THE OFFICIAL PATIENT’S SOURCEBOOK
on
PANCREATITIS
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Pancreatitis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83400-8 1. Pancreatitis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
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Dedication To the healthcare professionals dedicating their time and efforts to the study of pancreatitis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to the study of pancreatitis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to pancreatitis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Bacteria and Foorborne Illness
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The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
·
The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Constipation
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gallstones
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The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastritis
·
The Official Patient's Sourcebook on Gastroparesis
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The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
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The Official Patient's Sourcebook on Hemorrhoids
·
The Official Patient's Sourcebook on Hepatitis A
·
The Official Patient's Sourcebook on Hepatitis B
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
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The Official Patient's Sourcebook on Hirschsprung
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The Official Patient's Sourcebook on Indigestion
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The Official Patient's Sourcebook on Inguinal Hernia
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The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
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The Official Patient's Sourcebook on Irritable Bowel Syndrome
·
The Official Patient's Sourcebook on Lactose Intolerance
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The Official Patient's Sourcebook on Ménétrier
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The Official Patient's Sourcebook on Peptic Ulcer
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The Official Patient's Sourcebook on Porphyria
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The Official Patient's Sourcebook on Primary Biliary Cirrhosis
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The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
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The Official Patient's Sourcebook on Proctitis
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The Official Patient's Sourcebook on Rapid Gastric Emptying
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·
The Official Patient's Sourcebook on Short Bowel Syndrome
·
The Official Patient's Sourcebook on Ulcerative Colitis
·
The Official Patient's Sourcebook on Whipple Disease
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The Official Patient's Sourcebook on Wilson's Disease
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The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION...................................................................................... 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7
CHAPTER 1. THE ESSENTIALS ON PANCREATITIS: GUIDELINES ........... 9 Overview ....................................................................................................................................... 9 What Is Pancreatitis? .................................................................................................................. 11 Acute Pancreatitis ....................................................................................................................... 12 Chronic Pancreatitis .................................................................................................................... 14 Pancreatitis in Children .............................................................................................................. 16 Points to Remember..................................................................................................................... 16 For More Information.................................................................................................................. 17 More Guideline Sources .............................................................................................................. 17 Vocabulary Builder...................................................................................................................... 22
CHAPTER 2. SEEKING GUIDANCE ....................................................... 27 Overview ..................................................................................................................................... 27 Associations and Pancreatitis...................................................................................................... 27 Finding More Associations ......................................................................................................... 29 Finding Doctors........................................................................................................................... 30 Selecting Your Doctor ................................................................................................................. 32 Working with Your Doctor ......................................................................................................... 32 Broader Health-Related Resources .............................................................................................. 34 Vocabulary Builder...................................................................................................................... 34
CHAPTER 3. CLINICAL TRIALS AND PANCREATITIS ........................... 35 Overview ..................................................................................................................................... 35 Recent Trials on Pancreatitis ...................................................................................................... 38 Benefits and Risks........................................................................................................................ 40 Keeping Current on Clinical Trials ............................................................................................. 43 General References....................................................................................................................... 44 Vocabulary Builder...................................................................................................................... 45 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 47
CHAPTER 4. STUDIES ON PANCREATITIS............................................. 49 Overview ..................................................................................................................................... 49 The Combined Health Information Database .............................................................................. 49 Federally-Funded Research on Pancreatitis ................................................................................ 61 E-Journals: PubMed Central ....................................................................................................... 76 The National Library of Medicine: PubMed................................................................................ 77 Vocabulary Builder...................................................................................................................... 80
CHAPTER 5. PATENTS ON PANCREATITIS ........................................... 91 Overview ..................................................................................................................................... 91 Patents on Pancreatitis................................................................................................................ 92 Patent Applications on Pancreatitis.......................................................................................... 108 Keeping Current ........................................................................................................................ 109 Vocabulary Builder.................................................................................................................... 109
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Contents
CHAPTER 6. BOOKS ON PANCREATITIS ............................................. 113 Overview ................................................................................................................................... 113 Book Summaries: Federal Agencies ........................................................................................... 113 Book Summaries: Online Booksellers ........................................................................................ 119 The National Library of Medicine Book Index........................................................................... 123 Chapters on Pancreatitis ........................................................................................................... 127 General Home References .......................................................................................................... 135 Vocabulary Builder.................................................................................................................... 136
CHAPTER 7. MULTIMEDIA ON PANCREATITIS .................................. 141 Overview ................................................................................................................................... 141 Video Recordings....................................................................................................................... 141 Audio Recordings ...................................................................................................................... 143 Bibliography: Multimedia on Pancreatitis ................................................................................ 144 Vocabulary Builder.................................................................................................................... 147
CHAPTER 8. PERIODICALS AND NEWS ON PANCREATITIS ............... 149 Overview ................................................................................................................................... 149 News Services & Press Releases ................................................................................................ 149 Newsletter Articles .................................................................................................................... 157 Academic Periodicals covering Pancreatitis .............................................................................. 159 Vocabulary Builder.................................................................................................................... 160
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 163 Overview ................................................................................................................................... 163 NIH Guidelines ......................................................................................................................... 163 NIH Databases .......................................................................................................................... 164 Other Commercial Databases .................................................................................................... 168 The Genome Project and Pancreatitis........................................................................................ 169 Specialized References ............................................................................................................... 173
CHAPTER 10. DISSERTATIONS ON PANCREATITIS ............................ 175 Overview ................................................................................................................................... 175 Dissertations on Pancreatitis .................................................................................................... 175 Keeping Current ........................................................................................................................ 176 Vocabulary Builder.................................................................................................................... 176 PART III. APPENDICES .............................................................................................................. 177
APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 179 Overview ................................................................................................................................... 179 Your Medications: The Basics ................................................................................................... 180 Learning More about Your Medications ................................................................................... 181 Commercial Databases............................................................................................................... 184 Contraindications and Interactions (Hidden Dangers)............................................................. 189 A Final Warning ....................................................................................................................... 190 General References..................................................................................................................... 191 Vocabulary Builder.................................................................................................................... 191
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 195 Overview ................................................................................................................................... 195 What Is CAM? .......................................................................................................................... 195 What Are the Domains of Alternative Medicine? ..................................................................... 196 Can Alternatives Affect My Treatment?................................................................................... 199 Finding CAM References on Pancreatitis ................................................................................. 200 Additional Web Resources......................................................................................................... 210 General References..................................................................................................................... 215
Contents
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APPENDIX C. RESEARCHING NUTRITION ......................................... 217 Overview ................................................................................................................................... 217 Food and Nutrition: General Principles .................................................................................... 218 Finding Studies on Pancreatitis ................................................................................................ 222 Federal Resources on Nutrition................................................................................................. 226 Additional Web Resources......................................................................................................... 227 Vocabulary Builder.................................................................................................................... 231
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 233
Overview ................................................................................................................................... 233 Preparation ................................................................................................................................ 233 Finding a Local Medical Library ............................................................................................... 234 Medical Libraries Open to the Public ........................................................................................ 234
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 241 Overview ................................................................................................................................... 241 Your Rights as a Patient............................................................................................................ 241 Patient Responsibilities ............................................................................................................. 245 Choosing an Insurance Plan...................................................................................................... 246 Medicare and Medicaid ............................................................................................................. 248 NORD’s Medication Assistance Programs............................................................................... 251 Additional Resources................................................................................................................. 252 Vocabulary Builder.................................................................................................................... 253 ONLINE GLOSSARIES ............................................................................................................... 255 Online Dictionary Directories................................................................................................... 259 PANCREATITIS GLOSSARY..................................................................................................... 261 General Dictionaries and Glossaries ......................................................................................... 286 INDEX.............................................................................................................................................. 288
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Pancreatitis
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Pancreatitis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to pancreatitis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on pancreatitis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on pancreatitis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching pancreatitis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to pancreatitis. It also gives you sources of information that can help you find a doctor in your local area specializing in diagnosing and treating pancreatitis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with pancreatitis. Part II moves on to advanced research dedicated to pancreatitis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on pancreatitis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with pancreatitis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with pancreatitis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with pancreatitis.
Scope While this sourcebook covers pancreatitis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that pancreatitis is often considered a synonym or a condition closely related to the following: ·
Chronic Relapsing Pancreatitis
4
Pancreatitis
In addition to synonyms and related conditions, physicians may refer to pancreatitis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for pancreatitis:4 ·
072.3 mumps pancreatitis
·
577.0 acute pancreatitis
·
577.1 chronic pancreatitis
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to pancreatitis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses and conditions. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients with pancreatitis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
the smallest fraction of information dealing with pancreatitis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of pancreatitis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on pancreatitis. The essentials of a symptom typically include the definition or description of the symptom, a discussion of who it affects, the diseases that are associated with a given symptom, tests or diagnostic procedures that might be specific to the symptom, and treatments for the symptom. Your doctor or healthcare provider may have already explained the essentials of pancreatitis to you or even given you a pamphlet or brochure describing pancreatitis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
9
PANCREATITIS:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on pancreatitis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on pancreatitis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on pancreatitis. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Pancreatitis
There is no guarantee that any one Institute will have a guideline on a specific condition or disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare conditions and disorders. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with pancreatitis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
Institute supports basic and clinical research through investigator-initiated grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on pancreatitis.
What Is Pancreatitis?7 Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it derives from food for energy. Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start “digesting” it. Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Cysts, which are fluid-filled sacs of tissue, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.
Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/pancreas/pancreas.htm. 7
12 Pancreatitis
Acute Pancreatitis Some people have more than one attack and recover completely after each, but acute pancreatitis can be a severe, life-threatening illness with many complications. About 80,000 cases occur in the United States each year; some 20 percent of them are severe. Acute pancreatitis is usually caused by drinking too much alcohol or by gallstones. A gallstone can block the pancreatic duct, trapping digestive enzymes in the pancreas and causing pancreatitis. Some prescription drugs, pancreatic or intestinal abnormalities, abdominal trauma, or surgery can also cause pancreatitis. In some cases, recurrent pancreatitis is hereditary and caused by mutations in genes. In rare cases, the disease may result from infections, such as mumps, and in about 15 percent of the cases, the cause is unknown.
Symptoms Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant--just in the abdomen--or it may reach to the back and other areas. It may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Other symptoms may include ·
Swollen and tender abdomen
·
Nausea
·
Vomiting
·
Fever
·
Rapid pulse
Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.
Diagnosis Besides asking about a person’s medical history and doing a physical exam, a doctor will order a blood test to diagnose acute pancreatitis. During acute
Guidelines 13
attacks, the blood contains at least three times more amylase and lipase than usual. Amylase and lipase are digestive enzymes formed in the pancreas. Changes may also occur in blood levels of glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the pancreas improves, these levels usually return to normal. A doctor may also order an abdominal ultrasound to look for gallstones and a CAT (computerized axial tomography) scan to look for inflammation or destruction of the pancreas. CAT scans are also useful in locating pseudocysts. (See the section on chronic pancreatitis.)
Treatment Treatment depends on how bad the attack is. If no complications in the form of kidney failure or lung problems occur, acute pancreatitis usually improves on its own. Treatment is designed to support vital functions and prevent complications. A hospital stay will be necessary so that fluids can be replenished intravenously. Acute pancreatitis can also cause breathing problems. Many people develop hypoxia, which means that cells and tissues are not receiving enough oxygen. Doctors treat hypoxia by giving oxygen through a face mask. Despite treatment, some people still experience lung failure and require a ventilator. If pancreatic cysts occur and are considered large enough to interfere with the pancreas’s healing, your doctor may drain or surgically remove the cysts. Sometimes a person cannot stop vomiting and needs to have a tube placed in the stomach to remove fluid and air. In mild cases, a person may not eat for 3 or 4 days and instead may receive fluids and pain relievers through an IV (intravenous) line. Unless the pancreatic duct or bile duct is blocked by gallstones, an acute attack usually lasts only a few days. In severe cases, a person may be fed intravenously for 3 to 6 weeks while the pancreas slowly heals. This process is called total parenteral nutrition. However, for mild cases of the disease, total parenteral nutrition offers no benefit. If an infection develops, the doctor may prescribe antibiotics. Surgery may be needed for extensive infections. Surgery may also be necessary to find the
14 Pancreatitis
source of bleeding, to rule out problems that resemble pancreatitis, or to remove severely damaged pancreatic tissue. Before leaving the hospital, a person will be advised not to drink alcohol and not to eat large meals. After all signs of acute pancreatitis are gone, the doctor will try to decide what caused it in order to prevent future attacks. In some people, the cause of the attack is clear, but in others, more tests are needed.
Gallstones and Pancreatitis Gallstones can cause pancreatitis and they usually require surgical removal. Ultrasound or a CAT scan can detect gallstones and can sometimes give an idea of the severity of the pancreatitis. When gallstone surgery can be scheduled depends on how severe the pancreatitis is. If the pancreatitis is mild, gallstone surgery may proceed within about a week. More severe cases may mean gallstone surgery is delayed for a month or more. After the gallstones are removed and inflammation goes away, the pancreas usually returns to normal.
Chronic Pancreatitis If injury to the pancreas continues, from drinking alcohol, for example, chronic pancreatitis may develop. Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas and nearby tissues, causing scarring and pain. The usual cause of chronic pancreatitis is many years of alcohol abuse, but the chronic form may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged. The damaged ducts cause the pancreas to become infamed, tissue to be destroyed, and scar tissue to develop. Damage from alcohol abuse may not appear for many years, and then a person may have a sudden attack of pancreatitis. In 70 to 80 percent of adult patients, chronic pancreatitis appears to be caused by alcoholism. This form is more common in men than in women and often develops between the ages of 30 and 40. Chronic pancreatitis may also occur when the pancreatic duct is blocked or narrowed because of trauma or because pseudocysts have formed. Pseudocysts are cyst-like buildups of pancreatic fluid in the duct.
Guidelines 15
Some drugs can cause chronic pancreatitis too. In many cases, however, the cause is unknown. People with chronic pancreatitis may have one or even all three of the following problems: pain, diabetes, or malabsorption of food leading to weight loss. In some cases, chronic pancreatitis is inherited. Hereditary pancreatitis usually begins in childhood but may not be diagnosed for several years. A person with hereditary pancreatitis usually has the typical symptoms that come and go over time. Episodes last from 2 days to 2 weeks. A determining factor in the diagnosis of hereditary pancreatitis is two or more family members with pancreatitis in more than one generation. Treatment for individual attacks is usually the same as it is for acute pancreatitis. Any pain or nutrition problems are treated just as they are for chronic pancreatitis. Surgery can often ease pain and help manage complications.
Symptoms Some people have no pain, but most do. Pain in the back and abdomen may be constant and disabling. In certain cases, abdominal pain goes away as the condition advances, probably because the pancreas is no longer making digestive enzymes. People with chronic disease often lose weight, even when their appetite and eating habits are normal. The weight loss occurs because the body does not secrete enough pancreatic enzymes to break down food, so nutrients are not absorbed normally. Poor digestion leads to excretion of fat, protein, and sugar into the stool. If the insulin-producing cells of the pancreas (islet cells) have been damaged, diabetes may also develop at this stage.
Diagnosis Diagnosis may be difficult, but new techniques can help. Pancreatic function tests help a doctor decide whether the pancreas is still making enough digestive enzymes. Using ultrasonic imaging, endoscopic retrograde cholangiopancreatography (ERCP), and CAT scans, a doctor can see problems indicating chronic pancreatitis. Such problems include calcification of the pancreas, in which tissue hardens from deposits of insoluble calcium salts. In more advanced stages of the disease, when diabetes and
16 Pancreatitis
malabsorption occur, a doctor can use a number of blood, urine, and stool tests to help diagnose chronic pancreatitis and to monitor its progression.
Treatment Relieving pain is the first step in treating chronic pancreatitis. The next step is to plan a diet that is high in carbohydrates and low in fat. A doctor may prescribe pancreatic enzymes to take with meals if the pancreas does not secrete enough of its own. The enzymes should be taken with every meal to help the body digest food and regain some weight. Sometimes insulin or other drugs are needed to control blood glucose. In some cases, surgery is needed to relieve pain. The surgery may involve draining an enlarged pancreatic duct or removing part of the pancreas. For fewer and milder attacks, people with pancreatitis must stop drinking alcohol, stick to their prescribed diet, and take the proper medications.
Pancreatitis in Children Chronic pancreatitis is rare in children. Trauma to the pancreas and hereditary pancreatitis are two known causes of childhood pancreatitis. Children with cystic fibrosis, a progressive, disabling, and incurable lung disease, may also have pancreatitis. But more often the cause is not known.
Points to Remember ·
Pancreatitis begins when the digestive enzymes become active inside the pancreas and start “digesting” it.
·
Pancreatitis has two forms: acute and chronic.
·
Pancreatitis is often caused by gallstones or by alcohol abuse.
·
Symptoms of acute pancreatitis include pain in the abdomen, nausea, vomiting, fever, and a rapid pulse.
·
Treatment for acute pancreatitis can include intravenous fluids, oxygen, antibiotics, or surgery.
·
Acute pancreatitis becomes chronic when pancreatic tissue is destroyed and scarring develops.
Guidelines 17
·
Treatment for chronic pancreatitis includes easing the pain; eating a highcarbohydrate, low-fat diet; and taking enzyme supplements. Surgery is sometimes needed as well.
For More Information Information about pancreatitis is also available from: American Gastroenterological Association 7910 Woodmont Avenue, Suite 700 Bethesda, MD 20814 Phone: (301) 654-2055 Fax: (301) 654-5920 Email:
[email protected] Internet: www.gastro.org
More Guideline Sources The guideline above on pancreatitis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to pancreatitis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with pancreatitis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas.
18 Pancreatitis
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at the following: http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on pancreatitis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
When Your Doctor Prescribes VIDEX (didanosine) Contact: Bristol Myers Squibb, Oncology/Immunology Access Program, 1800 Robert Fulton Dr Ste 300, Reston, VA, 20191, (800) 272-4878. Summary: Information on didanosine or Videx and its role in HIV treatment is provided in this brochure, which urges the patient to take an active role in therapy. The usual dosing schedule is described with special precautions noted. Possible contraindications detailed are pancreatitis and peripheral neuropathy. The brochure urges the reader to report any adverse effects immediately.
·
Pancreatitis: Understanding This Painful Condition Source: San Bruno, CA: StayWell Company. 1998. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. PRICE: $ 17.95 for 50 copies; plus shipping and handling; bulk copies available. Order number 9779. Summary: This brochure describes acute pancreatitis (irritated or inflamed pancreas), a condition most often caused by gallstones. Acute
Guidelines 19
pancreatitis is very painful and emergency medical treatment is usually needed. Symptoms include severe pain in the upper abdomen (that goes through to the back), nausea and vomiting, abdominal swelling and tenderness, fever, rapid pulse, and shallow, fast breathing. Blood tests are used to determine whether the symptoms are due to acute pancreatitis; health history and physical exam can help confirm the diagnosis. Other tests used include ultrasound (to confirm gallstones), CT scan (computed tomography, used to show how much the pancreas is inflamed), and ERCP (endoscopic retrograde cholangiopancreatography, which examines the common bile duct for gallstones). The brochure briefly describes the treatment for acute pancreatitis, which can include resting the pancreas (nutrition and fluids are given through an intravenous line), medications for the pain, and dietary modifications (after leaving the hospital). The brochure emphasizes the importance of avoiding alcohol. One sidebar describes chronic pancreatitis, which is most often due to continued drinking of alcohol. Another section describes the anatomy and function of the pancreas. The brochure is illustrated with full color drawings. 6 figures. ·
Pancreas Disease. [Enfermedad del Pancreas] Source: Camp Hill, PA: Chek-Med Systems, Inc. 1996. 2 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. PRICE: $22 per pack of 50 pamphlets for order of 3-10 packs; 3 packet minimum. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient brochure, available in English and Spanish, provides information about various diseases of the pancreas. The characteristics of each of the five diseases of the pancreas are described: diabetes mellitus, acute pancreatitis, chronic pancreatitis, pancreatic deficiency, and pancreatic tumor. It is not known why insulin-producing cells in the pancreas die off, causing diabetes. Acute pancreatitis in which the pancreas becomes rapidly and severely inflamed is caused by heavy alcohol consumption, gallbladder disease, drugs, high blood fats, heredity, and other factors. It can be treated with hospitalization, bed rest, intravenous feeding, and use of certain medications which stop the pancreas from producing enzymes. Chronic pancreatitis occurs mostly in alcoholics. Pancreatic cancer is difficult to treat and requires early investigation. It is concluded that there are now effective ways to diagnose pancreatic conditions and, in most cases, good treatment programs can be outlined by the physician.
20 Pancreatitis
·
Pancreatitis Source: Bethesda, MD: American Gastroenterological Association. 199x. [4 p.]. Contact: American Gastroenterological Association (AGA). 7910 Woodmont Avenue, Seventh Floor, Bethesda, MD 20814. (800) 668-5237 or (301) 654-2055. Fax (301) 652-3890. Website: www.gastro.org. PRICE: Single copy free; bulk copies available. Summary: Pancreatitis is inflammation of the pancreas; it usually begins at an acute stage and in some cases may become chronic after a severe or recurrent attack. When the pancreas becomes inflamed, the digestive enzymes attack the tissue that produces them. This brochure from the American Gastroenterological Association (AGA) reviews the problem of pancreatitis. Topics include a description of acute and chronic pancreatitis, the symptoms of pancreatitis, how to know if medical assistance should be consulted for abdominal pain, and treatment options. With chronic pancreatitis, the pancreas may eventually stop producing the enzymes that are necessary for the body to digest and absorb nutrients. The symptoms of pancreatitis include a gradual or sudden severe pain in the center part of the upper abdomen that goes through to the back, nausea and vomiting, fever, jaundice (a yellowing of the skin), shock, weight loss, and symptoms of diabetes mellitus. Most cases of acute pancreatitis are mild and involve a short hospital stay to help heal the pancreas. Chronic pancreatitis is a much more persistent condition and occurs more often in men than in women. Treatment focuses on nutritional and metabolic needs and on relieving the pain of pancreatitis. Surgery may be required to remove contributing gallstones, to drain the pancreatic duct, or to remove part of the pancreas. Most people who have chronic pancreatitis have a good prognosis if they follow the required dietary changes and take their medications and required supplements. The brochure includes a diagram of the digestive tract, with organs labeled, and a glossary of related terms. 1 figure.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “pancreatitis” or synonyms. The following was recently posted:
Guidelines 21
·
ACR Appropriateness Criteria™ for acute pancreatitis. Source: American College of Radiology.; 1998; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1635&sSearch_string=pancreatitis
·
Operative treatment for chronic pancreatitis. Source: Society for Surgery of the Alimentary Tract, Inc..; 1998 June 3 (revised 2000 Jan); 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1393&sSearch_string=pancreatitis
·
Treatment of acute pancreatitis. Source: Society for Surgery of the Alimentary Tract, Inc..; 1998 June 3 (revised 2000 Jan); 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1392&sSearch_string=pancreatitis The NIH Search Utility
After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to pancreatitis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific conditions or disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
22 Pancreatitis
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Calcification: The process by which organic tissue becomes hardened by a deposit of calcium salts within its substance. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol,
Guidelines 23
particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Chronic: Persisting over a long period of time. [EU] Cyst: Any closed cavity or sac; normal or abnormal, lined by epithelium, and especially one that contains a liquid or semisolid material. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Didanosine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. Didanosine is a potent inhibitor of HIV replication, acting as a chain-terminator of viral DNA by binding to reverse transcriptase; ddI is then metabolized to dideoxyadenosine triphosphate, its putative active metabolite. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its
24 Pancreatitis
utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in
Guidelines 25
contrast to inflammatory lesions (neuritis). [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Tomography: The recording of internal body images at a predetermined
26 Pancreatitis
plane by means of the tomograph; called also body section roentgenography. [EU]
Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]
Seeking Guidance 27
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with pancreatitis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with pancreatitis. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Pancreatitis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of a condition or disorder can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
28 Pancreatitis
condition can all influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
Digestive Disorders Foundation (UK) Address: Digestive Disorders Foundation (UK) 3 St. Andrews Place, London, NW1 4LB, United Kingdom Telephone: 0171 486 0341 Fax: 0171 224 2012 Email:
[email protected] Web Site: http://www.digestivedisorders.org.u Background: The Digestive Disorders Foundation (DDF) is a voluntary organization in the United Kingdom dedicated to providing information to individuals with digestive disorders and their family members and funding research concerning these disorders. Since the DDF was founded in 1971, it has supported over 95 research fellowships. The Foundation also provides grants for equipment and travel fellowships, enabling researchers to visit laboratories abroad to improve their knowledge and expertise. In addition, the Digestive Disorders Foundation produces patient information leaflets discussing the symptoms, causes, and treatments of a wide range of digestive disorders including celiac disease; pancreatitis; peptic, gastric, and duodenal ulcers; diverticula; and Gilbert's syndrome. The Foundation is also committed to raising professional and public knowledge of digestive diseases through a series of events including scientific and public meetings. The DDF's web site on the Internet provides news updates, a glossary of medical terms, its series of patient information leaflets, and information concerning current research fellowships. Relevant area(s) of interest: Celiac Disease, Diverticular Disease, Irritable Bowel Syndrome, Pancreatitis
Seeking Guidance 29
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about pancreatitis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “pancreatitis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “pancreatitis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “pancreatitis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with pancreatitis. You should check back periodically with this database since it is updated every 3 months.
30 Pancreatitis
The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific conditions and diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “pancreatitis” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following internet links may be of particular interest: ·
Pancreatitis Support Group http://www.pancreaticdisease.com/
·
Yahoo! Groups http://groups.yahoo.com/group/pancreatitis/
·
Pancreatitis Association International http://www.pancassociation.org/
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with pancreatitis must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 31
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare conditions and diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11
32 Pancreatitis
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about pancreatitis?
·
Really listen to my questions?
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Answer in terms I understood?
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Show respect for me?
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Ask me questions?
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Make me feel comfortable?
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Address the health problem(s) I came with?
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Ask me my preferences about different kinds of treatments for pancreatitis?
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Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 33
·
Bring a “health history” list with you (and keep it up to date).
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Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
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Tell your doctor about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
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Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
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Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
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Ask your doctor to draw pictures if you think that this would help you understand.
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Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
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Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
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Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
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After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
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Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
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Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH]
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Clinical Trials 35
CHAPTER 3. CLINICAL TRIALS AND PANCREATITIS Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning pancreatitis.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for pancreatitis is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
36 Pancreatitis
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on pancreatitis.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for pancreatitis compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment.
How Is a Clinical Trial Conducted? Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on pancreatitis carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on pancreatitis. In other clinical trials, where a new surgery or device (not a medicine) is being
Clinical Trials 37
tested, patients in the control group may receive a “sham treatment.” This treatment, like a placebo, has no effect on pancreatitis and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how pancreatitis develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for pancreatitis. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a condition or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific condition or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of a condition or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history.
38 Pancreatitis
If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Pancreatitis The National Institutes of Health and other organizations sponsor trials on various conditions and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to pancreatitis.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Genetic Linkage Study for Hereditary Pancreatitis Condition(s): Pancreatitis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); University of Pittsburgh Purpose - Excerpt: Objectives: I. Establish linkage in families with hereditary pancreatitis between the phenotype and a chromosomal locus (loci) that contains the responsible gene. Study Type: Observational Contact(s): Pennsylvania; University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, Pennsylvania, 15213-2582, United States; Recruiting; David C. Whitcomb 412-648-9115. Study chairs or principal investigators: David C. Whitcomb, Study Chair; University of Pittsburgh
16
These are listed at www.ClinicalTrials.gov.
Clinical Trials 39
Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004475;jsessionid=D75765 24A4D03769232146F2E5A8E3A8 ·
Safety and efficacy study of IL-10 (Tenovil TM) in the prevention of Post-ERCP Acute Pancreatitis Condition(s): Bile Duct Diseases; Biliary Tract Diseases; Gallbladder Diseases; Pancreatitis; Pancreatic Diseases Study Status: This study is currently recruiting patients. Sponsor(s): Schering-Plough Purpose - Excerpt: The purpose of this study is to determine if a single dose of IL-10 compared to placebo is safe and effective in reducing the incidence of post-ERCP acute pancreatitis for subjects with increased risk. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00040131;jsessionid=D75765 24A4D03769232146F2E5A8E3A8
·
A Study of ddC in Patients with AIDS or Advanced AIDS-Related Complex (ARC) Who Have Not Had Success with Zidovudine (AZT) Condition(s): HIV Infections Study Status: This study is no longer recruiting patients. Sponsor(s): Hoffmann-La Roche Ltd Purpose - Excerpt: AMENDED: To provide ddC for patients with AIDS or advanced ARC who have failed treatment with, are intolerant to or are ineligible to receive zidovudine (AZT) and to demonstrate that ddC monotherapy is safe, and tolerable in this patient population. Original design: To provide zalcitabine (dideoxycytidine; ddC) for patients with AIDS or advanced AIDS-related complex (ARC) who have failed treatment with or are intolerant to zidovudine (AZT) and who are also intolerant to dideoxyinosine (ddI); to demonstrate that ddC monotherapy is safe and tolerable in the treatment of patients who previously experienced either treatment failure, hematologic intolerance or myositis with AZT treatment and pancreatitis or other toxicities (except peripheral neuropathy with ddI). Study Type: Interventional
40 Pancreatitis
Contact(s): New Jersey; Hoffmann - La Roche Inc, Nutley, New Jersey, 071101199, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002279;jsessionid=D75765 24A4D03769232146F2E5A8E3A8
Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for pancreatitis. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with pancreatitis. In cases where certain conditions or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f2 91. 17
Clinical Trials 41
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.
How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
·
Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
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After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
·
Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed). What about Costs?
In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Questions Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for pancreatitis? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
Clinical Trials 43
·
Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “pancreatitis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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·
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
·
For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
·
The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
·
Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
Clinical Trials 45
·
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Antiviral: Destroying viruses or suppressing their replication. [EU] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Chromosomal: Pertaining to chromosomes. [EU] Colitis: Inflammation of the colon. [EU] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Encephalitis: Inflammation of the brain. [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Foscarnet: An antiviral agent used in the treatment of cytomegalovirus retinitis. Foscarnet also shows activity against human herpesviruses and HIV. [NIH] Ganciclovir: Acyclovir analog that is a potent inhibitor of the Herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from AIDS-associated cytomegalovirus infections. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Monotherapy: A therapy which uses only one drug. [EU] Myelosuppression: Suppression of bone marrow activity, resulting in reduction in the number of platelets, red cells, and white cells. [EU] Myositis: Inflammation of a voluntary muscle. [EU] Neutropenia: Leukopenia in which the decrease in white blood cells is chiefly in neutrophils. [EU] Neutrophil: Having an affinity for neutral dyes. [EU]
46 Pancreatitis
Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Pneumonia: Inflammation of the lungs with consolidation. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH]
47
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on pancreatitis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on pancreatitis. In Part II, as in Part I, our objective is not to interpret the latest advances on pancreatitis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with pancreatitis is suggested.
Studies 49
CHAPTER 4. STUDIES ON PANCREATITIS Overview Every year, academic studies are published on pancreatitis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on pancreatitis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on pancreatitis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and pancreatitis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
50 Pancreatitis
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “pancreatitis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Rheumatologic Manifestations of Gastrointestinal Diseases Source: Gastroenterology Clinics of North America. 27(3): 533-562. September 1998. Summary: This journal article provides health professionals with information on the features and putative or theoretic inciting factors for gastrointestinal diseases with rheumatic manifestations. These can be divided into intestinal disorders and disorders of the liver, biliary tree, and pancreas. In intestinal disorders, the functions of intestinal permeability and immune responsiveness are probably of fundamental importance. Factors such as the production of autoantibodies and changes in the production or blood levels of numerous cytokines or pancreatic enzymes appear to have a critical role in disorders in the latter category. Among the intestinal disorders that have rheumatic manifestations are infections, atypical colitides, inflammatory bowel disease (IBD), celiac disease, and miscellaneous disorders. The infectious causes of rheumatic disease include enteric pathogens such as Campylobacter, Salmonella, Shigella, Yersinia, and Clostridium difficle; Tropheryma whippelli; and various intestinal parasites. Atypical colitides associated with gastrointestinal diseases include collagenous and lymphocytic colitis. Rheumatic manifestations of IBD include peripheral arthritis, sacroiliitis, ankylosing spondylitis, and osteomalacia. A condition that may be complicated by osteoarthropathy and osteopenia is celiac disease. Hepatobiliary and pancreatic disorders consist of viral hepatitis, hemochromatosis, autoimmune hepatitis, primary biliary cirrhosis, Wilson's disease, Shwachman's syndrome, cystic fibrosis, pancreatitis, pancreatic cancer, pancreatic panniculitis, and familial Mediterranean fever. 3 tables and 188 references.
·
Dermatologic Manifestations of Gastrointestinal Disorders Source: Gastroenterology Clinics of North America. 27(3): 615-636. September 1998.
Studies 51
Summary: This journal article provides health professionals with information on the dermatologic manifestations of gastrointestinal disorders. Many disorders of the gastrointestinal tract have cutaneous manifestations, so a careful examination of the skin may reveal clues to underlying diseases of the liver, gastrointestinal tract, and pancreas. Hepatitis A virus infection rarely causes cutaneous involvement. Jaundice is the main cutaneous manifestation in more fulminant cases of this infection. Hepatitis B virus infection may produce vasculitic and nonvasculitic cutaneous eruptions. Hepatitis C infection may produce cutaneous eruptions such as lichen planus and porphyria cutanea tarda. Cutaneous symptoms associated with cholestatic liver disease include pruritus and pigmentary changes such as jaundice and hypermelanosis. Liver dysfunction may result in vascular lesions such as spider angiomas and alterations in the normal appearance of the fingernails and toenails. Many conditions are characterized by gastrointestinal hemorrhage. Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder characterized by vascular dilations of the skin and the oral, nasal, and gastrointestinal mucosa. Various skin lesions are associated with blue rubber bleb nevus syndrome. This is a rare disorder which is characterized by large cutaneous hemangiomas and gastrointestinal bleeding from vascular malformations. Kaposi's sarcoma, a neoplasm of vascular endothelium and pericapillary cells that often presents on the skin, is associated with human immunodeficiency virus. Pseudoxanthoma elasticum, a genetic disorder of elastic fibers, is associated with distinctive skin abnormalities. Other hemorrhagic disorders with cutaneous manifestations include Ehlers-Danlos syndrome and malignant atrophic papulosis. Various gastrointestinal conditions producing polyps have cutaneous manifestations. Gardner's syndrome produces skin and bone lesions. Peutz-Jeghers syndrome causes small dark freckles on the lips and buccal mucosa. CanadaCronkhite syndrome is a rare disease characterized by cutaneous hyperpigmentation, alopecia, and nail changes. Other diseases producing gastrointestinal polyps and cutaneous manifestations include neurofibromatosis, Cowden's disease, Muir-Torre syndrome, and acrochordons. Cutaneous conditions associated with gastrointestinal neoplasms include cutaneous metastic disease, acanthosis nigricans, Leser-Trelat sign, tylosis palmaris et plantaris, carcinoid syndrome, and glucogonoma syndrome. Cutaneous manifestations such as erythema nodosum, oral aphthous ulcers, and pyoderma gangrenosum are associated with ulcerative colitis and Crohn's disease. Acute pancreatitis can be associated with Turner's sign and Cullen's sign. Pancreatic panniculitis also produces cutaneous manifestations. 10 figures and 77 references.
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Acupuncture for Gastrointestinal and Hepatobiliary Disorders Source: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy. 5(1): 27-45. 1999. Summary: This journal article provides an overview of the basic scientific data regarding the effects of acupuncture on gastrointestinal (GI) function, areas of clinical application, and promising directions for future research. Extensive research in both animal models and human subjects supports the effect of acupuncture on the physiology of the GI tract, including acid secretion, motility, neurohormonal changes, and changes in sensory thresholds. Much of the neuroanatomic pathway of these effects has been identified in animal models. A large body of clinical evidence supports the effectiveness of acupuncture for suppressing nausea associated with chemotherapy, postoperative state, and pregnancy. Prospective randomized controlled trials have shown the efficacy of acupuncture for analgesia for endoscopic procedures, including colonoscopy and upper endoscopy. Acupuncture also has been used for a variety of other conditions, including postoperative ileus, achalasia, peptic ulcer disease, functional bowel disease, diarrhea, constipation, inflammatory bowel disease, expulsion of gallstones and biliary ascariasis, and pain associated with pancreatitis. Although there are few randomized clinical trials, the author concludes that the welldocumented effects of acupuncture on the physiology of the GI tract and its extensive history of successful clinical use makes this a promising modality that warrants further study. The article has 3 figures and 117 references. (AA-M).
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Regression of Liver Fibrosis After Biliary Drainage in Patients with Chronic Pancreatitis and Stenosis of the Common Bile Duct Source: New England Journal of Medicine. 344(6): 418-423. February 8, 2001. Summary: Chronic obstruction of the common bile duct may cause hepatic (liver) fibrosis and secondary biliary cirrhosis (scarring). This article reports on a study of liver biopsy specimens from 11 patients with chronic stenosis (narrowing) of the common bile duct due to chronic pancreatitis (inflammation of the pancreas). All the patients had undergone liver biopsy before or at the time of surgical biliary decompression and all underwent a subsequent liver biopsy for various clinical reasons. The patients were followed as part of a prospective study of 501 patients who had been treated for chronic pancreatitis. Two pathologists, who were unaware of the sequence of specimens, graded fibrosis on a scale of 0 (none) to 3 (cirrhosis). The 11 patients were all men. Chronic pancreatitis was due to alcohol abuse in 10 of the men; 1
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had idiopathic disease. The median age at diagnosis was 38 years. The median interval between the first and second liver biopsies was 2.5 years (range of 0.3 to 9.0 years). The two patients who had restenosis of the biliary anastomosis were excluded from the analysis. In the remaining group of nine patients, the second specimen showed significant improvement in fibrosis. The fibrosis improved by two grades in two patients and by one grade in four patients; in three patients, the grade did not change. The pathologists agreed on the grading of specimens from 10 of the 11 patients. The authors conclude that, in patients with chronic pancreatitis and stenosis of the common bile duct, liver fibrosis may regress after biliary drainage. 1 figure. 2 tables. 24 references. ·
Chronic Pancreatitis: Diagnosis, Classification, and New Genetic Developments Source: Gastroenterology. 120(3): 682-707. February 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.gastrojournal.org. Summary: This review article focuses on the definitions and classification of chronic pancreatitis, on structural and genetic analysis, and on risk factors. Recent advances in molecular and genomic technologies and progress in pancreatic imaging techniques provided remarkable insight into genetic, environmental, immunologic, and pathobiological factors leading to chronic pancreatitis. Translation of these advances into clinical practice demands a reassessment of current approaches to diagnosis, classification, and staging. The authors maintain that an adequate pancreatic biopsy must be the gold standard against which all diagnostic approaches are judged. Although computed tomography (CT) remains the initial test of choice for the diagnosis of chronic pancreatitis, the roles of endoscopic retrograde pancreatography, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are considered. Once chronic pancreatitis is diagnosed, proper classification become important. Major predisposing risk factors to chronic pancreatitis may be categorized as either toxic metabolic, idiopathic (unknown), genetic, autoimmune, recurrent and severe acute pancreatitis, or obstructive (TIGAR O system). After classification, staging of pancreatic function, injury, and fibrosis becomes the next major concern. Further research is needed to determine the clinical and natural history of chronic pancreatitis developing in the context of various risk factors. New methods are needed for early diagnosis of chronic pancreatitis, and new therapies are needed to determine whether interventions will delay or prevent the progression of
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the irreversible damage characterizing end stage chronic pancreatitis. 8 figures. 5 tables. 242 references. ·
Recurrent Acute Pancreatitis: An Algorithmic Approach to Identification and Elimination of Inciting Factors Source: Gastroenterology. 120(3): 708-717. February 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.gastrojournal.org. Summary: Recurrent acute pancreatitis represents a challenging clinical problem associated with significant morbidity, impairment in quality of life, and expense. The evaluation of patients with recurrent acute pancreatitis requires systematic identification or elimination of correctable inciting factors. This article provides a comprehensive yet concise overview of the causes of recurrent acute pancreatitis; a detailed review of data relevant to implicated medications, the controversial issues of pancreas divisum and sphincter of Oddi dysfunction, and the role of genetic testing; a guideline for the evaluation of patients during the initial episode of acute pancreatitis; and a consensus algorithm within which putative inciting factors may be identified and eliminated. The guidelines offered pertain only to patients with recurrent acute pancreatitis in the absence of obvious evidence of chronic pancreatitis. Future advances in the treatment of these patients will almost certainly depend on improved imaging modalities, prospective clinical trials assessing the efficacy of endoscopic and surgical intervention, a better understanding of mutations and pathophysiologic mechanisms responsible for recurrent acute pancreatitis, and the development of novel, effective preventive and therapeutic strategies. 2 figures. 6 tables. 96 references.
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Adverse Drug Reactions in Patients with Gastroenterological Diseases: Does Age Increase the Risk? Source: Alimentary Pharmacology and Therapeutics. 15(2): 171-180. February 2001. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: It has been claimed that the risk of adverse drug reactions increases with age. However, only limited data exist for disease group specific risks and none for patients with liver and gastrointestinal
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disease. This article reports on a study undertaken to determine the incidence and characteristics of adverse drug reactions and the physicians' awareness of adverse drug reactions. During a 7 month period, a prospective study of 532 male patients (158 were aged 65 years or older; 30 percent of the sample) was conducted on a hepatogastroenterological (liver and GI) ward of a university hospital, using intensive bedside and computer assisted drug surveillance methods. No difference was found in the overall rate of adverse drugs reactions between older and young patients (25.4 percent versus 24.2 percent, respectively) during 6,213 treatment days. However, a significantly higher risk for developing adverse drug reactions could be shown for the elderly with biliary tract diseases. Independently of age, patients suffering from gastric ulcers, acute episodes of pancreatitis, cholangitis, or inflammatory bowel diseases (IBD) were at high risk of adverse drug reactions. Adverse drug reaction associated mortality (death) was encountered in four elderly and in none of the younger patients. Secondary pharmacological effects and drug toxicity were the main types of adverse drug reactions for both age groups. Although 75.3 percent of the adverse drug reactions were predictable, only 37.5 percent of all adverse drug reactions were recognized by the staff physicians. The authors stress that guidelines and educational programs should be developed to increase the awareness of adverse drug reactions and their prevention, especially in high risk patients and, thus, to improve patient outcomes. 1 figure. 6 tables. 43 references. ·
Understanding Pancreatitis and Pancreatic Cancer Source: Digestive Health and Nutrition. 3(3): 17-20. May-June 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail:
[email protected]. Summary: Acute pancreatitis (inflammation of the pancreas) can happen to anyone, anytime. However, repeated episodes put the patient at risk for chronic pancreatitis and pancreatic cancer, so it is important to learn about the risk factors and symptoms of these diseases. This article reviews the presenting symptoms of pancreatitis, the anatomy and physiology of the healthy pancreas, treatment options, and the risk factors for pancreatic cancer. The most common cause of acute pancreatitis is gallstones that get caught at the opening into the small intestine. Excessive alcohol use is another common cause of the disease. Diagnosis can include blood tests, an abdominal CT (computed tomography) scan, and endoscopic ultrasound. Treatment for acute pancreatitis is usually relatively low tech, featuring hydration (adequate
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fluids), pain management, and nutrition support (intravenous). During an episode of acute pancreatitis, which can last days or even a week, patients usually do not eat any food at all initially. Clear liquids and then low fat foods are added gradually as symptoms improve. When gallstones cause pancreatitis, surgery to remove them is usually necessary. For those who already have chronic pancreatitis or are at risk for developing it, a healthy lifestyle and positive attitude are essential. Many people with pancreatitis find that a low fat diet helps reduce the severity of acute episodes and also slows the progression of the chronic disease. One sidebar offers a description of hereditary pancreatitis, which is a rare condition. The final section of the article discusses pancreatic cancer, noting that both chronic and hereditary pancreatitis put people at higher risk for developing pancreatic cancer. Appended to the article is a list of websites for readers who want to locate additional information about pancreatitis. 2 figures. ·
Identification of Pancreatitis in the Ambulatory Setting Source: Gastroenterology Nursing. 24(1): 20-22. January-February 2001. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: Acute pancreatitis can be life threatening and nurse practitioners must know the signs, symptoms, and risk factors for pancreatitis. This article reviews the identification of pancreatitis in the ambulatory setting. The author uses a case study of a 59 year old white woman who presents to the clinic with vague complaints of abdominal pain. Her symptoms began the evening before presentation and are progressively worsening. The author uses this case to illustrate the differential diagnostic process. The most common differential diagnoses for this patient's symptoms include appendicitis, acute pancreatitis, mesenteric ischemia or infarction, perforated gastric or duodenal ulcer, intestinal obstruction, biliary colic, and perhaps even inferior wall myocardial infarction. Making a diagnosis of acute pancreatitis depends on clinical history, physical examination, serum enzyme assays, and radiologic tests. The main goal of treatment for pancreatitis is supportive care, limitation of complications, and prevention of necrosis (tissue death) of the pancreas. In the case example, the patient's pancreatitis was thought to be caused by a mixture of estrogen and an ACE inhibitor. Although alcohol consumption and gallstones are the most frequent causes of pancreatitis in the general population, mediations are now being recognized as important causative agents that are often overlooked. The author reiterates that early recognition and treatment of acute
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pancreatitis can reduce suffering and serious complications for the patient. 3 tables. 7 references. ·
Pancreatic Enzyme Therapy and Nutritional Status of Outpatients with Chronic Pancreatitis Source: Gastroenterology Nursing. 24(2): 84-87. March-April 2001. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: Patients with chronic pancreatitis are at risk for poor nutritional status. The two major clinical features of chronic pancreatitis are abdominal pain and maldigestion, both resulting in malnutrition. Abdominal pain often results in decreased oral intake, and decreased enzyme production results in maldigestion. Enzyme therapy often is included in treating chronic pancreatitis. There is limited data on the nutritional assessment of outpatients with chronic pancreatitis, and the efficacy of the use of enzyme therapy remains controversial. Serum albumin (levels of protein in the blood) level and measurement of ideal body weight are two simple measures of nutritional status that can be obtained by gastroenterology nurses. This article reports on a retrospective chart review that was done on patients seen in the authors' outpatient clinic for management of chronic pancreatitis. Serum albumin levels, and indicator of protein caloric malnutrition, were reviewed for 34 patients. Thirty-three percent of these patients were found to have mild to moderate protein calorie malnutrition as evidence by low serum albumin levels. Enzyme therapy information was reviewed for 33 patients. Patients receiving enzyme therapy had better nutritional status based on both serum albumin levels and percent of ideal body weight. The authors conclude that gastroenterology nurses can be instrumental in the recognition and treatment of nutritional deficiencies in chronic pancreatitis. 3 figures. 3 tables. 4 references.
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Diarrhea and Malabsorption in the Elderly Source: Gastroenterology Clinics of North America. 30(2): 427-444. June 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: Diarrhea from infectious organisms is common in the elderly and leads to frequent hospitalizations and a relatively high mortality (death) rate in this population. Diarrhea can be a disabling manifestation of several systemic disorders, including diabetes mellitus, and drug induced diarrhea is particularly common in advanced age. This article,
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from a special issue on gastrointestinal (GI) disorders in the elderly, addresses diarrhea and malabsorption in the elderly. Although the physiologic functions of intestinal digestion and absorption of macronutrients and most micronutrients are not decreased simply as a function of aging, malabsorptive diseases including chronic pancreatitis and celiac disease (gluten intolerance) are more common in the elderly than has been realized in the past. A particular potential cause of covert malabsorption of macro and micronutrients in older patients is bacterial overgrowth, which may occur in the absence of 'blind loops.' The impact of silent malabsorption on the nutritional health of older patients may be more severe than in the young. Physicians who care for elderly patients are cautioned to be alert to the possible presence of diarrhea and malabsorption. Older patients may not admit to having chronic diarrhea, particularly if they are also incontinent. When an intestinal infection and potential medication-induced gastrointestinal disturbances have been excluded, the differential diagnosis of diarrhea in the elderly is the same as in the young. In the elderly, micronutrient deficiency is a common presenting clinical picture; because the symptoms of malabsorption are covert, the diagnosis often is delayed and nutritional deficiencies are more common and more severe than in the young. 1 table. 102 references. ·
Serial Computed Tomography Is Rarely Necessary in Patients with Acute Pancreatitis: A Prospective Study in 102 Patients Source: Journal of the American College of Surgeons. 193(2): 146-152. August 2001. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: Computed tomography (CT) has proved to be helpful in patients with acute pancreatitis for differentiating between mild and severe forms. Follow up of acute pancreatitis with CT has been advocated but rarely studied. This article reports on a study undertaken to determine if late CT performed at day 7 might be helpful in establishing the prognosis or the type of complications, and to select a subgroup of patients with pancreatitis in whom CT could be beneficial. Contrast enhanced CT was performed at the admission day and 7 days after admission in 102 patients admitted for acute pancreatitis. The extent of pancreatic inflammation was classified according to Balthazar grade, and intrapancreatic necrosis (tissue death) on these examinations was prospectively assessed and compared with clinical and biologic data and with patient outcomes. Among 102 patients, complications developed in 24 (23 percent). Complications developed in only 8 percent of patients
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with Ranson score less than 2, making routine early CT unnecessary. For the patients with Ranson score less than 2 and Balthazar grades A and B at day 1 CT, late CT seemed to be useless. Complication was suspected by clinical and biologic tests before day 7 in 22 of 24 complicated patients (94 percent), suggesting that CT could be proposed only in cases of clinical or biologic deterioration. Late CT was correlated with a complicated course in patients with Balthazar grades D and E or intrapancreatic necrosis greater than 50 percent. Late CT was predictive of complications in cases of intrapancreatic necrosis enlarging since the first examination. The authors conclude that in cases of acute pancreatitis, there is little justification for systematic early CT, especially in patients with Ranson score less than 2, and late CT does not need to be performed routinely, but only in cases of clinical or biologic worsening. 2 figures. 4 tables. 26 references. ·
Acute and Chronic Pancreatitis Source: Practical Gastroenterology. 25(12): 47-54. December 2001. Contact: Available from Shugar Publishing. 12 Moniebogue Lane, Westhampton Beach, NY 11978. (516) 288-4404. Fax (516) 288-4435. Summary: There are over 100,000 hospital admissions for pancreatitis in the United States per year. Pancreatitis has numerous causes, obscure pathogenesis, and few effective treatments. This continuing education article reviews the diagnosis and management of patients with acute and chronic pancreatitis. Topics include anatomy and physiology, pathophysiology, etiology (cause), clinical presentation (symptoms), diagnosis, prognosis, treatment options, and complications, first for acute pancreatitis, then for chronic pancreatitis. The management of acute pancreatitis depends on the recognition of severity and the diagnosis and management of pancreatic necrosis (tissue death). The majority of patients will do well with conservative and supportive treatment, but necrotizing pancreatitis requires intervention due to the mortality associated with this local complication. Steatorrhea (excessive amounts of fats in the feces) in chronic pancreatitis responds to enzyme supplementation. Chronic pancreatic pain is very difficult to treat and a multidisciplinary approach is recommended. The characterization of the pain syndrome with diagnostic nerve blocks may prove to be very important at directing medical or surgical therapy. 10 figures. 4 tables. 30 references.
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Refractory Pancreatitis Secondary to Ruptured Hepatocellular Carcinoma into the Common Bile Duct Source: Digestive Diseases and Sciences. 46(5): 1029-1033. May 2001.
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Contact: Available from Kluwer Academic Publishers. Customer Service Department, P.O. Box 358, Accord Station, Hingham, MA 02018-0358. (781) 871-6600. Fax (781) 681-9045. E-mail:
[email protected]. Website: www.wkap.nl. Distribution Centre, P.O. Box 322, 3300 AH Dordrecht, The Netherlands. 31 78 6392392. Fax: 31 78 6546474. E-mail:
[email protected]. Summary: Hepatocellular carcinoma (HCC, liver cancer) is a common disease worldwide and continues to be the leading cause of death of males in Taiwan (from where this article originates). Jaundice is present in 19 to 44 percent of cases of HCC at the time of diagnosis and is usually attributed to the preexisting liver cirrhosis (scarring) or extensive hepatic parenchymal (the liver body) destruction by tumor. Icteric hepatoma (a type of liver tumor) is characterized by intermittent obstructive jaundice with associated complications, such as cholangitis (inflammation of the bile ducts) and hemobilia. In this article, the authors report the first case of icteric hepatoma that initially presented as pancreatitis in addition to obstructive jaundice. The 59 year old man was admitted with a 2 week history of tea colored urine, intermittent tarry stool, vomiting, and postprandial epigastralgia (pain in the stomach after meals) with radiation to his back. He denied alcohol abuse and drugs consumption and he had never experienced pancreatitis. After 8 days of hospital treatment, the patient was released and able to eat a normal diet at an outpatient visit one month later. However, he was rehospitalized 8 weeks later with another episode of pain; surgical treatment was implemented. The patient died of multisystem organ failure on the 32nd postoperative day. For this case, the treatment was focused on two goals. First, the consequences of the biliary obstruction including the pancreatitis should be resolved by nonoperative methods, if available. Second, the origin of the migrating tumor should be eradicated either by transarterial chemoembolization or hepatic (liver) resection. The present case was not suitable for hepatic resection or hepatic artery ligation because of intrahepatic metastasis of both lobes and portal vein thrombosis (clotting) seen at exploration. Although palliation could be satisfactorily given, the prognosis continues to be dismal. 4 figures. 11 references. ·
Acute Pancreatitis: Which Route Is Better for Nutritional Support? Source: Journal of Critical Illness. 15(1): 10-11. January 2000. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Greenwich, CT 06831-0010. (203) 661-0600. Summary: This article is an entry from a regular column in which physicians answer specific clinical problems. In this column, the question concerned the nutritional management of patients with acute pancreatitis
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and the preferred method of nutritional support (enteral or parenteral route). The author answers by noting that the optimal route and timing of nutritional support in patients with acute pancreatitis is controversial. Deciding when to start nutritional support depends on the patient's nutritional history and severity of pancreatitis. If a patient has adequate nutritional reserve and has mild or moderate pancreatitis, it is appropriate to wait 7 to 10 days before starting either enteral or parenteral nutrition and to give intravenous fluids only. There is insufficient evidence that shows nutrition alone positively affects the outcome of acute pancreatitis. Nutritional support simply supplies fluid, macronutrients (proteins, carbohydrates, and fats) and micronutrients (electrolytes, trace elements, and vitamins) while the patient takes nothing by mouth to minimize pancreatic stimulation. After 7 to 10 days without nutrition, negative nitrogen balance occurs, increasing a patient's risk of infection. At this point, nutritional support should be started if the patient is unable to take adequate oral nutrition. The author briefly summarizes two studies that support enteral over parenteral nutrition in the management of acute pancreatitis. The author cautions that in clinical practice, however, the choice is not always that easy. Patients frequently refuse nasal tubes and often do not tolerate the feedings. The author stresses that each case needs an individualized approach and that enteral nutrition should be used whenever possible. 5 references.
Federally-Funded Research on Pancreatitis The U.S. Government supports a variety of research studies relating to pancreatitis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to pancreatitis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, 18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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many federally-funded studies use animals or simulated models to explore pancreatitis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for pancreatitis: ·
Project Title: Acute Pancreatitis Principal Investigator & Institution: Steer, Michael L.; Professor of Surgery; Beth Israel Deaconess Medical Center 330 Brookline Ave Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-JUL-1982; Project End 0-NOV2001 Summary: (Adapted from investigator's abstract) Currently available evidence indicates that digestive enzyme zymogens such as trypsinogen become prematurely activated within acinar cells of the pancreas during the early stages of acute pancreatitis. Activated digestive enzymes are believed to cause cell injury leading to acinar cell death and pancreatitis. The proposed project will pursue the following specific aims: 1) to define the mechanisms responsible for premature activation of zymogens within the pancreas and the role of those activated digestive enzymes in the evolution of acute pancreatitis; and 2) to determine if the type of acinar cell death (ie, necrosis or apoptosis) during acute pancreatitis regulates the severity of that acute pancreatitis. The specific aim #1 studies will build on the observation that infusion of a supramaximally stimulating dose of the CCK analog caerulein causes intrapancreatic activation of trypsinogen as well as pancreatitis in rats. Furthermore, cathepsin B mediated activation of trypsinogen occurs when isolated acini are incubated in vitro with supramaximally stimulating concentrations of caerulein. In the proposed studies, the intracellular location of trypsinogen activation, the cellular events involved in trypsinogen activation, and the mechanism by which trypsinogen activation leads to cell injury will be determined. In the specific aim #2 studies, several models of experimental pancreatitis in laboratory animals (mice, rats, opossums) will be utilized to evaluate the possibility that apoptosis minimizes the severity of pancreatitis. The mechanisms underlying this phenomenon will be examined and the potential value of treating established pancreatitis by inducing apoptosis will be evaluated. Successful completion of these proposed studies will provide important new insights into the cellular basis for acute pancreatitis and identify methods of either preventing or minimizing the severity of this frequently lethal disease.
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Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Heat Shock Proteins and Pancreatitis Principal Investigator & Institution: Saluja, Ashok K.; ; Beth Israel Deaconess Medical Center 330 Brookline Ave Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 5-FEB-2001; Project End 1-JAN2006 Summary: (Adapted from the Applicant's Abstract): The broad, longterm aim of the work proposed in the present application is to determine the role of prior stress and heat shock proteins in regulating the severity of pancreatitis-a disease with considerable morbidity and mortality. The pathophysiological alterations underlying the development and ultimate severity of pancreatitis are not fully understood, but it is generally believed that premature activation of digestive enzyme zymogens within the pancreatic acinar cells themselves leads to acinar cell injury and pancreatitis. The mechanisms involved in this activation process are still controversial. Recent observations suggest that prior stress by either water immersion or hyperthermia ameliorates subsequent development of pancreatitis in rats. This proposal is based on our hypothesis that prior stress prevents pancreatitis by specifically increasing the expression of heat shock proteins (HSPs). Once upregulated, HSPs prevent premature activation of trypsinogen by blocking its colocalization with lysosomal enzymes. Furthermore, we believe that HSPs affect these phenomena by attenuating the sustained rise in intracellular Ca2+ which is normally observed during pancreatitis. The proposed studies will pursue the following specific aims: (a) to determine whether HSPs are actually responsible for post-stress protection against pancreatitis and whether that protection is generalizable to models of pancreatitis other than the caerulein-induced model; (b) to elucidate the mechanism of stressinduced protection against pancreatitis, and (c) to determine the mechanism by which HSPs alter intracellular Ca2+ homeostasis. These studies will use two different models of pancreatitis: (a) caerulein model in mice and rats and (b) bile salt-induced pancreatitis in rats. Stress and HSP expression will be induced by both physical and chemical approaches. Successful completion of these studies will eventually help us in planning strategies to pharmacologically manipulate the levels of HSPs, so that their induction can be used as a tool to decrease the severity of clinical pancreatitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Hypoxia and Free Radicals in Alcoholic Pancreatitis Principal Investigator & Institution: Arteel, Gavin E.; Pharmacology; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL2006 Summary: APPLICANT'S ABSTRACT: We hypothesize that ethanolinduced chronic pancreatitis is triggered by hypoxia/reoxygenation injury, leading to stimulation of inflammatory cell recruitment and activation of these cells by circulating endotoxins. We recently showed pancreatic injury characteristic of chronic pancreatitis in humans in an enteral model modified to deliver higher amounts of ethanol. Our first goal is to characterize this new model. Wistar rats will receive alcohol internally using our modified protocol for up to 6 months. Pancreatic function and injury will be determined and compared to changes in key molecular events. We expect that alcohol will cause progressive, irreversible changes in pancreatic morphology and function, similar to clinical observations. We will next test the hypothesis that alcohol causes hypoxia in pancreas in vivo. Initially, we will determine if the hypoxia marker pimonidazole can be used to index pancreatic hypoxia in rats. We will then determine the effect of alcohol on pancreatic hypoxia in our enteral model. We expect that chronic ethanol will cause early increases in hypoxia, suggesting that hypoxia might play a key early role in the initiation of damage. The effect of removing endotoxin by lactobacillus treatment to displace Gram-negative bacteria, or killing macrophages with silica will next be studied. We expect pancreatic damage will be blunted by these treatments, suggesting a role of endotoxin and macrophages in chronic alcoholic pancreatitis. Next, the hypothesis that free radicals play a causative role in chronic alcoholic pancreatitis will be tested. This question will be addressed using adeno-associated virus (RAAV) to deliver superoxide dismutase (SOD) and cause stable longterm pancreatic expression. First, optimal conditions to confer pancreatic transgene expression will be determined. The effect of RAAV containing superoxide dismutase (SOD) on pancreatic injury will be determined. Free radical formation and oxidative stress will also be quantitated. We expect that preventing oxidative stress with SOD will protect against chronic alcoholic pancreatitis, indicating that free radicals play an important role in the progression of chronic alcoholic pancreatitis. This work will lay the mechanistic foundation for future studies of targeted therapies to prevent alcoholic pancreatitis that can applied in the clinic, where such therapy is desperately needed. Further, through didactic training and interactions with his mentor and key faculty in the enteral
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model of alcohol exposure, molecular biology, and viral vector gene therapy, the applicant will acquire new skills that will greatly enhance his career development and bridge the gap to becoming a successful member of the academic and scientific community. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Liver-Lung Interaction during Acute Pancreatitis Principal Investigator & Institution: Gray, Keith D.; Surgery; Vanderbilt University 2101 W End Ave Nashville, Tn 37240 Timing: Fiscal Year 2002; Project Start 5-FEB-2002 Summary: A prominent feature of severe acute systemic inflammatory response syndrome (SIRS) including acute respiratory distress syndrome (ARDS). The physiology of these responses appears remarkably similar to responses to direct liver injury in other settings. Cytokines produced in the liver and lungs, including tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL-1), are implicated in the pathogenesis of SIRS and animal experiments have demonstrated them capable of precipitating acute lung injury. During acute pancreatitis, proteases are released into the portal system, exposing the liver to high levels of activated enzymes. Nuclear factor kappa-B (NF-kappaB), a transcriptional regulator of TNFalpha, IL-1 and other cytokines, is activated in the pancreas within 30 minutes of inducing experimental acute pancreatitis and subsequently within the liver and lung within 24 hours of acute liver injury. Our central hypothesis is that NF-kappaB activation in the pancreas and liver mediates acute lung injury associated with pancreatitis. Using the biliary cerulein/glycodeoxycholic acid model of acute pancreatitis will address two specific aims: 1) to determine whether altering NF-kappaB activation in the liver affects the pulmonary response to severe acute pancreatitis; 2) to determine the role of Kupffer cells in mediating the multi-system effects of pancreatitis by depleting Kupffer cells prior to induction of pancreatitis. These studies may allow the development of strategies to ameliorate multi-system to ameliorate multi-system injury including pulmonary failure,, which can be devastating during this illness. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Models of Type 1 and Type II Hereditary Pancreatitis Principal Investigator & Institution: Ulrich, Charles D.; Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2001; Project Start 1-MAY-2001; Project End 1-MAR2003
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Summary: (Applicant's Abstract): Acute and chronic pancreatitis remain major healthcare problems. The lack of effective preventive and therapeutic strategies in these disease states stems from a lack of understanding regarding disease pathogenesis. The investigator's group has identified mutations responsible for two delayed-onset, autosomal dominant inherited forms of acute and chronic pancreatitis. An RI 17H mutation in the human cationic trypsinogen gene links with type I hereditary pancreatitis (HP I). An N211 mutation in the same gene links with type II hereditary pancreatitis (HP II). Biochemical data from other groups when combined with the results of there preliminary studies support the hypothesis that the HP I mutation in cationic trypsin renders the molecule resistant to proteolytic digestion, the persistence of mutant trypsin activity resulting in the creation of a "milieu" sufficient for clinically-apparent acute pancreatitis. The alterations in protein biochemistry responsible for the HP II phenotype remain unclear. In an initial attempt to develop an animal model of HP I, the investigator generated transgenic mice containing a diet-inducible pancreatic acinar cell-specific promoter coupled to either wild-type or HP I mutant human cationic trypsinogen. Unfortunately, these mice fail to develop pancreatitis spontaneously, and all available antibodies to human cationic trypsin cross-react with an identically sized mouse trypsin. The investigator believes that enhanced expression of antibody epitopetagged human cationic trypsinogens will provide him with the best opportunity to develop a successful animal model of hereditary pancreatitis. Toward this end, the investigator proposes (1) studies comparing the biochemical properties of affinity-purified recombinant wild-type, R117H, and N21I human cationic trypsinogen/trypsin (+ Iepitope tag) utilizing a validated in vitro assay system. By design, these studies will also further test the investigator's hypothesis with regard to HP I mutant trypsin, and discern the biochemical alterations induced by the HP II mutation. The investigator will then (2) characterize murine pancreata and acinar cells expressing varying levels of epitope-tagged wild-type, R117H, and N2 11 human cationic trypsinogen/trypsin. The development of these animal models, in combination with the experimental design, should provide him with important insights into the events underlying the delayed-onset and pathophysiology of HP I, HP II and non-hereditary forms of acute and chronic pancreatitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Molecular Genetics of Hereditary Pancreatitis Principal Investigator & Institution: Whitcomb, David C.; Professor of Medicine, Cell Biology & Ph; Medicine; University of Pittsburgh at Pittsburgh 4200 5Th Ave Pittsburgh, Pa 15260
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Timing: Fiscal Year 2000; Project Start 1-APR-1999; Project End 0-NOV2002 Summary: Acute and chronic pancreatitis are major health-care problems in the United States causing years of pain and disability. Despite the impact of these diseases, mystery surrounds many of the predisposing causes and early molecular events. Furthermore, the devastating effects of acute pancreatitis and chronic pancreatitis, once established, cannot be reversed. We believe that in the future, advances in the treatment of pancreatic disease rest in the early identification of at-risk individuals as well as in the prevention of limitation of pancreatic injury. Thus, the goal of our program is to determine the molecular mechanisms that predispose to acute and chronic pancreatitis and to identify targets for disrupting pathophysiological processes. We believe that effective preemptive actions will prevent or limit pancreatic injury and thus, result in the reduction of he incidence and severity of acute and chronic pancreatitis. To understand the mechanisms of pancreatitis we will identify previously uncharacterized hereditary pancreatitis families and investigate several striking features of this disease including incomplete penetrance and the mechanisms causing pancreatitis with trypsinogen RR117H and N21I mutations. Answering this question may provide insight into the pathophysiology of acute and chronic pancreatitis and identify targets for new therapies, and help identify individuals at risk through genetic testing. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Molecular Mechanisms of Pancreatitis Principal Investigator & Institution: Logsdon, Craig D.; Associate Professor of Physiology; Physiology; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2000; Project Start 0-MAY-1998; Project End 8-FEB2002 Summary: Preliminary data supports an association between activation of stress-activated protein kinase pathway, expression of chemokines, and secretagogue-induced experimental pancreatitis. This work is designed to explore mechanisms and interrelationships between events in these pathways and their role in pancreatitis. The first aim is designed to test the hypothesis that chemokines are specifically and rapidly induced in acinar cells by treatments that induce pancreatitis utilizing the secretagogue hyperstimulation model, intraductal injection of bile salt and protease solutions, and ischemia/reperfusion models of pancreatitis. The second aim explores the hypothesis that activation of the stress kinase pathway is necessary and sufficient for the stimulation of
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chemokine gene expression. This will utilize both the in vivo animal models of pancreatitis, as well as in vitro studies with dispersed pancreatic acinar cells. The latter allows various manipulations for activation and inhibition of stress kinase signalling cascades, as well as the adenoviral-mediated gene delivery of constitutively-active or dominant-negative signalling genes. The third aim tests the hypotheses that NFkB is involved in chemokine gene expression in pancreatic acinar cells. This again utilizes both in vivo and in vitro approaches with various manipulations of NFkB and IkB. The final aim tests the hypothesis that modification of chemokine expression in vivo will influence the severity of pancreatitis. This will attempt to utilize adenoviral vectors to directly express the specific chemokines in the pancreas in vivo and explore effects on the characteristics of pancreatitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Molecular Pathomechanism of Hereditary Pancreatitis Principal Investigator & Institution: Sahin-Toth, Miklos; Associate Professor; Physiology; University of California Los Angeles Box 951361, 405 Hilgard Ave Los Angeles, Ca 90095 Timing: Fiscal Year 2001; Project Start 1-MAY-2001; Project End 0-APR2004 Summary: (Applicant's abstract): The broad, long-term objectives of this application are to understand the mechanism by which mutations in the human cationic trypsinogen gene (PRSS1) lead to hereditary pancreatitis (HP). HP is an autosomal dominant genetic disorder characterized by early-onset recurrent attacks of acute pancreatitis with frequent progression to chronic pancreatitis and occasionally to pancreatic cancer. HP belongs to the inherited forms of idiopathic chronic pancreatitis, a genetically heterogeneous disease group, where mutations have been found not only in PRSS1, but also in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and in the pancreatic secretory trypsin inhibitor gene (SPINK1). HP has been widely recognized as a highly relevant model system for all forms of human pancreatitis. In the majority of cases, three mutations, Arg117-His, Asn2l-,lle, and Ala8-Val, have been identified in PRSSI. The molecular defects caused by the HP mutations will be studied within the context of a current pathogenesis model, which suggests that HP is caused by excessive intrapancreatic trypsin activity via one of 3 mechanisms: (i) increased trypsinogen activation, (ii) decreased trypsin degradation; or (iii) impaired inhibition by pancreatic secretory trypsin inhibitor (PSTI). The principal objective of the experimental design is to study the effects of the HP-mutations in vitro, using recombinant human trypsinogens. Wild-type and mutant
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trypsinogens will be expressed in Escherichia coli, and purified to homogeneity with ecotin affinity chromatography. Catalytic properties and autocatalytic degradation (autolysis) of trypsins and autoactivation and autocatalytic degradation (zymogenolysis) of trypsinogens will be characterized. In addition, interactions between wild-type and mutant forms of cationic trypsin(ogen) with anionic trypsin(ogen) and mesotrypsin(ogen) will be examined. Finally, inhibition of human trypsin isoforms and HP mutant trypsins by wild-type and mutant PSTI proteins will be studied. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Oxidative Damage in Pancreatitis and Pancreatic Neoplasia Principal Investigator & Institution: Bell, Richard; ; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2000 Summary: Carcinoma of the pancreas if the fifth leading cause of cancer death in the United States; treatment for established carcinoma is largely ineffective, with mean survival measured in months. The possibility of detection of early neoplasms in a high-risk group forms the rationale for the current proposal. Chronic pancreatitis is the most significant risk factor for pancreatic cancer yet identified. Acute and chronic pancreatitis are associated with injury from reactive oxygen radicals. Oxidative damage to DNA during the development of chronic pancreatitis may lead to mutations which ultimately cause the development of subsequent pancreatic cancer. The eventual fate of oxidatively damaged cells may depend on anti-oxidant defense against further injury, changes in the ability of cells to undergo apoptosis, or changes in cell proliferation. These further changes may be a result of continued oxidative damage. In the first specific aim of the current proposal, normal pancreas and tissue with chronic pancreatitis and pancreatic cancer will be examined for markers of oxidative DNA damage, antioxidant defense, apoptosis, and proliferation. The second specific aim will address whether oxidative damage sensitizes the pancreatic duct epithelium to further changes in antioxidant defense, apoptosis and proliferation. We will determine whether antioxidant treatment can prevent these changes. This aim will also determine if cells exposed to oxidative stress are more sensitive to carcinogen challenge than normal duct cells. To examine similar questions in an in vivo model, chronic pancreatitis will be induced in hamsters and the resultant oxidative damage in pancreatic tissue measured, as well as changes in antioxidant defense, apoptosis, and
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proliferation. These animals will be observed for the development of spontaneous tumors and tested for the development of cancer in response to low doses of the carcinogen N-nitrosobis (2-oxopropyl) amine (BOP). Animals with chronic pancreatitis will be treated with antioxidants during the course of pancreatitis will be analyzed for markers of oxidative damage, antioxidant defense, apoptosis or proliferation which are found to be associated with neoplastic change in Aims 1 and 2. Aim 2, we will establish the feasibility of measuring these markers in pancreatic juice and brushing, determine the incidence of marker positivity in patients with chronic pancreatitis, validate the markers, and develop a cohort of chronic pancreatitis patients for long=term cancer surveillance. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Surgical Approach to Experimental Pancreatitis Principal Investigator & Institution: Nathan, Jaimie D.; Medicine; Duke University Durham, Nc 27706 Timing: Fiscal Year 2000; Project Start 1-SEP-2000 Summary: Acute pancreatitis carries significant morbidity and mortality. The cellular mechanisms that underlie the inflammatory process are poorly understood, and effective treatment of acute pancreatitis is unavailable. Neurogenic inflammation has been implicated in the evolution of acute pancreatitis. In other inflammatory diseases, substance P is released from primary sensory nerve endings by activation of the capsaicin receptor, vanilloid receptor subtype 1 (VR1), and triggers neurogenic inflammation by acting via the neurokinin-1 (NK-1) receptor on target cells. The severity of experimental pancreatitis is markedly reduced in NK-1 receptor-deficient mice, suggesting a proinflammatory role for the NK-1 receptor in acute pancreatitis. The hypothesis to be tested is that neurogenic inflammation contributes to the evolution of acute pancreatitis and is mediated by substance P release from primary sensory nerve endings. The following specific aims will be addressed in caerulein-induced experimental pancreatitis: (1) to demonstrate that the proinflammatory role of NK-1 receptors results from binding of substance P, (2) to determine by pharmacological and by surgical manipulations whether primary sensory afferent neurons are the source of substance P release, (3) to determine whether substance P release is mediated by activation of VR1. The severity of pancreatitis will be assessed by biochemical assays and histological examination following pretreatment with an NK-1 receptor antagonist, with capsaicin, and with a VR-l antagonist, and following dorsal rhizotomy. NK-1 receptor immunolocalization will be performed to assess binding of substance P.
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Elucidation of the mechanisms of neurogenic inflammation in acute pancreatitis may result in improved treatment modalities for this disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: the Calcium-Sensing Receptor in Acute Pancreatitis Principal Investigator & Institution: Saunders, Christine; Biochemistry; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2001; Project Start 1-APR-2001; Project End 0-NOV2003 Summary: (adapted from the application) Acute pancreatitis is an inflammatory disease with significant mortality, affecting about 80,000 Americans a year. The pathophysiologic mechanisms are not thoroughly elucidated, and to date there are few if any effective treatments. Calcium and lipid mediators are integral components of the signaling cascade involved in pancreatic inflammation. Changes in blood calcium levels have been associated with acute pancreatitis, both in humans and in laboratory animals. The recently cloned calcium-sensing receptor (CaSR), a G protein-coupled receptor (GPCR), by virtue of its ability to stimulate inflammatory lipid mediator synthesis, provides a possible mechanism for how calcium, lipid mediators and acute pancreatitis are linked. In fact, recent findings suggest that the CaSR in the pancreas is upregulated during acute pancreatitis in the rat. The hypothesis for the proposed studies is that the pancreatic CaSR is involved in initiating and/or propagating acute pancreatitis by activating PLA2, which stimulates lipid mediators involved in the inflammatory cascade. In this proposal, molecular biologic, biochemical and physiologic approaches will be combined to investigate the role of the pancreatic CaSR in experimental acute pancreatitis. The secretagogue (eg. cerulein) hyperstimulation model in rats is a well established model in which hourly administration of high doses of cerulein for 6 hours induces an edematous acute pancreatitis. Multiple techniques will be used to test the hypothesis by addressing the following specific aims: (1) to identify the pancreatic cells which express the functional CaSR; (2) to determine whether the CaSR is directly involved in acute pancreatitis in the rat; (3) to examine whether cytoskeletal depolymerization during acute pancreatitis provides a mechanism for how the CaSR is upregulated in cerulein-induced pancreatitis; (4) to examine whether there is "cross-talk" between the cholecystokinin A (CCK-A) receptor and the CaSR which might lead to activation of the CaSR in cerulein-treated rats. While the role of the CaSR in inherited diseases is emerging, its function in inflammatory conditions remains unknown. Since the CaSR activates lipid mediator synthesis, its
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potential role in inflammation seems logical and represents an exciting and novel possibility. Also, this study might serve as a paradigm for inflammatory conditions other than pancreatitis, the treatments for which have remained elusive. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: the Panins of Pancreatitis,Pancreas Cancer and Controls Principal Investigator & Institution: Goggins, Michael G.; Pathology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 0-JUN2003 Summary: Pancreatic cancer is the fifth leading cause of cancer death in the USA. Unfortunately, there is currently no effective screening test for asymptomatic disease and the vast majority of patients with pancreatic cancer present with advanced incurable disease. An effective method to detect early pancreatic cancers is urgently needed. This need is perhaps greatest in groups known to have an increased risk of developing pancreatic cancer. For example, patients with sporadic chronic pancreatitis have a lifetime risk of developing pancreatic cancer that approaches 4% and for patients with hereditary pancreatitis, the lifetime risk of pancreatic cancer is very high (approximately 50%). An improved understanding of early neoplasia in patients with chronic pancreatitis should form the foundation on which novel approaches to the early identification of invasive cancer could be developed. Several lines of evidence suggests that the precursor lesions of pancreatic carcinoma are the duct lesions known as pancreatic intraepithelial neoplasias (PanINs). First, PanINs are more common in pancreata with cancer than they were in pancreata without cancer. Second, PanINs found in pancreata with pancreatic cancer harbor many of the same genetic alterations as are found in pancreatic cancer such as activation of K-ras and inactivation of p16, DPC4, p53, and BRCA2. Third, several case studies report patients with PanINs progressing to invasive pancreatic cancer. Despite the risk of pancreatic cancer among patients with chronic pancreatitis, the genetic alterations in the PanINs from patients with chronic pancreatitis have not been well-studied. The aim of this study is to compare the frequency, timing and mechanism of several molecular events important for neoplastic progression in PanINs found in the setting of pancreatic cancer with PanINs found in the setting of chronic pancreatitis- associated and with PanINs from other benign pancreatic conditions. Specifically, using genetic, DNA methylation, and immunohistochemical techniques to compare the rates of a) genetic inactivation of DPC4 and b) genetic and epigenetic inactivation of p16 in 40 PanINs that arose in the setting of
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chronic pancreatitis 40 PanINs that arose in the setting of pancreatic cancer and 40 PanINs that arose in pancreata resected for benign pancreatic conditions without malignant potential. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Neural Regulation of Pancreatic Function Principal Investigator & Institution: Kirkwood, Kimberly S.; Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2000; Project Start 5-MAY-1994; Project End 1-JUL2003 Summary: (Adapted from Applicant's Abstract): Approximately 10% of patients with acute pancreatitis die from uncontrolled pancreatic inflammation that results in massive fluid losses and shock. The regulation of pancreatic inflammation is poorly understood. In the trachea, sensory nerves regulate inflammation by releasing tachykinins that bind to endothelial cells and induce arteriolar vasodilatation, plasma extravasation and neutrophil infiltration. This well-characterized phenomenon is called neurogenic inflammation. The general hypothesis of this proposal is that neurogenic mechanisms are essential to the pathogenesis of acute pancreatitis. Specifically, we hypothesize that a) tachykinins induce plasma extravasation and neutrophil infiltration in the pancreas by interacting with neurokinin receptors, b) the proinflammatory effects of tachykinins are terminated by cell surface peptidases, and c) tachykinins and their receptors regulate inflammation in a widely-used model of acute pancreatitis. Due to the recent availability of "knockout" mice in which the genes encoding neurokinin receptors or cell surface peptidases have been deleted by homologous recombination, these experiments will be performed in mice. Pancreatic inflammation will be assessed by 1) quantifying and localizing plasma extravasation using Evans blue and Monastral blue, respectively, 2) identifying and measuring endothelial cell gaps through which plasma extravasates using a silver stain and light microscopy, 3) quantifying and localizing neutrophil infiltration using myeloperoxidase, and 4) defining the extent of edema, and cytoplasmic vacuolization using histological criteria. Specific Aim 1 will define the contribution of exogenous and endogenous tachykinins to the initiation of acute pancreatic inflammation. The time-course and dose-response will be determined, and the neurokinin receptors that mediate these effects will be identified using antagonists and knockout mice, and localized using receptorspecific antisera. Specific Aim 2 will examine the role of peptidases in the termination of tachykinin-induced pancreatic inflammation. The
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peptidases neutral endopeptidase and angiotensin converting enzyme will be localized in the pancreas using specific antisera, and their importance in tachykinin-induced inflammation will be determined using inhibitors and knockout mice. Specific Aim 3 will define the importance of sensory nerves, and specifically tachykinins, in the pathogenesis of acute pancreatitis. Using neurokinin receptor antagonists, peptidase inhibitors, and knockout mice, we will delineate the neurogenic mechanisms that regulate inflammation in acute pancreatitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Nutrient Infusion for Enzyme Synthesis in Pancrcreatitis Principal Investigator & Institution: O'keefe, Stephen J.; ; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2000; Project Start 1-DEC-1977; Project End 0-NOV2002 Summary: The measurement of the use of specialized feeding techniques by the digestive system with the aim of developing the best way of feeding patients with digestive diseases such as acute pancreatitis. Intravenous feeding is one of the greatest advances in the management of surgical and critical-care patients in modern times. It especially helps in complicated abdominal procedures promoting faster recovery and preventing malnutrition, reduced host defense, and slower healing of wounds. However, it poses some problems by not utilizing the body's natural functions and disrupts metabolic control exerted by the liver and pancreas on the inflow of nutrients into the bloodstream. In the disease of acute pancreatitis, feeding through the intestines (enteral feeding), may worsen the symptoms. So, intravenous feeding has been favored. In this study, the proposal is to compare the physiological effects of feeding through the intestines and the effects of feeding intravenously on the synthesis and secretion of pancreatic enzymes, first in healthy volunteers, and then in patients with acute pancreatitis. This will enable the design of the safest and most cost effective method of nutritional support for patients with acute pancreatitis. The study will involve healthy volunteers who will be randomly divided into four groups, each group using a different diet. Subjects will be admitted to the General Clinical Research Center at MCV. A feeding tube (NGtube) will be passed through the nose into the stomach, the stomach will be emptied with the help of a drug, a light dinner will be provided, and fasting will occur until the next morning. In the morning, an intravenous (IV) catheter will be inserted into an arm. Two different amino acids will be administered, one through the IV and one through the NG tube. During the test, half-
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hourly samples of digestive juice will be suctioned from the feeding tube to measure the amount of amino acids in the digestive enzymes. Blood and breath samples will be taken. At the end of the test, a tube will be passed into the stomach and intestine and intestinal lining will be taken for analysis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Transgenic Mouse Models of Pancreatic Exocrine Function Principal Investigator & Institution: Delisle, Robert C.; Associate Professor; Anatomy and Cell Biology; University of Kansas Medical Center Medical Center Kansas City, Ks 66103 Timing: Fiscal Year 2002; Project Start 1-JUN-2002; Project End 1-MAY2004 Summary: (provided by applicant): This grant application proposes to develop genetically engineered mouse models for acute pancreatitis and cystic fibrosis-related pancreatitis. We will focus on a recently discovered gene, which preliminary data suggest may play a role in development of pancreatitis, and also in the pathogenesis of cystic fibrosis (CF). The gene is called crpd in the mouse and dmbt1 in humans and it encodes the protein Muclin, a high molecular weight, and sulfated glycoprotein. This gene is most highly expressed in the exocrine pancreas, but also as different transcripts in other organs including the intestine, gallbladder, and kidney. The hypothesis is that Muclin is required for normal zymogen granule formation and subsequent solubilization of digestive enzymes upon exocytosis of the granules. We predict that if this gene is a disrupted zymogen granule will fail to mature creating a situation in the acinar cell where the zymogens will be prone to become activated, resulting in pancreatitis. The Muclin-deficient mouse model is intended to explore this hypothesis and, if this is borne out, it will make looking for mutations in this gene in human idiopathic pancreatitis a reasonable endeavor. We also predict that mice over expressing Muclin will exhibit poor release of zymogens after exocytosis and will be prone to CF-like plugging of the acinar lumen, which may predispose to pancreatitis. In CFTR-/- mice, a model for CF, the pancreas exhibits over expression of Muclin, which is associated with protein, plugs in the acinar lumen. Mice with a Muclin transgene targeted to the pancreas will allow testing of this hypothesis. The specific aims are to produce genetically engineered mice: 1). Globally deficient in Muclin by targeting the first exon, which is present in all transcripts of this gene. 2). An exocrine cell-specific defective Muclin by targeting the last exon which is translated only in exocrine cell transcripts of the gene and codes for a transmembrane
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domain that may be important for Muclin' s exocrine function; 3). That over expresses Muclin in the pancreatic acinar cell using the rat elastase promoter to direct cell specific expression. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “pancreatitis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for pancreatitis in the PubMed Central database: ·
Activation of polyamine catabolism in transgenic rats induces acute pancreatitis by Leena Alhonen, Jyrki J. Parkkinen, Tuomo Keinanen, Riitta Sinervirta, Karl-Heinz Herzig, and Juhani Janne; 2000 July 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26940
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Commentary:Calcium signaling and acute pancreatitis: Specific response to a promiscuous messenger by Anant B. Parekh; 2000 November 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=34065
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Drug points:Pancreatitis associated with hydroxyurea in combination with didanosine by H J Longhurst and A J Pinching; 2001 January 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26596
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Role of substance P and the neurokinin 1 receptor in acute pancreatitis and pancreatitis-associated lung injury by Madhav Bhatia, Ashok K. Saluja, Bernd Hofbauer, Jean-Louis Frossard, Hong Sik Lee, Ignazio Castagliuolo, Chi-Chung Wang, Norma Gerard, Charalabos Pothoulakis, and Michael L. Steer; 1998 April 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22564
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19
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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with pancreatitis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “pancreatitis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “pancreatitis” (hyperlinks lead to article summaries): ·
Phospholipase activity in pancreatic exudate in experimental acute pancreatitis. Author(s): Gjone E, Ofstad E, Marton PF, Amundsen E. Source: Scandinavian Journal of Gastroenterology. 1967; 2(3): 181-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4963682&dopt=Abstract
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Possible drug-associated pancreatitis after paclitaxel-cremophor administration. Author(s): Mills KM, Johnson DM, Middlebrooks M, Burton GV. Source: Pharmacotherapy. 2000 January; 20(1): 95-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10641981&dopt=Abstract
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Protective effect of a microtubule stabilizer taxol on caerulein-induced acute pancreatitis in rat. Author(s): Ueda T, Takeyama Y, Kaneda K, Adachi M, Ohyanagi H, Saitoh Y.
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
22
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Source: The Journal of Clinical Investigation. 1992 January; 89(1): 234-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1370296&dopt=Abstract ·
Re: Vinorelbine-induced pancreatitis: a case report. Author(s): Raderer M, Kornek G, Scheithauer W. Source: Journal of the National Cancer Institute. 1998 February 18; 90(4): 329. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9486821&dopt=Abstract
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Soybean trypsin inhibitor and cerulein accelerate recovery of ceruleininduced pancreatitis in rats. Author(s): Jurkowska G, Grondin G, Masse S, Morisset J. Source: Gastroenterology. 1992 February; 102(2): 550-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1370663&dopt=Abstract
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The effect of microtubule stabilizer on rat caerulein-induced pancreatitis. Author(s): Ueda T. Source: The Kobe Journal of Medical Sciences. 1991 April; 37(2): 97-109. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1717741&dopt=Abstract
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The effects of free oxygen radical scavenger and platelet-activating factor antagonist agents in experimental acute pancreatitis. Author(s): Soybir G, Koksoy F, Ekiz F, Yalcin O, Fincan K, Haklar G, Yuksel M. Source: Pancreas. 1999 August; 19(2): 143-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10438161&dopt=Abstract
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The effects of green tea catechins (Polyphenon) on DL-ethionineinduced acute pancreatitis. Author(s): Takabayashi F, Harada N, Hara Y. Source: Pancreas. 1995 August; 11(2): 127-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7479668&dopt=Abstract
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Transcutaneous electrical nerve stimulation in the management of pancreatitis pain. Author(s): Roberts HJ. Source: Southern Medical Journal. 1978 April; 71(4): 396-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=76340&dopt=Abstract
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Treatment of acute pancreatitis with liyi tang--a report of 50 cases. Author(s): Chen Q, Lu J. Source: J Tradit Chin Med. 1997 December; 17(4): 250-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10437205&dopt=Abstract
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Treatment of late allograft pancreatitis with oral pancreatic extract. Author(s): Garvin PJ, Lindsey L, Aridge DL, Burton FR, Patel BK, George E, Reese J. Source: Transplantation. 1991 October; 52(4): 733-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1926355&dopt=Abstract
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Use of a synthetic protease inhibitor for the treatment of Lasparaginase-induced acute pancreatitis complicated by disseminated intravascular coagulation. Author(s): Murakawa M, Okamura T, Shibuya T, Harada M, Otsuka T, Niho Y. Source: Annals of Hematology. 1992 May; 64(5): 249-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1623061&dopt=Abstract
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Vinorelbine-induced pancreatitis: a case report. Author(s): Tester W, Forbes W, Leighton J. Source: Journal of the National Cancer Institute. 1997 November 5; 89(21): 1631. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9362167&dopt=Abstract
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Wilson's disease associated with pancreatitis. Author(s): Weizman Z, Picard E, Barki Y, Moses S.
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Source: Journal of Pediatric Gastroenterology and Nutrition. 1988 November-December; 7(6): 931-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3199280&dopt=Abstract ·
Zinc in mononuclear leucocytes in alcoholics with liver cirrhosis or chronic pancreatitis and in patients with Crohn's disease before and after zinc supplementation. Author(s): Bro S, Stokholm M, Jorgensen PJ. Source: J Trace Elem Electrolytes Health Dis. 1989 December; 3(4): 243-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2535348&dopt=Abstract
Vocabulary Builder Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU] Anionic: Pertaining to or containing an anion. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Artery: A large blood vessel that carries blood from the heart to other parts
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of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Ascariasis: Infection by nematodes of the genus ASCARIS. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Asparaginase: A hydrolase enzyme that converts L-asparagine and water to L-aspartate and NH3. EC 3.5.1.1. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autolysis: The spontaneous disintegration of tissues or cells by the action of their own autogenous enzymes. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Caerulein: A specific decapeptide obtained from the skin of Hila caerulea, an Australian amphibian. Caerulein is similar in action and composition to cholecystokinin. It stimulates gastric, biliary, and pancreatic secretion and certain smooth muscle. It is used in paralytic ileus and as diagnostic aid in pancreatic malfunction. [NIH] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiac: Pertaining to the heart. [EU] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants; it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH]
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Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution,
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and thus becomes capable of conducting electricity; an ionic solute. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Epigastralgia: Pain in the epigastrium. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Exocrine: 1. secreting outwardly, via a duct;. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate,
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is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Granule: A small pill made from sucrose. [EU] Hemobilia: Hemorrhage in or through the biliary tract, due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasms. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperstimulation: Excessive stimulation. [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Ileus: Obstruction of the intestines. [EU] Immersion: The placing of a body or a part thereof into a liquid. [NIH]
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Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intravascular: Within a vessel or vessels. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leukaemia: An acute or chronic disease of unknown cause in man and other warm-blooded animals that involves the blood-forming organs, is characterized by an abnormal increase in the number of leucocytes in the tissues of the body with or without a corresponding increase of those in the circulating blood, and is classified according of the type leucocyte most prominently involved. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell
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structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Metastasis: 1. the transfer of disease from one organ or part to another not directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH]
Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH]
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Motility: The ability to move spontaneously. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH]
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Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Postoperative: Occurring after a surgical operation. [EU] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Pruritus: Itching skin; may be a symptom of diabetes. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pulmonary: Pertaining to the lungs. [EU] Pyoderma: Any purulent skin disease. Called also pyodermia. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Refractory: Not readily yielding to treatment. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other
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ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Resection: Excision of a portion or all of an organ or other structure. [EU] Respiratory: Pertaining to respiration. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spondylitis: Inflammation of the vertebrae. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Tachykinins: A family of biologically active peptides sharing a common conserved C-terminal sequence, -Phe-X-Gly-Leu-Met-NH2, where X is either an aromatic or a branched aliphatic amino acid. Members of this family have been found in mammals, amphibians, and mollusks. Tachykinins have diverse pharmacological actions in the central nervous system and the cardiovascular, genitourinary, respiratory, and gastrointestinal systems, as well as in glandular tissues. This diversity of activity is due to the existence of three or more subtypes of tachykinin receptors. [NIH]
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Thrombosis: The formation, development, or presence of a thrombus. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transcutaneous: Transdermal. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
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CHAPTER 5. PATENTS ON PANCREATITIS Overview You can learn about innovations relating to pancreatitis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with pancreatitis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with pancreatitis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Pancreatitis By performing a patent search focusing on pancreatitis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on pancreatitis: ·
Method for Determining Whether a Human Patient Is Susceptible to Hereditary Pancreatitis, and Primers Therefore Inventor(s): Whitcomb; David (9609 Parkedge Dr., Allison Park, PA 15101), Ehrlich; Garth D. (Pittsburgh, PA), Gorry; Michael C. (Pittsburgh, PA) Assignee(s): Whitcomb; David (Allison Park, PA) Patent Number: 6,406,846 Date filed: October 14, 1997 Abstract: A method for determining whether a human patient is susceptible to hereditary pancreatitis. The method comprises the steps of obtaining nucleic acid from the human patient. Then there is the step of checking the nucleic acid for a mutation that indicates hereditary pancreatitis. A primer which reacts with a human trypsinogen gene to identify hereditary pancreatitis. A method for detecting in a human a mutation in a trypsinogen gene indicative of hereditary pancreatitis. The invention comprises the steps of obtaining a sample having DNA of the patient. Then there is the step of processing the sample so the DNA will be recognized by a desired restriction enzyme. Next there is the step of introducing the desired restriction enzyme to the DNA wherein the recognizing of the desired restriction enzyme to the DNA indicates the presence of the mutation. Excerpt(s): The present invention is related to determining whether a human patient is susceptible to hereditary pancreatitis. More specifically, the present invention is related to determining whether a human patient is susceptible to hereditary pancreatitis by identifying a single G to A transition mutation in the third exon of cationic trypsinogen, or digesting the trypsinogen gene in exon III with Afl III. ... Hereditary pancreatitis
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(HP) is an autosomal dominant disorder with 80% penetrance and variable expressivity [Perrault, J. Hereditary pancreatitis. Gastroenterol. Clin. North Am. 23:743-752 (1994); Madraso-de la Garza, J., Hill, I., Lebenthal, E. Hereditary pancreatitis. In: Go V, ed. The Pancreas: Biology, Pathobiology, and Disease. 2nd ed. New York: Raven, 1095-1101 (1993); Whitcomb, D. C., Preston, R. A., Aston, C. E., Sossenheimer, M. J., Barua, P. S., Zhang, Y., Wong-Chong, A., White, G., Wood, P., Gates, L. K., Jr., Ulrich, C., Martin, S. P., Post, J. C., and Ehrlich, G. D. A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology 110, 1975-1980 (1996); Bodic, L. L., Bignon, J. D., Raguenes, O., Mercier, B., Georgelin, T., Schnee, M., Soulard, F., Gagne, K., Bonneville, F., Muller, J. Y., Bachner, L., and Ferec, C. The hereditary pancreatitis gene maps to long arm of chromosome 7. Hum. Molec. Genet. 5, 549-554 (1996)]. Nearly 100 kindreds have been reported world-wide since the genetic nature of this disorder was recognized by Comfort and Steinberg in 1952 [Madraso-de la Garza, J., Hill, I., Lebenthal, E. Hereditary pancreatitis. In: Go V, ed. The Pancreas: Biology, Pathobiology, and Disease. 2nd ed. New York: Raven, 1095-1101 (1993); Comfort, M. and Steinberg, A. Pedigree of a family with hereditary chronic relapsing pancreatitis. Gastroenterology 21, 54 (1952)]. The majority of the families are of white European ancestry, but affected kindreds have been reported in Japan, India, and among other ethnic groups [Perrault, J. Hereditary pancreatitis. Gastroenterol. Clin. North Am. 23:743-752 (1994)]. HP is characterized by recurrent bouts of severe epigastric pain with onset, usually developing before ten years of age. The clinical, laboratory and pathologic features of HP are indistinguishable from attacks of pancreatitis from other causes. In addition to recurrent acute attacks, many HP patients progress to complicated chronic pancreatitis characterized by pancreatic calcifications, pseudocysts, chronic abdominal pain, pancreatic exocrine failure, diabetes mellitus and/or pancreatic cancer [Perrault, J. Hereditary pancreatitis. Gastroenterol. Clin. North Am. 23:743-752 (1994); Madraso-de la Garza, J., Hill, I., Lebenthal, E. Hereditary pancreatitis. In: Go V, ed. The Pancreas: Biology, Pathobiology, and Disease. 2nd ed. New York: Raven, 1095-1101 (1993)]. Despite years of research, no unique morphologic or biochemical markers have been identified for HP, and the pathophysiologic mechanisms that lead to intermittent attacks of acute pancreatitis remain obscure. Therefore, no rational or effective preventative strategies have been developed, and treatment consists solely of supportive care. ... Because of the absence of biochemical markers specific for HP, attention has focused on identifying the HP disease gene. The availability of a high-density map of the human genome, based on polymorphic simple tandem repeat (STR) markers, and familial S0 linkage analysis made it possible to identify an HP gene locus
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within the q35 region of chromosome seven [Whitcomb, D. C., Preston, R. A., Aston, C. E., Sossenheimer, M. J., Barua, P. S., Zhang, Y., WongChong, A., White, G., Wood, P., Gates, L. K., Jr., Ulrich, C., Martin, S. P., Post, J. C., and Ehrlich, G. D. A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology 110, 1975-1980 (1996); Bodic, L. L., Bignon, J. D., Raguenes, O., Mercier, B., Georgelin, T., Schnee, M., Soulard, F., Gagne, K., Bonneville, F., Muller, J. Y., Bachner, L., and Ferec, C. The hereditary pancreatitis gene maps to long arm of chromosome 7. Hum. Molec. Genet. 5, 549-554 (1996)]. It was thus desired to identify and sequence the HP gene to determine the site of the disease-causing mutation(s) in an effort to understand the molecular mechanism leading to HP. Several previously mapped genes on chromosome 7q were considered candidates for the HP disease gene because they are known to be expressed in the exocrine pancreas and encode enzymes that could potentially activate digestive enzymes within the pancreas. The hypothesis that pancreatitis results from inappropriate activation of pancreatic proenzymes was first promulgated 100 years ago and subsequently was demonstrated to be an experimental model for pancreatitis [Chiara, H. Ueber selbstverdauung des menschlichen pankreas. Zeitschrift fur heilkunde 17, 69-96 (1896); Steer, M. L., and Meldolesi, J. The cell biology of experimental pancreatitis. N. Engl. J. Med. 316 (3), 144-50, (1987)]. Although carboxypeptidase A1 (CPA1) was considered the primary candidate by Le Bodic [Bodic, L. L., Bignon, J. D., Raguenes, O., Mercier, B., Georgelin, T., Schnee, M., Soulard, F., Gagne, K., Bonneville, F., Muller, J. Y., Bachner, L., and Ferec, C. The hereditary pancreatitis gene maps to long arm of chromosome 7. Hum. Molec. Genet. 5, 549-554 (1996)], this gene mapped centromeric to the HP locus defined by obligate recombinations in an HP linkage study [Whitcomb, D. C., Preston, R. A., Aston, C. E., Sossenheimer, M. J., Barua, P. S., Zhang, Y., Wong-Chong, A., White, G., Wood, P., Gates, L. K., Jr., Ulrich, C., Martin, S. P., Post, J. C., and Ehrlich, G. D. A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology 110, 1975-1980 (1996); Stewart, E. A., Craik, C. S., Hake, L., and Bowcock, A. M. Human carboxypeptidase A identifies a Bg1II RFLP and maps to 7q31-qter. Am. J. Hum. Genet. 46 (4): 795-800, (1990); Rommens, J. M., Zengerling, S., Burns, J., Melmer, G., Kerem, B. S., Plavsic, N., Zsiga, M., Kennedy, D., Markiewicz, D., Rozmahel, R., et al. Identification and regional localization of DNA markers on chromosome 7 for the cloning of the cystic fibrosis gene. Am. J. Hum. Genet. 43 (5), 645-63 (1988); Rommens, J. M., Iannuzzi, M. C., Kerem, B., Drumm, M. L., Melmer, G., Dean, M., Rozmahel, R., Cole, J. L., Kennedy D., Hidaka, N., et al. Identification of the cystic fibrosis gene: chromosome walking and jumping. Science. 245 (4922): 1059-65 (1989); Martise, T. C., Perlin, M., and Chakravarti, A.
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Automated construction of genetic linkage maps using an expert system (MultiMap): a human genome linkage map. Nature Genetics. 6 (4), 384-90 (1994)] and was, therefore, excluded from further consideration. However, at least eight trypsinogen genes are located on chromosome 7q35 between the STR markers D7S495 and D7S498 and within the V and D-C segments of the complex T-cell receptor .beta. chain gene locus (TCR.beta.) [Rowen, L., Koop, B. F., Hood, L. The Complete 685-Kilobase DNA Sequence of the Human_T Cell Receptor Locus. Science (1996)]. Trypsinogen is an inactive proenzyme for trypsin, which becomes active when an eight amino acid amino-terminal peptide is removed. Although small amounts of trypsin are normally generated within the pancreas, this active trypsin is usually rapidly inactivated before pancreatic autodigestion occurs. Thus, the trypsinogen genes were considered primary candidates for the HP disease gene. Web site: http://www.delphion.com/details?pn=US06406846__ ·
Method of using IL-11 for inflammation associated with acute pancreatitis Inventor(s): Keith; James (Andover, MA), Schendel; Paul (Wayland, MA) Assignee(s): Genetics Institute, Inc. (Cambridge, MA) Patent Number: 6,274,135 Date filed: June 22, 1999 Abstract: Provided by the present invention are methods of treating a variety of disorders including AIDS, arthritis (rheumatoid arthritis, osteoarthritis, spondyloarthropathies), antibiotic induced diarrheal diseases (Closbidium difficile), multiple sclerosis, osteoporosis, gingivitis, peptic ulcer disease, esophagitis, diabetes, retinitis, uveitis, reperfusion injury after myocardial infarction (MI) or cerebral vascular accident (CVA), aphthous ulcers (oral), atherosclerosis (plaque rupture), prevention of tumor metastases, asthma, preeclampsia, acute pancreatitis, psoriasis, infertility and allergic disorders such as rhinitis, conjunctivitis, and urticaria. Excerpt(s): The present invention relates generally to methods of treating disorders such as AIDS, arthritis (rheumatoid arthritis, osteoarthritis, spondyloarthropathies), antibiotic induced diarrheal diseases (Clostridium difficile), multiple sclerosis, osteoporosis, gingivitis, peptic ulcer disease, esophagitis, diabetes, retinitis, uveitis, reperfusion injury after myocardial infarction (MI), cerebral vascular accident (CVA), aphthous ulcers (oral), atherosclerosis (plaque rupture), prevention of tumor metastases, asthma, preeclampsia, acute pancreatitis, psoriasis,
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infertility and allergic disorders such as rhinitis, conjunctivitis, and urticaria. ... Inflammatory responses include a broad range of host reaction to a variety of insults, such as injury, infection, or rejection. It is the over production of mediators that is believed to be associated with a broad range of disorders, including AIDS, arthritis (rheumatoid arthritis, osteoarthritis, spondyloarthropathies), antibiotic induced diarrheal diseases (Clostridium difficile), multiple sclerosis, osteoporosis, gingivitis, peptic ulcer disease, esophagitis, diabetes, retinitis, uveitis, reperfusion injury after myocardial infarction (MI), cerebral vascular accident (CVA), aphthous ulcers (oral), atherosclerosis (plaque rupture), tumor metastases, asthma, preeclampsia, acute pancreatitis, psoriasis, infertility and allergic disorders such as rhinitis, conjunctivitis, and urticaria. ... Acute pancreatitis is severe inflammation of the pancreas which often results in pancreatic necrosis. Death resulting from acute pancreatitis ensues as a result of multiple organ failure and other clinical symptoms resembling sepsis. In the early stages of acute pancreatitis, elevated serum levels of IL-1, IL-6 and TNF-.alpha. are frequently seen. Web site: http://www.delphion.com/details?pn=US06274135__ ·
Healing device applied to persistent wounds, fistulas, pancreatitis, varicose ulcers, and other medical or veterinary pathologies of a patient Inventor(s): Fernandez; Ernesto Ramos (Artigas 1087 1 flr, A, Buenos Aires, AR) Assignee(s): none reported Patent Number: 6,203,563 Date filed: May 26, 1999 Abstract: A healing device applied to wounds, fistulas, pancreatitis, varicose ulcers, and other medical or veterinary pathologies includes a compacting chamber for covering the wound over the affected or diseased zone of the patient. The compacting chamber is defined by a self adhesive polymeric material laminar sheet, made out of a waterproof material. The compacting chamber has a replaceable mass of aerated polymer fiber flock therewithin, as a wound-stabilizing dressing. The compacting chamber uses a vacuum for deforming and compacting a mass of polymer fiber flock into effective healing contact with the wound. The vacuum means is terminated upon achieving compaction of the mass of polymer fiber flock and upon effective healing contact of the mass of polymer fiber flock with the wound. Excerpt(s): It is a further main object of this invention a device for treating wounds, fistulas, pancreatitis, varicose ulcers and other medical or
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veterinarian pathologies requiring atmospheric depression, compacting an aerated material in direct contact with said wound or fistula, stopping the secretion of fluid from the body to the exterior environment, and establishing the conditions allowing the patient to regenerate its own tissues, with the given time, closing the opening of the wound of fistula. Web site: http://www.delphion.com/details?pn=US06203563__ ·
Antibodies specific for human pancreatitis associated protein Inventor(s): Iovanna; Juan-Lucio (Marseille, FR), Keim; Volker (Heddesheim, DE), Dagorn; Jean-Charles (Marseille, FR) Assignee(s): Institut National de la Santa et de la Recherche Medicale (Paris Cedex, FR) Patent Number: 5,959,086 Date filed: April 14, 1995 Abstract: The invention relates to the family of the protein (PAP) associated with acute pancreatitis in man and in the rat. It also relates to the nucleotide fragments coding for the above proteins. Also included in the framework of the invention are antibodies which recognize the PAP and which are capable of being used for the purpose of diagnosing pancreatitis. The invention also relates to the production of the PAP, in particular by genetic engineering. Excerpt(s): The present invention relates to proteins associated with acute pancreatitis and agents for the diagnosis of this disease. ... Acute pancreatitis is an inflammatory disease of the pancreas which, pathologically speaking, extends from the simple edematous form to the complete hemorrhagic necrosis of the gland. Necro-hemorrhagic pancreatitis is a very serious disease since, depending on the authors, its mortality is estimated to vary from 30 to 70%. In certain cases it is very difficult to establish the diagnosis of acute pancreatitis with certainty (Sarner, M. et al, Gastroenterol. (1984), 13: 865-870). This diagnosis is based in particular on clinical examination (acute abdominal pain), on the determination of a certain number of substances in the plasma or in the peritoneal fluid (Bradley, J. et al., Br. J. Surg. (1981), 68: 245-246; and Dubick, M. et al., Dig. Dis. Sci. (1987), 32: 305-312). The analytical determinations employed include those for amylase, lipase, trypsin, elastase, ribonuclease, phospholipase A2, .alpha.-2 macroglobulin, calcium, LDH, protease inhibitors and others. However, none of them has proved to be specific, practical or above all, discriminating. Hence, it is usually considered sufficient to determine amylasemia. Recently, ultrasonography and computerized tomography have appeared to be
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able to facilitate the diagnosis of pancreatitis without, however, decisive progress being made (Silverstein, W. et al., Am. J. Roentgenol., (1981), 137: 497-502). ... In 1984, Keim et al. published (Digestion, (1984), 29: 242249) results of the consequences of cannulation of the pancreatic duct and the induction of pancreatitis on the protein composition of the pancreatic juice in the rat, this animal being used an experimental model. After the operation of cannulation (1 to 2 days later), the authors observed a fall in the level of amylase in the pancreatic juice followed, 3 to 4 days after the operation, by a return to the normal amylase level. Web site: http://www.delphion.com/details?pn=US05959086__ ·
Method for decreasing severity of acute and chronic pancreatitis Inventor(s): Norman, Jr.; James G. (Tampa, FL) Assignee(s): University of South Florida (Tampa, FL) Patent Number: 5,919,444 Date filed: February 20, 1996 Abstract: A method for treating acute or chronic pancreatitis comprising administering an effective amount of an Interleukin-1 (IL-1) block to antagonize IL-1 production, and in one embodiment by inhibiting IL-1 production at the source, or a pharmaceutically acceptable salt thereof to a person who has pancreatitis. One such IL-1 block is an Interleukin-1 converting enzyme (ICE) antagonist. Excerpt(s): The present invention relates to a method for treating acute and chronic pancreatitis. ... Acute pancreatitis is a common clinical problem which remains evasive of specific therapy (Leach et al., 1992). Each year more than 210,000 admissions to U.S. hospitals are caused by acute pancreatitis while another 150,000 are due to chronic pancreatitis. Pancreatitis is most often caused by alcoholism or biliary tract disease. Less commonly, it is associated with hyperlipemia, hyperparathyroidism, abdominal trauma, vasculitis or uremia. The average length of hospitalization for the acute disease is 12.4 days, with a significant number of patients staying much longer because of associated complications. ... Chronic ethanol abuse is the most common cause of acute and chronic pancreatitis in the West, yet the pathophysiology of this disease remains poorly understood (Steinberg and Tenner, 1994). There are few medical therapies or pharmacologic agents currently available which have been shown to decrease the severity, duration, complication rate, or mortality for this common disease. Care for these patients, regardless of the etiology, remains primarily supportive, with attention directed towards maintaining an adequate circulating blood
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volume, supporting renal and respiratory systems, and providing adequate nutrition. This lack of specific therapy has prompted a great number of prospective trials during the past two decades in hopes of finding some way to decrease the progression and severity of this disease. To date, specific therapy remains unknown and a search for new, more effective modalities is necessary. Web site: http://www.delphion.com/details?pn=US05919444__ ·
Pancreatitis remedy Inventor(s): Okamura; Yuko (Sunto-gun, JP), Shimada; Junichi (Suntogun, JP), Noji; Toru (Sunto-gun, JP), Katagiri; Chikako (Sunto-gun, JP), Karasawa; Akira (Sunto-gun, JP) Assignee(s): Kyowa Hakko Kogyo Co., Ltd. (Tokyo, JP) Patent Number: 5,866,574 Date filed: April 8, 1998 Abstract: The present invention relates to a prophylactic agent or a therapeutic agent of pancreatitis, containing an adenosine uptake inhibitor or a pharmaceutically acceptable salt thereof. Excerpt(s): The present invention relates to a prophylactic agent of pancreatitis or a therapeutic agent thereof. ... Pancreatitis is a disease of which the onset is triggered by activation of pancreatic enzymes in pancreas, so that pancreas is auto-digested by activated pancreatic enzymes. As therapeutic agents of pancreatitis, use is made of for example gastric acid secretion suppressing agents, proteinase inhibiting agents, analgesics and anti-spasmodics, antibiotics and the like (Practice of Gastro-Intestinal Diagnostics 6, edited by Tadahiko Kozu, chief editor, Bunkodo, Tokyo, 1993). ... More specifically, histamine H.sub.2 receptor antagonists (blockers) including cimetidine, ranitidine, famotidine and the like are used as gastric acid secretion suppressing agents (Therapeutic Medicine Guide, '96 edition, edited by Medical Practice Editorial Committee, Bunkodo, Tokyo, 1996). Proteinase inhibiting agents include high-molecular urinastatin extracted from human urine and gabexate mesilate and nafamostat mesilate as lower molecular synthetic products ›Mebio, 13(6), 74-80 (1996)!. As the analgesics and anti-spasmodics, use is made of non-steroidal, anti-inflammatory analgesics (indomethacin) and non-opioid analgesics (pentazocine). As the antibiotics, use is made of penicillin-series antibiotics with wide spectrum (piperacillin), and cefemseries antibiotics of first and second generations (cefazolin and cefmetazole) (Practice of Gastro-Intestinal Diagnostics 6, edited by Tadahiko Kozu, chief editor, Bunkodo, 1993). However, the
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pharmacological effects of any of these pharmaceutical agents are not sufficient. Thus, more excellent prophylactic or therapeutic agents of pancreatitis have been needed. Web site: http://www.delphion.com/details?pn=US05866574__ ·
Detection of pancreatitis-associated protein for screening for cystic fibrosis Inventor(s): Iovanna; Juan-Lucio (Marseilles, FR), Dagorn; Jean-Charles (Marseilles, FR), Keim; Volker (Heddesheim, DE), Sarles; Jacques (Gemenos, FR) Assignee(s): Institut National de la Sante et de la Recherche Medicale (Paris, FR) Patent Number: 5,834,214 Date filed: August 30, 1995 Abstract: The invention relates to in vitro detection of human pancreatitis-associated protein (hPAP) for the purpose of screening for cystic fibrosis. hPAP is quantitated in a biological sample, preferably blood, and a high value is indicative of pancreatic dysfunction. Immunoassays as rapid, reliable methods for hPAP quantitation are provided as are antibodies for use in the assays and hybridomas for production of monoclonal antibodies preferred for use in the assays. Excerpt(s): The human pancreatitis-associated protein (PAP) was isolated, purified and characterized in man and described in the PCT patent application published on 31 Oct. 1991 under the No 91/16428. In the earlier application the PAP was suggested as a means for the detection of a specific disease, acute pancreatitis. ... The object of the present application is the detection of mucoviscidosis or of a mutation in the gene responsible for mucoviscidosis associated with a pancreatic disease by means of a determination of the PAP (pancreatitis-associated protein). ... The inventors have observed that in a disease such as mucoviscidosis, which is not necessarily associated, in particular in the infant, with an acute pancreatitis even in the case of pancreatic insufficiency, a significant, even considerable increase of the PAP level is noted compared with the normal value. This increase may be 2 to 3 times the normal value, and up to 100 times this value. The normal value is determined by reference to the median as defined below. Web site: http://www.delphion.com/details?pn=US05834214__
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·
Treatment and prophylaxis of pancreatitis Inventor(s): Fujiwara; Toshihiko (Ebina, JP), Horikoshi; Hiroyoshi (Funabashi, JP), Fukami; Masaharu (Yokohama, JP) Assignee(s): Sankyo Company, Limited (Tokyo, JP) Patent Number: 5,753,681 Date filed: March 17, 1997 Abstract: Insulin sensitizers, especially thiazolidinedione compounds, such as troglitazone, are useful for the treatment and prevention of pancreatitis. Excerpt(s): The present invention relates to a new use for a series of known compounds, including thiazolidinedione compounds, oxazolidinedione compounds, isoxazolidinedione compounds and oxadiazolidinedione compounds, in the treatment and prophylaxis of pancreatitis. ... Pancreatitis is commonly classified roughly as either acute pancreatitis or chronic pancreatitis depending on whether or not the condition persists after removal of the etiological agent. Except where the context otherwise requires, the term "pancreatitis", as used herein, includes both acute pancreatitis and chronic pancreatitis. ... Probably about 40% of cases of acute pancreatitis may be attributed to alcohol abuse. Other causes include idiopathic, cholelithiasis, overeating and traumatic origins. The top three causes account for 70 to 80% of this disease. Web site: http://www.delphion.com/details?pn=US05753681__
·
Decreased mortality of severe acute pancreatitis following proximal cytokine blockade Inventor(s): Norman, Jr.; James G. (Tampa, FL) Assignee(s): University of South Florida (Tampa, FL) Patent Number: 5,723,116 Date filed: January 6, 1995 Abstract: A method for treating acute pancreatitis is disclosed. The method comprises administering to a patient with acute pancreatitis an effective amount of a suitable tumor necrosis factor (TNF) antagonist such as a TNF soluble receptor or a pharmaceutically acceptable salt thereof. Excerpt(s): The present invention relates to a method for treating acute pancreatitis. ... Acute pancreatitis is a common clinical problem which
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remains evasive of specific therapy (Leach et al., 1992). Each year more than 210,000 admissions to U.S. hospitals are caused by acute pancreatitis. It is most often caused by alcoholism or biliary tract disease. Less commonly, it is associated with hyperlipemia, hyperparathyroidism, abdominal trauma, vasculitis or uremia. The average length of hospitalization for the disease is 12.4 days, with a significant number of patients staying much longer because of associated complications. ... Chronic ethanol abuse is the most common cause of acute and chronic pancreatitis in the West, yet the pathophysiology of this disease remains poorly understood (Steinberg and Tenner, 1994). There are few medical therapies or pharmacologic agents currently available which have been shown to decrease the severity, duration, complication rate, or mortality for this common disease. Care for these patients, regardless of the etiology, remains primarily supportive, with attention directed towards maintaining an adequate circulating blood volume, supporting renal and respiratory systems, and providing adequate nutrition. This lack of specific therapy has prompted a great number of prospective trials during the past two decades in hopes of finding some way to decrease the progression and severity of this disease. To date, specific therapy remains unknown and a search for new, more effective modalities is necessary. The overall mortality for acute pancreatitis varies between 6 and 18% and can raise as high as 50% in the more fulminant form (Steinberg and Tenner, 1994; Imrie and Whyte, 1975; Jacobs et al., 1977). Interestingly, the prognosis for this disease appears more dependent upon its systemic manifestations and complications than upon the severity of the local pancreatic inflammation (Imrie and Whyte, 1975; Jacobs et al., 1977). In fact, as many as 60% of deaths from acute pancreatitis which occur within one week of onset can be attributed to adult respiratory distress syndrome (ARDS), which cannot be distinguished from sepsis-associated ARDS (Steinberg and Tenner, 1994; Jacobs et al., 1977). Web site: http://www.delphion.com/details?pn=US05723116__ ·
Bradykinin-antagonists for the treatment of acute pancreatitis Inventor(s): Griesbacher; Thomas (Hitzendorf, AT), Lembeck; Fred (Graz, AT) Assignee(s): Hoechst Aktiengesellschaft (Frankfurt am Main, DE) Patent Number: 5,670,619 Date filed: April 22, 1994
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Abstract: The invention relates to the use of bradykinin-antagonists of the formulaR.sup.1 -A-B-C-E-F-G-J-K-R.sup.2wherein R.sup.1 represents hydrogen, C.sub.1 -C.sub.4 -alkanoyl which can be substituted by mercapto, hydroxyphenyl, (4-benzoyl)phenoxy or represents (4benzoyl)benzoyl-Lys; A represents D-Arg or D-Lys or stands for a direct bond; B represents Arg which can be substituted by NO.sub.2 or toluol-4sulfonyl or represents Lys which can be substituted by toluol-4-sulfonyl or CO--NH--C.sub.6 H.sub.5, or stands for a direct bond; C represents Hyp-Pro-Gly, Pro-Hyp-Gly, Pro-Pro-Gly or dehydroPro-Hyp-Gly; E represents Thi, Phe, Leu or Cha; F represents Ser or Cys; G represents DTic, D-Phe or D-Hyp substituted by C.sub.1 -C.sub.4 -alkoxy; J represents Tic, Aoc or Oic; K represents Arg or Ahx or stands for a direct bond; R.sup.2 is hydroxy or amino; and the physiologically tolerable salts thereof for the treatments of acute pancreatitis, to pharmaceutical agents containing them and to the use thereof for the preparation of appropriate pharmaceutical compositions. Excerpt(s): The invention relates to the use of bradykinin-antagonists or the physiologically tolerated salts thereof for the treatments of acute pancreatitis, to pharmaceutical agents containing them and to the use thereof for the preparation of appropriate pharmaceutical compositions. ... Bradykinin has long been thought to participate in acute pancreatitis. In 1989 however, Berg et. al. have defeated this hypothesis. Berg et al. have demonstrated (The Journal of Pharmacology and Experimental Therapeutics, Vol. 251, No. 2 (1989) p. 731-734) that hypotension caused by development of acute pancreatitis in rats was not influenced by DArg.sup.0 -Hyp.sup.3 -Thi.sup.5.8 -D-Phe.sup.7 -BK (D-Arg-Arg-ProHyp-Gly-Thi-Ser-D-Phe-Thi-Arg). ... The peptides of the formula I are useful in the treatment of acute pancreatitis which is characterized by a massive oedema of the gland and the retroperitoneal tissue, interstitial activation of proteolytic enzymes, elevation of serum amylase and lipase levels, hypovolaemia, hypoalbuminaemia, pulmonary oedema and severe pain. Web site: http://www.delphion.com/details?pn=US05670619__ ·
Interleukin-1 pancreatitis
receptor
antagonist
decreases
Inventor(s): Norman, Jr.; James G. (Tampa, FL) Assignee(s): University of South Florida (Tampa, FL) Patent Number: 5,508,262 Date filed: December 15, 1993
severity
of
acute
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Abstract: A method for treating acute pancreatitis comprising administering an effective amount of Interleukin-1 receptor antagonist (IL-1ra) or a pharmaceutically acceptable salt thereof to a person afflicted with that condition. Excerpt(s): The present invention relates to a method for treating acute pancreatitis. ... Acute pancreatitis is a common clinical problem which remains evasive of specific therapy..sup.1 Each year more than 15,000 admissions to U.S. hospitals are caused by acute pancreatitis. It is most often caused by alcoholism or biliary tract disease. Less commonly, it is associated with hyperlipemia, hyperparathyroidism, abdominal trauma, vasculitis or uremia. The average length of hospitalization for the disease is 12.4 days, with a significant number of patients staying much longer because of associated complications. ... With more recent understanding of the complex mechanisms of tissue and cellular injury associated with inflammatory processes, such as sepsis,.sup.5 it is reasonable to assume that many of these inflammatory processes are not specific to sepsis syndromes alone. Several authors have suggested that much of the intrinsic pancreatic damage seen in acute pancreatitis is due to the release of toxic substances from macrophages and other white blood cells which migrate into the damaged gland..sup.6,7,8,9,10,11,12 These substances are known as cytokines and are now well known as mediators of inflammation and tissue injury. Web site: http://www.delphion.com/details?pn=US05508262__ ·
Protein associated with acute pancreatitis agents for the screening of acute pancreatitis Inventor(s): Iovanna; Juan-Lucio (Marseille, FR), Volker; Keim (Heddesheim, FR), Dagorn; Jean-Charles (Marseille, FR) Assignee(s): Institut National de la Sante et de la Recherche Medicale (Paris Cedex, FR) Patent Number: 5,436,169 Date filed: December 19, 1991 Abstract: The invention relates to the family of the protein (PAP) associated with acute pancreatitis in man and in the rat. It also relates to the nucleotide fragments coding for the above proteins.Also included in the framework of the invention are antibodies which recognize the PAP and which are capable of being used for the purpose of diagnosing pancreatitis.The invention also relates to the production of the PAP, in particular by genetic engineering.
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Excerpt(s): The present invention relates to proteins associated with acute pancreatitis and agents for the diagnosis of this disease. ... Acute pancreatitis is an inflammatory disease of the pancreas which, pathologically speaking, extends from the simple edematous form to the complete hemorrhagic necrosis of the gland. Necrohemorrhagic hepatitis is a very serious disease since, depending on the authors, its mortality is estimated to vary from 30 to 70%. In certain cases it is very difficult to establish the diagnosis of acute pancreatitis with certainty (Sarner, M. et al, Gastroenterol. (1984), 13: 865-870). This diagnosis is based in particular on clinical examination (acute abdominal pain), on the determination of a certain number of substances in the plasma or in the peritoneal fluid (Bradley, J. et al., Br. J. Surg. (1981), 68: 245-246; and Dubick, M. et al., Dig. Dis. Sci. (1987), 32: 305-312). The analytical determinations employed include those for amylase, lipase, trypsin, elastase, ribonuclease, phospholipase A2, .alpha.-2 macroglobulin, calcium, LDH, protease inhibitors and others. However, none of them has proved to be specific, practical or above all, discriminating. Hence, it is usually considered sufficient to determine amylasemia. Recently, ultrasonography and computerized tomography have appeared to be able to facilitate the diagnosis of pancreatitis without, however, decisive progress being made (Silverstein, W. et al., Am. J. Roentgenol., (1981), 137: 497-502). ... In 1984, Keim et al. published (Digestion, (1984), 29: 242-249) results of the consequences of cannulation of the pancreatic duct and the induction of pancreatitis on the protein composition of the pancreatic juice in the rat, this animal being used as an experimental model. After the operation of cannulation (1 to 2 days later), the authors observed a fall in the level of amylase in the pancreatic juice followed, 3 to 4 days after the operation, by a return to the normal amylase level. Web site: http://www.delphion.com/details?pn=US05436169__ ·
S-adenosyl-methionine in the treatment of pancreatitis and of the immuno rejection in the pancreas transplant Inventor(s): Braganza; Joan M. (Sale, GB), Hutchinson; Ian V. (Stockport, GB) Assignee(s): Bioresearch S.p.A. (Milan, IT) Patent Number: 5,196,402 Date filed: August 15, 1990 Abstract: Therapeutic composition comprising S-adenosyl-methionine useful in the treatment of pancreatitis and as synergistic agent of cyclosporin in the prevention of the graft rejection in pancreas transplant.
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Excerpt(s): This invention relates to therapeutic compositions and method for the treatment of pancreatitis and in particular for the immuno-suppressive treatment of the graft rejection after pancreas transplant. ... Pancreatitis is a painful condition which may resolve spontaneously or may kill the sufferer from haemorrhagic necrosis or cause recurrent pain from chronic destruction of the gland. There is no specific treatment for it. ... We now have found, surprisingly, that the compound S-adenosylmethionine has valuable properties in the treatment of pancreatitis and as synergizing agent of the immunosuppressive effect of cyclosporine in combating graft rejection after the pancreas transplant. Web site: http://www.delphion.com/details?pn=US05196402__ ·
Method of treating acute pancreatitis with isometheptene Inventor(s): Marlettini; Maria G. (Bologna, IT), DeNovellis; Michelangelo (Bologna, IT), Labriola; Ernesto (Bologna, IT), Salomone; Teresa (Bologna, IT), Tomassetti; Paola (Bologna, IT) Assignee(s): Knoll AG (DE) Patent Number: 4,522,827 Date filed: July 2, 1982 Abstract: A method of relieving the symptoms of acute pancreatitis comprising administering Isometheptene to a person afflicted with that condition. Excerpt(s): This invention relates to a method for relieving symptoms of acute pancreatitis in mammals. More particularly, the invention concerns a method for treating persons afflicted with acute pancreatitis by administering to such a person a sufficient amount of Isometheptene to effectively relieve symptoms of that disease. ... Acute pancreatitis causes pathologic changes in the pancreas ranging from a mild edematous process to an overwhelming necrotizing lesion which may be lifethreatening. While its symptoms are variable it is principally characterized by epigastric pain radiating to either the upper quadrant or directly through to the back. The typical pain is gnawing, of sudden onset, of exceeding severity, unremitting, and sometimes colicky in character. It is not relieved by vomiting and is little affected by morphine, for example. Patients with this condition are also commonly found to have persistent high amylase in the blood and urine and frequently develop shock due to circulating vasoactive substances or retroperitoneal hemorrhage. ... Accordingly, it is an object of this invention to provide a treatment for acute pancreatitis which is effective in relieving its
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symptoms and in managing the patient's condition until a state of relative normalcy is obtained. This and other objects of the invention are attained by administering to a patient afflicted with acute pancreatitis an effective amount of Isometheptene to alleviate symptoms of that disease, especially by relieving the attendant pain and inhibiting pancreatic secretions. In one embodiment of the invention, the intended result is accomplished by an initial infusion of Isometheptene at a dosage level of 0.9-2.5 grams per twenty-four (24) hours until the symptoms are substantially diminished, followed by an oral maintenance dosage of 0.15 grams every six (6) hours for about ten (10) to fifteen (15) days. Web site: http://www.delphion.com/details?pn=US04522827__ ·
Method for the treatment of calcifying pancreatitis Inventor(s): Noda; Aiji (204-402, No. 2-3, Fujiyamadai 2-chome, Kasugaishi, Aichi-ken, JP) Assignee(s): none reported Patent Number: 4,517,309 Date filed: February 1, 1984 Abstract: Method for the treatment of calcifying pancreatitis which comprises administering an effective amount of trimethadione or dimethadione to a patient suffering from calcifying pancreatitis, by which pancreatic stones are effectively dissolved out. Excerpt(s): The present invention relates to a method for the treatment of calcifying pancreatitis. More particularly, it relates to a method for the treatment of calcifying pancreatitis comprising administering an effective amount of trimethadione (i.e. 3,5,5-trimethyloxazolidine-2,4-dione) or dimethadione (i.e. 5,5-dimethyloxazolidine-2,4-dione) to patients suffering from calcifying pancreatitis. ... Calcifying pancreatitis is usually initiated by formation of protein plugs within the pancreatic ducts, followed by precipitation of calcium carbonate (pancreatic stones). The stones are usually produced during the course of chronic pancreatitis, particularly alcoholic chronic pancreatitis, and advance inflammation of the gland, which results in gradual and irreversible lowering of the pancreatic endocrine and exocrine functions. Moreover, they frequently cause abdominal colicky pain and occasionally induce various complications including pancreatic cyst, abscess, and diabetes, for which surgical interventions and insuline therapy are inevitably required. ... In alcoholic calcifying pancreatitis, the stone is relatively small, usually less than 5 mm in diameter on abdominal plain X-ray film. In idiopathic or hereditary calcifying pancreatitis, on the other hand, the stone is
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generally a larger one. In both types of calcifying pancreatitis, distribution of the stone in the gland is diffused in more than half of the patients. Web site: http://www.delphion.com/details?pn=US04517309__
Patent Applications on Pancreatitis As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to pancreatitis: ·
Methods and Compositions for the Treatment of Pancreatitis Inventor(s): SACHS, GEORGE ; (ENCINO, CA), AOKI, KEI ROGER ; (COTO DE CAZA, CA) Correspondence: ALLERGAN INC; 2525 DUPONT DRIVE; IRVINE; CA; 92612 Patent Application Number: 20010018049 Date filed: April 8, 1999 Abstract: Methods and compositions for the treatment of acute pancreatitis in a mammal. Particular compositions comprise a binding element, a translocation element, and a therapeutic element able to prevent accumulation of digestive enzymes within the pancreas. Excerpt(s): The present invention includes methods and compositions for the treatment of acute pancreatitis. In a preferred embodiment the invention concerns the use of agents to reduce or prevent the secretion of pancreatic digestive enzymes within the pancreas. Such agents are targeted to pancreatic cells, and serve to prevent the exocytotic fusion of vesicles containing these enzymes with the plasma membrane. The invention is also concerned with methods of treating a mammal suffering from pancreatitis through the administration of such agents. ... Pancreatitis is a serious medical condition involving an inflammation of the pancreas. In acute or chronic pancreatitis the inflammation manifests itself in the release and activation of pancreatic enzymes within the organ itself, leading to autodigestion. In many cases of acute pancreatitis, the condition can lead to death. ... Pancreatitis can occur when an excess amount of trypsin saturates the supply of trypsin inhibitor. This, in turn, can be caused by underproduction of trypsin inhibitor, or the
24
This has been a common practice outside the United States prior to December 2000.
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overabundance of trypsin within the cells or ducts of the pancreas. In the latter case, pancreatic trauma or blockage of a duct can lead to localized overabundance of trypsin; under acute conditions large amounts of pancreatic zymogen secretion can pool in the damaged areas of the pancreas. If even a small amount of free trypsin is available activation of all the zymogenic proteases rapidly occurs, and can lead to digestion of the pancreas (acute pancreatitis) and in particularly severe cases to the patient's death. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with pancreatitis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “pancreatitis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on pancreatitis. You can also use this procedure to view pending patent applications concerning pancreatitis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal
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vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Cefazolin: Semisynthetic cephalosporin analog with broad-spectrum antibiotic action due to inhibition of bacterial cell wall synthesis. It attains high serum levels and is excreted quickly via the urine. [NIH] Cefmetazole: A semisynthetic cephamycin antibiotic with a broad spectrum of activity against both gram-positive and gram-negative microorganisms. It has a high rate of efficacy in many types of infection and to date no severe side effects have been noted. [NIH] Cholelithiasis: The presence or formation of gallstones. [EU] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Dimethadione: An anticonvulsant that is the active metabolite of trimethadione. [NIH] Epigastric: Pertaining to the epigastrium. [EU] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH]
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Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Hypovolaemia: Abnormally decreased volume of circulating fluid (plasma) in the body. [EU] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU]
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Piperacillin: Semisynthetic, broad-spectrum, ampicillin-derived ureidopenicillin antibiotic proposed for Pseudomonas infections. It is also used in combination with other antibiotics. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Precipitation: The act or process of precipitating. [EU] Preeclampsia: A condition that some women with diabetes have during the late stages of pregnancy. Two signs of this condition are high blood pressure and swelling because the body cells are holding extra water. [NIH] Prophylaxis: The prevention of disease; preventive treatment. [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rhinitis: Inflammation of the mucous membrane of the nose. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Spasmodic: Of the nature of a spasm. [EU] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vasculitis: Inflammation of a vessel, angiitis. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU]
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CHAPTER 6. BOOKS ON PANCREATITIS Overview This chapter provides bibliographic book references relating to pancreatitis. You have many options to locate books on pancreatitis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on pancreatitis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “pancreatitis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on pancreatitis:
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·
Pediatric Gastrointestinal Disease. 2nd ed Source: Philadelphia, PA: W.B. Saunders Company. 1999. 823 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 11830 Westline Industrial Drive, Saint Louis, MO 63146-9988. (800) 545-2522 or (314) 453-7010. Fax (800) 568-5136 or (314) 453-7095. E-mail:
[email protected]. Website: customerservice.wbsaunders.com. PRICE: $155.00 plus shipping and handling. ISBN: 0721674615. Summary: This medical textbook covers all facets of clinical pediatric gastrointestinal disease. The text emphasizes a clinical focus and incorporates anatomy and physiology considerations into each chapter rather than a separate section. The book is organized into distinct sections, starting with the common clinical problems and followed by organ specific diseases. General chapters on clinical problems cover chronic abdominal pain of childhood and adolescence, vomiting, diarrhea, constipation and encopresis (fecal soiling), failure to thrive, gastrointestinal hemorrhage, eating disorders and obesity, jaundice, ascites, caustic ingestion and foreign bodies, abdominal masses in pediatric patients, and abdominal surgical emergencies. Sections on diseases of the esophagus, stomach, and the small and large bowel (intestine) are followed by chapters reviewing the clinical facets of pediatric liver disease. Specific chapters include gastrointestinal reflux, achalasia and other motor disorders, congenital anomalies, gastric motility disorders, bezoars (a mass of food, hair or other components found in the stomach or intestine), maldigestion and malabsorption, celiac disease, short bowel syndrome, enteric parasites, Crohn's disease, ulcerative colitis, polyps, appendicitis, hernia, Hirschsprung's disease, neoplasms (cancerous and noncancerous), hepatitis, gallbladder diseases, and liver transplantation. The last two sections review diseases of the pancreas and basic nutrition in children, including pancreatitis, cystic fibrosis, nutritional assessment, parenteral (outside the digestive system, for example, intravenous nutrition) and enteral nutrition, and the management of diarrhea. Each chapter offers black and white photographs and figures and concludes with extensive references. A detailed subject index concludes the text.
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Clinical Practice of Gastroenterology. Volume Two Source: Philadelphia, PA: Current Medicine. 1999. 861 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00
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plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: This lengthy textbook brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This second volume includes 113 chapters in five sections: liver, gallbladder and biliary tract, pancreas, pediatric gastroenterology, and special topics. Specific topics include hepatic (liver) structure and function, jaundice, viral hepatitis, alcoholic liver injury, liver tumors, parasitic diseases of the liver, Wilson's disease, hemochromatosis, the pregnancy patient with liver disease, portal hypertension, hepatic encephalopathy, fulminant hepatic failure, liver transplantation, the anatomy of the gallbladder and biliary tract, gallstones, laparoscopic cholecystectomy (gallbladder removal), cholecystitis (gallbladder infection), primary sclerosing cholangitis, biliary obstruction, pancreatic anatomy and physiology, acute pancreatitis, pancreatic fistulas and ascites (fluid accumulation), chronic pancreatitis, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, esophageal atresia, gastroesophageal reflux in infants and children, achalasia and esophageal motility disorders, caustic and foreign body ingestion, vomiting, chronic abdominal pain, gastritis and peptic ulcer disease in children, malabsorption syndromes in children, inflammatory bowel disease in children and adolescents, acute appendicitis, cystic fibrosis, constipation and fecal soiling (incontinence), hepatitis in children, liver transplantation in children, failure to thrive, pediatric AIDS, the gastrointestinal manifestations of AIDS, the evaluation and management of acute upper gastrointestinal bleeding, principles of endoscopy, eating disorders, nutritional assessment, enteral and parenteral nutrition, gastrointestinal diseases in the elderly and in pregnancy, nosocomial infections, and the psychosocial aspects of gastroenterology (doctor patient interactions). The chapters include figures, algorithms, charts, graphs, radiographs, endoscopic pictures, intraoperative photographs, photomicrographs, tables, and extensive references. The volume concludes with a detailed subject index and a section of color plates. ·
Evidence Based Gastroenterology and Hepatology Source: London, UK: BMJ Publishing Group. 1999. 557 p. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. Email:
[email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. ISBN: 0727911821. Summary: This book emphasizes the approaches of evidence based medicine in gastroenterology (the study of the gastrointestinal tract and
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gastrointestinal diseases) and hepatology (the study of the liver and liver diseases). The authors use clinical epidemiology to present the strongest and most current evidence for interventions for the major diseases of the gastrointestinal tract and liver. Thirty chapters are included: an introduction to evidence based gastroenterology and hepatology; gastroesophageal reflux disease (GERD); ulcer disease and Helicobacter pylori; ulcer disease and nonsteroidal antiinflammatory drugs; treatment options for non-variceal gastrointestinal hemorrhage; the diagnosis and treatment of functional dyspepsia (indigestion); the diagnosis, treatment, and prognosis of celiac disease (gluten intolerance); the treatment of Crohn's disease; the diagnosis, prognosis, and treatment of ulcerative colitis (UC); pouchitis after restorative proctocolectomy; metabolic bone disease in gastrointestinal disorders; colorectal cancer in UC and the role of surveillance; population based screening and surveillance for colorectal cancer; irritable bowel syndrome (IBS); the surgical treatment of gallstone disease; the prognosis and treatment of acute pancreatitis; hepatitis C; hepatitis B; the screening and treatment of alcoholic liver disease; hemochromatosis and Wilson disease; primary biliary cirrhosis (PBC); autoimmune hepatitis; primary sclerosing cholangitis (PSC); the prevention and treatment of portal hypertensive bleeding; ascites, hepatorenal syndrome, and spontaneous bacterial peritonitis; hepatic encephalopathy; hepatocellular carcinoma; fulminant hepatic failure; the prevention and treatment of rejection after liver transplantation; and the prevention and treatment of infection after liver transplantation. Each chapter features the grading of recommendations and levels of evidence used by the authors to note the research basis on which their clinical guidelines are formed. Chapters conclude with extensive reference lists; the text concludes with a subject index. A glossary of acronyms is also provided. ·
Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 8: Pancreas Source: Philadelphia, PA: Current Medicine. 1998. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 5742270. E-mail:
[email protected]. Website: current-medicine.com. PRICE: $125.00 plus shipping and handling. ISBN: 0443078629. Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 10 chapters on the pancreas. Topics covered include neurohormonal control of the pancreas, pathogenesis of pancreatic
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diseases, acute pancreatitis, chronic pancreatitis, surgery for chronic pancreatitis, developmental anomalies of the pancreas, pancreatic cancer, the rationale and application of radioligand imaging in gastroenterology, cystic fibrosis, and hereditary pancreatitis. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively. A subject index concludes the volume. ·
Gastrointestinal and Hepatobiliary Pathophysiology Source: Madison, CT: Fence Creek Publishing. 1998. 475 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Malden, MA 02148. (800) 215-1000 or (781) 388-8250. Fax (781) 388-8270. E-mail:
[email protected]. Website: www.blackwellscience.com. PRICE: $27.95 plus shipping and handling. ISBN: 1889325015. Summary: This book on gastrointestinal and hepatobiliary pathophysiology is one from a series designed to meet the second and third year medical students' needs for a concise but comprehensive resource that focuses on organ system pathophysiology. The test covers the pathogenesis, diagnosis, treatment, and management of common diseases, using a format that includes one or more clinical cases integrated throughout the chapters to foster direct application of clinical problem solving skills; extensive use of margin notes that concisely highlight important concepts, define key terms, and pinpoint clinical correlations; questions at the end of each chapter, using the NBME format, that offer a means for accurate self assessment; and wide margins to accommodate note taking by students as they study. Thirty chapters cover an overview of gastrointestinal and hepatobiliary function; regulation of the digestive system; the anatomy, histology, and embryology of the gastrointestinal tract; an overview of gastrointestinal motility; gastrointestinal electrolyte and fluid secretion; digestion and absorption; management of water and electrolytes; liver anatomy and physiology; liver metabolism, physiology of bile formation, and gallstones; normal and disordered swallowing; peptic ulcer disease; small bowel disorders; acute and chronic pancreatitis; functional bowel disorders; the mucosal immune system; inflammatory bowel disease; infectious disorders of the gastrointestinal tract; viral hepatitis; hereditary liver disease; autoimmune liver disease; pathogenesis and consequences of portal hypertension; disorders of cholestasis, bilirubin metabolism, and jaundice; orthotopic liver transplantation; alcohol and the gastrointestinal tract; the pathophysiology of abdominal pain and pain syndromes; gastrointestinal disorders in pregnancy; the molecular biology of gastrointestinal malignancies and overview of neoplasms of the
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gastrointestinal tract; pharmacology; principles of nutritional support in the gastrointestinal patient; and gastrointestinal bleeding. A subject index concludes the textbook. ·
Alcohol and the Gastrointestinal Tract Source: Boca Raton, FL: CRC Press. 1996. 347 p. Contact: Available from CRC Press. 2000 Corporate Boulevard NW., Boca Raton, FL 33431. (800) 272-7737 or (561) 994-0555. Fax (800) 374-3401. Email:
[email protected]. Website: http://www.crcpress.com. PRICE: $179.00. ISBN: 0849324807. Summary: This medical text considers alcohol and the gastrointestinal tract. The topics include the metabolism of alcohol and its implications for the pathogenesis of disease; endocrine changes in alcoholism with special reference to GI hormones; the effects of ethanol on salivary glands; alcoholic pancreatitis; small bowel injury by ethanol; alcoholinduced malabsorption in the GI tract; alcohol and small intestinal permeability; GI motility disorders induced by ethanol; lipid metabolism in the intestinal tract and its modification by ethanol; alcohol's promotion of GI carcinogenesis; and objectives for future research in understanding the effects of ethanol on the GI tract. A subject index concludes the book.
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Pediatric Clinical Gastroenterology. 4th ed Source: St. Louis, MO: Mosby-Year Book, Inc. 1995. 1065 p. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive. St. Louis, MO 63146. (800) 426-4545 or (800) 325-4177 or (314) 8728370. Fax (314) 432-1380. PRICE: $100 (as of 1995). ISBN: 0815174063. Summary: This textbook of pediatric clinical gastroenterology presents 37 chapters in 5 sections: symptoms and signs; diseases of the gastrointestinal tract; diseases of the liver; diseases of the pancreas; and nutritional support. Specific topics include gastrointestinal (GI) emergencies of the neonate; intestinal obstruction; sucking and swallowing disorders; diseases of the esophagus; disorders of the stomach and duodenum; diarrheal disorders; carbohydrate intolerance; malabsorption syndrome; protein losing gastroenteropathy; immune homeostasis and the gut; inflammatory bowel diseases; constipation, fecal incontinence, and proctologic conditions; functional recurrent abdominal pain; parasitic and fungal disease of the GI tract; neonatal unconjugated hyperbilirubinemias; neonatal hepatitis; prolonged obstructive jaundice; acute and chronic viral hepatitis; bacterial, rickettsial, and parasitic infections and infestations; fulminant hepatic failure and hepatic coma; cirrhosis; portal hypertension; inborn errors of
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metabolism; hepatic tumors; liver transplantation; congenital anomalies and heredity disorders; cystic fibrosis; pancreatitis and pancreatic tumors; energy and nutrient requirements; infant feeding; and enteral and parenteral alimentation. Each chapter includes numerous references and a subject index concludes the volume.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to pancreatitis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
A Primer of Pancreatitis by Paul Georg Lankisch (Editor), et al (1997); ISBN: 354063259X; http://www.amazon.com/exec/obidos/ASIN/354063259X/icongroupi nterna
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Acute Pancreatitis by G. Glazer (1988); ISBN: 0702012483; http://www.amazon.com/exec/obidos/ASIN/0702012483/icongroupin terna
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Acute pancreatitis : research and clinical management ; ISBN: 0387175342; http://www.amazon.com/exec/obidos/ASIN/0387175342/icongroupin terna
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Acute Pancreatitis, Part I (1993); ISBN: 094581223X; http://www.amazon.com/exec/obidos/ASIN/094581223X/icongroupi nterna
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Acute Pancreatitis: An Interdisciplinary Synopsis by L. F. Hollender (1983); ISBN: 0806708417; http://www.amazon.com/exec/obidos/ASIN/0806708417/icongroupin terna
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Acute Pancreatitis: An Overview (Critical Care Nurse) by Susan L. Smith, Rebecca Wills Butler (1993); ISBN: 0840386737; http://www.amazon.com/exec/obidos/ASIN/0840386737/icongroupin terna
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Acute Pancreatitis: Diagnosis and Therapy by Edward L., Iii, M.D. Bradley (Editor) (1994); ISBN: 0781700914; http://www.amazon.com/exec/obidos/ASIN/0781700914/icongroupin terna
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Acute Pancreatitis:: Novel Concepts in Biology and Therapy by Markus Buchler (1999); ISBN: 0632053399; http://www.amazon.com/exec/obidos/ASIN/0632053399/icongroupin terna
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Chronic Pancreatitis (The Science and Culture Series, Medicine) by Eugene P. Dimagno (Editor), Alberto Maringhini (Editor) (1999); ISBN: 9810234406; http://www.amazon.com/exec/obidos/ASIN/9810234406/icongroupin terna
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Chronic Pancreatitis: An Interdisciplinary Approach by N. Soehendra (Editor), et al (1997); ISBN: 3110152312; http://www.amazon.com/exec/obidos/ASIN/3110152312/icongroupin terna
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Chronic Pancreatitis: Research and Clinical Management by H.G. Beger, et al (1990); ISBN: 0387520341; http://www.amazon.com/exec/obidos/ASIN/0387520341/icongroupin terna
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Chronic Pancreatitis: Research and Clinical Management (1990); ISBN: 3540520341; http://www.amazon.com/exec/obidos/ASIN/3540520341/icongroupin terna
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Complications of Pancreatitis: Medical and Surgical Management by Edward L Bradley (1982); ISBN: 072161907X; http://www.amazon.com/exec/obidos/ASIN/072161907X/icongroupi nterna
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Controversies in acute pancreatitis ; ISBN: 0387114106; http://www.amazon.com/exec/obidos/ASIN/0387114106/icongroupin terna
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Disorders of the Pancreas: Current Issues in Diagnosis and Management by Gerard P. Burns (Editor), Simmy Bank (Editor); ISBN: 0071054022; http://www.amazon.com/exec/obidos/ASIN/0071054022/icongroupin terna
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Dogs, Diet, & Disease: An Owner's Guide to Diabetes Mellitus, Pancreatitis, Cushing's Disease, & More by Caroline D. Levin; ISBN: 0967225329;
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Efficiency and limits of radiologic examination of the pancreas ; ISBN: 3135146014; http://www.amazon.com/exec/obidos/ASIN/3135146014/icongroupin terna
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Intentional and Unintentional Abuse of Infants and Children by Edward B. Singleton; ISBN: 0815199120; http://www.amazon.com/exec/obidos/ASIN/0815199120/icongroupin terna
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Medical and Surgical Diseases of the Pancreas by Jorge E. Valenzuela; ISBN: 0896401804; http://www.amazon.com/exec/obidos/ASIN/0896401804/icongroupin terna
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Medical and surgical diseases of the pancreas ; ISBN: 4260141805; http://www.amazon.com/exec/obidos/ASIN/4260141805/icongroupin terna
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New Developments of the Aetiogenesis of Chronic Pancreatitis Implications for Treatment & Disease Prophylaxis: Symposium Held During the World cong by Joan M. Braganza (Editor) (1998); ISBN: 3805568045; http://www.amazon.com/exec/obidos/ASIN/3805568045/icongroupin terna
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Pancreatic Enzymes in Health and Disease (1991); ISBN: 3540531874; http://www.amazon.com/exec/obidos/ASIN/3540531874/icongroupin terna
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Pancreatic Enzymes in Health and Disease by Paul G. Lankisch (Editor) (1991); ISBN: 0387531874; http://www.amazon.com/exec/obidos/ASIN/0387531874/icongroupin terna
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Pancreatitis by Peter A. Banks, Paul G. Lankisch (Contributor); ISBN: 3540617264; http://www.amazon.com/exec/obidos/ASIN/3540617264/icongroupin terna
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Pancreatitis by Earl Edward Gambill; ISBN: 0801617219; http://www.amazon.com/exec/obidos/ASIN/0801617219/icongroupin terna
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Pancreatitis by Daniel Paloyan; ISBN: 0874885701; http://www.amazon.com/exec/obidos/ASIN/0874885701/icongroupin terna
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Pancreatitis (1986); ISBN: 413068115X; http://www.amazon.com/exec/obidos/ASIN/413068115X/icongroupi nterna
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Pancreatitis (Clinical Surgery International, Vol 16) by David C. Carter (Editor), Andrew L. Warshaw (Editor) (1989); ISBN: 0443037922; http://www.amazon.com/exec/obidos/ASIN/0443037922/icongroupin terna
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Pancreatitis: Concepts and Classification (International Congress Series, No 642) by H. Sarles (Editor), et al; ISBN: 0444806504; http://www.amazon.com/exec/obidos/ASIN/0444806504/icongroupin terna
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Pancreatitis: Its Pathophysiology and Clinical Aspects (Japan Intractable Diseases Research Foundation Publication, No 24) by Toshio Sato, Hidemi Yamauchi (Editor) (1986); ISBN: 0860083918; http://www.amazon.com/exec/obidos/ASIN/0860083918/icongroupin terna
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Pathogenesis of Pancreatitis: Based on a Symposium Held on 15 November 1990 at the University of Manchester Under the Auspices of the Pancreatic Soc by Joan M. Braganza (Editor) (1991); ISBN: 0719034809; http://www.amazon.com/exec/obidos/ASIN/0719034809/icongroupin terna
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Standards in Experimental Acute Pancreatitis (European Surgical Research, Vol24, Supplement No 1) by M. Buchler, H.G. Beger (Editor) (1992); ISBN: 3805555717; http://www.amazon.com/exec/obidos/ASIN/3805555717/icongroupin terna
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Standards in pancreatic surgery ; ISBN: 3540553606; http://www.amazon.com/exec/obidos/ASIN/3540553606/icongroupin terna
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Standards in Pancreatic Surgery by H.G. Berger, et al (1993); ISBN: 0387553606; http://www.amazon.com/exec/obidos/ASIN/0387553606/icongroupin terna
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Surgical Treatment of Chronic Pancreatitis - New Standards (Journal Digestive Surgery , Vol 13, No 2) by M.W. Buchler (Editor), et al (1996); ISBN: 380556323X;
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The Open packing--laparostomy--in pancreatitis and peritonitis ; ISBN: 354052276X; http://www.amazon.com/exec/obidos/ASIN/354052276X/icongroupi nterna
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The Open Packing-Laparostomy-In Pancreatitis and Peritonitis by H.W. Waclawiczek, et al (1993); ISBN: 038752276X; http://www.amazon.com/exec/obidos/ASIN/038752276X/icongroupi nterna
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Topics in acute and chronic pancreatitis ; ISBN: 0387104399; http://www.amazon.com/exec/obidos/ASIN/0387104399/icongroupin terna
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Treatment Options for Chronic Pancreatitis by Elliot Jacob (Editor) (2001); ISBN: 5551071510; http://www.amazon.com/exec/obidos/ASIN/5551071510/icongroupin terna
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Treatment Options for Chronic Pancreatitis [DOWNLOAD: ADOBE READER] by Medifocus (2001); ISBN: B000063J3F; http://www.amazon.com/exec/obidos/ASIN/B000063J3F/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “pancreatitis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of
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Acute pancreatitis: diagnosis and therapy. Author: editor, Edward L. Bradley III; Year: 1994; New York, N.Y.: Raven Press, c1993; ISBN: 0781700914 (hardcover) http://www.amazon.com/exec/obidos/ASIN/0781700914/icongroupin terna
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Acute pancreatitis: experimental and clinical aspects of pathogenesis and management. Author: edited by G. Glazer and John H.C. Ranson; Year: 1988; London; Philadelphia: Baillie`re Tindall, 1988; ISBN: 0702012483 http://www.amazon.com/exec/obidos/ASIN/0702012483/icongroupin terna
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Acute pancreatitis: research and clinical management. Author: edited by Hans G. Beger and Markus Büchler; Year: 1987; Berlin; New York: Springer-Verlag, c1987; ISBN: 0387175342 (U.S.) http://www.amazon.com/exec/obidos/ASIN/0387175342/icongroupin terna
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Advances in hepatobiliary and pancreatic diseases: special clinical topics: proceedings of the Falk Symposium no. 83, held in Bolzano, Italy, April 7-8, 1995. Author: edited by G. Dobrilla, M. Felder, and G. de Pretis; Year: 1995; Dordrecht; Boston: Kluwer Academic Publishers, c1995; ISBN: 0792388925 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0792388925/icongroupin terna
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Bile acids in hepatobiliary disease: proceedings of the Falk Workshop held in London, UK, 29-30 March 1999. Author: edited by T.C. Northfield... [et al.]; Year: 2000; Dordrecht; Boston: Kluwer Academic, c2000; ISBN: 0792387554 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0792387554/icongroupin terna
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Biomedical aspects of alcohol and alcoholism: proceedings of the international conference V, Ibaraki, Osaka, Japan, October, 1985. Author: edited by Takenobu Kamada, Kinya Kuriyama, Hiroshi Suwaki; Year: 1988; [Osaka, Japan]: Aino Hospital Foundation; Tokyo: Gendaikikakushitsu Pub., c1988; ISBN: 4874700519
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Calcific pancreatitis and diabetes in the tropics: compared with those in sub-tropics. Author: P.J. Geevarghese; Year: 1992; Bombay: Varghese Pub. House, c1992
information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Chronic alcohol intake and secretory stimulation in the pathogenesis of acute pancreatitis: an experimental study. Author: by Juha Grönroos; Year: 1989; Turku: Turun yliopisto, 1989; ISBN: 9518803803
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Chronic pancreatitis: an interdisciplinary approach. Author: edited by J.R. Izbicki, K.F. Binmoeller, N. Soehendra; associate editor, W.T. Knoefel; assistant editor, C. Blöchle; contributors, P.A. Banks ... [et al.]; Year: 1997; Berlin; New York: Walter de Gruyter, 1997; ISBN: 3110152312 http://www.amazon.com/exec/obidos/ASIN/3110152312/icongroupin terna
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Chronic pancreatitis: novel concepts in biology and therapy. Author: edited by M.W. Büchler ... [et al.]; Year: 2002; Oxford, UK; Malden, MA: Blackwell Science, c2002; ISBN: 0632063998
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Chronic pancreatitis: proceedings of the 92nd course of the International School of Medical Sciences, Erice, Italy, 14-15 October 1996. Author: editors Eugene P. DiMagno, Alberto Maringhini; series editor A. Zichichi; Year: 1999; Singapore; New Jersey: World Scientific, c1999; ISBN: 9810234406 http://www.amazon.com/exec/obidos/ASIN/9810234406/icongroupin terna
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Chronic pancreatitis: research and clinical management. Author: H.G. Beger ... [et al.] (eds.); Year: 1990; Berlin; New York: Springer-Verlag, c1990; ISBN: 3540520341 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540520341/icongroupin terna
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Chronic pancreatitis in India. Author: edited by V. Balakrishnan; editorial assistant, K.R. Thankappan; Year: 1987; [India]: Indian Society of Pancreatology, c1987
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Disorders of the pancreas: current issues in diagnosis and management. Author: editors, Gerard P. Burns, Simmy Bank; Year: 1992; New York: McGraw-Hill, Health Professions Division, c1992; ISBN: 0071054022 http://www.amazon.com/exec/obidos/ASIN/0071054022/icongroupin terna
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Glucose tolerance and secretion of insulin in chronic pancreatitis. Author: Jindra Perusicová; Year: 1990; Praha: Univerzita Karlova, c1990
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Medical and surgical diseases of the pancreas. Author: edited by Jorge E. Valenzuela, Howard A. Reber, André Ribet; Year: 1991; New York: Igaku-Shoin, c1991; ISBN: 0896401804 (New York) http://www.amazon.com/exec/obidos/ASIN/0896401804/icongroupin terna
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Open packing--laparostomy--in pancreatitis and peritonitis. Author: H.-W. Waclawiczek, O. Boeckl, G. Pauser (eds.); Year: 1991; Berlin; New York: Springer-Verlag, c1991; ISBN: 354052276X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/354052276X/icongroupi nterna
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Pacreatitis. Author: P.G. Lankisch, P.A. Banks; Year: 1998; Berlin; New York: Springer, c1998; ISBN: 3540617264 (hardcover: alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540617264/icongroupin terna
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Pancreatic disease: towards the year 2000. Author: C.D. Johnson and C.W. Imrie (eds.); Year: 1999; London; New York: Springer, c1999; ISBN: 1852330376 (casebound: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1852330376/icongroupin terna
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Pancreatic enzymes in health and disease. Author: Paul G. Lankisch (ed.); Year: 1991; Berlin; New York: Springer-Verlag, c1991; ISBN: 3540531874 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540531874/icongroupin terna
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Pancreatitis: its pathophysiology and clinical aspects. Author: edited by Toshio Sato, and Hidemi Yamauchi; Year: 1985; [Tokyo]: University of Tokyo Press, c1985; ISBN: 0860083918 (U.S.) http://www.amazon.com/exec/obidos/ASIN/0860083918/icongroupin terna
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Pancreatitis: new data and geographical distribution. Author: H. Sarles, C.D. Johnson, J.F. Saunière; Year: 1991; Paris: Arnette, 1991; ISBN: 2718405465
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Pancreatitis. Author: edited by David C. Carter, Andrew L. Warshaw; Year: 1989; Edinburgh; New York: Churchill Livingstone, 1989; ISBN: 0443037922 http://www.amazon.com/exec/obidos/ASIN/0443037922/icongroupin terna
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Pathogenesis of pancreatitis: based on a symposium held on 15 November 1990 at the University of Manchester under the auspices of the Pancreatic Society of Great Britain and Ireland. Author: edited by Joan M. Braganza; preface by Henry T. Howat; Year: 1991; Manchester; New York: Manchester University Press; New York, NY, USA; Distributed exclusively in the U.S. and Canada by St. Martin's Press, c1991; ISBN: 0719034809 (hardback) http://www.amazon.com/exec/obidos/ASIN/0719034809/icongroupin terna
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Primer of pancreatitis. Author: P.G. Lankisch ... [et al.]; Year: 1997; Berlin; New York: Springer, c1997; ISBN: 354063259X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/354063259X/icongroupi nterna
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Prostaglandins, prostaglandin inhibitors, methylprednisolone, and thyrotropin releasing hormone in acute pancreatitis: an experimental and clinical study. Author: Heikki Kiviniemi; Year: 1984; Oulu: University of Oulu, 1984; ISBN: 9514218469 (pbk.)
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Standards in pancreatic surgery. Author: H.G. Beger, M. Büchler, P. Malfertheiner (eds.); Year: 1993; Berlin; New York: Springer-Verlag, c1993; ISBN: 3540553606 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540553606/icongroupin terna
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Third Scandinavian Pancreatic Meeting, Oslo, Norway, 8 March 1985. Author: edited by Ansgar O. Aasen ... [et al.]; Year: 1986; Oslo, Norway: Norwegian University Press; Elmont, NY, USA: Publications Expediting, c1986
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What's new on pancreatic diseases: contributions to the updating course on pancreatic diseases, Genova, April 22-25, 1992. Author: G.M. Gazzaniga, editor, M. Castagnola, G. Pastorino, co-editors; Year: 1994; Stuttgart; New York: G. Thieme Verlag, 1994; ISBN: 3137869013
Chapters on Pancreatitis Frequently, pancreatitis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with pancreatitis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and pancreatitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “pancreatitis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on pancreatitis: ·
Pancreatitis in Inflammatory Bowel Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 329-332.
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Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 5687281. Fax (905) 522-7839. Email:
[email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on pancreatitis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and Ulcerative Colitis (UC), together known as inflammatory bowel disease (IBD). There is a higher incidence and prevalence of pancreatitis in patients with inflammatory bowel disease (IBD) than in the general population. The pancreatitis can be acute or chronic, or subclinical or overt, and has many causes. The most common cause is medications used to treat IBD, especially azathioprine and 6 mercaptopurine. Other causes of pancreatitis include duodenal involvement from Crohn's disease (CD), gallstones (cholelithiasis), and primary sclerosing cholangitis (PSC). Pancreatitis also can be caused by high serum concentrations of triglycerides during total parenteral nutritional (TPN) therapy for CD, and may also be a primary extra-intestinal manifestation of IBD. Treatment is different for each cause. For drug-induced pancreatitis, discontinuation of the drug should improvethe pancreatitis. For TPNinduced pancreatitis, oral medium-chain triglycerides should be substituted for the lipid emulsion. For pancreatitis that has developed from gallstones, the usual treatment is laparoscopic cholecystectomy (removal of the gallbladder). Idiopathic (of unknown cause) pancreatitis is often successfully treated by treating the underlying IBD. 1 table. 10 references. ·
Diet and Gastrointestinal Problems Source: in Townsend, C.E. and Roth, R.A. Nutrition and Diet Therapy. 7th ed. Albany, NY: Delmar Publishers. 1999. 343-360 p. Contact: Available from Delmar Publishers. 3 Columbia Circle, Albany, NY 12212. (800) 865-5840. E-mail:
[email protected]. PRICE: $44.95 plus shipping and handling. ISBN: 0766802965. Summary: This chapter on diet and gastrointestinal problems is from an undergraduate textbook on nutrition and diet therapy. The chapter describes the uses of diet therapy in gastrointestinal illness; identifies foods allowed and disallowed in the therapeutic diets covered; and helps readers learn to adapt normal diets to meet the requirements of various illnesses. The authors note that disturbances of the gastrointestinal tract require many different therapeutic diets. Peptic ulcers are treated with drugs, and diet therapy generally involves only avoiding alcohol and
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caffeine. Diverticulosis may be treated with a high fiber diet, whereas diverticulitis is treated with a gradual progression from a clear liquid to a high fiber diet. Ulcerative colitis may require a low residue diet combined with high protein and high kcal. Cirrhosis (liver scarring) requires a substantial, balanced diet, with occasional restrictions on fat, protein, salt, or fluids. Diet therapy for hepatitis can include a full, well balanced diet, although protein may be restricted, depending on the patient's condition. Patients with cholecystitis (gallbladder infection) and cholelithiasis (gallstones) require a fat restricted diet and, in cases of overweight, a kcal restricted diet as well. Pancreatitis diet therapy ranges from total parenteral nutrition to an individualized diet as tolerated. The chapter includes lists of key terms to learn, recommended discussion topics, and suggested supplemental activities, and a section of review questions so readers can test their comprehension of the material. Two illustrative case studies are appended. 1 figure. 8 tables. ·
Acute Pancreatitis Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume Two. Philadelphia, PA: Current Medicine. 1999. p. 1159-1169. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Acute pancreatitis varies from clinically mild to fulminating disease and has been recorded as a cause of sudden death. This chapter on acute pancreatitis is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. Advances made in establishing biochemical and clinical criteria for the severity and prognosis of an attack of acute pancreatitis have markedly influenced the therapeutic approach. Early administration of improved antibiotics, the role of cytokine inhibitors, and the judicious use of endoscopic or surgical techniques to establish the etiology and treat the complications of the disease have reduced the mortality rate from acute pancreatitis (to about 5 to 10 percent for the acute attack). The author notes that the inability to reduce this mortality rate further, despite the increased understanding of the pathophysiology, is one of the more disappointing aspects of the disease. Topics include anatomy, anatomic abnormalities, physiology, etiology (alcohol and gallstones, medications, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, idiopathic pancreatitis), mechanism (duct obstruction, direct toxic effect on acinar cells, neurohormonal
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mechanisms, vascular insufficiency, enzyme cytokine cascade), pathology, outcome, clinical features (differential diagnosis, assessment of severity, and early assessment of etiology), complications, special diagnostic tests, treatment options, and prognosis. 5 figures. 4 tables. 31 references. ·
Chronic Pancreatitis Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume Two. Philadelphia, PA: Current Medicine. 1999. p. 1181-1194. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Chronic pancreatitis is characterized clinically by recurrent or persistent abdominal pain, although the disease may also present without pain. Steatorrhea, diabetes, or both may occur in late stages of the disease, heralding pancreatic insufficiency. This chapter on chronic pancreatitis is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. The author notes that, in developed nations, alcoholism is generally considered the leading cause of chronic pancreatitis. The chapter covers epidemiology, pathology, pathogenesis, other forms of chronic pancreatitis (tropical calculous, hereditary, idiopathic chronic, and rare forms of chronic pancreatitis), clinical features, diagnosis, treatment (pain management, endoscopic therapy, neurolytic therapy, management of pancreatic insufficiency, management of pancreatic diabetes), and prognosis. The typical patient with alcoholic pancreatitis returns to the emergency room more and more frequently with pain, which becomes constant and requires round the clock doses of a narcotic analgesic. In course, the patient starts losing weight, develops steatorrhea, demonstrates evidence of nutritional deficiency, and ultimately develops brittle diabetes. Patients who continue to drink alcohol have a lower survival rate than those who discontinue or decrease alcohol intake. 10 figures. 7 tables. 21 references.
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Acute Pancreatitis: Prognosis and Treatment Source: in McDonald, J.W.D.; Burroughs, A.K.; Feagan, B.G., eds. Evidence Based Gastroenterology and Hepatology. London, UK: BMJ Publishing Group. 1999. p. 271-293.
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Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. Email:
[email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. Summary: This chapter on the prognosis and treatment of acute pancreatitis is from a book that emphasizes the approaches of evidence based medicine in gastroenterology (the study of the gastrointestinal tract and gastrointestinal diseases) and hepatology (the study of the liver and liver diseases). The authors of this chapter review the evidence available from the literature that examines the use of various prognostic instruments and the medical, surgical, and endoscopic treatment options available for acute pancreatitis. Most patients with acute pancreatitis will have a mild form and ultimately follow a benign clinical course, but up to 20 percent will develop severe pancreatitis with all its inherent morbidity (illness) and risk of mortality (death). Medical management remains the mainstay of treatment for patients with acute pancreatitis. Early reduction in the systemic response to pancreatitis might be achieved with drug therapy, but this has not been proven to be effective with the medications presently available. Antibiotic prophylaxis is likely to become part of the standard therapy for those with necrotizing pancreatitis. While total parenteral nutrition (TPN) is of little benefit for those with severe pancreatitis, early enteral feeding shows promise and should become the standard method of nutritional supplementation in these patients. The role of peritoneal lavage (washing out of the organ or peritoneal cavity) remains controversial and the patient population that may benefit from this intervention is not well defined. The surgical approach still remains controversial but, based on the evidence available, widespread necrosectomy (removal of the dead tissue) and lavage, or necrosectomy and open management probably results in a better overall outcome than the conventional surgical approach. 10 tables. 123 references. ·
Gastrointestinal Disorders Source: in Norris, J., et al., eds. Professional Guide to Diseases. 5th edition. Springhouse, PA: Springhouse Corporation. 1995. p. 653-719. Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 346-7844 or (215) 6468700. Fax (215) 646-4508. PRICE: $34.95 (as of 1995). ISBN: 0874347696. Summary: This chapter on gastrointestinal disorders is from an extensive reference guide to diseases. The chapter covers diseases of the mouth and esophagus, including stomatitis and other oral infections, gastroesophageal reflux, tracheoesphageal fistula, esophageal atresia,
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corrosive esophagitis and stricture, Mallory-Weiss syndrome, esophageal diverticula, and hiatal hernia; diseases of the stomach, intestine and pancreas, including gastritis, gastroenteritis, peptic ulcers, ulcerative colitis, necrotizing enterocolitis, Crohn's disease, pseudomembranous enterocolitis, irritable bowel syndrome, celiac disease, diverticular disease, appendicitis, peritonitis, intestinal obstruction, inguinal hernia, intussusception, volvulus, Hirschsprung's disease, inactive colon, and pancreatitis; and diseases of the anorectum, including hemorrhoids, anorectal abscess and fistula, rectal polyps, anorectal stricture, stenosis, or contracture, pilonidal disease, rectal prolapse, anal fissure, pruritus ani, and proctitis. The book defines each disorder and provides information about causes, signs and symptoms, diagnosis, treatment options, and special considerations. 6 references. ·
Gastrointestinal Disease in the Aged Source: in Reichel, W., et al., eds. Care of the Elderly: Clinical Aspects of Aging. 4th ed. Baltimore, MD: Williams and Wilkins. 1995. p. 198-205. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. PRICE: $69.00 (as of 1996). ISBN: 0683072099. Summary: This chapter on gastrointestinal (GI) disease in the aged is from a text on the clinical aspects of aging. This chapter covers problems associated with the esophagus, the stomach, the small bowel and pancreas, and the colon and rectum; liver disease; biliary disease; and pancreatic disease. Specific conditions discussed include appendicitis, heartburn, dysphagia, drug-induced gastritis, gastroparesis, lactose intolerance, inflammatory bowel disease, diverticulosis, colon cancer, constipation, fecal incontinence, irritable bowel syndrome, jaundice, hepatitis, gallstones, pancreatitis, and pancreatic cancer. 1 table. 22 references.
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Gastrointestinal and Hepatic Systems Source: in Adler, S.N., et al. Pocket Manual of Differential Diagnosis. 3rd ed. Boston, MA: Little, Brown and Company. 1994. p. 153-199. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail:
[email protected]. Website: http://www.lrpub.com. PRICE: $24.95. ISBN: 0316011096. Summary: This chapter outlining gastrointestinal and hepatic systems comes from a pocket manual of differential diagnosis. The chapter contains multiple listings, representing symptoms, clinical signs,
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laboratory tests, radiologic findings, and disease processes. Topics include nausea and vomiting; dysphagia and odynophagia; abdominal pain; the characteristic location of abdominal pain associated with various diseases; constipation; diarrhea; maldigestion and malabsorption syndromes; gastrointestinal bleeding; abdominal distention; peritonitis; pancreatitis; hyperamylasemia not associated with pancreatitis; hepatomegaly; jaundice; hepatitis and abnormal liver function tests; cirrhosis and chronic liver disease; ascites; and ascitic fluid characteristics in various disease states. References for further reading follow each entry. ·
Nutrition in Gastrointestinal Disease: An Overview Source: in Kirby, D.F. and Dudrick, S.J., eds. Practical Handbook of Nutrition in Clinical Practice. Boca Raton, FL: CRC Press. 1994. p. 49-63. Contact: Available from CRC Press. 2000 Corporate Boulevard NW., Boca Raton, FL 33431. (800) 272-7737 or (561) 994-0555. Fax (800) 374-3401. Email:
[email protected]. Website: http://www.crcpress.com. PRICE: $89.95. ISBN: 0849378478. Summary: This chapter, from a clinical nutrition textbook, provides an overview of nutrition in gastrointestinal disease. The authors review the normal mechanisms of digestion and absorption, with emphasis on nutritional abnormalities. The implications of acute GI tract failure are discussed. Specific diseases involving the GI system are also addressed, with emphasis on the role of nutritional support as both primary and adjunctive therapy. Diseases include short bowel syndrome, inflammatory bowel disease, acute and chronic pancreatitis, liver disease, diverticular disease, peptic ulcer disease, dumping syndrome, irritable bowel syndrome, and fistulas. Recommendations for the use of nutritional intervention and therapy are offered as indicated. 68 references. (AA-M).
·
Gastrointestinal and Pancreatic Disease Source: in Gottschlich, M.M.; Matarese, L.E.; and Shronts, E.P., eds. Nutrition Support Dietetics: Core Curriculum. 2nd ed. Silver Spring, MD: American Society of Parenteral and Enteral Nutrition. 1993. p. 275-310. Contact: Available from American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.). 8630 Fenton Street, Suite 412, Silver Spring, MD 20910. (301) 587-6315. PRICE: $50 for A.S.P.E.N. members; $77 for nonmembers. Summary: This chapter, from a textbook of nutrition support dietetics, presents a detailed outline describing the nutritional support for gastrointestinal and pancreatic disease. Topics include the normal
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function of the gastrointestinal (GI) tract; specific gut fuels, including glutamine, protein, fiber, and short-chain fatty acids; common GI disorders, including esophageal perforation, esophageal obstruction, esophageal varices, esophageal resection, gastric surgery, inflammatory bowel disease, and malabsorption; short bowel syndrome (SBS); enteric fistulas; chylous ascites; and pancreatic disorders, including pancreatitis, and cystic fibrosis. For each disease or condition, the author covers nutritional management, including parenteral or enteral nutrition, physiology, pharmacologic treatment, and complications. The chapter concludes with a list of self-assessment questions. 44 references. ·
Gastrointestinal Disease Source: in Scully, C.; Cawson, R.A. Medical Problems in Dentistry. 3rd ed. Woburn, MA: Butterworth-Heinemann. 1993. p. 189-214. Contact: Available from Butterworth-Heinemann. 255 Wildwood Avenue, Woburn, MA 01801. (800) 366-2665. Fax (800) 446-6520. PRICE: $85.00. Summary: In this chapter, from an extensive text on medical problems in dentistry, the authors discuss gastrointestinal disease, limiting their discussion to those oral complaints for which there may be important medical implications. Topics include oral ulcers, including recurrent aphthae; dry mouth (xerostomia), including that caused by Sjogren's syndrome; HIV infection; sialorrhea (hypersalivation); salivary gland swellings; Frey's syndrome; cervical lymph node enlargement; oral pigmentation; discoloration of teeth; teething; burning mouth; halitosis and disturbed taste sensation; congenital disorders; esophageal disease; dysphagia; reflux esophagitis; the normal function of the stomach; peptic ulcer; cancer of the stomach; small intestine disease; dermatitis herpetiformis; Crohn's disease; acute pancreatitis; chronic pancreatitis; pancreatic tumors; ulcerative colitis; diverticular disease; irritable bowel syndrome; familial polyposis coli; carcinoma of the colon; and antibioticassociated (pseudomembranous) colitis. For each condition discussed, the authors provide brief information about the clinical aspects, the general management, and the dental aspects. 1 figure. 12 tables. 50 references.
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Diagnosis and Management of Chronic Pancreatitis Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 95-101. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 193559725. (215) 251-2230. PRICE: $39.50. ISBN: 0812114361.
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Summary: This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the diagnosis and management of chronic pancreatitis. The author notes that the clinical presentation of chronic pancreatitis varies according to the stage of the disease and the amount of destruction of the exocrine and endocrine components of the gland. Topics include the pathogenesis of pancreatitis, including alcohol-related pancreatitis, diagnostic considerations, the metabolic diseases associated with chronic pancreatitis, screening tests and indicators of chronic pancreatitis, and the management of three main complications of chronic pancreatitis: insulindependent diabetes, cyst formation, and steatorrhea. 1 figure. 1 table. 14 references. ·
Gastrointestinal Conditions Source: in Loeb, S., ed. Teaching Patients with Chronic Conditions. Springhouse, PA: Springhouse Corporation. 1992. p. 408-480. Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, Springhouse, PA 19477. (800) 346-7844. PRICE: $29.95; plus $3.50 shipping and handling. ISBN: 0874344972. Summary: This chapter, from a book for nurses about education for patients with chronic conditions, addresses gastrointestinal conditions. Conditions covered include irritable bowel syndrome; inflammatory bowel disease; cirrhosis; chronic pancreatitis; hiatal hernia; constipation; and fecal incontinence. The chapter contains information about drug therapy for each condition, noting reactions and important teaching points. Each section lists teaching topics related to that area and provides numerous patient education handouts for photocopying and distribution to patients. Each section concludes with a list of sources of information and support and further readings.
General Home References In addition to references for pancreatitis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna
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· American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
Vocabulary Builder Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Bezoars: Concretions of swallowed hair, fruit or vegetable fibers, or similar substances found in the alimentary canal. [NIH]
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Bilirubin: A bile pigment that is a degradation product of HEME. [NIH] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Dermatitis: Inflammation of the skin. [EU] Dietetics: The study and regulation of the diet. [NIH] Distention: The state of being distended or enlarged; the act of distending. [EU]
Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Glutamine: A non-essential amino acid present abundantly throught the
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body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatomegaly: Enlargement of the liver. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Inguinal: Pertaining to the inguen, or groin. [EU] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Peritonitis:
Inflammation of the peritoneum; a condition marked by
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exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Proctitis: Inflammation of the rectum. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Reflux: A backward or return flow. [EU] Sialorrhea: Increased salivary flow. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
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CHAPTER 7. MULTIMEDIA ON PANCREATITIS Overview Information on pancreatitis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on pancreatitis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most disorders do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on pancreatitis is the Combined Health Information Database. You will need to limit your search to “video recording” and “pancreatitis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “pancreatitis” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on pancreatitis:
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·
Gastroenterology for the Primary Care Physician Source: Mount Laurel, NJ: CME Conference Video, Inc. 1994. (instructional package). Contact: Available from CME Conference Video, Inc. 2000 Crawford Place, Suite 100, Mount Laurel, NJ 08054. (800) 284-8433. Fax (800) 2845964. PRICE: $450 plus $12.25 shipping and handling (as of 1995); group practice package available. Program No. 153. Summary: This continuing education course is designed to update internists, family practitioners, and other primary care physicians on new developments in gastroenterology. The format of the course focuses on case presentations emphasizing important and evolving concepts in gastroenterology. The emphasis is on practical diagnostic and therapeutic choices and the development of cost effective management algorithms. Topics include hepatitis C, non-cardiac chest pain, psychopharmacologic approaches to acid reduction, peptic ulcer disease, Helicobacter pylori, risk factors for NSAID injury, Clostridium difficile, travelers' diarrhea, constipation in the elderly, pancreatitis, endoscopic ultrasound, gastroesophageal reflux disease, Barrett's esophagus, liver disease, GI manifestations in AIDS, esophagitis, fecal incontinence, diagnostic testing, irritable bowel syndrome, inflammatory bowel disease, drug therapy, chronic diarrhea, gallstone disease, colon cancer, cirrhosis, and ascites. The program offers 11 hours of AMA-PRA Category 1 credit. (AA-M).
·
Postgraduate Gastroenterology Program Source: Mt. Laurel, NJ: CME Conference Video, Inc. 1992. (videocassettes and syllabus). Contact: Available from P.O. Box 5077, Cherry Hill, NJ 08034-5077. (800) 284-8433. Fax (800) 284-5964. PRICE: $675. Group practice packages available. Summary: This continuing education video series is designed to enhance understanding of pathophysiology and patient management of gastrointestinal (GI) organ systems and GI disorders and to improve viewers' diagnostic and treatment abilities. Six sections cover gastroduodenal disorders; clinical applications of research; liver diseases; pancreatic and biliary tract diseases; inflammatory bowel syndrome (IBS); and esophageal disorders. Specific topics include helicobacter pylori and peptic ulcer disease; gastric emptying; gastroparesis; hormones and neuropeptides; interferon therapy of chronic liver disease; liver transplantation; hepatic encephalopathy; sclerosing cholangitis; chronic pancreatitis; endoscopic retrograde cholangiopancreatography
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(ECRP); colorectal polyps; surgical therapy for IBS; IBS and constipation; swallowing physiology; and Barrett's esophagus. The video includes interactive sessions between experts in the field of gastroenterology. (AAM).
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “pancreatitis” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most conditions and disorders do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on pancreatitis: ·
[Digestive Disease Week 1992 Sessions Audiocassettes] Source: Timonium, MD: Milner-Fenwick, Inc. 1992. (audiocassettes). Contact: Available from AGA Audiovisual Materials in Gastroenterology and Liver Disease. c/o Milner Fenwick, Inc., 2125 Greenspring Drive, Timonium, MD 21093-3100. PRICE: $15 per cassette; discount available for series purchase. Summary: These audiocassettes reproduce clinical symposia, research forums, and lectures sponsored by Digestive Disease Week (DDW). Topics available include the pathogenesis, diagnosis, and treatment of gastroesophageal reflux disease (GERD); controversial issues in acute pancreatitis; the epidemiology, pathogenetic mechanisms, and molecular biology of Helicobacter pylori; the physiological and psychological basis for functional gastrointestinal pain; the management of esophageal varices; obesity, weight loss, and gallstones; therapy of inflammatory bowel disease (IBD); and clinical management strategies for anemia, colon polyps, dyspepsia of unknown cause, dysphagia, achalasia, motility disorders, and liver enzyme abnormalities. Topics in lectures include: alcoholic hepatitis; vitamin status and the elderly; erythromycin, macrolides and motilin as prokinetic agents; gallbladder mucosal function; Crohn's disease; and antibiotic selection for gastroenterology practice.
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Non-Surgical Treatment of Pain in Chronic Pancreatitis Source: Timonium, MD: Milner-Fenwick, Inc. 199x. (audiocassette). Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093-9989. (800) 638-8652 or (301) 252-1700. PRICE: $14.95. Order number CAS 15. Summary: This audiocassette includes four programs about the nonsurgical treatment of the pain associated with chronic pancreatitis. Chaired by Dr. Eugene DiMagno, the topics are: mechanisms of pain (Dr. Howard Reber, Los Angeles, CA); enzymes and feedback regulation (Dr. Chung Owyang, Ann Arbor, MI); endoscopic treatment (Dr. Joseph Geene, Racine, WI); and unproven treatments (Dr. Peter Banks, Boston, MA). (AA-M).
Bibliography: Multimedia on Pancreatitis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in pancreatitis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on pancreatitis. For more information, follow the hyperlink indicated: ·
Accessory papilla sphincteroplasty for the dominant dorsal duct syndrome : pancreas divisum redefined. Source: author, Andrew L. Warshaw; produced by DG, Davis & Geck; Year: 1991; Format: Videorecording; [Wayne, N.J.]: American Cyanamid, c1991
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Acute pancreatitis : current controversies in acute pancreatitis: recorded at DDW 1995 in San Diego. Source: AGA, American Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?]
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Acute pancreatitis. Source: AACN [and] Medi-Sim, Inc; Year: 1987; Format: Electronic resource; Edwardsville, KS: Medi-Sim, c1987
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Approach to the patient with fulminant pancreatitis : recorded at DDW 1989, Washington, D.C. Year: 1989; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, c1989
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Cellular basis of acute pancreatitis : recorded at DDW 1990, San Antonio. Year: 1990; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, c1990
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Clinical acute pancreatitis : recorded at DDW 1995 in San Diego. Source: AGA; Year: 1995; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, [1995?]
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Controversies in management of pancreatitis : recorded at DDW 1991 in New Orleans. Year: 1991; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, [1991]
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Diagnosis and management of recurrent acute pancreatitis : recorded at DDW 1991 in New Orleans. Year: 1991; Format: Sound recording; [Bethesda, Md..]: American Gastroenterological Society, [1991]
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Endoscopic management of chronic pancreatitis. Source: [presented by] American Society for Gastrointestinal Endoscopy; Medical Surgical Department of Gastroenterology and Hepato-pancreatology, Erasmus Hospital, Brussels University; Year: 1998; Format: Videorecording; Timonium, MD: Distributed by Milner-Fenwick, 1998
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Gastroenterology section. Source: American Medical Association; Year: 1994; Format: Electronic resource; Norwood, MA: SilverPlatter Education, c1994
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Laparoscopic longitudinal pancreaticojejunostomy : (modified Puestow) for chronic pancreatitis. Source: from the Film Library and the Clinical Congress of ACS; Year: 1996; Format: Videorecording; [Cleveland, Ohio]: Cleveland Clinic Foundation, c1996
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Laparoscopic transgastric cystogastrostomy for pseudocyst of the pancreas. Source: from the Film Library and the Clinical Congress of ACS; Year: 1993; Format: Videorecording; Woodbury, CT: Ciné Med, [1993]
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Local resection of the head of the pancreas and longitudinal pancreaticojejunostomy of the body and tail. Source: author, Charles F. Frey; co-author, Dale Strawn; produced by Davis & Geck, Medical Device Division; Year: 1987; Format: Videorecording; Danbury, Conn.: American Cyanamid, c1987
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Modified Puestow procedure : lateral pancreato-jejunostomy for chronic pancreatitis. Source: an educational service provided by DG, Davis+Geck; produced by Cine´-Med; Year: 1993; Format: Videorecording; Woodbury, Conn.: American Cyanamid Co., c1993
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Mr. Lewis. Source: Corbett and Beveridge; Year: 1985; Format: Electronic resource; [Philadelphia, Pa.]: Saunders, c1985
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Non-surgical treatment of pain in chronic pancreatitis : recorded at DDW 1990, San Antonio. Year: 1990; Format: Sound recording; [Bethesda, Md.]: American Gasteroenterological Association, c1990
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Open drainage of infected pancreatic necrosis. Source: American College of Surgeons; Year: 1991; Format: Videorecording; [Atlanta, Ga.]: Emory University, c1991
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Operation for chronic pancreatitis. Source: [presented by] American College of Surgeons, Ciné-Med; Year: 1997; Format: Videorecording; Woodbury, CT.: Ciné-Med, 1997
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Operative management of chronic pancreatitis concomitant with distal common bile duct stricture. Source: produced by Ciné Med; Year: 1994; Format: Videorecording; Woodbury, Conn.: Ciné-Med, c1994
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Pancreatic inflammatory disease : diagnosis, staging, and intervention. Source: the Radiological Society of North America; Year: 1992; Format: Videorecording; [Oak Brook, Ill.]: RSNA, c1992
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Pancreatic sphincteroplasty for relapsing pancreatitis. Source: from the Film Library and the Clinical Congress of ACS, Cleveland Clinic Foundation; Year: 1999; Format: Videorecording; [Cleveland, Ohio]: Cleveland Clinic Foundation, c1999
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Pancreatitis. Source: [authors, Peter A. Banks ... et al.]; Year: 1990; Format: Slide; [Bethesda, Md.]: American Gastroenterological Association, c1990
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Pancreatitis. Source: [presented by the Ohio Medical Education Network]; Year: 1988; Format: Slide; [Columbus, Ohio]: The Network, [1988]
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Pyloric preserving pancreatectomy for chronic pancreatitis. Source: from the Film Library and the Clinical Congress of ACS; produced by LCTV; Year: 1995; Format: Videorecording; Woodbury, CT: Ciné-Med, [1995]
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Roux en Y pancreatico jejunostomy for hereditary chronic pancreatitis. Source: American College of Surgeons; from the Film Library and the Clinical Congress of ACS; Lyoni Departement Video, Espace Audiovisuel, Espace Video; Year: 1995; Format: Videorecording; [Woodbury, CT]: Ciné-Med, [1995]
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Surgical approach to complicated cases of chronic pancreatitis and biliary obstruction. Source: [presented by] American College of Surgeons, Ciné Clinic; Year: 1997; Format: Videorecording; Woodbury, CT: Ciné-Med, 1997
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Surgical management of Crohn's disease; Distal pancreatectomy for chronic pancreatitis. Source: Medicom International Incorporated;
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produced by Gregory Luque Productions, Inc; Year: 1987; Format: Videorecording; [Sarasota, Fla.]: Medicom, c1987 ·
Surgical treatment of infected pancreatic abscess. Source: author, John H.C. Ranson; produced by DG, Davis & Geck, Medical Device Division; Year: 1988; Format: Videorecording; [Wayne, N.J.]: American Cyanamid, c1988
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Thorascopic treatment of trapped lung syndrome secondary to traumatic hemothorax ; Thoracoscopic splanchnicectomy for intractable pain from chronic pancreatitis. Source: Society American Gastrointestinal Endoscopic Surgeons; Year: 1997; Format: Videorecording; Woodbury, Conn.: Distributed by Ciné-Med, c1997
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Unusual cause of pancreatitis ; Laparoscopic distal pancreatectomy for cystadenoma. Source: Society American Gastrointestinal Endoscopic Surgeons, SAGES; Year: 1998; Format: Videorecording; Woodbury, CT: Ciné-Med, [1998]
Vocabulary Builder Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Hemothorax: Hemorrhage within the pleural cavity. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH]
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Pancreatectomy: A procedure in which a surgeon takes out the pancreas. [NIH]
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CHAPTER 8. PERIODICALS AND NEWS ON PANCREATITIS Overview Keeping up on the news relating to pancreatitis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on pancreatitis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover pancreatitis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on pancreatitis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “pancreatitis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to pancreatitis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “pancreatitis” (or synonyms). The following was recently listed in this archive for pancreatitis: ·
Variety of drugs boost pancreatitis risk after ERCP Source: Reuters Medical News Date: April 03, 2002 http://www.reuters.gov/archive/2002/04/03/professional/links/20020 403clin003.html
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Obesity and glyburide use associated with the acute pancreatitis risk Source: Reuters Medical News Date: February 11, 2002 http://www.reuters.gov/archive/2002/02/11/professional/links/20020 211clin011.html
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CT unnecessary in work-up of many patients with acute pancreatitis Source: Reuters Medical News Date: August 20, 2001 http://www.reuters.gov/archive/2001/08/20/professional/links/20010 820clin018.html
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Smoking speeds up cancer in pancreatitis patients Source: Reuters Health eLine Date: July 11, 2001 http://www.reuters.gov/archive/2001/07/11/eline/links/20010711elin 002.html
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Distal resection is safe and effective for postobstructive chronic pancreatitis Source: Reuters Medical News Date: July 02, 2001 http://www.reuters.gov/archive/2001/07/02/professional/links/20010 702clin005.html
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Hydroxyurea increases risk of pancreatitis in HIV-infected patients Source: Reuters Medical News Date: April 19, 2001 http://www.reuters.gov/archive/2001/04/19/professional/links/20010 419clin007.html
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Islet autotransplantation shows benefit after resection for chronic pancreatitis Source: Reuters Medical News Date: April 04, 2001 http://www.reuters.gov/archive/2001/04/04/professional/links/20010 404clin012.html
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IL-10 reduces incidence of post-ERCP pancreatitis Source: Reuters Industry Breifing Date: February 21, 2001 http://www.reuters.gov/archive/2001/02/21/business/links/20010221 clin004.html
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Biliary drainage reduces liver fibrosis in patients with chronic pancreatitis Source: Reuters Medical News Date: February 07, 2001 http://www.reuters.gov/archive/2001/02/07/professional/links/20010 207clin012.html
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Hydroxyurea may trigger pancreatitis when combined with didanosine Source: Reuters Medical News Date: January 17, 2001 http://www.reuters.gov/archive/2001/01/17/professional/links/20010 117clin003.html
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Pirenzepine a beneficial alternative to nasogastric suction for acute pancreatitis Source: Reuters Medical News Date: January 12, 2001 http://www.reuters.gov/archive/2001/01/12/professional/links/20010 112clin004.html
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Acute pancreatitis with hepatitis B exacerbation has poor prognosis Source: Reuters Medical News Date: November 27, 2000 http://www.reuters.gov/archive/2000/11/27/professional/links/20001 127clin022.html
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Intravenous contrast may be harmful for patients with acute pancreatitis Source: Reuters Medical News Date: November 16, 2000 http://www.reuters.gov/archive/2000/11/16/professional/links/20001 116clin004.html
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Distal pancreatectomy increases risk for diabetes in pancreatitis patients Source: Reuters Medical News Date: November 15, 2000 http://www.reuters.gov/archive/2000/11/15/professional/links/20001 115epid001.html
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Loxiglumide may benefit patients with acute attacks of chronic pancreatitis Source: Reuters Industry Breifing Date: November 10, 2000 http://www.reuters.gov/archive/2000/11/10/business/links/20001110 drgd005.html
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Blood glucose levels have prognostic value in acute pancreatitis Source: Reuters Medical News Date: November 10, 2000 http://www.reuters.gov/archive/2000/11/10/professional/links/20001 110clin016.html
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Early resection plus islet transplant advised for patients with chronic pancreatitis Source: Reuters Medical News Date: October 10, 2000 http://www.reuters.gov/archive/2000/10/10/professional/links/20001 010clin013.html
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Serum glucose level predicts severe complications of gallstone pancreatitis Source: Reuters Medical News Date: September 20, 2000 http://www.reuters.gov/archive/2000/09/20/professional/links/20000 920clin004.html
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Abbott alerts physicians of life-threatening pancreatitis cases linked to Depakote Source: Reuters Industry Breifing Date: August 01, 2000 http://www.reuters.gov/archive/2000/08/01/business/links/20000801 rglt009.html
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ERCP usually detects cause of "idiopathic" recurrent pancreatitis Source: Reuters Industry Breifing Date: July 27, 2000 http://www.reuters.gov/archive/2000/07/27/business/links/20000727 clin009.html
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Pancreas divisum an important cause of recurrent pancreatitis in children Source: Reuters Medical News Date: June 20, 2000 http://www.reuters.gov/archive/2000/06/20/professional/links/20000 620clin003.html
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Trypsinogen activation peptide predicts pancreatitis severity 24 hours after symptom onset Source: Reuters Medical News Date: June 06, 2000 http://www.reuters.gov/archive/2000/06/06/professional/links/20000 606clin012.html
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Serum IL-10 and IL-11 concentrations reflect acute pancreatitis severity Source: Reuters Medical News Date: December 24, 1999 http://www.reuters.gov/archive/1999/12/24/professional/links/19991 224clin003.html
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Bristol-Myers Squibb extends warning on ddI-related pancreatitis Source: Reuters Medical News Date: November 23, 1999 http://www.reuters.gov/archive/1999/11/23/professional/links/19991 123rglt001.html
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Chronic pancreatitis patients who smoke at high risk of pancreatic cancers Source: Reuters Medical News Date: May 14, 1999 http://www.reuters.gov/archive/1999/05/14/professional/links/19990 514epid004.html
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Hydrocortisone use does not prevent pancreatitis after cholangiopancreatography Source: Reuters Medical News Date: April 22, 1999 http://www.reuters.gov/archive/1999/04/22/professional/links/19990 422clin006.html
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AIDS does not increase severity of acute pancreatitis Source: Reuters Medical News Date: March 18, 1999 http://www.reuters.gov/archive/1999/03/18/professional/links/19990 318clin005.html
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Idiopathic chronic pancreatitis linked to CFTR gene mutations Source: Reuters Medical News Date: September 03, 1998 http://www.reuters.gov/archive/1998/09/03/professional/links/19980 903clin003.html
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Pancreatitis linked to cystic fibrosis Source: Reuters Health eLine Date: September 02, 1998 http://www.reuters.gov/archive/1998/09/02/eline/links/19980902elin 010.html
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Extracorporeal Membrane Oxygenation Efficacious For ARDS Linked To Acute Pancreatitis Source: Reuters Medical News Date: April 28, 1998 http://www.reuters.gov/archive/1998/04/28/professional/links/19980 428clin004.html
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Pancreatitis May Not Increase Risk For Pancreatic Cancer Source: Reuters Medical News Date: August 13, 1997 http://www.reuters.gov/archive/1997/08/13/professional/links/19970 813epid002.html
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Small Gallstones Linked To Pancreatitis, Watchful Waiting 'Unwarranted' Source: Reuters Medical News Date: August 11, 1997 http://www.reuters.gov/archive/1997/08/11/professional/links/19970 811clin001.html
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New Dipstick Test Effective For Acute Pancreatitis Screening In The ED Source: Reuters Medical News Date: June 19, 1997 http://www.reuters.gov/archive/1997/06/19/professional/links/19970 619clin001.html
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Hereditary Pancreatitis Patients At Increased Risk Of Pancreatic Cancer Source: Reuters Medical News Date: March 28, 1997 http://www.reuters.gov/archive/1997/03/28/professional/links/19970 328epid001.html
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Early Intervention For Nonobstructive Biliary Pancreatitis Not Beneficial Source: Reuters Medical News Date: January 23, 1997 http://www.reuters.gov/archive/1997/01/23/professional/links/19970 123clin005.html
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Genes Linked To Hereditary Pancreatitis, Familial Psoriasis Identified Source: Reuters Medical News Date: October 02, 1996 http://www.reuters.gov/archive/1996/10/02/professional/links/19961 002clin002.html
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[] - Ansan Acquires Rights For Pancreatitis Drug From Boehringer Ingelheim Source: Reuters Medical News Date: June 05, 1996 http://www.reuters.gov/archive/1996/06/05/professional/links/19960 605xxxx002.html
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Urinary Test Strip May Help Diagnose Acute Pancreatitis Source: Reuters Medical News Date: March 20, 1996 http://www.reuters.gov/archive/1996/03/20/professional/links/19960 320clin003.html
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Early Use of Antibiotics In Cases of Suspected Necrotizing Pancreatitis May Reduce Mortality Rates Source: Reuters Medical News Date: September 08, 1995 http://www.reuters.gov/archive/1995/09/08/professional/links/19950 908clin009.html
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Octreotide Shows Promise In The Treatment Of Acute Pancreatitis Source: Reuters Medical News Date: August 14, 1995 http://www.reuters.gov/archive/1995/08/14/professional/links/19950 814clin004.html
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Pancreatitis Predisposes Some Individuals To Pancreatic Cancer Source: Reuters Medical News Date: July 18, 1995 http://www.reuters.gov/archive/1995/07/18/professional/links/19950 718clin011.html
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CT-Associated Risk in Pancreatitis Plus New Marker For Pancreatic Cancer Featured At Gastroenterology Meeting Source: Reuters Medical News Date: May 15, 1995 http://www.reuters.gov/archive/1995/05/15/professional/links/19950 515clin013.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “pancreatitis” (or synonyms). As this service is oriented to
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technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “pancreatitis” (or synonyms). If you know the name of a company that is relevant to pancreatitis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “pancreatitis” (or synonyms).
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “pancreatitis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on pancreatitis:
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Following Endoscopic Therapy... Pancreatitis Patients Report Pain Relief Source: Gastroenterology and Endoscopy News. 51(10): 1, 41. 2000. Contact: Available from McMahon Publishing Group. 545 West 45th Street, 8th Floor, New York, NY 10036. (212) 957-5300. Website: www.mcmahonmed.com. Summary: This news article reports on a retrospective study that has demonstrated that endoscopic therapy can have significant long term benefits on patients with chronic pancreatitis (inflammation of the pancreas), and that the technique offers similar success rates to those of surgery, while being minimally invasive for the patient. The study revealed that more than 60 percent of patients with chronic pancreatitis or unexplained abdominal pain resulting from pancreatic sphincter dysfunction reported a greater than 50 percent decrease in their pain 16 months after endoscopic therapy. Complications of endoscopic pancreatic sphincterotomy (EPS) included pancreatitis (9 percent of patients), bleeding (4 percent of patients), and early stent occlusion (blockage) in 9 percent of patients. There were no deaths related to the procedure and no patient developed severe acute pancreatitis. The study results need to be evaluated further in a prospective fashion. The article includes the comments of one expert who cautions that the role of endoscopic therapy in pancreatic disease has always been controversial, especially because pancreatitis is a 'dreaded complication' of endoscopic therapy to the pancreas.
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Pancreatitis: Painful Attacks Should Not Be Ignored Source: Mayo Clinic Health Letter. 17(10): 4-5. October 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This newsletter article from the Mayo Clinic reviews the problem of pancreatitis attacks, stressing that acute pancreatitis warrants immediate medical care to avoid complications that can be fatal. Acute pancreatitis attacks consist of a sudden pain in the upper abdomen that seems to go straight through to the back and that does not ease up. The author briefly reviews the physiology and functions of the pancreas, including production of the hormones insulin and glucagon, which help regulate metabolism; and production of pancreatic juices and enzymes that are delivered to the upper part of the small intestine (duodenum) to help digest fats, proteins, and carbohydrates. Inflammation of the pancreas disrupts these functions. Acute pancreatitis comes on suddenly when digestive juices from the pancreas escape the ducts leading to the
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small intestine and instead enter pancreas tissue itself, causing potentially severe damage. Acute pancreatitis is usually caused by either gallstones leaving the gallbladder and obstructing the pancreatic duct, or by excessive alcohol use. Most attacks of pancreatitis range from mild to moderate and may last only a couple of days. Treatment often involves a hospital stay and no food or drink by mouth (in order to rest the pancreas). By comparison, chronic pancreatitis (progressive inflammation and damage to the pancreas) is sometimes difficult to detect early. Most of the time it is caused by excessive alcohol use over many years. Treatment for chronic pancreatitis focuses on pain management and preventing attacks by avoiding alcohol, following a careful diet, and working closely with a health care provider. 1 figure.
Academic Periodicals covering Pancreatitis Academic periodicals can be a highly technical yet valuable source of information on pancreatitis. We have compiled the following list of periodicals known to publish articles relating to pancreatitis and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on pancreatitis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on pancreatitis: ·
Gastrointestinal Endoscopy. (Gastrointest Endosc) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ga strointestinal+Endoscopy&dispmax=20&dispstart=0
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Journal of Gastroenterology and Hepatology. (J Gastroenterol Hepatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology+and+Hepatology&dispmax=20&dispstart=0
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Journal of Internal Medicine. (J Intern Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Internal+Medicine&dispmax=20&dispstart=0
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Journal of the National Cancer Institute. (J Natl Cancer Inst) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+the+National+Cancer+Institute&dispmax=20&dispstart=0
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Scandinavian Journal of Gastroenterology. (Scand J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Sc andinavian+Journal+of+Gastroenterology&dispmax=20&dispstart=0
Vocabulary Builder Acidosis: Too much acid in the body. For a person with diabetes, this can lead to diabetic ketoacidosis. [NIH] Astemizole: A long-acting, non-sedative antihistaminic used in the treatment of seasonal allergic rhinitis, asthma, allergic conjunctivitis, and chronic idiopathic urticaria. The drug is well tolerated and has no anticholinergic side effects. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and
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cardiac patients. [NIH] Saquinavir: An HIV protease inhibitor which acts as an analog of an HIV protease cleavage site. It is a highly specific inhibitor of HIV-1 and HIV-2 proteases. [NIH] Stavudine: A dideoxynucleoside analog that inhibits reverse transcriptase and has in vitro activity against HIV. [NIH] Triazolam: A short-acting benzodiazepine used in the treatment of insomnia. Some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. Its use at lower doses with appropriate care and labeling has been reaffirmed by the FDA and most other countries. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common disorders, the National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 27 See http://www.nlm.nih.gov/databases/databases.html. 26
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat pancreatitis, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and pancreatitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “pancreatitis” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with pancreatitis. The following is a sample result:
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Digestive Diseases in the United States: Epidemiology and Impact Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1994. 799 p. Contact: Available from National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 8915389 or (301) 654-3810. E-mail:
[email protected]. PRICE: $15.00. Summary: This monograph is a compendium of descriptive statistics about the scope and impact of digestive diseases in the United States. Each chapter provides national and population data based on the prevalence, incidence, medical care, disability, mortality, and research needs. Twenty chapters cover the following conditions: infectious diarrheas, viral hepatitis, esophageal cancer, gastric cancer, colorectal cancer, liver cancer, pancreatic cancer, hemorrhoids, esophageal diseases, peptic ulcer, gastritis and nonulcer dyspepsia, acute appendicitis, abdominal wall hernia, inflammatory bowel diseases, diverticular disease of the colon, constipation, irritable bowel syndrome, chronic liver disease and cirrhosis, gallstones, and pancreatitis. These chapters compare the impact and costs of the disease to other diseases. The book also includes an overview chapter, a chapter about the cost of digestive diseases in the United States, and a listing of all digestive diseases diagnostic codes for the ninth and tenth editions of the International Classification of Diseases. Extensive figures are used throughout the volume. 3 appendices. The NLM Gateway28
The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.29 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families,
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
28 29
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and the public.30 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “pancreatitis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 343326 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349372
HSTAT31 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.32 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.33 Simply search by “pancreatitis” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 31 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 32 The HSTAT URL is http://hstat.nlm.nih.gov/. 33 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention 30
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Coffee Break: Tutorials for Biologists34 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.36 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
(SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 35 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 36 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
Physician Guidelines and Databases 169
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Pancreatitis With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to pancreatitis. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).37 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “pancreatitis” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
37
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Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for pancreatitis: ·
Pancreatitis, Hereditary Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?167800
·
Pancreatitis, Sclerosing Cholangitis, and Sicca Complex Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?260480
·
Pancreatitis-associated Protein Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?167805
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome,
Physician Guidelines and Databases 171
Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html ·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
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·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom e, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “pancreatitis” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database38 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an alphabetical index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database39 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 39 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 38
Physician Guidelines and Databases 173
1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “pancreatitis” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in pancreatitis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, 2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
Dissertations 175
CHAPTER 10. DISSERTATIONS ON PANCREATITIS Overview University researchers are active in studying almost all known disorders and conditions. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to pancreatitis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Pancreatitis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to pancreatitis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with pancreatitis: ·
Adverse Effects of Phenobarbital Therapy in Epileptic Dogs by Gaskill, Cynthia Lynn; Phd from University of Prince Edward Island (canada), 2002, 250 pages http://wwwlib.umi.com/dissertations/fullcit/NQ63254
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·
Pancreatic and Hepatobiliary Disorders in Inflammatory Bowel Disease by Heikius, Bengt Mikael; Md from Oulun Yliopisto (finland), 2001, 126 pages http://wwwlib.umi.com/dissertations/fullcit/f444081
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to pancreatitis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
Vocabulary Builder Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory GABA subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH]
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with pancreatitis and related conditions.
Researching Your Medications 179
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with pancreatitis. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for pancreatitis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of pancreatitis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
180 Pancreatitis
Your Medications: The Basics40 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of pancreatitis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with pancreatitis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for pancreatitis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
40
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 181
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for pancreatitis). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for pancreatitis. One such source
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is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.41 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of pancreatitis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to pancreatitis: Corticosteroids ·
Dental - U.S. Brands: Kenalog in Orabase; Orabase-HCA; Oracort; Oralone http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsd ental202010.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
41
Researching Your Medications 183
·
Inhalation - U.S. Brands: AeroBid; AeroBid-M; Azmacort; Beclovent; Decadron Respihaler; Pulmicort Respules; Pulmicort Turbuhaler; Vanceril; Vanceril 84 mcg Double Strength http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsi nhalation202011.html
·
Nasal - U.S. Brands: Beconase; Beconase AQ; Dexacort Turbinaire; Flonase; Nasacort; Nasacort AQ; Nasalide; Nasarel; Nasonex; Rhinocort; Vancenase; Vancenase AQ 84 mcg; Vancenase pockethaler http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsn asal202012.html
·
Ophthalmic - U.S. Brands: AK-Dex; AK-Pred; AK-Tate; Baldex; Decadron; Dexair; Dexotic; Econopred; Econopred Plus; Eflone; Flarex; Fluor-Op; FML Forte; FML Liquifilm; FML S.O.P.; HMS Liquifilm; Inflamase Forte; Inflamase Mild; I-Pred; Lite Pred; Maxidex; Ocu-Dex; Ocu-Pred; Ocu-Pr http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso phthalmic202013.html
·
Otic - U.S. Brands: Decadron http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso tic202014.html
·
Rectal - U.S. Brands: Anucort-HC; Anu-Med HC; Anuprep HC; Anusol-HC; Anutone-HC; Anuzone-HC; Cort-Dome; Cortenema; Cortifoam; Hemorrhoidal HC; Hemril-HC Uniserts; Proctocort; Proctosol-HC; Rectosol-HC http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsr ectal203366.html
Didanosine ·
Systemic - U.S. Brands: Videx http://www.nlm.nih.gov/medlineplus/druginfo/didanosinesyste mic202616.html
Fenofibrate ·
Systemic - U.S. Brands: Tricor http://www.nlm.nih.gov/medlineplus/druginfo/fenofibratesyste mic203516.html
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Insulin ·
Systemic - U.S. Brands: Humulin 50/50; Humulin 70/30; Humulin 70/30 Pen; Humulin L; Humulin N; Humulin N Pen; Humulin R; Humulin R, Regular U-500 (Concentrated); Humulin U; Lente; Lente Iletin II; Novolin 70/30; Novolin 70/30 PenFill; Novolin 70/30 Prefilled; Novolin L; Novoli http://www.nlm.nih.gov/medlineplus/druginfo/insulinsystemic 203298.html
Mumps Virus Vaccine Live ·
Systemic - U.S. Brands: Mumpsvax http://www.nlm.nih.gov/medlineplus/druginfo/mumpsvirusvac cinelivesystemic202382.html
Zalcitabine ·
Systemic - U.S. Brands: HIVID http://www.nlm.nih.gov/medlineplus/druginfo/zalcitabinesyste mic202652.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with pancreatitis (including those with contraindications):42 ·
Abacavir Sulfate http://www.reutershealth.com/atoz/html/Abacavir_Sulfate.htm
·
Atenolol Chlorthalidone http://www.reutershealth.com/atoz/html/Atenolol_Chlorthalidone.ht m
42
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 185
·
Betamethasone http://www.reutershealth.com/atoz/html/Betamethasone.htm
·
Chlorthalidone http://www.reutershealth.com/atoz/html/Chlorthalidone.htm
·
Clofibrate http://www.reutershealth.com/atoz/html/Clofibrate.htm
·
Corticotropin http://www.reutershealth.com/atoz/html/Corticotropin.htm
·
Corticotropin (Adrenocorticotropic hormone; ACTH) http://www.reutershealth.com/atoz/html/Corticotropin_(Adrenocortic otropic_hormone;_ACTH).htm
·
Cortisone http://www.reutershealth.com/atoz/html/Cortisone.htm
·
Cortisone (Cortisone Acetate) http://www.reutershealth.com/atoz/html/Cortisone_(Cortisone_Acetat e).htm
·
Delavirdine Mesylate http://www.reutershealth.com/atoz/html/Delavirdine_Mesylate.htm
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Dexamethasone http://www.reutershealth.com/atoz/html/Dexamethasone.htm
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Diazoxide Oral http://www.reutershealth.com/atoz/html/Diazoxide_Oral.htm
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Diazoxide Parenteral http://www.reutershealth.com/atoz/html/Diazoxide_Parenteral.htm
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Didanosine http://www.reutershealth.com/atoz/html/Didanosine.htm
·
Didanosine (ddl; dideoxyinosine) http://www.reutershealth.com/atoz/html/Didanosine_(ddl;_dideoxyin osine).htm
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Diphenoxylate HCl Atropine Sulfate http://www.reutershealth.com/atoz/html/Diphenoxylate_HCl_Atropi ne_Sulfate.htm
·
Erythromycin Ethylsuccinate Sulfisoxazole http://www.reutershealth.com/atoz/html/Erythromycin_Ethylsuccinat e_Sulfisoxazole.htm
·
Estradiol http://www.reutershealth.com/atoz/html/Estradiol.htm
186 Pancreatitis
·
Estrogens Conjugated http://www.reutershealth.com/atoz/html/Estrogens_Conjugated.htm
·
Estropipate http://www.reutershealth.com/atoz/html/Estropipate.htm
·
Estropipate (Piperazine Estrone Sulfate) http://www.reutershealth.com/atoz/html/Estropipate_(Piperazine_Est rone_Sulfate).htm
·
Ethacrynic Acid http://www.reutershealth.com/atoz/html/Ethacrynic_Acid.htm
·
Ethacrynic Acid (Ethacrynate) http://www.reutershealth.com/atoz/html/Ethacrynic_Acid_(Ethacryna te).htm
·
Fenofibrate http://www.reutershealth.com/atoz/html/Fenofibrate.htm
·
Foscarnet Sodium http://www.reutershealth.com/atoz/html/Foscarnet_Sodium.htm
·
Foscarnet Sodium (Phosphonoformic Acid) http://www.reutershealth.com/atoz/html/Foscarnet_Sodium_(Phosph onoformic_Acid).htm
·
Furosemide http://www.reutershealth.com/atoz/html/Furosemide.htm
·
Gemfibrozil http://www.reutershealth.com/atoz/html/Gemfibrozil.htm
·
Hydrochlorothiazide Triamterene(HCTZ Triamterene) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide_Triamt erene(HCTZ_Triamterene).htm
·
Hydrochlorothiazide(HCTZ) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide(HCTZ) .htm
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Hydrocortisone (Cortisol) http://www.reutershealth.com/atoz/html/Hydrocortisone_(Cortisol).ht m
·
Hydroxyurea http://www.reutershealth.com/atoz/html/Hydroxyurea.htm
·
Infliximab http://www.reutershealth.com/atoz/html/Infliximab.htm
Researching Your Medications 187
·
Isotretinoin http://www.reutershealth.com/atoz/html/Isotretinoin.htm
·
Lamivudine http://www.reutershealth.com/atoz/html/Lamivudine.htm
·
Lopinavir Ritonavir http://www.reutershealth.com/atoz/html/Lopinavir_Ritonavir.htm
·
Lovastatin http://www.reutershealth.com/atoz/html/Lovastatin.htm
·
Meloxicam http://www.reutershealth.com/atoz/html/Meloxicam.htm
·
Methylprednisolone http://www.reutershealth.com/atoz/html/Methylprednisolone.htm
·
Metolazone http://www.reutershealth.com/atoz/html/Metolazone.htm
·
Metronidazole http://www.reutershealth.com/atoz/html/Metronidazole.htm
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Monoctanoin http://www.reutershealth.com/atoz/html/Monoctanoin.htm
·
Nelfinavir Mesylate http://www.reutershealth.com/atoz/html/Nelfinavir_Mesylate.htm
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Nitrofurantoin http://www.reutershealth.com/atoz/html/Nitrofurantoin.htm
·
Octreotide Acetate http://www.reutershealth.com/atoz/html/Octreotide_Acetate.htm
·
Pancrelipase http://www.reutershealth.com/atoz/html/Pancrelipase.htm
·
Peginterferon Alfa-2B http://www.reutershealth.com/atoz/html/Peginterferon_Alfa-2B.htm
·
Pentamidine Isethionate http://www.reutershealth.com/atoz/html/Pentamidine_Isethionate.ht m
·
Pravastatin Sodium http://www.reutershealth.com/atoz/html/Pravastatin_Sodium.htm
·
Prednisolone http://www.reutershealth.com/atoz/html/Prednisolone.htm
188 Pancreatitis
·
Prednisone http://www.reutershealth.com/atoz/html/Prednisone.htm
·
Ranitidine http://www.reutershealth.com/atoz/html/Ranitidine.htm
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Rifampin http://www.reutershealth.com/atoz/html/Rifampin.htm
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Saquinavir Mesylate http://www.reutershealth.com/atoz/html/Saquinavir_Mesylate.htm
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Simvastatin http://www.reutershealth.com/atoz/html/Simvastatin.htm
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Sulfasalazine http://www.reutershealth.com/atoz/html/Sulfasalazine.htm
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Sulfisoxazole http://www.reutershealth.com/atoz/html/Sulfisoxazole.htm
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Sulindac http://www.reutershealth.com/atoz/html/Sulindac.htm
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Triamcinolone http://www.reutershealth.com/atoz/html/Triamcinolone.htm
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Trimethoprim Sulfamethoxazole http://www.reutershealth.com/atoz/html/Trimethoprim_Sulfamethox azole.htm
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Valproic Acid and Derivatives http://www.reutershealth.com/atoz/html/Valproic_Acid_and_Derivati ves.htm
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Zalcitabine http://www.reutershealth.com/atoz/html/Zalcitabine.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
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Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with pancreatitis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat pancreatitis or potentially create deleterious side effects in patients with pancreatitis. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense.
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Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with pancreatitis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with pancreatitis. The FDA warns patients to watch out for43: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
43
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General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna · Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetone: A chemical formed in the blood when the body uses fat instead of glucose (sugar) for energy. If acetone forms, it usually means that the cells do not have enough insulin, or cannot use the insulin that is in the blood, to use glucose for energy. Acetone passes through the body into the urine. Someone with a lot of acetone in the body can have breath that smells fruity and is called "acetone breath." See also: Ketone bodies. [NIH] ACTH: Adrenocorticotropic hormone. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH]
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Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethacrynic Acid: A compound that inhibits symport of sodium, potassium, and chloride primarily in the ascending limb of Henle, but also in the proximal and distal tubules. This pharmacological action results in excretion of these ions, increased urinary output, and reduction in extracelluar fluid. This compound has been classified as a loop or high ceiling diuretic. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Liquifilm: A thin liquid layer of coating. [EU] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It also tends to lower blood pressure and increase potassium loss. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Ophthalmic: Pertaining to the eye. [EU] Pancrelipase: A preparation of hog pancreatic enzymes standardized for lipase content. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to PREDNISOLONE in the liver. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic
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circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to pancreatitis. Finally, at the conclusion of this chapter, we will provide a list of readings on pancreatitis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?44 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?45 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.46
46
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Pancreatitis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for pancreatitis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to pancreatitis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “pancreatitis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to pancreatitis: ·
A randomized double-blind study using CaNa2EDTA, a phospholipase A2 inhibitor, in the management of human acute pancreatitis. Author(s): Tykka HT, Vaittinen EJ, Mahlberg KL, Railo JE, Pantzar PJ, Sarna S, Tallberg T.
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Source: Scandinavian Journal of Gastroenterology. 1985 January; 20(1): 512. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3922048&dopt=Abstract ·
Acupuncture and transcutaneous electric nerve stimulation in the treatment of pain associated with chronic pancreatitis. A randomized study. Author(s): Ballegaard S, Christophersen SJ, Dawids SG, Hesse J, Olsen NV. Source: Scandinavian Journal of Gastroenterology. 1985 December; 20(10): 1249-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3912961&dopt=Abstract
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Acute haemorrhagic pancreatitis following L-asparaginase therapy in acute lymphoblastic leukaemia --a case report. Author(s): Tan CL, Chiang SP, Wee KP. Source: Singapore Med J. 1974 December; 15(4): 278-82. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4533158&dopt=Abstract
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Acute pancreatitis associated with chemotherapy for germ cell tumors in two patients. Author(s): Socinski MA, Garnick MB. Source: Annals of Internal Medicine. 1988 April; 108(4): 567-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2450502&dopt=Abstract
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Alexithymic features of the patients with chronic pancreatitis. Author(s): Nakai Y, Sugita M, Nakagawa T, Araki T, Ikemi Y. Source: Psychotherapy and Psychosomatics. 1979; 31(1-4): 205-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=482541&dopt=Abstract
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Alterations in intestinal function in acute pancreatitis in an experimental model. Author(s): Wang XD, Wang Q, Andersson R, Ihse I.
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Source: The British Journal of Surgery. 1996 November; 83(11): 1537-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9026331&dopt=Abstract ·
Analysis of occluded pancreatic stents and juices in patients with chronic pancreatitis. Author(s): Smits ME, Groen AK, Mok KS, van Marle J, Tytgat GN, Huibregtse K. Source: Gastrointestinal Endoscopy. 1997 January; 45(1): 52-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9013170&dopt=Abstract
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Antifibrotic effect of the herbal medicine Saiko-keishi-to (TJ-10) on chronic pancreatitis in the WBN/Kob rat. Author(s): Su SB, Motoo Y, Xie MJ, Taga H, Sawabu N. Source: Pancreas. 2001 January; 22(1): 8-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11138977&dopt=Abstract
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Antioxidant treatment in hereditary pancreatitis. A pilot study on three young patients. Author(s): Uomo G, Talamini G, Rabitti PG. Source: Dig Liver Dis. 2001 January-February; 33(1): 58-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11303976&dopt=Abstract
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Aprotinin and Na2CaEDTA in experimental hemorrhagic pancreatitis in pigs. Author(s): Puolakkainen P, Paananen A, Kaarne M, Kuusi T, Lempinen M, Schroder T. Source: Scandinavian Journal of Gastroenterology. 1987 January; 22(1): 35-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2436280&dopt=Abstract
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Beneficial effect of a soy flour diet in chronic pancreatitis. Author(s): Pap A, Berger Z, Varro V. Source: The Mount Sinai Journal of Medicine, New York. 1983 May-June; 50(3): 208-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6312297&dopt=Abstract
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Beneficial effects of a novel IH636 grape seed proanthocyanidin extract in the treatment of chronic pancreatitis. Author(s): Banerjee B, Bagchi D. Source: Digestion. 2001; 63(3): 203-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11351148&dopt=Abstract
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Cholecystokinin cleavage to cholecystokinin-octapeptide in vivo and in vitro: accelerated cleavage in acute pancreatitis. Author(s): Springer CJ, Calam J. Source: Gastroenterology. 1988 July; 95(1): 143-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2453390&dopt=Abstract
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Comprehensive treatment of acute hemorrhagic pancreatitis. Author(s): Nugent FW, Atendido WA, Gibb SP. Source: The American Journal of Gastroenterology. 1967 June; 47(6): 5117. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4292673&dopt=Abstract
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Controlled trial of high-dose octreotide in treatment of acute pancreatitis. Evidence of improvement in disease severity. Author(s): Beechey-Newman N. Source: Digestive Diseases and Sciences. 1993 April; 38(4): 644-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8462363&dopt=Abstract
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Cytostatics in the treatment of chronic and acute pancreatitis. Author(s): Popiela T, Turczynowski W, Zajac A. Source: Hepatogastroenterology. 1980 October; 27(5): 390-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7009361&dopt=Abstract
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Diabetes mellitus and pancreatitis as a complication of L-asparaginase therapy. Author(s): Charan VD, Desai N, Singh AP, Choudhry VP. Source: Indian Pediatrics. 1993 June; 30(6): 809-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8132268&dopt=Abstract
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Effect of herbal medicine Saiko-keishi-to (TJ-10) on rat spontaneous chronic pancreatitis: comparison with other herbal medicines. Author(s): Motoo Y, Su SB, Xie MJ, Taga H, Sawabu N. Source: Int J Pancreatol. 2000 April; 27(2): 123-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10862511&dopt=Abstract
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Effect of osteopathic manipulative treatment of length of stay for pancreatitis: a randomized pilot study. Author(s): Radjieski JM, Lumley MA, Cantieri MS. Source: J Am Osteopath Assoc. 1998 May; 98(5): 264-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9615558&dopt=Abstract
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Effect of the microtubule-disrupting drug colchicine on rat ceruleininduced pancreatitis in comparison with the microtubule stabilizer taxol. Author(s): Ueda T, Takeyama Y, Adachi M, Toyokawa A, Kishida S, Yamamoto M, Saitoh Y. Source: Pancreas. 1995 October; 11(3): 294-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8577685&dopt=Abstract
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Effects of green tea catechins (Polyphenon 100) on cerulein-induced acute pancreatitis in rats. Author(s): Takabayashi F, Harada N. Source: Pancreas. 1997 April; 14(3): 276-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9094158&dopt=Abstract
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Electrical stimulation of the celiac plexus for pain relief in chronic pancreatitis. A clinical note. Author(s): Srikantha K, Choi JJ, Wu WH. Source: Acupunct Electrother Res. 1986; 11(2): 111-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2879414&dopt=Abstract
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Emblica officinalis: a novel therapy for acute pancreatitis--an experimental study. Author(s): Thorat SP, Rege NN, Naik AS, Thatte UM, Joshi A, Panicker KN, Bapat RD, Dahanukar SA.
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Source: Hpb Surg. 1995; 9(1): 25-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8857450&dopt=Abstract ·
Enhancement of pancreas and diagnosis of pancreatitis using manganese dipyridoxyl diphosphate. Author(s): Baba Y, Lerch MM, Tanimoto A, Kreft BP, Saluja AK, Zhao L, Chen J, Steer ML, Stark DD. Source: Investigative Radiology. 1994 June; 29 Suppl 2: S300-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7928263&dopt=Abstract
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Expression of pancreatitis-associated protein (PAP) in rat spontaneous chronic pancreatitis: effect of herbal medicine Saiko-keishi-to (TJ-10). Author(s): Su SB, Motoo Y, Xie MJ, Sakai J, Taga H, Sawabu N. Source: Pancreas. 1999 October; 19(3): 239-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10505754&dopt=Abstract
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Foreign serum-induced pancreatitis in mice. I. A new model of acute pancreatitis. Author(s): Janigan DT, Nevalainen TJ, MacAulay MA, Vethamany VG. Source: Laboratory Investigation; a Journal of Technical Methods and Pathology. 1975 December; 33(6): 591-607. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1202281&dopt=Abstract
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Hereditary pancreatitis-associated mutation asn(21) --> ile stabilizes rat trypsinogen in vitro. Author(s): Sahin-Toth M. Source: The Journal of Biological Chemistry. 1999 October 15; 274(42): 29699-704. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10514442&dopt=Abstract
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High dose octreotide in the management of acute pancreatitis. Author(s): Karakoyunlar O, Sivrel E, Tanir N, Denecli AG. Source: Hepatogastroenterology. 1999 May-June; 46(27): 1968-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10430379&dopt=Abstract
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Hyperbaric oxygen therapy attenuates pancreatic microcirculatory derangement and lung edema in an acute experimental pancreatitis model in rats. Author(s): Chen HM, Shyr MH, Ueng SW, Chen MF. Source: Pancreas. 1998 July; 17(1): 44-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9667519&dopt=Abstract
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Hyperbaric oxygen therapy in the treatment of refractory peripancreatic abscess associated with severe acute pancreatitis. Author(s): Izawa K, Tsunoda T, Ura K, Yamaguchi T, Ito T, Kanematsu T, Tsuchiya R. Source: Gastroenterol Jpn. 1993 April; 28(2): 284-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8486216&dopt=Abstract
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Hyperbaric oxygen, allopurinol, and diet-induced acute pancreatitis. Author(s): Degertekin H, Ertan A, Yater RD, Van Meter K, Akdamar K. Source: Annals of Internal Medicine. 1985 September; 103(3): 474-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4026099&dopt=Abstract
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Induction of apoptosis reduces the severity of caerulein-induced pancreatitis in mice. Author(s): Saluja A, Hofbauer B, Yamaguchi Y, Yamanaka K, Steer M. Source: Biochemical and Biophysical Research Communications. 1996 March 27; 220(3): 875-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8607859&dopt=Abstract
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Induction of apoptosis with an extract of Artemisia asiatica attenuates the severity of cerulein-induced pancreatitis in rats. Author(s): Hahm KB, Kim JH, You BM, Kim YS, Cho SW, Yim H, Ahn BO, Kim WB. Source: Pancreas. 1998 August; 17(2): 153-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9700946&dopt=Abstract
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Is there a place for pancreatic enzymes in the treatment of pain in chronic pancreatitis? Author(s): Mossner J.
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Source: Digestion. 1993; 54 Suppl 2: 35-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7693533&dopt=Abstract ·
Lack of association between cassava consumption and tropical pancreatitis syndrome. Author(s): Narendranathan M, Cheriyan A. Source: Journal of Gastroenterology and Hepatology. 1994 May-June; 9(3): 282-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8054529&dopt=Abstract
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Lecithin-cholesterol acyltransferase deficiency presenting with acute pancreatitis: effect of infusion of normal plasma on triglyceride-rich lipoproteins. Author(s): Watts GF, Mitropoulos KA, al-Bahrani A, Reeves BE, Owen JS. Source: Journal of Internal Medicine. 1995 August; 238(2): 137-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7629481&dopt=Abstract
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Lipid peroxidation and antioxidant system changes in acute L-arginine pancreatitis in rats. Author(s): Varga IS, Matkovics B, Hai DQ, Kotorman M, Takacs T, Sasvari M. Source: Acta Physiol Hung. 1997-98; 85(2): 129-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9706307&dopt=Abstract
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Lymphoma-associated pancreatitis as a presenting manifestation of immunoblastic lymphoma. Author(s): Safadi R, Or R, Bar Ziv J, Polliack A. Source: Leukemia & Lymphoma. 1994 January; 12(3-4): 317-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7513221&dopt=Abstract
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Lysolecithin concentration in pancreatic tissue during therapy with phospholipase A2-inhibitors in acute necrotizing pancreatitis. Author(s): Kahle M, Konig H, Filler RD. Source: Klin Wochenschr. 1989 February 1; 67(3): 177-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2494378&dopt=Abstract
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No effect of long-term treatment with pancreatic extract on recurrent abdominal pain in patients with chronic pancreatitis. Author(s): Malesci A, Gaia E, Fioretta A, Bocchia P, Ciravegna G, Cantor P, Vantini I. Source: Scandinavian Journal of Gastroenterology. 1995 April; 30(4): 3928. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7610357&dopt=Abstract
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Nutrition supplementation in patients with acute and chronic pancreatitis. Author(s): Scolapio JS, Malhi-Chowla N, Ukleja A. Source: Gastroenterology Clinics of North America. 1999 September; 28(3): 695-707. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10503145&dopt=Abstract
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Organic matrix of pancreatic stones associated with nutritional pancreatitis. Author(s): Montalto G, Multigner L, Sarles H, De Caro A. Source: Pancreas. 1988; 3(3): 263-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3387420&dopt=Abstract
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Paclitaxel-induced pancreatitis: a case report. Author(s): Hoff PM, Valero V, Holmes FA, Whealin H, Hudis C, Hortobagyi GN. Source: Journal of the National Cancer Institute. 1997 January 1; 89(1): 913. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8978416&dopt=Abstract
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Pancreatic microvascular permeability in caerulein-induced acute pancreatitis. Author(s): Sweiry JH, Mann GE. Source: The American Journal of Physiology. 1991 October; 261(4 Pt 1): G685-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1928354&dopt=Abstract
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·
Pancreatitis and pulmonary hemorrhage complicating closed-chest cardiac massage. Author(s): Cowan D. Source: Can Med Assoc J. 1966 November 5; 95(19): 976-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5922913&dopt=Abstract
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Pancreatitis and the lungs. Author(s): McWilliams H, Gross R. Source: The American Surgeon. 1974 August; 40(8): 448-52. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4602093&dopt=Abstract
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Pancreatitis during combination chemotherapy. Author(s): Newman CE, Ellis DJ. Source: Clin Oncol. 1979 March; 5(1): 83-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=421389&dopt=Abstract
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Pancreatitis following ingestion of a homeopathic preparation. Author(s): Kerr HD, Yarborough GW. Source: The New England Journal of Medicine. 1986 June 19; 314(25): 1642-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3713765&dopt=Abstract
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Pancreatitis Partners: a sharing and educational support group. Author(s): Shepp PH, Chase P, Rawls E. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 1999 July-August; 22(4): 155-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10745743&dopt=Abstract
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Phospholipase A2 inhibitors and their possible clinical use in the treatment of acute pancreatitis. Author(s): Tykka H, Mahlberg K, Pantzar P, Tallberg T. Source: Scandinavian Journal of Gastroenterology. 1980; 15(5): 519-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6777862&dopt=Abstract
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to pancreatitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Pancreatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/pan creatitis.html Pancreatitis Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html ·
Herbs and Supplements Ampicillin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Antioxidants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Azathioprine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Beta-Blockers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Corticosteroids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Digestive Enzymes
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Enzymes.htm Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Glucocorticoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Insulin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Lipase Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Lipase.htm Medium-Chain Triglycerides Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000206.html Methionine Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Supp/Methionine.htm Skullcap Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Sulfonamides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Thiazide Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html ·
Related Conditions Celiac Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Cholesterol, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html High Cholesterol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html High Triglycerides Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Triglycerides.ht m Hypercholesterolemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Hyperparathyroidism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperp arathyroidismPrimarycc.html Malabsorption Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Malabsorption.htm Morning Sickness Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Morning_Sickness.ht m Mumps Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Mumps cc.html Pancreas, Inflammation of Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Pancreatic Insufficiency Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pancreatic_Insufficien cy.htm Parathyroid, Overactive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperp arathyroidismPrimarycc.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna
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For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with pancreatitis. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with pancreatitis may be given different recommendations. Some recommendations may be directly related to pancreatitis, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of pancreatitis. We will then show you how to find studies dedicated specifically to nutrition and pancreatitis.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:47 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
47
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
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RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge.
What Are Dietary Supplements?48 Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”49 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.50 The ODS notes that considerable research on the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 49 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 50 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 48
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effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Pancreatitis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.51 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
51
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find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “pancreatitis” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on pancreatitis: ·
Enteral nutrition in acute pancreatitis. Author(s): Division of Digestive Disease and Nutrition, University of Massachusetts Medical Center, Worcester 01655, USA. Source: Karamitsios, N Saltzman, J R Nutr-Revolume 1997 July; 55(7): 279-82 0029-6643
·
Evidence of primary beta-cell destruction by T-cells and beta-cell differentiation from pancreatic ductal cells in diabetes associated with active autoimmune chronic pancreatitis. Author(s): Department of Endocrinology and Metabolism, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan. Source: Tanaka, S Kobayashi, T Nakanishi, K Okubo, M Murase, T Hashimoto, M Watanabe, G Matsushita, H Endo, Y Yoshizaki, H Kosuge, T Sakamoto, M Takeuchi, K Diabetes-Care. 2001 September; 24(9): 1661-7 0149-5992
The following information is typical of that found when using the “Full IBIDS Database” when searching using “pancreatitis” (or a synonym): ·
Animal model of acute pancreatitis induced by synthetic prooxidant. Author(s): Medical University, Gdansk (Poland) I.N.R.C.A. and Biancalana Mazera Foundation, Ancona (Italy) Ancona University, (Italy) Source: Sledzinski, Z. Stanek, A. Wajda, Z. Wozniak, M. Brunelli, A. Scutti, G. Bertoil, E. Lezoche, E. Polish-Journal-of-Environmental-Studies (Poland). (1998). volume 7(6) page 373. rats cells pancreatitis acute course free radicals oxygen pathogenesis bile ducts anaesthesia amylases esterases enzymic activity secretion postmortem examination necrosis leukocytes endoplasmic reticulum laboratory experimentation 1230-1485 Summary: rat cellule pancreatite processus aigu radical libre oxygene pathogenese canal biliaire anesthesie amylase esterase activite enzymatique secretion necropsie necrose leucocyte reticulum endoplasmique experimentation en laboratoire
224 Pancreatitis
Additional physician-oriented references include: ·
Acute hypercalcemia, pancreatic duct permeability, and pancreatitis in cats. Author(s): Surgical Service, Veterans Administration Hospital, Columbia, Mo. Source: Cates, M C Singh, S M Peick, A L Harvey, M H Reber, H A Surgery. 1988 August; 104(2): 137-41 0039-6060
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Acute pancreatitis after morphine administration. Source: Famularo, G Pozzessere, C Polchi, S De Simone, C Ital-JGastroenterol-Hepatol. 1999 Aug-September; 31(6): 522-3 1125-8055
·
Acute pancreatitis secondary to isotretinoin-induced hyperlipidemia. Author(s): St. Anthony Hospital, 608 NW 9th Street, Suite 4100, Oklahoma City, OK 73102, USA. Source: Jamshidi, Mohammad Obermeyer, Robert J Govindaraj, Satish Garcia, Armand Ghani, Abdul J-Okla-State-Med-Assoc. 2002 February; 95(2): 79-80 0030-1876
·
Acute pancreatitis. Hillbrow Hospital experience. Source: D'Egidio, A S-Afr-J-Surg. 1988 December; 26(4): 163-5 0038-2361
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Alcoholism and pancreatitis. Source: Korsten, M.A. Alcohol-Health-Res-World-Natl-Inst-AlcoholAbuse-Alcohol. Washington, D.C. : U.S. Department of Health and Human Services. 1989. volume 13 (3) page 232-237. ill. 0090-838X
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Alcohol-related cirrhosis with pancreatitis. The role of oxidative stress in the progression of the disease. Author(s): Department of Virology and Immunology, Maria CurieSklodowska University, Akademicka, Lublin, Poland. Source: Szuster Ciesielska, A Daniluk, J Kandefer Szerszen, M ArchImmunol-Ther-Exp-(Warsz). 2001; 49(2): 139-46 0004-069X
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Anticonvulsant-induced chronic pancreatitis. A case report. Author(s): Servizio di Pronto Soccorso, Ospedale S. Orsola, Bologna, Italy. Source: Pezzilli, R Billi, P Melandri, R Broccoli, P L Fontana, G Ital-JGastroenterol. 1992 June; 24(5): 245-6 0392-0623
·
Can somatostatin prevent injection pancreatitis after ERCP? Author(s): Department of Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden. Source: Persson, B Slezak, P Efendic, S Haggmark, A Hepatogastroenterology. 1992 June; 39(3): 259-61 0172-6390
Researching Nutrition 225
·
Celiac disease and recurrent pancreatitis. Author(s): Department of Gastroenterology and Hepatology, University of Iowa College of Medicine, Iowa City, Iowa, USA. Source: Patel, R S Johlin, F C Murray, J A Gastrointest-Endosc. 1999 December; 50(6): 823-7 0016-5107
·
Cholecystokinin fails to promote pancreatic regeneration in diabetic rats following the induction of experimental pancreatitis. Author(s): First Department of Medicine, University of Szeged, H-6701, Szeged, P.O. Box 469, Hungary.
[email protected] Source: Takacs, T Hegyi, P Jarmay, K Czako, L Gog, C Rakonczay, Z Jr Nemeth, J Lonovics, J Pharmacol-Res. 2001 Nov; 44(5): 363-72 1043-6618
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Chronic calcifying pancreatitis: epidemiology and current concept of the lithogenesis. Author(s): INSERM U 315, Marseille, France. Source: Sarles, H Berger, Z Acta-Med-Hung. 1989; 46(4): 225-33 0236-5286
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Chronic pancreatitis in Warsaw. Author(s): Department of Metabolic Diseases and Gastroenterology, National Food and Nutrition Institute, Warszawa, Poland. Source: Dzieniszewski, J Jarosz, M Ciok, J Mater-Med-Pol. 1990 JulSeptember; 22(3): 202-4 0025-5246
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Clinical and immunological indicators in patients with chronic pancreatitis and their dynamics in the process of diet therapy. Source: Kiseleva, O.A. Budagovskaia, VolumeN. Voitko, N.E. Vopr-Pitan. Moskva : "Meditsina". Jan/February 1984. (1) page 21-26. 0042-8833
·
Comparison of different endocrine stimulation tests in nondiabetic patients with chronic pancreatitis. Author(s): Department of Medicine, University Hospital Ulm, Germany. Source: von Tirpitz, C Glasbrenner, B Mayer, D Malfertheiner, P Adler, G Hepatogastroenterology. 1998 Jul-August; 45(22): 1111-6 0172-6390
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Conservative treatment of acute pancreatitis: the use of somatostatin. Author(s): 2nd Department of Internal Medicine-Propaedeutic, Athens University, Evangelismos Hospital, Greece. Source: Ladas, S D Raptis, S A Hepatogastroenterology. 1992 October; 39(5): 466-9 0172-6390
·
Dietary management of feline pancreatitis. Source: Marks, S.L. Proc-North-Am-Vet-Conf. [Gainesville, Fla.] : Eastern States Veterinary Association, 1992-. 2000. volume 14 page 490-491.
226 Pancreatitis
·
Early jejunal nutrition and changes in the immunological parameters of patients with acute pancreatitis. Author(s): Second Department of Surgery, University of Debrecen, Debrecen, Moricz Zs. str. 22., 4004 Debrecen, Hungary.
[email protected] Source: Hallay, J Kovacs, G Szatmari, K Bako, A Szentkereszty, Z Lakos, G Sipka, S Sapy, P Hepatogastroenterology. 2001 Sep-October; 48(41): 1488-92 0172-6390
·
Effect of a specific synthetic inhibitor of neutrophil elastase (ONO5046) on the course of acute hemorrhagic pancreatitis in dogs. Author(s): Department of Surgery, National Sendai Hospital, 2-8-8 Miyagino, Miyagino-ku, Sendai 983-8520, Japan. Source: Imamura, M Mikami, Y Takahashi, H Yamauchi, H JHepatobiliary-Pancreat-Surg. 1998; 5(4): 422-8 0944-1166
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Effect of long-term ethanol feeding on the restoration process of acute necrotizing pancreatitis induced in rats. Author(s): Second Department of Internal Medicine, Asahikawa Medical College, Japan. Source: Terasawa, K Koike, D Takebe, T Gastroenterol-Jpn. 1988 August; 23(4): 448-56 0435-1339
·
Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography: results of a randomized study. Author(s): Gastrointestinal Endoscopy Section, Hospital Clinic I Provincial, University of Barcelona, Spain. Source: Bordas, J M Toledo Pimentel, V Llach, J Elena, M Mondelo, F Gines, A Teres, J Gastrointest-Endosc. 1998 March; 47(3): 230-4 0016-5107
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
Researching Nutrition 227
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to pancreatitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Pyridoxine
228 Pancreatitis
Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Vitamin D Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_D.htm ·
Minerals Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Magnesium.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Selenium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html
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Food and Diet Barley Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Beef Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Beef.htm Diabetes Source: Integrative Medicine Communications; www.onemedicine.com
Researching Nutrition 229
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Gluten-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Grains Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/High_Fiber_Diet.htm Juices Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Kiwi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kiwi.htm Low-Fat Diet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Oats Source: Healthnotes, Inc.; www.healthnotes.com
230 Pancreatitis
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Rye Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Soy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Soybeans Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Weight Loss Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm Weight Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Pancre atitiscc.html Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Celiac_Disease.htm
Researching Nutrition 231
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter
232 Pancreatitis
in the central and peripheral nervous systems. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 233
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.52
52
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
234 Pancreatitis
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):53 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
53
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 235
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
236 Pancreatitis
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 237
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
238 Pancreatitis
·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld /
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 239
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 241
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with pancreatitis faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.54 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
54Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 243
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
244 Pancreatitis
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 245
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.55
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”56 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 56 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 55
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.57 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.58 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 58 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 57
Your Rights and Insurance 247
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 249
contact information on how to find more in-depth information about Medicaid.59
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or endstage renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
59
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 251
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.60 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
60
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare conditions or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:61 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
61
Your Rights and Insurance 253
Vocabulary Builder Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU]
Online Glossaries 255
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to pancreatitis and keep them on file. The NIH, in particular, suggests that patients with pancreatitis visit the following Web sites in the ADAM Medical Encyclopedia: ·
Basic Guidelines for Pancreatitis
256 Pancreatitis
Pancreatitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001144.htm SLE Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000435.htm ·
Signs & Symptoms for Pancreatitis Abdominal distention Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003122.htm Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Bowel sounds Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003137.htm Chills Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003091.htm Erythema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Jaundice Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003243.htm
Online Glossaries 257
Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Skin, clammy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003216.htm Sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm ·
Diagnostics and Tests for Pancreatitis Abdominal X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003815.htm Abdominal X-rays Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003815.htm Alkaline phosphatase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003470.htm Aspartate aminotransferase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm
258 Pancreatitis
Bilirubin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003479.htm CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm Glucagon Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003716.htm Secretin stimulation test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003892.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm ·
Background Topics for Pancreatitis Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm
Online Glossaries 259
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 261
PANCREATITIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetone: A chemical formed in the blood when the body uses fat instead of glucose (sugar) for energy. If acetone forms, it usually means that the cells do not have enough insulin, or cannot use the insulin that is in the blood, to use glucose for energy. Acetone passes through the body into the urine. Someone with a lot of acetone in the body can have breath that smells fruity and is called "acetone breath." See also: Ketone bodies. [NIH] Acidosis: Too much acid in the body. For a person with diabetes, this can lead to diabetic ketoacidosis. [NIH] ACTH: Adrenocorticotropic hormone. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH]
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Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU]
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Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Ascariasis: Infection by nematodes of the genus ASCARIS. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Asparaginase: A hydrolase enzyme that converts L-asparagine and water to L-aspartate and NH3. EC 3.5.1.1. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astemizole: A long-acting, non-sedative antihistaminic used in the treatment of seasonal allergic rhinitis, asthma, allergic conjunctivitis, and chronic idiopathic urticaria. The drug is well tolerated and has no anticholinergic side effects. [NIH] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autolysis: The spontaneous disintegration of tissues or cells by the action of their own autogenous enzymes. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Bezoars: Concretions of swallowed hair, fruit or vegetable fibers, or similar substances found in the alimentary canal. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Bilirubin: A bile pigment that is a degradation product of HEME. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or
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involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Caerulein: A specific decapeptide obtained from the skin of Hila caerulea, an Australian amphibian. Caerulein is similar in action and composition to cholecystokinin. It stimulates gastric, biliary, and pancreatic secretion and certain smooth muscle. It is used in paralytic ileus and as diagnostic aid in pancreatic malfunction. [NIH] Calcification: The process by which organic tissue becomes hardened by a deposit of calcium salts within its substance. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiac: Pertaining to the heart. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants; it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH]
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Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cefazolin: Semisynthetic cephalosporin analog with broad-spectrum antibiotic action due to inhibition of bacterial cell wall synthesis. It attains high serum levels and is excreted quickly via the urine. [NIH] Cefmetazole: A semisynthetic cephamycin antibiotic with a broad spectrum of activity against both gram-positive and gram-negative microorganisms. It has a high rate of efficacy in many types of infection and to date no severe side effects have been noted. [NIH] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholelithiasis: The presence or formation of gallstones. [EU] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the
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solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cyst: Any closed cavity or sac; normal or abnormal, lined by epithelium, and especially one that contains a liquid or semisolid material. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dermatitis: Inflammation of the skin. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH]
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Didanosine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. Didanosine is a potent inhibitor of HIV replication, acting as a chain-terminator of viral DNA by binding to reverse transcriptase; ddI is then metabolized to dideoxyadenosine triphosphate, its putative active metabolite. [NIH] Dietetics: The study and regulation of the diet. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dimethadione: An anticonvulsant that is the active metabolite of trimethadione. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Encephalitis: Inflammation of the brain. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endocrinology:
A subspecialty of internal medicine concerned with the
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metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epigastralgia: Pain in the epigastrium. [EU] Epigastric: Pertaining to the epigastrium. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH]
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Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethacrynic Acid: A compound that inhibits symport of sodium, potassium, and chloride primarily in the ascending limb of Henle, but also in the proximal and distal tubules. This pharmacological action results in excretion of these ions, increased urinary output, and reduction in extracelluar fluid. This compound has been classified as a loop or high ceiling diuretic. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Exocrine: 1. secreting outwardly, via a duct;. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula:
An abnormal passage or communication, usually between two
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internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Foscarnet: An antiviral agent used in the treatment of cytomegalovirus retinitis. Foscarnet also shows activity against human herpesviruses and HIV. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] Ganciclovir: Acyclovir analog that is a potent inhibitor of the Herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from AIDS-associated cytomegalovirus infections. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond
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that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Granule: A small pill made from sucrose. [EU] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemobilia: Hemorrhage in or through the biliary tract, due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasms. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemothorax: Hemorrhage within the pleural cavity. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatomegaly: Enlargement of the liver. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used
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alone, the term may refer to herpes simplex or to herpes zoster. [EU] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperstimulation: Excessive stimulation. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg
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diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Hypovolaemia: Abnormally decreased volume of circulating fluid (plasma) in the body. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Ileus: Obstruction of the intestines. [EU] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH]
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Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Inguinal: Pertaining to the inguen, or groin. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intravascular: Within a vessel or vessels. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH]
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Lamivudine: A reverse transcriptase inhibitor and ZALCITABINE analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leukaemia: An acute or chronic disease of unknown cause in man and other warm-blooded animals that involves the blood-forming organs, is characterized by an abnormal increase in the number of leucocytes in the tissues of the body with or without a corresponding increase of those in the circulating blood, and is classified according of the type leucocyte most prominently involved. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liquifilm: A thin liquid layer of coating. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death.
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Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Metastasis: 1. the transfer of disease from one organ or part to another not directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It also tends to lower blood pressure and increase potassium loss. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH]
Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU]
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Mucosa: A mucous membrane, or tunica mucosa. [EU] Myelosuppression: Suppression of bone marrow activity, resulting in reduction in the number of platelets, red cells, and white cells. [EU] Myositis: Inflammation of a voluntary muscle. [EU] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neutropenia: Leukopenia in which the decrease in white blood cells is chiefly in neutrophils. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH]
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Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Ophthalmic: Pertaining to the eye. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures
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after minimal trauma. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatectomy: A procedure in which a surgeon takes out the pancreas. [NIH]
Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Pancrelipase: A preparation of hog pancreatic enzymes standardized for lipase content. [NIH] Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate
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fever. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory GABA subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Piperacillin: Semisynthetic, broad-spectrum, ampicillin-derived ureidopenicillin antibiotic proposed for Pseudomonas infections. It is also used in combination with other antibiotics. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs with consolidation. [EU] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Postoperative: Occurring after a surgical operation. [EU] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Precipitation: The act or process of precipitating. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Preeclampsia: A condition that some women with diabetes have during the
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late stages of pregnancy. Two signs of this condition are high blood pressure and swelling because the body cells are holding extra water. [NIH] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Proctitis: Inflammation of the rectum. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Prophylaxis: The prevention of disease; preventive treatment. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: Itching skin; may be a symptom of diabetes. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pulmonary: Pertaining to the lungs. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Pyoderma: Any purulent skin disease. Called also pyodermia. [EU] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Receptor:
1. a molecular structure within a cell or on the surface
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characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reflux: A backward or return flow. [EU] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Resection: Excision of a portion or all of an organ or other structure. [EU] Respiratory: Pertaining to respiration. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Rheumatoid: Resembling rheumatism. [EU] Rhinitis: Inflammation of the mucous membrane of the nose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Saquinavir: An HIV protease inhibitor which acts as an analog of an HIV protease cleavage site. It is a highly specific inhibitor of HIV-1 and HIV-2 proteases. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or
Glossary 283
homogeneous substance. Sarcomas are often highly malignant. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sialorrhea: Increased salivary flow. [NIH] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spondylitis: Inflammation of the vertebrae. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stavudine: A dideoxynucleoside analog that inhibits reverse transcriptase and has in vitro activity against HIV. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stents: Devices that provide support for tubular structures that are being
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anastomosed or for body cavities during skin grafting. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU] Tachykinins: A family of biologically active peptides sharing a common conserved C-terminal sequence, -Phe-X-Gly-Leu-Met-NH2, where X is either an aromatic or a branched aliphatic amino acid. Members of this family have been found in mammals, amphibians, and mollusks. Tachykinins have diverse pharmacological actions in the central nervous system and the cardiovascular, genitourinary, respiratory, and gastrointestinal systems, as well as in glandular tissues. This diversity of activity is due to the existence of three or more subtypes of tachykinin receptors. [NIH] Thermoregulation: Heat regulation. [EU] Thrombosis: The formation, development, or presence of a thrombus. [EU] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography.
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[EU]
Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transcutaneous: Transdermal. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Triazolam: A short-acting benzodiazepine used in the treatment of insomnia. Some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. Its use at lower doses with appropriate care and labeling has been reaffirmed by the FDA and most other countries. [NIH]
Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU]
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Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a vessel, angiitis. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
288 Pancreatitis
INDEX A Abdomen ..12, 15, 16, 19, 20, 24, 25, 158, 277, 284 Abscess .......107, 132, 137, 147, 206, 267 Acetone .......................................191, 261 Adenosine..............................99, 109, 261 Adolescence ..........87, 114, 136, 261, 279 Adverse ...........18, 54, 161, 192, 274, 285 Algorithms....................................115, 142 Alimentary........25, 85, 136, 263, 274, 279 Allopurinol............................................206 Alopecia.................................................51 Anaesthesia...........................85, 223, 273 Analgesic ....111, 130, 191, 192, 261, 276, 284 Anastomosis ..........................................53 Anemia ........................................143, 171 Anionic ...................................................69 Anomalies ............................114, 117, 119 Anorectal .............................................132 Antibiotic .......25, 95, 110, 112, 134, 143, 147, 265, 268, 280, 283 Antibody......66, 82, 84, 86, 111, 266, 272, 273, 276 Anticonvulsant .............................110, 267 Antioxidant.....................................69, 207 Antiviral ..........................................45, 270 Appendicitis ..56, 114, 115, 132, 137, 166, 267 Arginine ...............................................207 Arteriolar ................................73, 109, 264 Artery .........................25, 60, 88, 281, 282 Ascariasis ..............................................52 Ascites ....... 111, 114, 115, 116, 133, 134, 142, 278 Asparaginase.........................79, 201, 203 Assay.....................................66, 111, 273 Asymptomatic ........................................72 Atypical ..................................................50 Autolysis ................................................69 B Benign .............................72, 87, 131, 277 Bezoars ...............................................114 Bile..... 13, 19, 24, 45, 52, 60, 63, 67, 82, 84, 117, 137, 146, 223, 263, 265, 271, 274 Biliary....50, 52, 55, 56, 60, 65, 81, 84, 98, 102, 104, 115, 116, 132, 137, 142, 146, 264, 265, 271 Bilirubin ................................................117 Biochemical .................66, 70, 71, 93, 129
Biopsy ............................................. 52, 53 Bradykinin ........................................... 103 Buccal ..................... 51, 81, 139, 264, 284 C Caerulein....... 62, 63, 70, 77, 78, 206, 208 Calcification........................................... 15 Capsules ............................................. 221 Carbohydrate .......... 17, 23, 118, 220, 270 Carcinoma................. 60, 69, 72, 116, 134 Cardiac........................ 142, 160, 209, 276 Cardiovascular .............................. 89, 284 Catabolism ............................................ 76 Catheter ................................................ 74 Caustic ........................................ 114, 115 Cefazolin ............................................... 99 Cefmetazole.......................................... 99 Cerebral ................................ 95, 137, 269 Cervical ............................................... 134 Chemotherapy ...................... 52, 201, 209 Cholangitis ...... 55, 60, 115, 116, 128, 142 Cholecystectomy ........................ 115, 128 Cholecystitis................................ 115, 129 Cholelithiasis......... 84, 101, 128, 129, 271 Cholestasis ......................................... 117 Chromosomal ....................................... 38 Cimetidine ............................................. 99 Cirrhosis..... 50, 52, 60, 80, 116, 118, 133, 135, 142, 166, 224 Coagulation........................................... 79 Colic ...................................................... 56 Colitis ...... 50, 51, 114, 116, 129, 132, 134 Colonoscopy ......................................... 52 Colorectal............................ 116, 143, 166 Concomitant........................................ 146 Conjunctivitis................... 95, 96, 160, 263 Constipation ...... 52, 114, 115, 118, 132, 133, 135, 139, 142, 143, 166, 279 Contracture ......................................... 132 Cutaneous............................... 51, 87, 279 Cyst....................................... 14, 107, 135 Cytokines ................................ 50, 65, 104 Cytomegalovirus ........................... 45, 270 D Degenerative ...... 111, 137, 219, 267, 278 Dehydration........................................... 12 Dermatitis............................................ 134 Diarrhea ... 52, 57, 81, 114, 133, 142, 218, 263 Didanosine .............................. 18, 76, 151 Dietetics .............................................. 133
Index 289
Digestion....... 15, 22, 25, 34, 58, 66, 109, 117, 133, 137, 261, 267, 279, 284 Dimethadione ......................................107 Distal............112, 146, 147, 192, 269, 281 Distention.....................................133, 256 Diverticulitis .........................................129 Dorsal ............................................70, 144 Duodenum ......11, 22, 118, 147, 158, 263, 270 Dyspepsia............................116, 143, 166 Dysphagia....................132, 133, 134, 143 E Embryology..........................................117 Encephalopathy...................115, 116, 142 Encopresis...........................................114 Endogenous ..........................................73 Endoscopy.....................................52, 115 Endothelium...........................................51 Endotoxins.............................................64 Enterocolitis .........................................132 Enzyme..... 17, 23, 56, 57, 59, 62, 63, 74, 81, 88, 92, 98, 130, 143, 253, 261, 263, 268, 281 Epigastralgia..........................................60 Epigastric .......................93, 106, 137, 267 Epithelium................................23, 69, 266 Erythema ...............................................51 Erythromycin........................................143 Esophagitis ....................95, 132, 134, 142 Ethanol ....................64, 98, 102, 118, 226 Exocrine...........................75, 93, 107, 135 Exocytosis .............................................75 Exogenous...............................73, 83, 269 Extravasation.........................................73 Exudate ...................................77, 83, 269 F Famotidine.............................................99 Fatal.....................................................158 Fats.....11, 19, 22, 23, 59, 61, 82, 86, 158, 218, 263, 265, 269, 275 Feces .......................59, 81, 137, 263, 267 Fibrosis .......16, 50, 52, 53, 68, 75, 82, 94, 100, 114, 115, 117, 119, 134, 137, 151, 154, 265, 266 Fissure.................................................132 Fistula ........84, 87, 97, 131, 147, 270, 278 G Gastritis ...............................115, 132, 166 Gastroduodenal ...................142, 147, 270 Gastroenteritis .......................89, 132, 282 Gingivitis ................................................95 Glucose ..11, 13, 16, 23, 24, 25, 152, 191, 261, 270, 274, 279 Glutamine ............................................134 Gluten ............................................58, 116 Glyburide .............................................150
Granule ................................................. 75 H Halitosis .............................................. 134 Heartburn ............................................ 132 Helicobacter ........................................ 142 Hematology........................................... 10 Hemobilia .............................................. 60 Hemorrhage .......... 51, 106, 114, 116, 209 Hemorrhoids ............................... 132, 166 Hemothorax ........................................ 147 Hepatic.... 52, 60, 115, 116, 118, 132, 142 Hepatitis ...... 50, 105, 114, 115, 116, 117, 118, 129, 132, 133, 142, 143, 152, 166 Hepatobiliary ............................... 117, 124 Hepatocellular ..................................... 116 Hepatomegaly..................................... 133 Heredity......................................... 19, 119 Hernia ......................... 114, 132, 135, 166 Herpes .......................................... 45, 272 Histamine ...................... 99, 110, 265, 269 Homeostasis ................................. 63, 118 Homologous.......................................... 73 Hormones ...... 11, 82, 88, 118, 139, 142, 147, 158, 266, 277, 282, 284 Hybridomas......................................... 100 Hydrogen ........ 23, 46, 103, 264, 267, 286 Hydroxyurea.......................................... 76 Hyperbilirubinemia ........................ 24, 274 Hyperlipidemia .................................... 224 Hyperpigmentation................................ 51 Hyperstimulation ............................. 67, 71 Hypertension......... 87, 115, 117, 118, 278 Hyperthermia ........................................ 63 Hypotension ........................................ 103 Hypovolaemia ..................................... 103 Hypoxia ........................................... 13, 64 I Idiopathic.. 53, 68, 75, 101, 107, 129, 130, 138, 153, 160, 263, 273 Ileus ........................................ 52, 81, 264 Immersion ............................................. 63 Incision.......................................... 85, 274 Incontinence ....... 115, 118, 132, 135, 142 Indicative.. 87, 90, 92, 100, 111, 273, 277, 279, 286 Induction ................... 63, 65, 98, 105, 225 Infarction ........................... 56, 88, 95, 282 Infertility............................. 26, 95, 96, 285 Infiltration .............................................. 73 Infusion ................................. 62, 107, 207 Ingestion ..... 114, 115, 138, 209, 221, 271 Inguinal ............................................... 132 Insulin..... 11, 15, 16, 19, 24, 25, 125, 135, 158, 191, 261, 270, 274, 279 Intermittent ...................................... 60, 93 Interstitial............... 82, 103, 112, 265, 283
290 Pancreatitis
Intestinal .....12, 24, 50, 56, 58, 75, 81, 82, 85, 118, 128, 132, 138, 201, 218, 264, 265, 271, 274, 275 Intestines .........74, 84, 137, 269, 270, 273 Intravascular ..........................................79 Intrinsic ................................................104 Invasive .........................................72, 158 Ischemia ............................56, 67, 89, 282 Isotretinoin ...........................................224 L Lactobacillus..........................................64 Lesion ....................................83, 106, 268 Lethal .....................................................62 Leukaemia ...........................................201 Ligation ..................................................60 Lipid ..24, 71, 86, 118, 128, 160, 192, 270, 274, 275, 276 Lipoprotein.....................................86, 275 Lumen....................................................75 Lymphocytic...........................................50 M Macrolides ...........................................143 Malabsorption ...15, 16, 58, 114, 115, 118, 133, 134, 170 Malignant ......51, 73, 81, 86, 89, 263, 264, 276, 283 Mediator.................................................71 Mesenteric .............................................56 Metastasis .................60, 86, 87, 276, 277 Methionine ...........................105, 192, 284 Micronutrients ..................................58, 61 Microscopy ............................................73 Molecular ....10, 26, 53, 64, 67, 68, 71, 72, 75, 88, 94, 99, 117, 143, 164, 168, 169, 281, 285 Monotherapy..........................................39 Morphine......................106, 138, 224, 277 Motility ...........52, 114, 115, 117, 118, 143 Mucosa ....................51, 87, 139, 277, 284 Myositis..................................................39 N Narcotic ...............................111, 130, 276 Nasal ...............................................51, 61 Nausea ........16, 19, 20, 52, 133, 137, 270 Necrosis......56, 58, 59, 62, 65, 89, 96, 97, 101, 105, 106, 146, 223, 282 Neoplasms..51, 69, 84, 87, 114, 117, 271, 277 Neoplastic ........................70, 72, 110, 272 Neural ..................................................219 Neurons .................................70, 147, 277 Neuropathy ........................18, 39, 46, 286 Neuropeptides .....................142, 147, 277 Neutrophil ......................................73, 226 Niacin...................................................219 Nitrofurantoin ...............................192, 278
Nitrogen ................................................ 61 Nosocomial ......................... 115, 138, 278 O Octreotide ................................... 203, 205 Oedema .............................................. 103 Oral .. 51, 57, 61, 79, 81, 87, 95, 107, 128, 131, 134, 138, 139, 160, 264, 271, 278, 284 Osteoarthritis ........................................ 95 Osteomalacia ........................................ 50 Osteoporosis......................................... 95 Outpatients............................................ 57 Overdose ............................................ 219 P Pancreatectomy.................. 146, 147, 152 Panniculitis...................................... 50, 51 Parasitic ...................................... 115, 118 Parenteral ...... 13, 61, 114, 115, 119, 128, 129, 131, 134 Pathologic ..................... 93, 106, 112, 281 Peptic ...... 28, 52, 95, 115, 117, 132, 133, 134, 142, 166 Perforation .......................... 134, 137, 267 Peritonitis ............ 116, 123, 126, 132, 133 Pharmacist .................................. 180, 190 Piperacillin............................................. 99 Plexus ................................................. 204 Polymorphic .......................................... 93 Porphyria............................................... 51 Postoperative .................................. 52, 60 Postprandial .......................................... 60 Potassium ............. 13, 192, 220, 269, 276 Precipitation ........................................ 107 Precursor .............................................. 72 Preeclampsia ........................................ 95 Prevalence .................................. 128, 166 Proctitis ............................................... 132 Progressive ............... 16, 64, 87, 159, 277 Prolapse.............................................. 132 Prophylaxis ................. 101, 131, 192, 278 Protease............ 67, 79, 97, 105, 161, 282 Proteins...... 11, 61, 63, 69, 82, 87, 88, 97, 104, 105, 147, 158, 218, 220, 266, 268, 278, 281 Proteolytic ..................................... 66, 103 Proximal ........ 23, 101, 147, 192, 267, 269 Pruritus.......................................... 51, 132 Psoriasis ............................... 95, 112, 281 Pulmonary............... 65, 84, 103, 209, 272 Pulse ......................................... 12, 16, 19 Pyoderma.............................................. 51 R Receptor ...... 70, 71, 73, 76, 95, 99, 101, 103, 104, 110, 176, 269, 280 Recombinant................................... 66, 68 Reflux.. 114, 115, 116, 131, 134, 142, 143
Index 291
Refractory ............................................206 Regeneration .........................82, 225, 265 Resection...............60, 134, 145, 151, 152 Respiratory ................65, 89, 99, 102, 284 Retrograde.........15, 19, 53, 115, 129, 142 Rheumatoid ...........................................95 Rhinitis .............................95, 96, 160, 263 Riboflavin.............................................218 S Sarcoma ................................................51 Sclerosis ........................................95, 171 Secretion ..52, 74, 81, 87, 89, 97, 99, 108, 110, 117, 125, 223, 264, 265, 269, 272, 278, 283 Selenium..............................................220 Serum .......56, 57, 89, 96, 103, 110, 128, 139, 192, 205, 265, 270, 279, 283 Sialorrhea ............................................134 Somatostatin...25, 87, 224, 225, 226, 278, 279 Spectrum ..10, 90, 99, 110, 112, 265, 280, 286 Sphincter .........................54, 89, 158, 283 Spondylitis .............................................50 Sporadic ................................................72 Stenosis .........................................52, 132 Stents ..................................................202 Stomach .11, 13, 25, 60, 74, 84, 114, 118, 132, 134, 137, 147, 270, 279 Stomatitis .............................................131 Subclinical ...........................................128 Sulfur ...........................111, 160, 275, 276 Suppressive.........................................106 Synergistic ...........................................105
Systemic ...... 57, 65, 102, 111, 131, 139, 278, 284 T Tachykinins ........................................... 73 Thermoregulation................................ 218 Thrombosis ........................................... 60 Thyroxine ............................ 139, 220, 284 Tomography.... 13, 19, 53, 55, 58, 97, 105 Toxicity.................................................. 55 Toxicology..................................... 10, 165 Trachea................................................. 73 Transcutaneous .................................. 201 Transplantation .. 114, 115, 116, 117, 119, 142 Triazolam .................................... 161, 285 U Ulcer. 52, 56, 95, 115, 116, 117, 133, 134, 142, 166 Ultrasonography ..................... 53, 97, 105 Urology.................................................. 10 Urticaria........................... 95, 96, 160, 263 Uveitis ................................................... 95 V Vascular ... 51, 84, 95, 111, 112, 130, 271, 278, 285 Vasculitis............................... 98, 102, 104 Vasoactive .......................................... 106 Vasodilatation ....................................... 73 Viruses .......................... 45, 193, 262, 286 X Xerostomia.......................................... 134 Z Zalcitabine............................................. 39
292 Pancreatitis
