scholarly journals Perspectives in Pancreatic Pain

HPB Surgery ◽  
1997 ◽  
Vol 10 (5) ◽  
pp. 269-277 ◽  
Author(s):  
A. S. Salim

This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described.

Author(s):  
Volodymyr Kopchak ◽  
Mykhailo Nychytailo ◽  
Oleksandr Duvalko ◽  
Vasyl Khanenko ◽  
Volodymyr Trachuk ◽  
...  

We reviewed the charts of 752 patients, who have undergone surgery for various forms of chronic pancreatitis at “Shalimov’s National Institute of Surgery and Transplantation of the NAMS of Ukraine” in the years from 2007 to 2017. The average age of the 591 males (78,6 %) and 161 females (22,4 %) was 43,0 ± 3,2 years. Out of these, 446 (62,4 %) patients with pseudocysts and pancreatic fistula and also with isolated main pancreatic duct lithiasis underwent drainage procedures. The 269 (37.6%) patients were subjected to different types of resection, including the Frey operation, pancreatoenterostomy with artificial pancreatic duct formation, the Berne technique, the Beger procedure, pancreatoduodenectomy, distal-pancreatic resection and other procedures. After pancreatic resections, the patients did not require repeated surgical interventions for chronic pancreatitis. In some cases of chronic pancreatitis, there was an isolated lesion of the pancreas: in such cases (13 patients), we performed distal resection of the pancreas. Among the observed patients here were no fatal cases. Satisfactory results were obtained in 92.6 % of cases at longterm follow-up. Post-operative complications occurred in 27 patients (4.6 %), in 6 (1.03 %) patients there was a need for repeated surgery. Progression of the disease in patients previously operated in our clinic was observed in 32 (5.5 %), and 72 patients, initially operated in other medical institutions. Patients after direct resection of the pancreas did not require repeated surgery for chronic pancreatitis. The main causes of unsatisfactory results of the surgical treatment for chronic pancreatitis have been found to be: false indications for initial surgery, improper primary surgical techniques, insufficient use of drainage procedures, as well as, performing a drainage procedure instead of a resection. Key words: chronic pancreatitis, surgical treatment, resection and drainage procedures. For citation: Usenko OY, Kopchak VM, Nychytailo MY, Duvalko OV, Khanenko VV, Trachuk VI, Khomiak AI. Modern principles of surgical treatment of chronic pancreatitis. Journal of the National Academy of Medical Sciences of Ukraine. 2019;25(3):306–12


2012 ◽  
Vol 142 (5) ◽  
pp. S-150
Author(s):  
Tugba Colak ◽  
Liansheng Liu ◽  
Kshama R. Mehta ◽  
Mohan M. Shenoy ◽  
Reetesh Pai ◽  
...  

2015 ◽  
Vol 308 (8) ◽  
pp. G710-G719 ◽  
Author(s):  
Shusheng Wang ◽  
Hong-Yan Zhu ◽  
Yi Jin ◽  
Youlang Zhou ◽  
Shufen Hu ◽  
...  

The mechanism of pain in chronic pancreatitis (CP) is poorly understood. The aim of this study was designed to investigate roles of norepinephrine (NE) and P2X receptor (P2XR) signaling pathway in the pathogenesis of hyperalgesia in a rat model of CP. CP was induced in male adult rats by intraductal injection of trinitrobenzene sulfonic acid (TNBS). Mechanical hyperalgesia was assessed by referred somatic behaviors to mechanical stimulation of rat abdomen. P2XR-mediated responses of pancreatic dorsal root ganglion (DRG) neurons were measured utilizing calcium imaging and whole cell patch-clamp-recording techniques. Western blot analysis and immunofluorescence were performed to examine protein expression. TNBS injection produced a significant upregulation of P2X3R expression and an increase in ATP-evoked responses of pancreatic DRG neurons. The sensitization of P2X3Rs was reversed by administration of β-adrenergic receptor antagonist propranolol. Incubation of DRG neurons with NE significantly enhanced ATP-induced intracellular calcium signals, which were abolished by propranolol, and partially blocked by protein kinase A inhibitor H-89. Interestingly, TNBS injection led to a significant elevation of NE concentration in DRGs and the pancreas, an upregulation of β2-adrenergic receptor expression in DRGs, and amplification of the NE-induced potentiation of ATP responses. Importantly, pancreatic hyperalgesia was markedly attenuated by administration of purinergic receptor antagonist suramin or A317491 or β2-adrenergic receptor antagonist butoxamine. Sensitization of P2X3Rs, which was likely mediated by adrenergic signaling in primary sensory neurons, contributes to pancreatic pain, thus identifying a potential target for treating pancreatic pain caused by inflammation.


Pancreas ◽  
2006 ◽  
Vol 33 (3) ◽  
pp. 268-279 ◽  
Author(s):  
Shoichiroh Takamido ◽  
Yosky Kataoka ◽  
Akihide Tanano ◽  
Yilong Cui ◽  
Tsukasa Ikeura ◽  
...  

Pancreatology ◽  
2013 ◽  
Vol 13 (3) ◽  
pp. S13
Author(s):  
Jan G. D’Haese ◽  
Tom D. D’Haese ◽  
Hamza Sezgin ◽  
Timo Kehl ◽  
Ihsan Ekin Demir ◽  
...  

2020 ◽  
Vol 47 (2) ◽  
pp. 6-18
Author(s):  
D. Lew ◽  
E. Afghani ◽  
S. Pandol

This article presents the results of modern epidemiological studies that emphasize the increasing prevalence of acute and chronic pancreatitis (CP) in many countries, as well as the high likelihood of developing secondary diabetes mellitus, pancreatic cancer. The risk factors for CP occurrence are listed, such as: alcohol, smoking, genetic predisposition, anatomical and obstructive disorders; pathogenetic mechanisms of CP development in the outcome of acute pancreatitis are considered. Attention is paid to laboratory instrumental diagnosis of CP, the advantages and disadvantages of transabdominal ultrasound, computed tomography and magnetic resonance imaging. The emphasis is made on the use of endoscopic ultrasound, diagnostic tests to evaluate exocrine pancreatic function (fecal elastase-1, trypsinogen, triglyceride breath test, cholecystokinin test). The role of correction of modifiable factors and the rejection of bad habits in the treatment of CP is noted. Modern pharmacotherapy regimens for CP with analgesics (starting with non-steroidal anti-inflammatory drugs), tricyclic antidepressants, pregabalin, enzyme replacement therapy, simvastatin are described. Surgical techniques for pain relief in CP (endoscopic decompression, shock wave lithotripsy, resection) are considered. The therapeutic techniques for preventing CP complications are described, and the expediency of conducting prolonged enzyme replacement therapy is emphasized. The problematic aspects of pancreatology are listed that need to be studied in future in order to improve outcomes and prognosis in patients with CP.


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