Chronic Relapsing Pancreatitis in a Child: Use of the Puestow Procedure to Achieve Ductal Drainage

A case of chronic relapsing pancreatitis presenting in an 8-year old African Jamaican girl is outlined. Aggressive supportive management failed to control pain and vomitting. The Puestow Procedure effectively aborted these symptoms. The use of the Puestow procedure should not be inordinately delayed in chronic relapsing pancreatitis if symptoms persist, since it may not only control pain but also halt declining pancreatic function.(Au)

Acute myocarditis following Tityus trinitatis envenoming: morphological and pathophysiological characteristics

The clinicopathological features of four cases of scorpion envenoming by Tityus trinitatis are presented. The cardiac histopahtology is recorded in the two fatal cases. The pathology of the acute myocarditis was a mixed picture of a toxic myocarditis and coagulative myocytolysis. These cardiac lesions are also seen in catecholamine induced cardiotoxicity and lend support to the theory that an adrenergic surge follows scorpion envenoming. A brief review of scorpion envenoming syndrome is undertaken in the light of these findings (AU)

What are the long-term results of endoscopic pancreatic sphincterotomy for pancreatitis?

Endoscopic pancreatic sphincterotomy (EPS) has been touted as effective therapy for several disorders including chronic pancreatitis and unexplained abdominal pain associated with pancreatic sphincter dysfunction (pSOD). Although short-term data are encouraging, there are no reports on how these patients fare beyond the first few months after EPS. The data on all patients who had EPS performed at the Johns Hopkins Hospital over a 4 year period between August 1992 and November 1996 were reviewed. Patients were then contacted by a physician other than the original endoscopist and asked to rate their pain using the linear pain scale score (0-10 where 10 is the worst possible pain). Patients were asked to score their pain before EPS and also at follow-up. Clinical improvement was defined as a >50 percent reduction in the pain score. The data on 55 patients were available for review. There were 17 men and 38 women age (yrs) ñSD: 43.6 ñ 16.7. Indications for EPS included 1) chronic pancreatitis (n=40); 2) unexplained abdominal pain with pSOD (n=15). EPS was associated with pancreatitis in 5 patients (9 percent), bleeding in 2 (3.6 percent) and early stent occlusion in 5 (9 percent). 7 patients had surgical sphincteroplasty after EPS. No patient died from EPS. After a median follow-up of 16 months (longest, 52 months) 60 percent of all patients improved, with an overall improvement in pain scores (mean ñ SD) from 8.8 ñ 1.8 pre-EPS to 3.6 ñ 3.4 post-EPS (p<0.0001). The response rate was even more impressive in the pSOD group with 73 percent of the patients reporting improvement and a reduction in pain scores from 9.0 ñ 1.6 to 2.9 ñ 3.3 after sphincter ablation (p<0.001). In a subgroup of patients with pancreatic disease and pancreatic sphincter dysfunction, EPS results in sustained significant clinical improvement.(AU)

Chronic relapsing pancreatitis from a scorpion sting in Trinidad

Chronic relapsing pancreatitis is a rare cause of abdominal pain in children and exceptionally rarely is related to a scorpion sting. We describe a 13-year-old girl who, following envenoming by a scorpion, developed recurrent attacks of sharp, intermittent pain in the umbilical region associated with fever, nausea, anorexia and vomiting, and changes in her psychological behaviour. Thorough clinical evaluation, including CT scanning, disclosed unabated pancreatitis, particularly in children, a scorpion sting should be considered an aetiologically possibility(AU)

Chronic pancreatitis in Jamaica

Thirty-five patients with chronic pancreatitis (CP) treated with over a 15-year period were studied. There were 29 men and 6 women with a mean age of 47 years (range 21-67). Twenty-seven (77 percent) were chronic alcoholics, two (6 percent) had gallstones, one had stenosis of the Ampulla of Vater and in five (14 percent) no obvious cause was found. Thirty patients (86 percent) presented with abdominal pain. Chronic diarrhoea was present in 8 (23 percent), and steatorrhoea was documented in 6 of these. Fifteen (43 percent) had pancreatic calcifications. Five developed pseudocysts and 16 (46 percent) developed diabeted mellitus. Twelve patients required surgery. Three continue to have severe recurrent relapses of pain but the majority (91 percent) have had a relatively stable course with medical management. (AU)

Hyperamylasemia and pancreatitis in leptospirosis

Hyperamylasemia has been documented in up to 65 percent of our patients with leptospirosis and jaundice. However, pancreatitis is an uncommon complication of leptospirosis. Three patients with leptospirosis and pancreatitis are described and compared with two leptospirosis patients who had hyperamylasemia but in whom the diagnosis of pancreatitis could not be substantiated. The cause of the hyperamylasemia in the latter patients was nonpancreatic. The elevation of the amylase in these latter two patients could not be explained by renal insufficiency, because the level of the amylase was greater than three to fourtimes the normal value, the upper limit to which amylase rises in renal failure.Thus, hyperamylasemia in patients with leptospirosis can be from pancreatic and nonpancreatic sources. Leptospirosis should be considered in the differential diagnosis of hyperamylasemia and pancreatitis (AU)

Review of the aetiology and pathogenesis of acute pancreatitis: Part IV: Auto-immune reactions, neurogenic and miscellaneous factors

It is possible that in many cases, acute pancreatitis may develop because of auto-immune reactions. There are positive indications that neurogenic factors may play an important role in the development of some cases of acute pancreatitis. The problems pertaining to hereditary pancreatitis, the association of pancreatitis with pregnancy, ureamia, certain drugs and the sting of scorpions have been discussed (AU)

A review of the aetiology and pathogenesis of acute pancreatitis: Part III: Nutritional factors and metabolic disorders

Protein deficiency may increase the susceptability of patient to pancreatic damage. It has been suggested that this protein malnutrition may be the important factor in producing pancreatic lesions in chronic alcholics with poor dietary habits. The association of pancreatic tissue is still controversial even though there have been reports of pancreatitis associated with corticosteroid therapy (AU)

A review of the aetiology and pathogenesis of acute pancreatitis Part II: Obstruction with hyper-secretion theory, alcoholism, vascular factors and trauma

Acute pancreatitis is generally accepted as being due to obstruction of the pancreatic duct and hyper-section but the activation of trypsinogen into trypsin is not fully understood. The value of trasylol in pancreatitis is debatable. The roles of alcoholism, circulatory disturbances and trauma in the aetiology of pancreatitis are discussed (AU)

A review of the aetiology and pathogenesis of acute pancreatitis: part 1: Classification, role of infection, common channel theory and duodenal reflux

There are still contradictory opinions concerning the aetiology and pathogenesis of acute pancreatitis. The problem of lymphatic spread of infection from the biliary tract to the pancreas, which in the thirties was considered as improbable, has been re-opened by the results of more recent investigations. The common channel theory which was once considered to be the explanation for most cases of pancreatitis, can account for only a small proportion of cases of pancreatitis. There is still lack of agreement as to the role of duodenal reflux in the causation of pancreatitis (AU)

Experimental studies on the aetiology of acute scorpion pancreatitis

This study examined the action of the venom of the scorpion Tityus trinitatis on the pancreas and gastrointestinal tract in anaesthetized dogs, on the isolated extracorporeal haemoperfused canine pancreas and on the isolated canine sphincter of Oddi. The venom induces exocrine secretion in both the isoslated and intact pancreas and causes contraction of the isolated sphincter of Oddi. These results are discussed in relation to the pathogenesis of acute scorpion pancreatitis and possibly of some other forms of acute pancreatitis. (Summary)

Medical disorders in a small Caribbean island: an analysis of the diseases of adults in Dominica in 1972 and 1973

An analysis was undertaken, for the first time, of the total picture of the medical disorders of adults on a small Caribbean island. At present non-infectious diseases, especially diabetes and hypertension, are of major importance. Parasitic infestation of the gut occurred in 50-60 percent of the hospital population. The pattern of diseases indicates that the island is in a transitional stage of its medical development, and that resources need to be directed to the curative as well as to public health programmes. The impact of pecularities of local geography and customs are discussed as contributing to some of the more unusual diseases of the Caribbean.(Summary)

Hyperparathyroidism: an unusual presentation

A patient with hyperparathyroidism presented with a rare form of chronic pancreatitis (massive bloody ascites). He was normocalcaemic on all occassions except one, when he was deliberately re-investigated to try and discover the etiology of his pancreatitis. The association between hyperparathyroidism and pancreatitis is discussed (AU)

Massive pancreatic ascites

A case of massive bloody ascites is described. This was associated with a benign pseudocyst of the pancreas of undetermined etiology. The ascites recurred after drainage but has not recurred after drainage of the pseudocyst (AU)

Acute scorpion pancreatitis in Trinidad

Over a two-month period 30 patients were admitted to hospital following stings of the scorpion of Trinidad, the tityus trinitatis. In 24 cases acute pancreatitis developed soon after the sting, but in nine of these no abdominal pain occurred. All the patients made an uneventful recovery. Although such complications have been reported no pseudocyst formations or acute haemorrhagic pancreatitis occurred in this series (AU)