p = 0.0059) more frequent than exocrine (38%). Unemployment increased from 2 to 41%; retirement rose from 0 to 33%, mainly as a result of pancreatitis. Twenty one (38%) patients died. Chronic pancreatitis related death rate was 14%. Three patients died of extrapancreatic carcinomas.

Adult↗
PubMed1994

Lipase/amylase ratio: not helpful in the early etiological differentiation of acute pancreatitis.

The value of the lipase/amylase ratio for early etiological differentiation of acute pancreatitis was tested in 103 consecutive patients with acute pancreatitis from an ongoing prospective study. On admission, amylase, but not lipase, was significantly lower in alcoholics than in nonalcoholics in general and especially in patients with biliary pancreatitis. Alcoholics as a group had significantly higher lipase/amylase ratios than non-alcoholics and patients with acute biliary pancreatitis. But although the mean values of the ratio were significant, sensitivity, specificity, positive and negative predictive values of lipase/amylase ratio were insufficient to separate alcoholics from nonalcoholics, patients with alcohol-induced pancreatitis from those with biliary etiology, and patients with biliary pancreatitis from those with pancreatitis of other etiologies in the individual case. Finally, there was no correlation between the ratio and the amount of pancreatic changes as judged from computed tomography. We concluded that the ratio does not allow for early routine clinical differentiation between etiologies of pancreatitis and evaluation of the severity of the disease.

Acute Disease↗
PubMed1994

High, not low, amylase and lipase levels indicate severe acute pancreatitis!

Serum amylase, lipase and C-reactive protein (CRP) levels upon and CRP again within 72 hours after admission were estimated in 115 consecutive patients with acute pancreatitis and correlated with contrast-enhanced computed tomography (CT) results performed within 72 hours after admission and scored for morphological changes and necroses. Serum enzyme levels > or = 3 times the upper limit of normal and CRP levels > or = 10 times on admission and maximal CRP levels > or = 10 times within 72 hours after admission significantly correlated with severe pancreatic morphological changes. Thus, contrary to previous belief, high, not low, enzyme levels indicate severe acute pancreatitis. Furthermore, maximal CRP levels > or = 10 times the upper limit of normal within 72 hours in all patients and amylase admission levels of > or = 3 times the upper limit of normal in alcoholics were significantly indicative of pancreatic necroses. Thus, serum enzyme estimation upon, and maximal CRP levels within 72 hours after, admission may help the clinician to evaluate the severity of acute pancreatitis when imaging procedures are not immediately available.

Acute Disease↗
PubMed1994

Pleural effusions: a new negative prognostic parameter for acute pancreatitis.

OBJECTIVE: To evaluate the incidence, localization, and size of pleural effusions in 133 patients with acute pancreatitis. METHODS: A contrast-enhanced computed tomographic scan was prospectively obtained within 72 h after admission. RESULTS: Patients with pleural effusions (66 = 50%) had significantly more severe morphological changes of the pancreas and necroses (independent of the size and localization of the effusions and etiology of the acute pancreatitis), more often had a pancreatic pseudocyst, and had a higher mortality rate than patients without this complication. CONCLUSION: Pleural effusions are indicative of severe acute pancreatitis and are a negative prognostic parameter for the course of the disease.

Acute Disease↗
PubMed1994

Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group.

OBJECTIVES: The aim of this study was to determine which factors predict mortality in a cohort of patients with chronic alcoholic and nonalcoholic pancreatitis. Patients with chronic pancreatitis are known to have a reduced life expectancy, but the quantitative relationship between various clinical features and survival is unclear. METHODS: We evaluated survival among 2015 subjects with chronic pancreatitis treated at seven centers located in six countries. RESULTS: Mean age at diagnosis was 46 +/- 13 yr and mean duration of follow-up was 7.4 +/- 6.2 yr. Overall survival at 10 yr was 70% (95% confidence interval (CI), 68-73%) and at 20 yr was 45% (95% CI, 41-49%). Survival was significantly less than in the background population. There were 559 deaths observed among those with chronic pancreatitis compared with an expected number of 157.4, yielding a standardized mortality ratio (SMR) of 3.6 (95% CI, 3.3-3.9). Older subjects and those with alcoholic pancreatitis had a significant reduction in survival. In a multivariate analysis, mortality of middle-aged and older subjects was 2.3 (95% CI, 1.8-2.8) and 6.3 (95% CI, 4.7-8.3) times greater than subjects less than 40 yr at diagnosis. Smoking (hazard ratio, 1.4; 95% CI, 1.0-1.9), drinking (hazard ratio, 1.6; 95% CI, 1.2-2.2), or development of cirrhosis (hazard ratio, 2.5; 95% CI, 2.0-3.2) increased the risk of death during the observation period, but we observed no survival difference in operated vs. nonoperated patients. CONCLUSIONS: Age at diagnosis, smoking, and drinking are major predictors of mortality in patients with chronic pancreatitis.

Age of Onset↗
PubMed1993

Standards for the diagnosis of chronic pancreatitis and for the evaluation of treatment.

The diagnosis of chronic pancreatitis should be based on the characteristic case history and a combination of exocrine pancreatic function tests and morphological examinations. For diagnostic purposes, an indirect pancreatic function test may be sufficient when direct tests are not available. Otherwise, and especially for scientific evaluation of chronic pancreatitis, a direct pancreatic function test is necessary. In each patient, an ultrasound examination of the pancreas should be performed and, if inconclusive, also computed tomography. In a symptomatic patient, that is, a patient suffering from relapsing pain attacks, an ERCP examination is indicated. A score for the severity of chronic pancreatitis using symptoms, results of function tests, and morphological examinations should be developed for a world-wide comparison of studies. Treatment results should be reported not earlier than 2 yr after the initiation of conservative treatment or surgery. The evaluation of treatment should be based on a score (also to be developed) making use of symptoms.

Chronic Disease↗
PubMed1993

Function tests in the diagnosis of chronic pancreatitis. Critical evaluation.

Direct pancreatic function tests, such as the secretin-pancreozymin test and the Lundh test, are--by direct measurement of the contents of duodenal secretion following exogenous (hormonal) or endogenous (test meal) stimulation--the best way to assess exocrine pancreatic function. However, these tests are time-consuming, invasive, and expensive, and therefore their use is limited to specialized centers only. Several studies have shown that indirect pancreatic function tests are a practicable alternative to direct pancreatic function tests for diagnosing exocrine pancreatic insufficiency. They allow staging of the disease and thereby facilitate comparison of different studies. They are also useful in some cases for determining whether pancreatic enzyme replacement therapy is necessary or not. In contrast to morphological procedures, they involve neither side effects, risks for the patient, nor complications for patients, investigators, and laboratory staff alike. The procedures being standardized, the test results depend to a lesser extent on the experience of the investigator, and more on the selection of and the instructions to the patient, and to some extent, on the severity of the exocrine pancreatic insufficiency. Like all pancreatic function tests, the indirect tests do not give a clue to etiology nor help investigators to differentiate between pancreatic insufficiency owing to chronic pancreatitis and that owing to pancreatic cancer. The role of pancreatic function tests in diagnosing early chronic pancreatitis in comparison to morphological examinations remains to be established.

Chronic Disease↗
PubMed1993

Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease.

The natural course of the classical symptoms of chronic pancreatitis, i.e. pain, exocrine and endocrine pancreatic insufficiency, was followed up in 335 patients over a median of 9.8 years (mean 11.3 +/- 8.3 years). Pain relief was not obtained in the majority of patients, even after a long-term observation of > 10 years, and severe exocrine/endocrine insufficiency, severe duct abnormalities and pancreatic calcifications developed. Alcohol abstinence failed to have a significant beneficial effect on pain. Pancreatic surgery led to pain relief immediately after operation, but later on the pain course between operated and nonoperated patients was not significantly different. Repeated exocrine pancreatic function tests in 143 patients showed that functional exocrine impairment came to a standstill (46%), or improved (11%). At the end of observation, 22% of 335 patients still had normal endocrine function and only 40% required insulin treatment. Alcohol abstinence had a significant beneficial effect on endocrine, but not on exocrine pancreatic insufficiency. Chronic pancreatitis led to a sharp increase in unemployment and retirement. Pancreatic carcinoma occurred in 3% and extrapancreatic carcinoma in 4%. The mortality rate within the observation period was 22%, pancreatitis-induced complications accounted for 13% of these deaths.

Adult↗
PubMed1993

Enzyme treatment of exocrine pancreatic insufficiency in chronic pancreatitis.

Exocrine pancreatic insufficiency combined with pancreatic pain and endocrine pancreatic insufficiency are the leading symptoms of chronic pancreatitis. Due to the large functional reserve capacity of the gland, decompensation, i.e. steatorrhea, does not occur before lipase excretion is reduced to < or = 10% of normal. Pancreatic enzyme substitution is indicated when fecal fat excretion exceeds a critical value (normally > 15 g/day) and/or when weight loss is present. A number of studies have dealt with the problems of gastric acid inactivation of pancreatic enzyme preparations as well as their gastric emptying nonsimultaneously with the food. For the present, it is recommended that pancreatic enzyme substitution in patients with proven exocrine pancreatic insufficiency and normal gastric acid secretion be given in multiunit, acid-protected dosages. In patients with gastric hyposecretion and in those who underwent partial or total gastrectomy, enzyme substitution should be administered as granules to enable mixing and simultaneous transport of enzymes with the chyme. The ultimate aim of further scientific and clinical research remains the total abolishment of pancreatic steatorrhea.

Celiac Disease↗