The diagnosis of chronic cholecystitis and pancreatitis

Results are submitted of ultrasonic monitoring of gallbladder, pancreas and duodenum during the I, II, III phases of digestion in 186 patients who ranged from 30 to 60 years old. The form was studied of the gallbladder as was its size and location together with the volume, thickness of walls, presence of deformities; echogenicity of pancreas, outline, state of the main duct. Interdigestive duodenal motility and intracavitary pressure were recorded. Relationship has been established of the gallbladder and pancreas contraction phases to the condition of the intracavitary pressure in the duodenum.     

Valproate-associated pancreatitis and cholecystitis in six mentally retarded adults

BACKGROUND: Pancreatitis is usually considered a rare side effect of valproate. We describe five cases of pancreatitis and one case of cholecystitis associated with the use of valproate. METHOD: Through chart review, we identified all patients in our facility treated with valproate between 1989 and 1994, and all cases of pancreatitis and cholecystitis identified during that same period in our population of 322 mentally retarded patients. We also searched MEDLINE for all published cases of pancreatitis or cholecystitis associated with valproate treatment. RESULTS: Five (7%) of 72 valproate-treated patients experienced pancreatitis, and one experienced cholecystitis; all recovered fully. This brings the total number of reported cases of valproate-associated pancreatitis to 55. CONCLUSION: Pancreatitis may occur more frequently than previously recognized in mentally retarded adults treated with valproate. Developmentally disabled patients should be carefully monitored for this potentially lethal side effect.     

Chronic pancreatitis, acute pancreatitis

MRCP has been recognized as a safe and noninvasive diagnostic method. In the present study we evaluated the usefulness of MRCP in diagnosis of chronic and acute pancreatitis. Two-dimensional fast asymmetric spin-echo (FASE) MRCP was performed in 40 patients with chronic pancreatitis and 13 with acute pancreatitis. In 29 patients (72.5%) with chronic pancreatitis and 9 (66.7%) with acute pancreatitis, main pancreatic duct (MPD) was visualized entirely. MRCP could demonstrate the characteristic findings of chronic pancreatitis such as dilatation and irregularity of MPD in most cases. In acute pancreatitis, MRCP indicated that MPD was normal in diameter, but irregular in configuration compared with that of the control group. MRCP may facilitate the diagnosis of chronic and acute pancreatitis.     

Eosinophilic cholecystitis, appendiceal inflammation, pericarditis, and cephalosporin-associated eosinophilia

A patient with eosinophilic cholecystitis and accompanying eosinophilic appendiceal inflammation, eosinophilic pericarditis, and peripheral eosinophilia is described. Review of the nine previously reported cases of eosinophilic cholecystitis suggests that this is the first case with closely associated eosinophilic appendiceal inflammation and pericarditis as manifestations of a systemic hypereosinophilic syndrome. The possible etiologic role of cephalosporin hypersensitivity is discussed.     

Current status of diuretics, beta-blockers, alpha-blockers, and alpha-beta-blockers in the treatment of hypertension

The article describes the current status of four main antihypertensives. Diuretics are making a bit of a comeback after seeing their popularity wane during the 1980s. beta-blockers also saw a bit of a popularity decrease in the 1980s due to some adverse side effects which the author feels were somewhat exaggerated. alpha-blockers have yet to be particularly successful in the treatment of hypertension, due to adverse side effects. alpha-beta-blockers appear to hold significant promise in the further treatment of hypertension.     

Hypertension, diuretics, and antihypertensive medications as possible risk factors for renal cell cancer

We identified the serotypes and genomes patterns of 100 strains of Pseudomonas aeruginosa (P. aeruginosa) that had been isolated from patients who were admitted to the hospital of the Fukui Medical School between 1992 and 1995. A monoclonal diagnostic kit was used to identify the serotypes. Genome patterns were determined by pulsed field gel electrophoresis (PFGE). Serotypes A, B, C, D, E, F, G and I exhibited distinct genome patterns. Differences in genome patterns were also observed in strains of serotypes E and G, depending on the types of clinical samples collected and/or the area of the hospital from which they were isolated. Many of the multiple antibiotic-resistant strains of P. aeruginosa exhibited serotype E. The genome pattern differed between strains that were susceptible vs. resistant to multiple antibiotics. The latter strains exhibited similar genome patterns regardless of their origin. These findings suggest that analysis of genome patterns is important for identifying the origin of nosocomial infection caused by P. aeruginosa, serotype E.     

Mannitol and other diuretics in severe neurotrauma

Mannitol has replaced other diuretics as the agent of first choice for control of raised intracranial pressure (ICP) after brain injury. Mannitol should be given as a bolus intravenous infusion, over 10 to 30 mins, in doses ranging from 0.25 to 1.0 g/kg body weight. It may be given when high ICP is suspected, prior to computed tomography scanning, e.g., in patients who develop a fixed, dilated pupil or neurologic deterioration. This agent may also be used pre- or intraoperatively in patients with intracranial hematomas, and when high ICP is demonstrated in the ICU. It is more effective and safer when administered in bolus doses than as a continuous infusion. Mannitol may be safely used during the early resuscitation phase in hypovolemic patients with concomitant head injury, provided that plasma expanders and/or crystalloid solutions are given to correct the hypovolemia simultaneously. A Foley catheter should always be inserted when mannitol is used. Serum osmolality should be measured frequently after mannitol and maintained < 320 mOsm to avoid renal failure. Its beneficial effects and the rationale for its use are also reviewed.     

Value of diuretics in hypertension

Diuretics still remain a cornerstone in the treatment of hypertension. Adverse effects such as disorders of the carbohydrate and lipid metabolism as well as development of hypokalemia or hypomagnesemia are obviously directly correlated to the administered dosage. Therefore, there is increasing agreement for low-dose drug therapy. In contrast to hydrochlorothiazide treatment, metabolic disorders are less commonly encountered with indapamide therapy. A pronounced diuretic efficacy is linked to the combined use of diuretics which act on different segments of the nephron (for example administration of a loop diuretic together with a thiazide). In chronic renal failure indapamide appears to be superior to hydrochlorothiazide considering preservation of renal function. In contrast to thiazides, indapamide is the therapy of choice in patients with diabetes.     

Complicated noncalculous cholecystitis

Results of the observation of 160 operated patients with acalculous cholecystitis complicated by biliary hypertension resulting from choledocholithiasis, stenosis of the great duodenal papilla, indurative and acute pancreatitis or purulent cholangitis in 52,5% are described. The authors believe that the surgical intervention should include, in addition to cholecystectomy, choledochotomy followed by correction of the alterations revealed.     

Inhibition of alkaline phosphatase by several diuretics

Acetazolamide, furosemide, ethacrynic acid and chlorothiazide, diuretics of considerable structural diversity, inhibit alkaline phosphatase. The inhibition is reversible and the mechanism is of the mixed type, having both competitive and non-competitive characteristics. Ki is calculated to be 8.4, 7.0, 2.8 and 0.1 mmol/l for acetazolamide, furosemide, ethacrynic acid and chlorothiazide, respectively. Chlorothiazide is a much more potent inhibitor of alkaline phosphatase than the other three diuretics. The combination of ethacrynic acid and cysteine, itself an alkaline phosphatase inhibitor, is less inhibitory than ethacrynic acid alone. Rat and human kidney alkaline phosphatase are equally sensitive to chlorothiazide, ethacrynic acid and furosemide.     

Acute pancreatitis. Classification, diagnosis, therapy

Acute pancreatitis is a multietiologic entity with rather diverse clinical courses. Whereas edematous pancreatitis has a mortality of less than 1%, nowadays; still approximately 20% of all patients with the necrotizing form succumb to the disease. To further improve therapeutic results a standardized approach should be used. For effective treatment the differentiation between edematous and necrotizing pancreatitis is crucial. All patients with signs of pancreatic necroses during abdominal ultrasound and patients with organ insufficiencies should undergo a CT-scan to define exactly the nature and the extent of the disease. Primarily all patients are treated conservatively. Main indications for operative intervention are signs for infection of pancreatic necroses and an acute abdomen due to local complications of acute pancreatitis. In cases of biliary origin an elective cholecystectomy has to be performed during a free interval to prevent a recurrence.