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Results for “Pancreatitis, Chronic”

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At least 19 recordsLinked to original sources
PubMed1979

Non-operative differentiation between pancreatic cancer and chronic pancreatitis.

Eighty-five of 186 patients investigated for suspected pancreatic cancer had an unequivocal final diagnosis of either pancreatic cancer (58 patients) or chronic pancreatitis (27 patients). They had been studied prospectively using ultrasonography, computerized tomography, radionuclide scanning, endoscopic retrograde cholangiopancreatography (ERCP), selective celiac and superior mesenteric angiography, duodenal drainage studies, cytologic studies, serum carcinoembryonic antigen assay, and pancreatic oncofetal antigen assay, The results were compared to determine which test would most frequently and reliably differentiate between pancreatic cancer and pancreatitis in a patient believed to have one or other disease. Criteria for interpreting results, first for highest rate of correct diagnoses, and second for highest accuracy were derived. Applying these criteria, ultrasonography achieved the highest rate of correct diagnoses (97% of patients diagnosed with 84% accuracy). ERCP, duodenal drainage studies, and cytology were the most accurate tests ((86% accuracy each test) but, with this accuracy, ERCP most frequently gave a diagnosis (diagnosis rate: ERCP--70%, duodenal drainage--32%, cytology--35%). The results suggest that ultrasonography is the best noninvasive test, and that a combination of ERCP, pancreatic juice assay and cytology in a single procedure may prove to be the best discriminating investigation.

Adult↗
PubMed1978

Symposium on pancreatitis: 4. Surgery in chronic pancreatitis.

When the pain associated with chronic pancreatitis is due to ductal obstruction, it is logical that surgical management should be designed to relieve that obstruction while preserving as much of the functioning gland as possible. A number of cases are described to illustrate the various procedures available and to indicate the features that govern the selection of the one most appropriate for a particular patient. The operations include partial pancreatectomy, Roux-en-Y pancreaticojejunostomy and longitudinal pancreaticojejunostomy; these can be modified to suit the peculiar circumstances of a given case.

Adult↗
PubMed1979

Impaired pancreatic polypeptide release in chronic pancreatitis with steatorrhoea.

Pancreatic polypeptide (PP) is a newly discovered hormonal peptide localised in a distinct endocrine cell type in the pancreas. PP circulates in plasma and in normal subjects levels rise substantially on the ingestion of food (mean rise 138 pmol/l). In 10 patients with chronic pancreatitis with exocrine deficiency the PP response to a test breakfast was greatly reduced (mean rise 20 pmol/l, P less than 0.001). PP response to the meal was normal in 10 patients with active coeliac disease and 12 patients with acute tropical sprue with steatorrhoea.

Adult↗
PubMed1979

Insulin secretion and pancreatic exocrine function in patients with chronic pancreatitis.

The relationship between insulin responses to oral glucose and pancreatic exocrine function were examined in 15 patients with chronic pancreatitis. Good correlations were found between the insulin responses and exocrine pancreatic function measured as the concentrations of pancreatic enzymes in duodenal juice after intravenous cholecystokinin-pancreazymin (CCK-PZ). There appears to be a roughly parallel loss of endocrine and exocrine function in the course of chronic pancreatitis.

Administration, Oral↗
PubMed1979

Pancreatic polypeptide response in patients with chronic pancreatitis.

We studied the plasma pancreatic polypeptide (PP) response to a meal in patients with pancreatitis and attempted to correlate the PP increment with the degree of pancreatic exocrine insufficiency. Control subjects and patients with recurrent pancreatitis showed significant mean increase (P less than 0.05) in plasma PP concentration in response to food. By contrast chronic pancreatitis patients had no significant increase in plasma PP. However, some subjects with normal pancreatic had no response and some patients with chronic pancreatitis did show a response. In addition, no correlation was observed between the PP response and pancreatic exocrine secretion. We conclude that the PP response to a meal has only limited value in the detection of pancreatic destruction.

Adult↗
PubMed1979

Pancreatic duct ligation in the therapy of chronic pancreatitis.

Total ligation of the pancreatic ducts of a normal gland in dogs and man results in atrophy of the acinar cells with preservation of islet cell function. Theoretically, this might be applied in the therapy of chronic pancreatitis since, in effect, an exocrine pancreatectomy results. Sustained islet cell function, as evidenced by a normal glucose tolerance test, following pancreatic duct ligation, was demonstrated in dogs for periods of up to two years. Resection of the head of the pancreas and ligation of the distal gland in six patients with chronic pancreatitis and an abnormal glucose tolerance test resulted in the development of insulin-dependent diabetes in all instances. Insulin-dependent diabetes was also demonstrated in one patient with a normal preoperative glucose tolerance test. Recurrent pancreatitis developed in only one patient. The study suggests that pancreatic duct ligation is effective in treating chronic pancreatitis but casts considerable doubt on the effectiveness of this procedure in preventing the development of diabetes, if the glucose tolerance test is abnormal

Adult↗
PubMed2024

Genetics of constant and severe pain in the NAPS2 cohort of recurrent acute and chronic pancreatitis patients.

Recurrent acute and chronic pancreatitis (RAP, CP) are complex, progressive inflammatory diseases with variable pain experiences impacting patient function and quality of life. The genetic variants and pain pathways in patients contributing to most severe pain experiences are unknown. We used previously genotyped individuals with RAP/CP from the North American Pancreatitis Study II (NAPS2) of European Ancestry for nested genome-wide associated study (GWAS) for pain-severity, chronicity, or both. Lead variants from GWAS were determined using FUMA. Loci with p<1e-5 were identified for post-hoc candidate identification. Transcriptome-wide association studies (TWAS) identified loci in cis and trans to the lead variants. Serum from phenotyped individuals with CP from the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies (PROCEED) was assessed for BDNF levels using Meso Scale Discovery Immunoassay. We identified four pain systems defined by candidate genes: 1) Pancreas-associated injury/stress mitigation genes include: REG gene cluster, CTRC, NEURL3 and HSF22. 2) Neural development and axon guidance tracing genes include: SNPO, RGMA, MAML1 and DOK6 (part of the RET complex). 3) Genes linked to psychiatric stress disorders include TMEM65, RBFOX1, and ZNF385D. 4) Genes in the dorsal horn pain-modulating BDNF/neuropathic pathway included SYNPR, NTF3 and RBFOX1. In an independent cohort BDNF was significantly elevated in patients with constant-severe pain. Extension and expansion of this exploratory study may identify pathway- and mechanism-dependent targets for individualized pain treatments in CP patients. PERSPECTIVE: Pain is the most distressing and debilitating feature of chronic pancreatitis. Yet many patients with chronic pancreatitis have little or no pain. The North American Pancreatitis Study II (NAPS2) includes over 1250 pancreatitis patients of all progressive stages with all clinical and phenotypic characteristics carefully recorded. Pain did not correlate well with disease stage, inflammation, fibrosis or other features. Here we spit the patients into groups with the most severe pain and/or chronic pain syndromes and compared them genetically with patients reporting mild or minimal pain. Although some genetic variants associated with pain were expressed in cells (1) of the pancreas, most genetic variants were linked to genes expressed in the nervous system cells associated with (2) neural development and axon guidance (as needed for the descending inhibition pathway), (3) psychiatric stress disorders, and (4) cells regulating sensory nerves associated with BDNF and neuropathic pain. Similar and overlapping genetic variants in systems 2 -4 are also seen in pain syndromes form other organs. The implications for treating pancreatic pain are great in that we can no longer focus on just the pancreas. Furthermore, new treatments designed for pain disorders in other tissues may be effective in some patient with pain syndromes from the pancreas. Further research is needed to replicate and extend these observations so that new, genetics-guided rational treatments can be developed and delivered.

Humans↗
PubMed1978

Pancreatic retention cyst secondary to chronic pancreatitis. A cause of hemobilia.

We describe a 47-year-old male with chronic calcific pancreatitis who had a four-year history of occult gastrointestinal bleeding with three prior hospitalizations. At endoscopy on the fourth admission, hemobilia was identified. Arteriography showed a 3-cm-diameter dye blush in the head of the pancreas. A retention cyst had eroded into an adjacent artery, causing bleeding. A stone at the ampulla of Vater apparently served as a ball valve to prevent massive hemorrhage. We discuss the pathogenesis of hemobilia in chronic pancreatitis and suggested therapy.

Biliary Tract Diseases↗
PubMed1979

Pure pancreatic juice studies in normal subjects and patients with chronic pancreatitis.

Pure pancreatic juice was obtained from within the pancreatic duct in 54 patients after endoscopic cannulation of the papilla of Vater. In all 20 normal subjects there was a brisk response to intravenous injections of GIH secretin in small dosage (1 and 4 CU). Peak bicarbonate concentrations occurred after a 4 CU stimulus, whereas volumes, and bicarbonate and protein outputs were greatest after 70 CU. Total protein and amylase concentrations were highest in the first specimens collected from each patient, and fell rapidly after stimulation. Plateau levels for all indices were achieved 10-20 minutes after starting infusions of secretin and pancreozymin. When normal patients and those with chronic pancreatitis were compared, there was considerable overlap in all indices (volume, bicarbonate and total protein concentrations) after bolus injections of secretin. Most patients with chronic pancreatitis achieved a peak bicarbonate concentration in excess of 100 mmol/l. The median concentrations were not significantly different from normal after any dose of secretin when pooled 10 minute samples were analysed. However there were significant differences in peak bicarbonate concentrations (after 1 and 4 CU, but not after 70 CU), when one minute samples were compared. There were also statistically significant differences in the median 10 minute responses for volume after 1 and 70 CU, for bicarbonate output after 1, 4, and 70 CU, and for protein output after 70 CU. The results of juice studies in patients believed to have early chronic pancreatitis did not differ significantly from those in normal subjects or those with chronic pancreatitis. Endoscopic duct cannulation cannot guarantee complete recovery of pancreatic secretions, and measurements of volume and output may be inaccurate. When standard biochemical indices are used, the diagnostic role of pure juice studies is limited; further research may reveal more specific disease markers.

Bicarbonates↗
PubMed1979

[Creation of a model of chronic pancreatitis].

A model of chronic pancreatitis has been created in 13 mongrel dogs. The animals were withdrawn from the experiment 2 months after the beginning of it. According to the author's data, artifically created insufficiency of the constrictors of the common bile and pancreatic ducts in dogs is analogous to unfitness of the sphincter in man and results in the development of the changes in the abdominal cavity, specific for chronic pancreatitis.

Acid Phosphatase↗
PubMed1977

Current status of pancreatojejunostomy in the management of chronic pancreatitis.

Thirty patients with chronic pancreatitis were treated by pancreatojejunostomy, six caudal and twenty-four longitudinal anastomoses. Follow-up data up to twenty years are reported and the early and long-term results compared. There were no deaths. Long-term results with caudal pancreatojejunostomy were 50 per cent excellent or improved and with longitudinal pancreatojejunostomy, 70 per cent excellent or improved. The best results were obtained when intraductal calcification was present. Longitudinal pancreatojejunostomy is recommended as the initial treatment of choice for chronic pancreatitis in patients with ductal obstruction, particularly when calcification is present.

Adult↗
PubMed1978

Symposium on pancreatitis: 3. Diagnostic tools in the management of chronic pancreatitis.

The chief diagnostic tools used in planning the management of chronic pancreatitis require close collaboration of the surgeon and radiologist. Barium meal, endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography and angiography are the most useful procedures. The barium meal is the initial screening procedure. Uultrasonography should follow if there is suspicion of a pseudocyst or pancreatic abscess. It is also may be of value in demonstrating localized chronic pancreatitis. The most useful of all the tests is ERCP. This shows the pancreatic duct, the common bile duct, or both ducts, so that the surgeon may avoid operation where there is no defect to correct, or it may guide him in selecting an operation that is designed to correct the anatomical abnormalities of either duct. Angiography is occasionally of use when the foregoing procedures have not provided enough information. In over 80% of patients it is possible for the surgeon to undertake an operation with foreknowledge of the pancreas that will help him select the correct procedure to alleviate the patient's symptoms.

Angiography↗