[121st Internal Medicine Seminar--XXVI Vanysek Seminar held on the anniversary of the birth of Dr. Rudolf Vanysek, the founder of Internal Medicine in Brno. Friday 15 March 2002, Brno. Inflammatory diseases of the pancreas].

Vnitr Lek 2002, 48(9):821-897

[Advances in the diagnosis and therapy of chronic pancreatitis].

P Dítě

Vnitr Lek 2002, 48(9):823-828

Chronic pancreatitis is a permanent diagnostic and therapeutic problem. There is no method diagnosing early stages of the disease. Contemporary diagnosis is based on morphological methods. The gold standard is ERCP, but similar results are provided also by non-invasive NMR cholangiopancreatography. Ultrasound examination provides reliable information on the presence of cystoids and major solid formations. Spiral CT is the method which by visualizing the pancreatic duct and structural changes is indispensible. Functional tests are in the diagnostic algorithm only marginal. Treatment of the disease involves dietetic provisions, prohibition of alcohol,...

[Etiological factors of acute pancreatitis].

J Spicák

Vnitr Lek 2002, 48(9):829-841

Acute pancreatitis develops immediately after the causative impulse, while chronic pancreatitis develops after the long-term action of the noxious agent. A typical representative of acute pancreatitis is biliary pancreatitis, chronic pancreatitis develops in alcoholism and has a long latency. As alcoholic pancreatitis is manifested at first as a rule by a potent attack, it is classified in this stage as acute pancreatitis. The most frequent etiological factors in our civilization are thus cholelithiasis and alcoholism (both account for 20-50% in different studies). The assumed pathogenetic principles in acute biliary pancreatitis are the common canal...

[Principles of conservative treatment of severe acute pancreatitis].

T Vanásek, P Hůlek, T Fejfar

Vnitr Lek 2002, 48(9):842-846

The main principles of conservative treatment of severe acute pancreatitis include early diagnosis of the disease, diagnosis of its severe form and assessment of the etiology of pancreatitis, replacement of fluids, adjustment of the milieu intérieur, administration of antibiotics in patients with confirmed necroses, in particular if they exceed 25 - 30%, early endoscpic treatment of pancreatitis with a biliary etiology, adequate nutrition, prevention and treatment of complications. The diagnosis of pancreatitis is based on clinical examination, biochemical evidence of elevated amylase and lipase concentrations and on the imaging of the pancreas. In...

[Acute biliary pancreatitis--endoscopic therapy yes or no?].

R Keil

Vnitr Lek 2002, 48(9):847-850

Biliary pancreatitis accounts for 30 - 60% of all cases of acute pancreatitis. During the last ten years a number of randomized trials was implemented which evaluated the role of acute endoscopic retrograde cholangiopancreatography and papillosphincterotomy in the treatment of biliary pancreatitis. From analysis of different trials ensues that an urgent endoscopic operation is indicated unequivocally in patients with the acute form of biliary pancreatitis, furthermore in patients with concurrent cholangoitis or the presence of obstructive jaundice. The author assumes that, based on detailed analysis of the results, urgent endoscopic retrograde cholangiopancreatography...

[Artificial nutrition in acute pancreatitis].

Z Zadák, F Musil, R Hyspler, L Sobotka, V Bláha

Vnitr Lek 2002, 48(9):851-855

The authors describe the administration of different types of artificial nutrition depending on the clinical condition of patients with acute pancreatitis. They summarize contemporary findings on the pathophysiology of the disease, evaluation of everity according to Ranson's criteria and the tactics of nutritional support in acute pancreatitis.

[Acute pancreatitis from the aspect of the surgeon].

J Wechsler, J Zák, D Wechsler

Vnitr Lek 2002, 48(9):856-860

The authors provide evidence of the extreme increase of the frequency of acute pancreatitis. At the First Surgical Clinic in Brno in 1934 the frequency of acute pancreatitis (AP) was 0.2 pro mille (in the course of 3 years 4 patients among 20 000 hospitalized patients), at present (65 years later) in 1999 - 2001 it is 0.7%--74 patients among 10 676 hospitalized patients. This is 35 times more, 48 men (65%) and 26 women (35%). The mean age was 48.6 years, range 26 - 83 years. The lethality of the whole group was 9.5%. From the total number of 74 patients seriously ill patients (Atlanta II classification) 25 patients--34%, Atlanta I--49 patients--66%....

[Etiopathogenesis of chronic pancreatitis--present state].

M Zavoral, F Závada

Vnitr Lek 2002, 48(9):861-864

Chronic pancreatitis is in advanced European and North American countries the statistically most important source of morbidity and mortality among benign pancreatopathies. It is defined as affection of the pancreas by chronic inflammation whereby the secretory parenchyma is gradually replaced by fibrous tissue. The fibrosis is irreversible and the disease has a progressing trend. In advanced countries the main pathogenetic factor has been for some centuries alcohol consumption. Chronic pancreatitis can be classified with regard to its morphology, etiology or pathogenesis. Most frequently the classification of chronic pancreatitis with regard to morphological...

[Clinical symptomatology of chronic pancreatitis].

A Hep

Vnitr Lek 2002, 48(9):865-866

The author describes the clinical picture of chronic pancreatitis, incl. less commonly used clinical examinations.

[Imaging methods in the diagnosis of chronic pancreatitis].

A V Válek, M Mechl

Vnitr Lek 2002, 48(9):867-873

According to the document "Indication criteria for imaging methods" of 2000 approved by the European commission and experts representing European radiology and nuclear medicine in collaboration with the British UK Royal College of Radiologists in patients with chronic pancreatitis a simple picture of the abdomen is indicated in particular for detection of classifications. Other imaging methods include ultrasound examination (no radiation load) which in slim patients can lead to a final conclusion, or CT examination (great radiation load) suitable also for obese patients and the method is particularly effective for the detection of calcifications. ERCP...

[Endoscopic diagnosis of chronic pancreatitis].

V Zboril

Vnitr Lek 2002, 48(9):874-877

Endoscopy entered the diagnosis of pancreatic diseases in 1972 as the first endoscopic retrograde cholangiopancreaticography and during subsequent decades it markedly extended its field of action to comprise also endoscopic therapy of the pancreas. At present it represents together with abdominal sonography, computed tomography, endosonography, and nuclear magnetic resonance the basic spectrum of morphological examination methods of the pancreas. The disadvantage of endoscopic retrograde cholangiopancreaticography is the invasive character of this method associated with complications. In chronic pancreatitis this method can be used in particular to...

[Diabetes mellitus in chronic pancreatitis and insulin sensitivity].

Z Vlasáková, V Bartos, J Spicák

Vnitr Lek 2002, 48(9):878-881

Diabetes mellitus as a specific etiological type of disease is a relatively frequent complication of chronic pancreatitis and is found always after total pancreatectomy. It is not clear whether in the frequently profound hypoglycaemias of these patients also increased insulin sensitivity may participate. Data in the literature are not uniform. The objective of the submitted work was to assess the insulin sensitivity in 10 patients with chronic pancreatitis (confirmed by ERCP) and diabetes and to compare them with 10 controls and 10 diabetics type 2 treated by diet matched for age and body mass index. The effect of insulin was assessed by the method...

[Conservative therapy of chronic pancreatitis].

P Fric

Vnitr Lek 2002, 48(9):882-886

Conservative therapy is applied to various extent in all subjects with chronic pancreatitis. It includes removal of the provoking agent (most frequently alcohol abuse and biliary disease), dietary regimen, treatment of pain, maldigestion, and diabetes. Removal of the provoking agent prevents progression of the disease and relieves intensity of the main symptoms, particularly of pain. Diet in remission should include approximately 1g of protein/kg body mass. Fat intake should be encouraged within limits of individual tolerance. With low caloric intake carbohydrates should be enriched up to 65 - 70% of total energy intake. Abdominal pain may be due to...

[Nutritional profile and treatment of subjects with chronic pancreatitis].

A Záková, J Zák

Vnitr Lek 2002, 48(9):887-890

The authors give an account on the nutritional status of patients with chronic pancreatitis according to the Cambridge classification of ERCP changes grade II and III, treated conservatively and by surgery. From a perspectively followed up group of 30 patients with chronic obstructive pancreatitis before surgery 53.5% suffered from malnutrition. Nine months after surgery the nutritional status improved in 9 of 16 patients, malnutrition persisted in 23.3%. During a check-up examination 3 years after surgery and despite dietetic treatment and enzyme substitution 20% patients suffered from malnutrition. In some of the patients low zinc and magnesium serum...

[Possibility of endoscopic therapy of chronic pancreatitis].

A Vavrecka

Vnitr Lek 2002, 48(9):891-894

[Surgical approaches to treatment of chronic pancreatitis].

M Růzicka, M Stracár, T Krejcí

Vnitr Lek 2002, 48(9):895-897

In the treatment of pancreatitis in recent decades various surgical methods are used. Essentially we can divide them into resection and drainage methods. In the submitted paper the authors review possible surgical treatment of chronic pancreatitis and indications of optimal surgical methods in different forms of chronic pancreatitis. The application of these surgical procedures is demonstrated on a group of patients operated by the authors in 1985-2001. The authors discuss the problem of indication of patients for surgical treatment and selection of the optimal surgical methods for the treatment of chronic pancreatitis.

[Diabetes mellitus associated with chronic pancreatitis].

J Perusicová

Vnitr Lek 2002, 48(9):898-905

Diabetes mellitus (DM) as part of chronic pancreatitis (ChP) belongs into the group of secondary DM with typical insulin deficiency. The prevalence and incidence of DM in ChP depends on the selected diagnostic criteria, geographical conditions and duration and grade of pancreatitis. Based on our findings during a 15-year investigation of impaired glucose tolerance and insulin secretion in patients with ChP the authors submit some partial (published and unpublished) results. The largest investigated group were 122 patients with ChP diagnosed according to the morphological appearance during ERCP. The authors detected a mutual close relationship between...