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Medical Management of Pancreatitis

Medical Management of Pancreatitis Abstract The therapy of pancreatitis is neither standardized nor specific, and often it is disappointingly ineffective. Certain trends in therapy are, however, noticeable. During the last two decades the treatment of acute pancreatitis has emphasized nonoperative supportive and symptomatic measures in the early phases of the disease. General adoption of this plan has been attended by an appreciable reduction in the fatalities which formerly resulted. Even so, there remains an apparent irreducible mortality, the magnitude of which is in the neighborhood of 10%.* It appears that not only is improvement in therapy responsible for the greater survival rate but also improvement in diagnostic procedures has led to recognition of many milder, relatively innocuous, instances of the disease which previously would have been undiagnosed. Not only does this mild acute pancreatitis have a low mortality rate, but patients with severer forms of the disease also recover more frequently than formerly.† Kirby and References 1. References 1 and 2. 2. References 3 and 4. 3. References 6 and 7. 4. References 1 and 8-11. 5. References 8 and 9. 6. References 13 and 14. 7. References 8 and 14. 8. References 8, 10, and 16. 9. References 18-20. 10. References 8, 10, 20, 23, and 24. 11. References 8, 10, 20, and 25. 12. References 8, 10, 20, and 27. 13. References 22, 23, 27, 29, and 30. 14. References 30-32. 15. References 11 and 23. 16. References 34 and 35. 17. References 37 and 38. 18. References 1 and 7. 19. References 2, 9, 10, and 23. 20. References 5, 30, and 44. 21. Machella, T. E.: Acute and Chronic Pancreatitis, Veterans Administration Technical Bulletin TB 10-87, March 2, 1953. 22. Fallis, L. S.: Acute Pancreatitis , Proc. Roy. Soc. Med. 46:113-115 ( (Feb.) ) 1953. 23. Kirby, C. K.; Howard, J. K., and Rhoades, J. E.: Death Due to Delayed Hemorrhage in Acute Pancreatitis , Surg., Gynec. & Obst. 100: 458-462 ( (April) ) 1955. 24. Siler, V. E.; Wulsin, J. H., and Carter, B. N., II.: Important Clinical Factors of Acute Pancreatitis , Surg., Gynec. & Obst. 100:357-365 ( (March) ) 1955. 25. Priestly, J. T.; Taylor, L. M., and Rogers, J. D.: Surgical Treatment of Chronic Relapsing Pancreatitis , Surgery 37:317-336 ( (Feb.) ) 1955. 26. Comfort, M. W.; Gambill, E. E., and Baggenstoss, A. H.: Chronic Relapsing Pancreatitis: A Study of 29 Cases Without Associated Disease of the Biliary or Gastrointestinal Tract , Gastroenterology 6:239-285 ( (April) ) 27. 376-408 (May) 1946. 28. Gambill, E. E.; Comfort, M. W., and Baggenstoss, A. H.: Chronic Relapsing Pancreatitis: An Analysis of 27 Cases Associated with Disease of the Biliary Tract , Gastroenterology 11:1-33 ( (July) ) 1948. 29. Dreiling, D. A., and Richman, A.: Pancreatitis: A Review , J. Mt. Sinai Hosp. 21:122-136 ( (Sept.-Oct.) ) 30. 176-194 (Nov.-Dec.) 1954. 31. Ivy, A. C., and Gibbs, G. E.: Pancreatitis: A Review , Surgery 31:614-642 ( (April) ) 1952. 32. Berk, J. E.: Management of Acute Pancreatitis , J. A. M. A. 152:1-5 ( (May 2) ) 1953. 33. Zollinger, R. M.; Keith, L. M., Jr., and Ellison, E. H.: Pancreatitis , New England J. Med. 251:497-502 ( (Sept. 23) ) 1954. 34. Gold, H.; Kwit, N. T., and Modell, W.: The Effect of Extracardiac Pain on the Heart , A. Res. Nerv. & Ment. Dis., Proc. 23:345-357, 1943. 35. New and Nonofficial Remedies, 1954 , Philadelphia, J. B. Lippincott Company, 1954. 36. Utendorfer, R. W., and Bergh, G. S.: The Effect of Demerol on the Sphincter of Oddi in Man , Gastroenterology 11:341-343 ( (Sept.) ) 1948. 37. Keats, A. S.; D'Alessandro, G. L., and Beecher, H. K.: A Controlled Study of Pain Relief by Intravenous Procaine , J. A. M. A. 147: 1761-1763 ( (Dec. 29) ) 1951. 38. Doubilet, H., and Mulholland, J. H.: The Results of Sphincterotomy in Pancreatitis , J. Mt. Sinai Hosp. 17:458-462 ( (March-April) ) 1951. 39. Butsch, W. L.; McGowan, J. M., and Walters, W.: Clinical Studies on Influence of Certain Drugs in Relation to Biliary Pain and to Variations in Biliary Pressure , Surg., Gynec. & Obst. 63:451-456 ( (Oct.) ) 1936. 40. Elman, R.: A Note on the Use of Nitroglycerine in the Immediate Treatment of Acute Nonhemorrhagic Pancreatitis , Am. J. Digest. Dis. 6:474-475 ( (Sept.) ) 1939. 41. Cunha, F.: Diagnosis and Treatment of Pancreatic Disease , Am. J. Surg. 58:16-28 ( (Oct.) ) 1942. 42. Bockus, H. L.; Roth, J. L., and Sifore, R. A.: Diagnosis and Treatment of Acute Pancreatitis , S. Clin. North America 31:1583-1601 ( (Dec.) ) 1951. 43. de Alvare, L. R.: Contribucion al estudio de los pancreatitis agudas (hemorragicos): El Tratamiento quirurgigo diferido , Vida Nueva 60: 1-30 ( (July) ) 1947. 44. Gage, M., and Gillespie, G.: Acute Pancreatitis and Its Treatment , South. M. J. 44: 770-774 ( (Sept.) ) 1941. 45. Paxton, J. R., and Payne, J. H.: Acute Pancreatitis: A Statistical Review of 307 Established Cases of Acute Pancreatitis , Surg., Gynec. & Obst. 86:69-75 ( (Jan.) ) 1948. 46. Lium, R.: The Diagnosis and Conservative Treatment of Acute Pancreatitis , New England J. Med. 219:881-885 ( (Dec. 31) ) 1938. 47. Shingleton, W. W., and Anlyan, W. G.: Methantheline (Banthine) Bromide in Acute Pancreatitis , J. A. M. A. 147:1655 ( (Dec. 22) ) 1951. 48. Goodman, L. S., and Gilman, A.: The Pharmacological Basis of Therapeutics , Ed. 2, New York, The Macmillan Company, 1955. 49. Pearson, S., and Lungven, J. C.: The Relief of Pain in Acute Pancreatitis , Ann. West. Med. & Surg. 2:550-552 ( (Dec.) ) 1948. 50. Davies, R. M.; Moore, F. T., and Wynn-Williams, D.: Treatment of Acute Pancreatitis with Hexamethonium Bromide , Brit. M. J. 2: 1251-1252 ( (Dec. 5) ) 1953. 51. Tejerina-Fatheringham, W.: Acute Pancreatitis: Pathophysiology and Treatment , Gastroenterology 10:687-696 ( (April) ) 1948. 52. Cattell, R. B., and Warren, K. W.: Surgery of the Pancreas , Philadelphia, W. B. Saunders Company, 1953. 53. Orr, R. B., and Warren, K. W.: Continuous Epidural Analgesia in Acute Pancreatitis , Lahey Clin. Bull. 6:204-210 ( (Jan.) ) 1950. 54. Berk, J. E., and Kruperman, L. W.: The Use of Fractional Epidural Block in Management of Acute Pancreatitis , Am. J. M. Sc. 224:507-513 ( (Nov.) ) 1952. 55. Kenwell, H. N., and Wels, P. B.: Acute Hemorrhagic Pancreatitis: Report of 11 Consecutive Cases Treated with Human Serum Albumin , Surg., Gynec. & Obst. 96:169-170 ( (Feb.) ) 1953. 56. Stephenson, H. E., Jr.; Pfeffer, R. B., and Seypol, G. M.: Acute Hemorrhagic Pancreatitis: Report of a Case with Cortisone Treatment , A. M. A. Arch. Surg. 65:307-308 ( (Aug.) ) 1952. 57. Eskwith, I. S.; Cagage, V. A., and Sollosy, A.: Acute Hemorrhagic Pancreatitis: Treatment with Cortisone , New England J. Med. 252:494-495 ( (March 24) ) 1955. 58. Edmonson, H. A.; Berne, C. S.; Hamann, R. E., and Wertman, M.: Calcium, Potassium, Magnesium, and Amylase Disturbances in Acute Pancreatitis , Am. J. Med. 12:34-42 ( (Jan.) ) 1952. 59. Renner, W. F.: Postoperative Acute Pancreatitis and Lower Nephron Syndrome , J. A. M. A. 147:1654-1655 ( (Dec. 22) ) 1951. 60. Lynch, M. J.: Nephrosis and Fat Embolism in Acute Hemorrhagic Pancreatitis , A. M. A. Arch. Int. Med. 94:709-717 ( (Nov.) ) 1954. 61. Heacock, C. H., and Cara, D. J.: Radiation Therapy of Pancreatitis , Radiology 62:654-659 ( (May) ) 1954. 62. Rauch, R. F., and Stenstrom, K. W.: Effects of X-Ray Radiation on Pancreatic Function in Dogs , Gastroenterology 20:595-603 ( (April) ) 1952. 63. Warren, K. W.; Fallis, L. S., and Barron, J.: Acute Pancreatitis and Diabetes , Ann. Surg. 132:1103-1110 ( (Dec.) ) 1950. 64. Persky, L.; Schweinburg, F. B.; Jacob, S., and Fine, J.: Aureomycin in Experimental Acute Pancreatitis of Dogs , Surgery 30:652-656 ( (Oct.) ) 1951. 65. Raker, J. W., and Bartlett, M. K.: Acute Pancreatitis: The Fate of the Patients Surviving One or More Acute Attacks , New England J. Med. 249:751-757 ( (Nov. 5) ) 1953. 66. Berk, J. E.: The Treatment of Pancreatitis , Pennsylvania M. J. 56:265-269 ( (April) ) 1953. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Internal Medicine American Medical Association

Medical Management of Pancreatitis

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Publisher
American Medical Association
Copyright
Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1955.00250140054005
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Abstract

Abstract The therapy of pancreatitis is neither standardized nor specific, and often it is disappointingly ineffective. Certain trends in therapy are, however, noticeable. During the last two decades the treatment of acute pancreatitis has emphasized nonoperative supportive and symptomatic measures in the early phases of the disease. General adoption of this plan has been attended by an appreciable reduction in the fatalities which formerly resulted. Even so, there remains an apparent irreducible mortality, the magnitude of which is in the neighborhood of 10%.* It appears that not only is improvement in therapy responsible for the greater survival rate but also improvement in diagnostic procedures has led to recognition of many milder, relatively innocuous, instances of the disease which previously would have been undiagnosed. Not only does this mild acute pancreatitis have a low mortality rate, but patients with severer forms of the disease also recover more frequently than formerly.† Kirby and References 1. References 1 and 2. 2. References 3 and 4. 3. References 6 and 7. 4. References 1 and 8-11. 5. References 8 and 9. 6. References 13 and 14. 7. References 8 and 14. 8. References 8, 10, and 16. 9. References 18-20. 10. References 8, 10, 20, 23, and 24. 11. References 8, 10, 20, and 25. 12. References 8, 10, 20, and 27. 13. References 22, 23, 27, 29, and 30. 14. References 30-32. 15. References 11 and 23. 16. References 34 and 35. 17. References 37 and 38. 18. References 1 and 7. 19. References 2, 9, 10, and 23. 20. References 5, 30, and 44. 21. Machella, T. E.: Acute and Chronic Pancreatitis, Veterans Administration Technical Bulletin TB 10-87, March 2, 1953. 22. Fallis, L. S.: Acute Pancreatitis , Proc. Roy. Soc. Med. 46:113-115 ( (Feb.) ) 1953. 23. Kirby, C. K.; Howard, J. K., and Rhoades, J. E.: Death Due to Delayed Hemorrhage in Acute Pancreatitis , Surg., Gynec. & Obst. 100: 458-462 ( (April) ) 1955. 24. Siler, V. E.; Wulsin, J. H., and Carter, B. N., II.: Important Clinical Factors of Acute Pancreatitis , Surg., Gynec. & Obst. 100:357-365 ( (March) ) 1955. 25. Priestly, J. T.; Taylor, L. M., and Rogers, J. D.: Surgical Treatment of Chronic Relapsing Pancreatitis , Surgery 37:317-336 ( (Feb.) ) 1955. 26. Comfort, M. W.; Gambill, E. E., and Baggenstoss, A. H.: Chronic Relapsing Pancreatitis: A Study of 29 Cases Without Associated Disease of the Biliary or Gastrointestinal Tract , Gastroenterology 6:239-285 ( (April) ) 27. 376-408 (May) 1946. 28. Gambill, E. E.; Comfort, M. W., and Baggenstoss, A. H.: Chronic Relapsing Pancreatitis: An Analysis of 27 Cases Associated with Disease of the Biliary Tract , Gastroenterology 11:1-33 ( (July) ) 1948. 29. Dreiling, D. A., and Richman, A.: Pancreatitis: A Review , J. Mt. Sinai Hosp. 21:122-136 ( (Sept.-Oct.) ) 30. 176-194 (Nov.-Dec.) 1954. 31. Ivy, A. C., and Gibbs, G. E.: Pancreatitis: A Review , Surgery 31:614-642 ( (April) ) 1952. 32. Berk, J. E.: Management of Acute Pancreatitis , J. A. M. A. 152:1-5 ( (May 2) ) 1953. 33. Zollinger, R. M.; Keith, L. M., Jr., and Ellison, E. H.: Pancreatitis , New England J. Med. 251:497-502 ( (Sept. 23) ) 1954. 34. Gold, H.; Kwit, N. T., and Modell, W.: The Effect of Extracardiac Pain on the Heart , A. Res. Nerv. & Ment. Dis., Proc. 23:345-357, 1943. 35. New and Nonofficial Remedies, 1954 , Philadelphia, J. B. Lippincott Company, 1954. 36. Utendorfer, R. W., and Bergh, G. S.: The Effect of Demerol on the Sphincter of Oddi in Man , Gastroenterology 11:341-343 ( (Sept.) ) 1948. 37. Keats, A. S.; D'Alessandro, G. L., and Beecher, H. K.: A Controlled Study of Pain Relief by Intravenous Procaine , J. A. M. A. 147: 1761-1763 ( (Dec. 29) ) 1951. 38. Doubilet, H., and Mulholland, J. H.: The Results of Sphincterotomy in Pancreatitis , J. Mt. Sinai Hosp. 17:458-462 ( (March-April) ) 1951. 39. Butsch, W. L.; McGowan, J. M., and Walters, W.: Clinical Studies on Influence of Certain Drugs in Relation to Biliary Pain and to Variations in Biliary Pressure , Surg., Gynec. & Obst. 63:451-456 ( (Oct.) ) 1936. 40. Elman, R.: A Note on the Use of Nitroglycerine in the Immediate Treatment of Acute Nonhemorrhagic Pancreatitis , Am. J. Digest. Dis. 6:474-475 ( (Sept.) ) 1939. 41. Cunha, F.: Diagnosis and Treatment of Pancreatic Disease , Am. J. Surg. 58:16-28 ( (Oct.) ) 1942. 42. Bockus, H. L.; Roth, J. L., and Sifore, R. A.: Diagnosis and Treatment of Acute Pancreatitis , S. Clin. North America 31:1583-1601 ( (Dec.) ) 1951. 43. de Alvare, L. R.: Contribucion al estudio de los pancreatitis agudas (hemorragicos): El Tratamiento quirurgigo diferido , Vida Nueva 60: 1-30 ( (July) ) 1947. 44. Gage, M., and Gillespie, G.: Acute Pancreatitis and Its Treatment , South. M. J. 44: 770-774 ( (Sept.) ) 1941. 45. Paxton, J. R., and Payne, J. H.: Acute Pancreatitis: A Statistical Review of 307 Established Cases of Acute Pancreatitis , Surg., Gynec. & Obst. 86:69-75 ( (Jan.) ) 1948. 46. Lium, R.: The Diagnosis and Conservative Treatment of Acute Pancreatitis , New England J. Med. 219:881-885 ( (Dec. 31) ) 1938. 47. Shingleton, W. W., and Anlyan, W. G.: Methantheline (Banthine) Bromide in Acute Pancreatitis , J. A. M. A. 147:1655 ( (Dec. 22) ) 1951. 48. Goodman, L. S., and Gilman, A.: The Pharmacological Basis of Therapeutics , Ed. 2, New York, The Macmillan Company, 1955. 49. Pearson, S., and Lungven, J. C.: The Relief of Pain in Acute Pancreatitis , Ann. West. Med. & Surg. 2:550-552 ( (Dec.) ) 1948. 50. Davies, R. M.; Moore, F. T., and Wynn-Williams, D.: Treatment of Acute Pancreatitis with Hexamethonium Bromide , Brit. M. J. 2: 1251-1252 ( (Dec. 5) ) 1953. 51. Tejerina-Fatheringham, W.: Acute Pancreatitis: Pathophysiology and Treatment , Gastroenterology 10:687-696 ( (April) ) 1948. 52. Cattell, R. B., and Warren, K. W.: Surgery of the Pancreas , Philadelphia, W. B. Saunders Company, 1953. 53. Orr, R. B., and Warren, K. W.: Continuous Epidural Analgesia in Acute Pancreatitis , Lahey Clin. Bull. 6:204-210 ( (Jan.) ) 1950. 54. Berk, J. E., and Kruperman, L. W.: The Use of Fractional Epidural Block in Management of Acute Pancreatitis , Am. J. M. Sc. 224:507-513 ( (Nov.) ) 1952. 55. Kenwell, H. N., and Wels, P. B.: Acute Hemorrhagic Pancreatitis: Report of 11 Consecutive Cases Treated with Human Serum Albumin , Surg., Gynec. & Obst. 96:169-170 ( (Feb.) ) 1953. 56. Stephenson, H. E., Jr.; Pfeffer, R. B., and Seypol, G. M.: Acute Hemorrhagic Pancreatitis: Report of a Case with Cortisone Treatment , A. M. A. Arch. Surg. 65:307-308 ( (Aug.) ) 1952. 57. Eskwith, I. S.; Cagage, V. A., and Sollosy, A.: Acute Hemorrhagic Pancreatitis: Treatment with Cortisone , New England J. Med. 252:494-495 ( (March 24) ) 1955. 58. Edmonson, H. A.; Berne, C. S.; Hamann, R. E., and Wertman, M.: Calcium, Potassium, Magnesium, and Amylase Disturbances in Acute Pancreatitis , Am. J. Med. 12:34-42 ( (Jan.) ) 1952. 59. Renner, W. F.: Postoperative Acute Pancreatitis and Lower Nephron Syndrome , J. A. M. A. 147:1654-1655 ( (Dec. 22) ) 1951. 60. Lynch, M. J.: Nephrosis and Fat Embolism in Acute Hemorrhagic Pancreatitis , A. M. A. Arch. Int. Med. 94:709-717 ( (Nov.) ) 1954. 61. Heacock, C. H., and Cara, D. J.: Radiation Therapy of Pancreatitis , Radiology 62:654-659 ( (May) ) 1954. 62. Rauch, R. F., and Stenstrom, K. W.: Effects of X-Ray Radiation on Pancreatic Function in Dogs , Gastroenterology 20:595-603 ( (April) ) 1952. 63. Warren, K. W.; Fallis, L. S., and Barron, J.: Acute Pancreatitis and Diabetes , Ann. Surg. 132:1103-1110 ( (Dec.) ) 1950. 64. Persky, L.; Schweinburg, F. B.; Jacob, S., and Fine, J.: Aureomycin in Experimental Acute Pancreatitis of Dogs , Surgery 30:652-656 ( (Oct.) ) 1951. 65. Raker, J. W., and Bartlett, M. K.: Acute Pancreatitis: The Fate of the Patients Surviving One or More Acute Attacks , New England J. Med. 249:751-757 ( (Nov. 5) ) 1953. 66. Berk, J. E.: The Treatment of Pancreatitis , Pennsylvania M. J. 56:265-269 ( (April) ) 1953.

Journal

A.M.A. Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1955

References