Chronic Relapsing Pancreatitis Research Articles

Massive bilateral hemorrhagic pleural effusions in chronic relapsing pancreatitis.

Bizarre pulmonary signs and symptoms may occur in association with pancreatitis. The frequency of pulmonary changes is estimated to be 14% to 17%. 1-4 Pleural effusions were first described in acute pancreatitis and more recently in chronic pancreatitis as well. 5-7 In the collective data from three large series of pancreatitis cases in the literature (518 patients), the frequency of pleural effusions was 5.2%, (27 patients). 1,3,4 Pleural effusions occurred on the left side in 18 patients and were bilateral in seven patients. Eight detailed descriptions of bilateral pleural effusions associated with pancreatitis have been recorded, a total of 15 cases. 7-12 In the patient to be described, chronic relapsing pancreatitis was associated with bilateral bloody pleural effusions. There have been two previous case reports of bilateral hemorrhagic pleural effusions in patients with pancreatitis. 7-11 Report of a Case A 52-year-old chronic alcoholic was admitted to the Manhattan Veterans Administration

Surgical management of chronic relapsing pancreatitis

Review of the thirty year experience at the Lahey Clinic with 530 cases of chronic pancreatitis shows that the clinical, physiologic, and pathologic manifestations of the disease are extremely varied and indicates that the most significant feature in the treatment of these patients is the choosing of the appropriate operation for each individual patient after careful exploration of the pancreas. The progressive and irreversible structural changes include fibrosis, atrophy, cystic degeneration, patchy necrosis, abscess formation, and pancreaticolithiasis, often with complete or partial obstruction of the pancreatic ducts. Because duct obstruction is the main pathophysiologic change, early operations directed to the biliary tract, stomach, and autonomic nervous system were generally unsatisfactory, especially in patients with advanced chronic pancreatitis. In contrast, satisfactory longterm results were obtained in 70 per cent of patients who had operations directly on the pancreas. These procedures included drainage of associated pancreatic cysts and abscesses, transduodenal decompression of pancreatic ducts, transpancreatic ductal decompression, distal pancreatectomy, pancreaticoduodenectomy, and total pancreatectomy. Unsatisfactory results were related to choice of an inappropriate operation, inability of the patient to free himself from alcoholism, and persistence of residual pancreatic inflammatory disease. The clinical antecedents of the disease, the metabolic consequences, and the results of various operations are discussed.

Surgical treatment of chronic relapsing pancreatitis.

Surgical treatment of chronic relapsing pancreatitis.

Surgery for chronic relapsing pancreatitis.

Eight cases of chronic relapsing pancreatitis are reviewed. It is re-emphasized that at this stage of the disease the major duct is involved in multiple strictures and cannot be drained by terminal anastomosis. The advantages of longitudinal pancreatico-jejunostomy are outlined, particularly in regard to the preservation of pancreatic function. The outstanding result in this series has been the relief of pain and the considerable gain in weight and well-being, even though no patient has apparently stopped drinking.

Hereditary chronic relapsing pancreatitis: A clue to pancreatitis in general?

Hereditary chronic relapsing pancreatitis: A clue to pancreatitis in general?

Chronic relapsing pancreatitis

T HE RETROPERITONEAL SITUATION of the pancreas makes it relatively inaccessible in the anatomic sense and provides difficulty in assessing the presence and extent of pathologic processes on a clinical basis. Steatorrhea implies deficiency of its exocrine function and the onset of diabetes mellitus indicates disturbance of its endocrine efficiency. Until calcareous change with calcification within the pancreas provides radiologic evidence of pancreatic structural disorder, it remains difficult to assess objectively the very severe and agonizing pain which accompanies chronic relapsing pancreatitis. (Fig. 1.) Elevations in serum amylase and serum lipase, although frequently associated with episodes of acute pancreatitis, are rarely prominent in chronic pancreatitis by which time repeated attacks of acute or subacute pancreatitis have resulted in architectural changes within the pancreas.

A preliminary study of the structure and function of enlarged parotid glands in chronic relapsing pancreatitis by sialography and biopsy methods.

A preliminary study of the structure and function of enlarged parotid glands in chronic relapsing pancreatitis by sialography and biopsy methods.

Chronic relapsing pancreatitis. Recognition and management.

Chronic relapsing pancreatitis is firmly established as a disease entity with characteristic clinical manifestations and pathologic changes. Diagnosis is difficult because the severity and frequency of the attacks are unpredictable and cumulative pancreatic damage is variable. Severe abdominal pain in the presence of minimal physical evidence of abnormality is the most helpful diagnostic criterion. Etiologic factors, clinical features, diagnostic aids, and choice of treatment are considered.

Zollinger-Ellison tumor associated with a malabsorption syndrome with abdominal distention resembling large bowel obstruction

A patient with a Zollinger-Ellison syndrome and pancreatic insufficiency demonstrated the following interesting points: 1. 1. There were repeated episodes of abdominal distention which were interpreted initially as sigmoid volvulus, and which were interpreted after sigmoidectomy as low colonic obstruction. 2. 2. The symptom of diarrhea which is present in a high percentage of patients with the Zollinger-Ellison tumor was mistakenly attributed to other associated diseases; in this case, chronic relapsing pancreatitis with severe malabsorption. 3. 3. Therapy for pancreatic insufficiency may not be effective in the presence of gastric hypersecretion, as in this patient, because the pancreatin may be rushed through the gut too rapidly or it may be inactivated by the acid. 4. 4. Aerobilia did not represent a biliary enteric fistula but resulted from a patulous sphincter of Oddi. 5. 5. Diarrhea caused by gastric hypersecretion resulted in hypochloremic alkalosis. 6. 6. The patient had three possible mechanisms for the gastric hypersecretion: tumor, pancreatic exocrine atrophy, and episodes of acute pancreatitis. 7. 7. The patient had marked gastric hypersecretion documented three years prior to her death from the complications of a chronic peptic ulcer. 8. 8. The chronic peptic ulcer was located at the cardioesophageal junction.

Gastric intramural pseudocyst in chronic pancreatitis

Two unusual cases of anterior rupture of the main pancreatic duct in chronic relapsing pancreatitis are presented. The uncommon occurrence of a gastric intramural collection of amylase associated with the main pancreatic duct is documented.

PSYCHOSIS WITH PANCREATITIS

Toxic psychoses may accompany or follow a variety of apparently nonspecific physiological stresses, including fever, infection, malnutrition, and electrolyte imbalance. A number of predisposing factors may increase susceptibility to precipitating events; prominent among these is alcoholism. In the alcoholic, delirium tremens is recognized as a potential complication of alcohol withdrawal, pneumonia, or a debilitating illness. The question is whether the pathologic response is to the accompanying illness or a result of alcohol withdrawal enforced by hospitalization. Psychosis associated with pancreatitis in a group composed primarily of alcoholics is discussed in the August issue of the<i>Archives of Internal Medicine</i>.¹Although varied stimuli may produce a similar clinical picture, the investigators emphasize this does not necessarily imply nonspecificity of stimulus. Thirty patients with chronic relapsing pancreatitis, 16 of whom experienced acute hallucinatory psychosis during an acute flare-up of pancreatitis, are discussed. Six patients experienced recurring psychosis with repeated episodes of

PSYCHOSIS WITH PANCREATITIS; A FREQUENT OCCURRENCE INFREQUENTLY RECOGNIZED.

HALLUCINATIONS are rarely reported in association with chronic relapsing pancreatitis, although diabetes, steatorrhea, and pancreatic calcification are commonly recognized complications of this disorder. Clinical observation led us to suspect that hallucinations often accompany pancreatitis, and a survey of the medical records at the Johns Hopkins Hospital of patients with pancreatitis confirmed the frequent association of these two conditions. The present report is based on a prospective medical and psychiatric evaluation of 30 patients with pancreatitis and a similar number of alcoholics with pneumonia. The incidence of hallucinations in each of the two groups is compared in order to evaluate the significance of associated psychosis. In addition, the incidence of hallucinations in patients with pancreatitis is compared with the incidence of diabetes, steatorrhea, and pancreatic calcification as a means of determining the relative importance of psychosis as a complication of pancreatitis. Materials and Methods Thirty consecutive patients admitted to the

Hereditary pancreatitis. The role of surgical intervention.

The occurrence of hereditary pancreatitis was first suspected by Comfort and Steinberg5in 1952. They reported the appearance of chronic relapsing pancreatitis in four members of a single family, possibly affecting two others. Since that report, an additional four kindreds with hereditary pancreatitis have been reported.7,8,10Several other families have been studied in which the evidence is suggestive that hereditary pancreatitis is present.8,12In the five kindreds reported to date, 22 definite pancreatitis cases have been detected along with 16 suspected cases. We have studied an additional kindred with hereditary pancreatitis. The clinical course of this disease is similar to that of the usual variety of chronic relapsing pancreatitis. Recurrent episodes of pancreatitis occur at varying intervals, with the onset of the usual sequelae of chronic pancreatitis as the disease pursues its course. Pancreatic calcifications have been observed in approximately half.12These calcifications are usually in

Transduodenal pancreatic duct dilatation and curettage in chronic relapsing pancreatitis

1. 1. Fourteen cases of transduodenal pancreatic duct dilatation and curettage for chronic relapsing pancreatitis are reported. 2. 2. In twelve cases, definite obstructive pathologic disease amenable to correction with this approach was demonstrated. 3. 3. To date, twelve of the fourteen patients have shown an excellent end result. 4. 4. On this basis, it would appear reasonable to employ transduodenal pancreatic duct dilatation and curettage as an initial procedure in the surgical management of chronic relapsing pancreatitis.

Radiological changes in bone due to intramedullary fat necrosis in pancreatitis: A preliminary report

Summary This preliminary report presents medullary bone changes occurring in pancreatitis. A case of osteolytic lesions occurring in a girl aged eleven in the acute phase of fat necrosis in pancreatitis is described. Subsequently fat necrosis is demonstrated in the pathological specimen of a man who died following an attack of haemorrhagic pancreatitis, and two cases of calcification in the femoral shafts, with one of which there were necrotic changes in the hip joint, in patients with chronic relapsing pancreatitis are described. In the absence of a history of exposure to abnormal pressures, deep sea diving, caisson work, etc., and in the absence of other sources of embolism, it is considered that in these cases these appearances represented calcification in areas of long-standing fat necrosis in bone associated with pancreatitis.

Hereditary pancreatitis: Description of a fifth kindred and summary of clinical features

A fifth kindred with hereditary pancreatitis is described. In four generations of this kindred, six persons are definitely affected with this disease and four others probably have it. In affected kindreds the mode of inheritance appears to be as a non-sex-linked Mendelian dominant. Poor penetrance of the gene and incomplete recessiveness are not excluded. Hereditary pancreatitis often is manifest from early childhood. The sexes so far have been affected with equal frequency. Usually the pancreatic calcifications have appeared as calculi in the larger pancreatic ducts. Gallstones have been observed in only one of twenty-two patients, but in most other respects the clinical picture resembles that of the non-hereditary variety of chronic relapsing pancreatitis. In four of the five kindreds with hereditary pancreatitis, approximately half of the persons so studied (with or without pancreatitis) have excreted abnormally large amounts of lysine and cystine (less often arginine) in the urine. The features of this aminoaciduria are essentially those of “cystinuria,” genetically the incompletely recessive type. To the present, no etiologic or pathogenetic relationship between the aminoaciduria and the pancreatitis is apparent.

Pathological considerations in the choice of operation for chronic relapsing pancreatitis.

THE most controversial aspect of pancreatic surgery concerns the choice of an appropriate operative procedure in the management of chronic relapsing pancreatitis. The evolution of the surgical treatment of this disease characterizes the evolution of surgery of the pancreas in general. The slow and painful progress in knowledge of pancreatic surgery is recognizable. The initial timid, indirect and circuitous approach to the surgical treatment of chronic pancreatitis, dictated by ignorance of the etiology and pathology of the disease and by the fear of attacking the pancreas directly, is apparent. Concern with the theories of etiology overshadowed considerations of the precise . . .

Atypical Pancreatitis

Summary One must be constantly alert to the possibilityof pancreatitis with unusual clinical manifestations. We have presented 6 atypical cases of pancreatitis as follows: 1.Pancreatitis presenting as perinephricinflammation and subdiaphragmatic abscess that resulted in left nephrectomy. 2.An extensive left abdominal abscesseventually shown to be secondary to pancreatitis. 3.Painless chronic pancreatitis manifestedby the complications of steatorrhea, diabetes mellitus, and pancreatic calcification. 4.Chronic relapsing pancreatitis of thehereditary form manifested by pancreatic calcification and by anemia that was the result of hemorrhage apparently from gastroesophageal varices secondary to thrombosis of the splenic vein. 5.Chronic relapsing pancreatitis thatsimulated peptic ulcer. 6.Chronic relapsing pancreatitis withclinical manifestations simulating those of Addison's disease, intraabdominal malignancy, diffuse collagen disease, and cirrhosis. Unusual complications were thrombosis of the portal vein, hydrothorax, and chylous ascites.

Further observations on the use of I-131-labeled triolein in the diagnosis of chronic relapsing pancreatitis.

Further observations on the use of I-131-labeled triolein in the diagnosis of chronic relapsing pancreatitis.

An Evaluation of the Starch Tolerance Test in Pancreatic Insufficiency

Summary The starch tolerance test was performed in 101 patients without pancreatic disease and in 43 patients with pancreatic disease. The possible pitfalls of the test are discussed. Positive results were observed in 15 of the 27 cases with chronic relapsing pancreatitis and in 8 of the 9 cases with carcinoma of the pancreas. The test gave a normal result in 100 patients and a false positive result in 1 patient without pancreatic disease. When the starch tolerance test was positive, it appeared to be a reliable indicator of pancreatic disease. A negative starch tolerance test did not rule out pancreatic disease.