Historical review of our knowledge of acute pancreatitis. / Revisión histórica de algunos conocimientos sobre pancreatitis aguda.

Acute pancreatitis is one of most common causes of consultation due to abdominal pain in medical emergency units and it requires hospital admission. Although the majority of cases are mild and patients tend to recover quickly, a small percentage of cases is severe, with mortality in the region of 5-10%. This historical review considers how our understanding of this disease has changed since it was first described in 1579 thanks to the contributions of renowned experts such as Nicolaes Tulp, Reginald Fitz, Nicholas Senn and many others who, through their expertise and dedication, have improved the survival of patients with this disease.

El arte de la cirugía pancreática. Pasado, presente y future / The art of pancreatic surgery. Past, present and future. The history of pancreatic surgery

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Cullen Sign and Grey Turner Sign Revisited.

Cullen sign and Grey Turner sign, named after Thomas Stephen Cullen, MB, and George Grey Turner, MBBS, respectively, are signs of abdominal wall hemorrhage and are generally associated with acute pancreatitis. However, the research from which these signs arose was documented long before Cullen and Grey Turner made their contributions. The present article examines the history, pathologic mechanisms, and clinical application of these signs in relation to acute pancreatitis and ectopic pregnancy.

Living "anyway:" stories of access.

Elana Dykewomon's 1974 novel, Riverfinger Women, was among the first lesbian books with a "happy ending." Her seven books of fiction and poetry include the Lambda Award winner Beyond the Pale (now an audio and e-book) and Lambda nominee, Risk. She was an editor of the lesbian-feminist journal, Sinister Wisdom, for eight years. Her literary work foregrounds the lesbian heroic as integral to women's communities. As a social justice activist, she has organized and participated in anti-war, anti-racist, anti-classist, fat and disability rights work since the 1970s. She is now working with Old Lesbians Organizing for Change. She is happy to live embedded in dyke community as a lesbian radical committed to a loving justice. While she suffered psychiatric abuse at 13 (and acknowledges long-term adaptive behavior on that account), she has not experienced disabling mental illness since. Her primary disabilities are mobility impairment through severe, progressive arthritis and constant low-to-powerful pain, sometimes diagnosed as fibromyalgia. Her acute illnesses include pancreatitis and a rare-in-adults kidney disease currently in remission.

Apuntes históricos sobre el tratamiento quirúrgico de la pancreatitis aguda severa / Historical notes on surgical treatment of severe acute pancreatitis

Se discute la evolución del tratamiento quirúrgico de la pancreatitis aguda severa, sobre la base del análisis y fundamentación cronológica de las publicaciones originales, que aparecen particularmente referenciadas. Durante las primeras seis décadas del siglo XX, la cirugía ablativa radical y temprana en el tratamiento de la pancreatitis aguda severa era ampliamente practicada en Europa y América, con mortalidad promedio superior al 60 por ciento. A finales de la década de los 60, aparecen los primeros reportes que demuestran que los tratamientos quirúrgicos menos radicales eran más efectivos y se suceden con rapidez gran número de publicaciones que paulatinamente reportan los beneficios de técnicas quirúrgicas más conservadores de desbridamiento y drenaje de las áreas de necrosis pancreáticas infectadas. Simultáneamente se establece las ventajas del tratamiento médico conservador y los procedimientos quirúrgicos de re-intervención planificada y tardía en la necrosis pancreática. Se destacan además, las ventajas de un grupo de novedosas técnicas mínimamente invasiva de drenaje y desbridamiento guiadas por imágenes o endoscopia, las cuales han ganado aceptación general de forma rápida y convincente y cuyo futuro es altamente prometedor (AU)

The evolution of the surgical treatment of severe acute pancreatitis is discussed, on the base of the analysis and chronological foundation of the original publications that appear particularly indexed. During the first six decades of the XX century, the radical and early ablative surgery in the treatment of the severe acute pancreatitis was extensively practiced in Europe and America, with average mortality superior to 60 percent. At the end of 1960, the first reports appeared and demonstrated that least radical surgical treatments were more effective and big number of publications happens rapidity that gradually report the benefits of drainage and debridement surgical skills in areas of infected pancreatic necrosis. Simultaneously there are established the advantages of the conservative medical treatment and the surgical procedures of planned and late re-intervention in the pancreatic necrosis. The advantages of a group of novel skills minimally invasive of drainage and debridement are stand out guided by images or endoscopy, which have gained general acceptance in a rapid and convincing form and whose future it is highly promising (AU)

Prophecy about post-endoscopic retrograde cholangiopancreatography pancreatitis: from divination to science.

One unresolved issue of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP), which occurs in up to 40% of patients. Identification of risk factors for PEP is especially important in the field of ERCP practice because it may assist physicians in taking protective measures in situations with high risk. A decade ago, Freeman et al meticulously evaluated a large number of potentially relevant risk factors for PEP, which can be divided into patient-related and procedure-related issues. In this commentary, we summarize this classic article and reevaluate the risk factors for PEP from the current point of view. This is followed by assessment of strategies for prevention of PEP that can be divided into mechanical and pharmacologic methods.

Insulitis in human type 1 diabetes: The quest for an elusive lesion.

The histopathology of type 1 diabetes is defined by a decreased ß-cell mass in association with insulitis, a characteristic lymphocytic infiltration limited to the islets of Langerhans and prominent in early stage disease in children. A cytotoxic T-cell mediated destruction of insulin-producing ß-cells is thought to be initiated by an unknown (auto)antigen, leading to the destruction > 75% of ß-cell mass at clinical diagnosis. Although considered to be pathognomonic for recent onset disease, insulitis has only been described in approximately 150 cases over the past century. This review describes the quest for this elusive lesion and gives its incidence in various patient subpopulations stratified for age of onset and duration of the disease. It discusses recent new insights into the regenerative capacity of the ß-cell mass in the pre-clinical stages of the disease and relates these findings to the inflammatory processes within the islet tissue.

Treatment of acute pancreatitis: an attempted historical review.

This attempt at a historical review of the treatment of acute pancreatitis summarizes the findings of studies carried out in decades long past and shows their impact on the therapy of this disease today. It identifies in retrospect the correct avenues of research and the blind alleys, and describes the ebb and flow of interest in various forms of management. Acquaintance with the work of previous investigators may prevent the unnecessary rediscovery of old principles of treatment. Not all of the studies discussed can be found with search engines: they come from the author's personal library, collected over his 40 years as an active pancreatologist, and from the knowledge of the early literature bequeathed to him by his teachers and mentors.

Acute pancreatitis: a historical perspective.

Among the various pancreatic disorders, the pace of scientific discovery in acute pancreatitis has been particularly slow. The objective of this paper was to briefly review the history of scientific discovery of the clinical features, pathophysiology, and treatment of acute pancreatitis. A clinical description of acute pancreatitis was first presented in 1652 by the Dutch anatomist Nicholas Tulp, and despite the nearly 350 years that have passed, there continue to be many unanswered questions. In the late 19th and early 20th century, Reginald Fitz, Nicholas Senn, Eugene Opie, and others made seminal contributions that continue to influence our present understanding of acute pancreatitis. Despite remarkable progress in the past 6 decades, our ability to accurately diagnose and estimate the severity of acute pancreatitis remains limited. History provides multiple examples of empiric remedies and surgical interventions based on the prevailing theories and opinions of the scientific luminaries du jour, and indeed, after 3 centuries of inquiry, the most effective interventions for acute pancreatitis are purely supportive in nature and not specific to the pancreas. However, the perseverance of successive generations of the finest scientific minds provides hope that we will unravel the many mysteries of this enigmatic gland.

A historic perspective on the contributions of surgeons to the understanding of acute pancreatitis.

BACKGROUND: Acute pancreatitis is a disease with a broad spectrum of presentation, severity, and treatment. Current management involves a multidisplinary team of surgeons, gastroenterologists, and interventional radiologists whose varied clinical skills contribute to the evolving diagnostic and therapeutic strategies for this disease. However, critical aspects of therapy have remained the responsibility of the general surgeon. The purpose of this review is to examine the many contributions of surgeons in acute pancreatitis. DATA SOURCES: A review of the literature taken from PubMed on seminal articles published by surgeons on the subject of acute pancreatitis. CONCLUSIONS: Surgeons have made significant contributions to the understanding of the pathophysiology and evolution of therapy of acute pancreatitis. The specialty should continue to take a leadership role to improve outcomes.