Showing papers on "Pancreatitis published in 1980"

Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis.

Abstract: Pancreas divisum occurs when the embryological ventral and dorsal parts of the pancreas fail to fuse, so that pancreatic drainage is mainly through the accessory papilla. In 169 patients with primary biliary tract disease who underwent pancreatography incidental to endoscopic cholangiography, the incidence of pancreas divisum was 3.6%. Among 78 patients with unexplained recurrent pancreatitis, the incidence was 25.6%. The hypothesis that the duct anomaly can cause obstructive pain and pancreatitis is presented, and supported by a detailed analysis of 47 patients with the condition.

Experimental pancreatitis in the rat. Sodium taurocholate-induced acute haemorrhagic pancreatitis.

Abstract: Sodium taurocholate injected into the pancreatic duct system of the rat caused acute haemorrhagic pancreatitis. The pancreatic lesions were immediate and characterized by interstitial oedema, extensive necrotic changes of the acinar cells, and haemorrhages during the first 24 h after the injection. In animals surviving 72 h there were marked acinar atrophy and pancreatic fibrosis. The mortality increased according to the amount of sodium taurocholate injected. Except for necrosis of occasional liver cells, other organs examined were histologically normal. This investigation created an experimental model for studying the pathogenesis of acute pancreatitis. The results support the hypothesis that bile can initiate acute haemorrhagic pancreatitis.

CT of fluid collections associated with pancreatitis

Abstract: Fluid collections are an important component of severe pancreatitis because they may produce a detectable mass and may be responsible for prolongation of fever and pain. Among 59 cases of clinically verified pancreatitis, 32 were shown by CT to be complicated by pancreatic and/or extrapancreatic fluid collections. Pancreatic fluid collections, diagnosed in 16 patients, were typically on the anterior or anterolateral surface of the gland and were covered only by a thin layer of fibrous connective tissue. Extrapancreatic fluid collections were detected in the lesser sac (19 cases), anterior pararenal space (15), posterior pararenal space (six), in or around the left lobe of the liver (five), in the spleen (three), and in the mediastinum (one). The potential undesirable consequences of escape of pancreatic juice are necrosis, abscess formation, or prolonged inflammation of the peripancreatic tissues. Relative preservation of pancreatic integrity as observed by CT was regularly found in patients with large ex...

Total or near total pancreatectomy and islet autotransplantation for treatment of chronic pancreatitis.

Abstract: Total or near total pancreatectomy is the surest way to relieve the pain of chronic pancreatitis but is rarely applied because the metabolic consequences are so severe. For most patients drainage procedures are applicable, but pancreatectomy may be the only alternative for small duct disease or where procedures to improve duct drainage have failed. Preservation of endocrine function is a major problem in patients who require pancreatectomy. Experiments in pancreatectomized dogs have shown that intrasplenic or intraportal transplantation of unpurified pancreatic islet tissue dispersed by collagenase digestion can prevent diabetes. We have applied this technique to ten patients with chronic pancreatitis, small ducts, and intractable pain. The entire pancreas of > 95% of the pancrease was excised, minced, dispersed by collagenase digestion and infused into the portal vein < 2 1/2 hours after removal. Mean (+/- SD) rise in portal pressure was 17 +/- 8 cm of water. Liver function tests were altered minimally. All patients were relieved of pain. One patient died of a complication not related to the islet autotransplant; viable islets were identified in the liver at autopsy. Of the remaining nine patients, three have been insulin independent for 1, 9, and 38 months. One patient was insulin indpendent for 15 months and now takes 12 units of insulin daily. Three have nonketosis prone diabetes (tested by insulin withdrawal) and take 15--30 units of insulin per day. C-peptide studies in these patients show that functioning islets are present. Two patients are diabetic and require 35 and 60 units of insulin per day. In eight of nine patients tested serum insulin concentrations fell to undetectable levels during the interval between pancreatectomy and islet transplantation. Serum insulin levels during the first few hours after islet transplantation predicted success. In the insulin independent or in the patients with mild diabetes, insulin levels were persistently greater than or equal to 6 microU/ml. In the other two patients, the increase in insulin concentration was not sustained. Islet tissue preparation from a diseased pancreas is difficult. The surgeon and the patient must still be willing to accept diabetes for relief of pain when performing this operation. In some patients, however, islet autotransplantation can prevent or partially ameliorate diabetes after pancreatectomy, and preservation of endocrine function is worthwhile.

[Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis].

Abstract: 1. A duodenum-preserved resection of the pancreas head was performed in 12 patients with chronic pancreatitis and tumor of the pancreas head without malignancy. The defect of the pancreas was repaired by an interposition of an jejunal 100p. -- 2. The clinical lethality was 0%. Follow-up after an average of three years showed 75% of the patients were completely able to return to work. -- 3. This resection procedure saves the patient from partial gastrectomy, common duct resection, and duodenectomy as compared to duodenopancreatectomy.

Hyperparathyroidism and pancreatitis. Chance or a causal association

Abstract: Of 1,153 patients with surgically confirmed primary hyperparathyroidism operated on at the Mayo Clinic between 1950 and 1975, only 17 (1.5%) had coexisting or prior pancreatitis. This frequency of association approximates the reported incidence of pancreatitis among general hospital patient populations. Other factors of possible etiologic significance in pancreatitis, such as gallstones or alcohol abuse, were present in 11 of the 17 patients. Cure of the hyperparathyroidism was usually not associated with amelioration of symptoms due to pancreatitis. A review of the available data, including experimental evidence, does not support a cause-and-effect relationship between primary hyperparathyroidism or hypercalcemia and pancreatitis. ( JAMA 243:246-247, 1980)

Intraductal proliferation in the pancreas and its relationship to human and experimental carcinogenesis

Abstract: In 21 patients who had undergone total pancreatectomy for pancreatic head carcinoma, the uninvolved pancreas was examined with regard to the type, incidence and regional distribution of duct epithelial proliferation. The results were compared with those in 37 operative specimens from patients with chronic pancreatitis, in 46 normal pancreases from autopsies and with findings in experimental pancreatic carcinogenesis. While the incidence of squamous metaplasia and non-papillary epithelial hypertrophy varied little in the different groups, papillary epithelial hyperplasia was found three times more often in cases of carcinoma, with associated mild duct obstruction. Atypical epithelial proliferation was only detected in the vicinity of carcinomas. Unequivocal transition from papillary hyperplasia to atypical proliferation was not observed. In hamsters treated with dihydroxy-di-n-propylnitrosamine (DHPN) for induction of pancreatic duct carcinomas, the early duct lesions closely resembled atypical epithelial proliferation of human pancreas. It is concluded that (1) papillary epithelial hyperplasia is probably only indicative of early duct obstruction and/or a general neoplastic stimulus, (2) intraductal epithelial proliferation with atypia is a true precursor of duct carcinoma, and (3) chronic pancreatitis lacks atypical duct lesions.

Transplantation of dispersed pancreatic islet tissue in humans. Autografts and allografts

Abstract: Islet transplantation is successful in animals and holds considerable promise as endocrine replacement therapy for patients with diabetes mellitus, but clinical application to diabetic patients has been difficult We have shown the technical feasibility of human islet transplantation by autotransplantation of dispersed pancreatic islet tissue into the portal vein in three patients with chronic pancreatitis and incapacitating, intractable pain who underwent near-total (greater than 97%) pancreatectomy In all three patients, the excised pancreas was dispersed by collagenase digestion, but no effort was made to purify the islets Islet yield, as judged by tissue insulin content, ranged from 24 to 55% The first patient, who never received insulin after the pancreatectomy and islet autotransplantation, had a normal oral glucose tolerance test by 3 wk and has remained normoglycemic for over 2 yr In the second patient, viable islets were histologically identified in the liver parenchyma The third patient was treated with hyperalimentation for 3 wk after the pancreatectomy and islet autotransplantation and, during this period, required insulin After cessation of hyperalimentation and initiation of oral geedings, the patient was withdrawn from insulin Although abnormalities of carbohydrate metabolism were present, the patient did not require insulin for more than 1 yr Seven diabetic renal allograft recipients have received allografts of dispersed pancreatic islet tissue prepared in the same way No patients were cured of diabetes, although transient evidence of islet function--increase in serum or urinary C-peptide levels or decrease in exogenous insulin requirements--occurred in some Although rejection was probably responsible for most of the failures, transplantation of allogeneic human islet tissue as a free graft is metabolically inefficient With the current state of immunosuppressive therapy, the primary role of islet transplantation may be in a situation where rejection cannot occur: as an autograft to obviate the occurrence of diabetes after extensive pancreatectomy for benign disease

Iodine-125 implant and external beam irradiation in patients with localized pancreatic carcinoma: a comparative study to surgical resection.

Abstract: Twelve patients with biopsy-proven clinically localized ductal pancreatic cancers (less than 7 cm in greatest diameter) judged unsuitable for resection were treated by bypass surgery, an Iodine-125 implant (20-39 mCi), and postoperative irradiation (4000-4500 rads). The potential problems of significant bleeding, pancreatic fistula, or pancreatitis were not experienced. A local recurrence developed in one patient and two recurred in regional lymph nodes. The projected median survival of the group is 11 months with four of the 12 patients still surviving. For purposes of comparison all patients with pancreatic ductal carcinoma treated by radical resection during a similar time were evaluated. All ten have died with a median survival of six months. Twelve of 22 (55%) of the combined implanted and resected groups have developed distant metastasis. Further pursuit of intraoperative techniques of irradiation in combination with adjuvant multidrug chemotherapy seems indicated in an attempt to prolong patient survival which is now limited by hematogenous metastases.

Ultrasound patterns of disorders affecting the gastrointestinal tract.

Abstract: A mass associated with the gastrointestinal tract was detected by sonography in 33 patients. Etiologies included primary or metastatic tumor; intussusception; inflammation secondary to bowel infarction, pancreatitis, or irradiation; and a dilated, fluid-filled gut related to retained gastric contents, obstruction, ileus, or an ileal bypass. Mesenteric or omental changes were identified with inflammation and frequently with metastatic disease. The diagnosis was confirmed by repeat sonography, abdominal radiography, barium examination of the small bowel, computed tomography, surgery, or autopsy. Ultrasound patterns are characteristic in tumor, intussusception, and inflammation; specific features allowing differentiation between tumor and inflammation are described. Colonic haustra, valvulae conniventes, or bowel contours and peristalsis on real-time sonography are helpful in identifying fluid-filled bowel loops.

Toxic shock syndrome, a newly recognized disease entity. Report of 11 cases

Abstract: The toxic shock syndrome has only recently been described. Eleven female patients aged 13 to 43 years (median 17) with toxic shock syndrome have been seen at the Mayo Clinic since August 1975. One patient died. Seven patients had one or more recurrences. As previously described, the syndrome was often life-threatening, afflicted mostly menstruating females, and was characterized by a very brief prodromal illness consisting of high fever, vomiting, diarrhea, conjunctivitis, headache, irritability, sore throat, myalgias, abdominal tenderness, and erythematous rash. The disorder can progress to hypotension or prolonged refractory shock, adult respiratory distress syndrome, diffuse intravascular coagulation with severe thrombocytopenia, and renal failure. Pancreatitis was observed in two cases. During convalescence, pronounced desquamation and peeling of the skin occurred. Numerous laboratory abnormalities are observed. In 5 of the 11 patients, Staphylococcus aureus was isolated from conjunctiva, oral cavity or nares, vagina, or stool. A recently described pyrogenic exotoxin was identified in the isolates of three patients; its etiologic role remains speculative. Therapy is mainly supportive. Antistaphylococcal therapy for the acute illness and for prevention of recurrences has not yet proved to be of any benefit. The role of vaginal tampons, if any, in the pathogenesis of this disorder remains unclear.

Pancreatic acinar ultrastructure in human acute pancreatitis.

Abstract: Ultrastructural alterations in pancreatic acini from six patients operated for acute necrotizing pancreatitis are described. One of the patients suffered from biliary tract disease, the rest had excessive alcohol intake as the presumed aetiology. Areas of the pancreatic parenchyma showing oedematous inflammation in light microscopy were studied in the electron microscope. Findings in acinar cells included changes in zymogen granules and an increased autophagocytosis in addition to unspecific organelle alterations. Zymogen granules showed increase in size and number, loss or variation of electron-density and peripheral dissolution. Increased autophagic activity was indicated by several autophagic vacuoles and residual bodies. Acinar lumina were dilated showing effacement of microvilli and invaginations in the luminal plasma membrane of the acinar cells. In acinar lumina and in the interstitium fibrillar material was observed, with an increasing frequency in those areas showing severe cellular disintegration. These findings suggest: 1) an increased activity of zymogen granules, 2) an increased autophagocytosis, and 3) penetration of acinar luminal contents into the interstitium.

Histological evidence of initiating factors in acute necrotising pancreatitis in man.

Abstract: In this necropsy review of 37 cases of acute pancreatitis, evidence is presented that there are at least two different initiating mechanisms in acute necrotising pancreatitis in man. Firstly, there is primary duct inflammation, with subsequent inflammation and necrosis of the pancreatic parenchyma surrounding the excretory ducts. Included in this group are cases secondary to alcohol abuse and cholelithiasis. Secondly, there is necrosis confined to the microcirculatory periphery of the pancreatic lobule. These cases are usually secondary to some form of shock (septic or cardiogenic) and are thought to represent ischaemic pancreatitis. These patterns of necrosis are discussed in relation to the pancreatic anatomy and clinical findings.

Pancreatitis associated with valproic acid therapy for epilepsy.

Abstract: Valproic acid is useful for absence, myoclonic, and grand ma1 seizures and adjunctively for mixed seizures [31. The drug has been well tolerated in most patients, but vomiting, rashes, hair loss, leukopenia, and thrombocytopenia have been observed. Seven patients have developed hepatitis, which was fatal in 6 151. We recently treated a child who developed pancreatitis in direct association with valproic acid therapy.

Common Duct Stricture From Chronic Pancreatitis

Abstract: • Common bile duct stricture secondary to chronic pancreatitis is difficult to detect clinically. Surgical bypass is necessary if complications from biliary obstruction develop. In 21 patients operated on between 1968 and 1979, the earliest typical biochemical finding was a persistently elevated serum alkaline phosphatase level. The SGOT level was minimally elevated in seven patients, but did not correlate with changes in the stricture. An increased bilirubin level was noted either during an acute exacerbation of pancreatitis or late in the course of the stricture development, when obstruction was almost complete. Operative cholangiograms taken in 12 of these patients and transhepatic cholangiograms taken in nine demonstrated a stricture of the intrapancreatic bile duct more than 2 cm long. Operations were performed for treatment of obstructive jaundice (11), ascending cholangitis (three), suspected pancreatic cancer (three), and progressive biliary cirrhosis (two). Sphincteroplasty, initially attempted in four patients, uniformly failed to relieve the obstruction due to the length of strictured duct. Satisfactory drainage was obtained for up to ten years with choledochoduodenostomy (12), choledochojejunostomy (three), and cholecystojejunostomy (six). ( Arch Surg 115:582-586, 1980)

Computed tomography, ultrasonography, and endoscopic retrograde cholangiopancreatography in the diagnosis of pancreatic disease: a comparative study.

Abstract: A prospective study was performed comparing the sensitivity of computed tomography, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic disease. Forty patients with suspected pancreatic carcinoma, acute recurrent or chronic pancreatitis, and/ or jaundice were studied. CT was the most sensitive study in evaluation of pancreatitis. ERCP was most accurate in evaluation of pancreatic malignancy. Ultrasonography was the least sensitive method in detecting pancreatic disease and dilatation of the extrahepatic biliary ducts.

Incidence and Significance of Juxtapapillary Diverticula at Endoscopic Retrograde Cholangiopancreatography

Abstract: In a retrospective study of 755 patients undergoing endoscopic retrograde cholangiopancreatography from 1973 to 1977 at the Royal Free Hospital, 38 (5%) had a juxtapapillary diverticulum. This resulte

Experimental pancreatitis in the rat. The role of phospholipase A in sodium taurocholate-induced acute haemorrhagic pancreatitis.

Abstract: Acute haemorrhagic pancreatitis was induced in rats by injecting 0.2 ml of 5% (92.9 mmol/l) aqueous solution of sodium taurocholate into the common biliopancreatic duct. Lysolecithin was separated from the pancreatic homogenate by thin-layer chromatography and quantified by phosphorus determination. The lysolecithin content increased rapidly, remained elevated for 12 h, and returned to the control level 24 h after the injection. Treatment with a trypsin inhibitor, aprotinin (Trasylol), given intraperitoneally and intravenously during 2 h postoperatively (800,000 units/kg of body weight) had no beneficial effects compared with physiological saline treatment. When the animals were treated similarly with a phospholipase A inhibitor, procaine hydrochloride (40 mg/kg of body weight), 45% of them survived 72 h (p less than 0.01). It was concluded that phospholipase A, which converts lecithin into lysolecithin, plays a significant role in the pathogenesis of acute pancreatitis.

Endoscopic retrograde cholangiopancreatography (ERCP) in pancreatic disease: a reassessment of the specificity of ductal abnormalities indifferentiating benign from malignant disease.

Abstract: A blind study of 49 patients with narrowing of the common bile duct or pancreatic duct on endoscopic retrograde cholangiopancreatography (ERCP) was done. The double duct sign appeared in four of eight pancreatic carcinoma patients, but also occurred in 15 of 41 pancreatitis patients. Other signs, which occurred only in carcinoma in prior studies (nodular, eccentric narrowing, and eccentric and irregular rat-tailed stenosis) also occurred in both groups. These results highlight the unreliability of utilizing morphological ductal changes as the only ERCP criteria in differentiating pancreatic carcinoma from pancreatitis. The most reliable criterion for pancreatitis was multiple stenoses in one duct. Pancreatic carcinoma cannot be diagnosed accurately if signs of pancreatitis are also present, and other examinations may be needed.