Chronic Pancreatitis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

CHRONIC

PANCREATITIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Chronic Pancreatitis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00253-1 1. Chronic Pancreatitis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on chronic pancreatitis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CHRONIC PANCREATITIS .......................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Chronic Pancreatitis ................................................................... 10 E-Journals: PubMed Central ....................................................................................................... 22 The National Library of Medicine: PubMed ................................................................................ 23 CHAPTER 2. NUTRITION AND CHRONIC PANCREATITIS ................................................................ 69 Overview...................................................................................................................................... 69 Finding Nutrition Studies on Chronic Pancreatitis .................................................................... 69 Federal Resources on Nutrition ................................................................................................... 71 Additional Web Resources ........................................................................................................... 71 CHAPTER 3. ALTERNATIVE MEDICINE AND CHRONIC PANCREATITIS.......................................... 73 Overview...................................................................................................................................... 73 National Center for Complementary and Alternative Medicine.................................................. 73 Additional Web Resources ........................................................................................................... 76 General References ....................................................................................................................... 77 CHAPTER 4. BOOKS ON CHRONIC PANCREATITIS .......................................................................... 79 Overview...................................................................................................................................... 79 Book Summaries: Federal Agencies.............................................................................................. 79 Chapters on Chronic Pancreatitis ................................................................................................ 83 CHAPTER 5. MULTIMEDIA ON CHRONIC PANCREATITIS ............................................................... 85 Overview...................................................................................................................................... 85 Video Recordings ......................................................................................................................... 85 CHAPTER 6. PERIODICALS AND NEWS ON CHRONIC PANCREATITIS ............................................ 87 Overview...................................................................................................................................... 87 News Services and Press Releases................................................................................................ 87 Newsletter Articles ...................................................................................................................... 89 Academic Periodicals covering Chronic Pancreatitis................................................................... 90 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 91 Overview...................................................................................................................................... 91 U.S. Pharmacopeia....................................................................................................................... 91 Commercial Databases ................................................................................................................. 92 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 95 Overview...................................................................................................................................... 95 NIH Guidelines............................................................................................................................ 95 NIH Databases............................................................................................................................. 97 Other Commercial Databases....................................................................................................... 99 APPENDIX B. PATIENT RESOURCES ............................................................................................... 101 Overview.................................................................................................................................... 101 Patient Guideline Sources.......................................................................................................... 101 Finding Associations.................................................................................................................. 103 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 105 Overview.................................................................................................................................... 105 Preparation................................................................................................................................. 105 Finding a Local Medical Library................................................................................................ 105 Medical Libraries in the U.S. and Canada ................................................................................. 105 ONLINE GLOSSARIES................................................................................................................ 111 Online Dictionary Directories ................................................................................................... 113

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CHRONIC PANCREATITIS DICTIONARY ........................................................................... 115 INDEX .............................................................................................................................................. 161

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with chronic pancreatitis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about chronic pancreatitis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to chronic pancreatitis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on chronic pancreatitis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to chronic pancreatitis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on chronic pancreatitis. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CHRONIC PANCREATITIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on chronic pancreatitis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and chronic pancreatitis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “chronic pancreatitis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Regression of Liver Fibrosis After Biliary Drainage in Patients with Chronic Pancreatitis and Stenosis of the Common Bile Duct Source: New England Journal of Medicine. 344(6): 418-423. February 8, 2001. Summary: Chronic obstruction of the common bile duct may cause hepatic (liver) fibrosis and secondary biliary cirrhosis (scarring). This article reports on a study of liver biopsy specimens from 11 patients with chronic stenosis (narrowing) of the common bile duct due to chronic pancreatitis (inflammation of the pancreas). All the patients had undergone liver biopsy before or at the time of surgical biliary decompression and all underwent a subsequent liver biopsy for various clinical reasons. The patients were followed as part of a prospective study of 501 patients who had been treated for chronic pancreatitis. Two pathologists, who were unaware of the sequence of specimens,

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graded fibrosis on a scale of 0 (none) to 3 (cirrhosis). The 11 patients were all men. Chronic pancreatitis was due to alcohol abuse in 10 of the men; 1 had idiopathic disease. The median age at diagnosis was 38 years. The median interval between the first and second liver biopsies was 2.5 years (range of 0.3 to 9.0 years). The two patients who had restenosis of the biliary anastomosis were excluded from the analysis. In the remaining group of nine patients, the second specimen showed significant improvement in fibrosis. The fibrosis improved by two grades in two patients and by one grade in four patients; in three patients, the grade did not change. The pathologists agreed on the grading of specimens from 10 of the 11 patients. The authors conclude that, in patients with chronic pancreatitis and stenosis of the common bile duct, liver fibrosis may regress after biliary drainage. 1 figure. 2 tables. 24 references. •

Chronic Pancreatitis: Complications and Management Source: Journal of Clinical Gastroenterology. 29(3): 225-240. October 1999. Contact: Available from Lippincott Williams and Wilkins, Inc. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Summary: Chronic pancreatitis is characterized by progressive and irreversible loss of pancreatic exocrine and endocrine function. In the majority of cases, particularly in Western populations, the disease is associated with alcohol abuse. This article reviews recent research and prevailing concepts regarding the three major complications of chronic pancreatitis: abdominal pain, malabsorption, and diabetes. Of these, pain is the most difficult to treat and is therefore the most frustrating symptom for both the patient and the physician. While analgesics form the cornerstone of pain therapy, a number of other treatment modalities (inhibition of pancreatic secretion, antioxidants, and surgery) have also been described. Unfortunately, the efficacy of these treatments is hard to assess, primarily because of the lack of properly controlled clinical trials. Replacement of pancreatic enzymes (particularly lipase) in the gut is the mainstay of treatment for malabsorption. Diabetes secondary to chronic pancreatitis is difficult to control and its course is often complicated by hypoglycemic attacks. Therefore, it is essential that caution is exercised when treating this condition with insulin. The authors also present a discussion of current opinion on clinical issues relating to the other known complications of chronic pancreatitis, including pseudocysts, venous thromboses, biliary and duodenal obstruction, biliary cirrhosis, and pancreatic cancer. 2 figures. 2 tables. 170 references.

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Pain and Chronic Pancreatitis Source: European Journal of Gastroenterology and Hepatology. 3(6): 425-433. June 1991. Summary: Pain is the principal symptom of chronic pancreatitis, and relief of pain the principal aim of treatment. The mechanism of pain production has been a matter of considerable speculation, but remains unclear. This review article collates the available evidence regarding the cause of pain in chronic pancreatitis in an attempt to explain the variable results of treatment. Topics include pancreatic ductal pressure, biliary tract obstruction, pseudocyst formation, perineural inflammation and infiltration, interruption of pain pathways, significance of calcification, and the interplay of abstinence from alcohol, pancreatic function, and pain. 73 references.

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Pancreatic Enzyme Therapy and Nutritional Status of Outpatients with Chronic Pancreatitis Source: Gastroenterology Nursing. 24(2): 84-87. March-April 2001.

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Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: Patients with chronic pancreatitis are at risk for poor nutritional status. The two major clinical features of chronic pancreatitis are abdominal pain and maldigestion, both resulting in malnutrition. Abdominal pain often results in decreased oral intake, and decreased enzyme production results in maldigestion. Enzyme therapy often is included in treating chronic pancreatitis. There is limited data on the nutritional assessment of outpatients with chronic pancreatitis, and the efficacy of the use of enzyme therapy remains controversial. Serum albumin (levels of protein in the blood) level and measurement of ideal body weight are two simple measures of nutritional status that can be obtained by gastroenterology nurses. This article reports on a retrospective chart review that was done on patients seen in the authors' outpatient clinic for management of chronic pancreatitis. Serum albumin levels, and indicator of protein caloric malnutrition, were reviewed for 34 patients. Thirty-three percent of these patients were found to have mild to moderate protein calorie malnutrition as evidence by low serum albumin levels. Enzyme therapy information was reviewed for 33 patients. Patients receiving enzyme therapy had better nutritional status based on both serum albumin levels and percent of ideal body weight. The authors conclude that gastroenterology nurses can be instrumental in the recognition and treatment of nutritional deficiencies in chronic pancreatitis. 3 figures. 3 tables. 4 references. •

Chronic Pancreatitis: Asia-Pacific Consensus Report Source: Journal of Gastroenterology and Hepatology. 17(4): 508-518. April 2002. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail: [email protected]. Website: www.blackwell-science.com. Summary: The current knowledge about chronic pancreatitis (CP) is limited and there is a particular lack of information about the entity known as tropical pancreatitis. A consensus working party was convened by the Trustees of the Journal of Gastroenterology and Hepatology Foundation to conduct a systematic investigation into available evidence about the epidemiology, etiopathogenesis, diagnosis and management of CP. A literature search and formal survey of international experts in the field were used to assemble reliable evidence about these issues. This review article summarizes the results of the working party's findings and presents a series of practice guidelines to improve diagnosis, investigation and treatment of patients with CP, particularly those in the Asia-Pacific region. The authors also identify areas for further research. 98 references.

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Risk Factors for Diabetes Mellitus in Chronic Pancreatitis Source: Gastroenterology. 119(5): 1324-1332. November 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: The influence of disease progression and pancreatic surgery on the appearance of diabetes mellitus in patients with chronic pancreatitis is unknown. This article reports on a prospective cohort study of 500 consecutive patients with chronic pancreatitis (alcoholics, 85 percent); patients were followed over a mean period of 7.0 years (plus or minus 6.8 years) in a medical surgical institution between 1973 and 1996. Analysis of risk factors for diabetes mellitus was performed after the exclusion of 47

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patients. Patients who underwent elective pancreatic surgery (n = 231; 51 percent) were compared with patients who never underwent surgery (n = 222; 49 percent). The cumulative rate of diabetes mellitus was 83 percent (plus or minus 4 percent) 25 years after the clinical onset of chronic pancreatitis (insulin requirement, 54 percent). The prevalence of diabetes mellitus did not increase in the surgical group overall but was higher 5 years after distal pancreatectomy (a surgical procedure that removes 50 to 70 percent of the distal pancreas; 57 percent of the patients) than after pancreaticoduodenectomy (36 percent), pancreatic drainage (36 percent), or cystic, biliary, or digestive drainage (24 percent), without difference in the latter ones. Pancreatic drainage did not prevent the onset of diabetes mellitus. Distal pancreatectomy and early onset of pancreatic calcifications were the only independent risk factors for diabetes mellitus. The authors conclude that the risk of diabetes mellitus is not influenced by elective pancreatic surgical procedures other than distal pancreatectomy in patients with chronic pancreatitis. This risk seems to be largely caused by progression of the disease because it increased by more than 3 fold after the onset of pancreatic calcifications. 4 figures. 4 tables. 55 references. •

Acute and Chronic Pancreatitis Source: Practical Gastroenterology. 25(12): 47-54. December 2001. Contact: Available from Shugar Publishing. 12 Moniebogue Lane, Westhampton Beach, NY 11978. (516) 288-4404. Fax (516) 288-4435. Summary: There are over 100,000 hospital admissions for pancreatitis in the United States per year. Pancreatitis has numerous causes, obscure pathogenesis, and few effective treatments. This continuing education article reviews the diagnosis and management of patients with acute and chronic pancreatitis. Topics include anatomy and physiology, pathophysiology, etiology (cause), clinical presentation (symptoms), diagnosis, prognosis, treatment options, and complications, first for acute pancreatitis, then for chronic pancreatitis. The management of acute pancreatitis depends on the recognition of severity and the diagnosis and management of pancreatic necrosis (tissue death). The majority of patients will do well with conservative and supportive treatment, but necrotizing pancreatitis requires intervention due to the mortality associated with this local complication. Steatorrhea (excessive amounts of fats in the feces) in chronic pancreatitis responds to enzyme supplementation. Chronic pancreatic pain is very difficult to treat and a multidisciplinary approach is recommended. The characterization of the pain syndrome with diagnostic nerve blocks may prove to be very important at directing medical or surgical therapy. 10 figures. 4 tables. 30 references.

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Surgical Management of Chronic Pancreatitis Source: Practical Gastroenterology. 16(3): 11-13, 17-18. March 1992. Summary: This article addresses the surgical management of chronic pancreatitis. The authors discuss the indications for surgical intervention, surgical alternatives, large-duct pancreatitis, biliary obstruction, duodenal obstruction, and ascites. They note that surgery, like medical treatment, will not repair the damaged pancreas, nor will it halt the progression of the disease. However, surgery can play a very important role in management of the disease, and can significantly improve the quality of life of those affected. 6 figures. 1 table. 6 references.

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Diagnostic Tests in Chronic Pancreatitis Source: Practical Gastroenterology. 16(1): 23-27, 30. January 1992. Summary: This article describes the diagnostic tests used to determine chronic pancreatitis. The authors note that pancreatic calcifications and histology are the only two findings that definitively establish the diagnosis of chronic pancreatitis. Since radiologic calcification is demonstrable in only some 20 to 40 percent of patients in most series, and histology is available in only a small number of patients, the majority of patients require ancillary investigation to assist in the diagnosis. Topics include tests of pancreatic function in common use, morphologic tests, tests of endocrine function, tests of exocrine function, and etiologic tests. 4 tables. 8 references. (AA-M).

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Nutritional Management in Acute and Chronic Pancreatitis Source: Gastroenterology Clinics of North America. 27(2): 421-434. June 1998. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article reviews the nutritional management of patients with acute or chronic pancreatitis. Topics include determining the need and route for nutritional support, factors that affect caloric requirements, enteral access, formulas, complications of pancreatitis and how they affect nutritional therapy, outpatient therapy, and evidence that nutritional therapy makes a difference. The authors note that not all patients with acute or chronic pancreatitis require nutritional alimentation. For those whose disease is more severe, however, failure to provide nutritional support can contribute to reduced defenses, an increased rate of complications, and a prolonged hospital course. Nutritional therapy in the past was governed by the principle that the gut should rest, and stimulation of pancreatic exocrine secretion should be avoided. These concepts have been replaced by the principle that pancreatic stimulation should be reduced to subclinical levels; that gut integrity should be maintained; and that the stress response should be contained to reduce the likelihood of multiple organ failure, nosocomial infection, and mortality. 70 references.

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Chronic Pancreatitis Source: Lancet. 350(9088): 1379-1385. November 8, 1997. Summary: This article updates physicians on the diagnosis and treatment of chronic pancreatitis. Chronic pancreatitis is an inflammatory disease in which progressive and irreversible structural changes to the pancreas result in a permanent impairment of both the exocrine and endocrine functions. The authors cover classification; etiology, including alcohol-related (70 to 80 percent of all cases of chronic pancreatitis), idiopathic, hereditary, tropical, obstructive, hyperparathyroidism, trauma, pancreas divisum, and alfa-1-antitrypsin deficiency; clinical features, including pain, pancreatic insufficiency, glucose intolerance, diabetes mellitus, and classical physical appearance; diagnostic tests, including dynamic tests and pancreatic imaging; differential diagnosis; treatment options, including for pain management, relief of obstruction, maldigestion, and malabsorption; and complications, including duodenal and bile duct obstruction, pancreatic pseudocyst, pancreatic fistula, splenic-vein thrombosis, and pseudoaneurysm formation. The authors conclude with a brief section considering when patients with chronic pancreatitis should be referred to a specialist. 4 figures. 50 references. (AA-M).

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Chronic Pancreatitis: Surgical Treatment and Procedures Source: Practical Gastroenterology. 20(9): 40, 43-44, 46, 51-52, 54-56, 59-60, 62-63. August 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, the eighth in a series on pancreatic disease, considers the use of surgical treatment for patients with chronic pancreatitis (CP). Surgery for chronic pancreatitis is performed for complications of the disease, for intractable pain, or when cancer cannot be excluded. The authors lament that the ideal operation, which should be simple to perform, provide longlasting pain relief, rectify the complications, avoid further endocrine and exocrine insufficiency, and have low mortality and morbidity, does not exist. Partington Rochelle decompression of the major pancreatic duct can be performed with low morbidity and mortality. Disenchantment with the operation has resulted from repeated failure to achieve sustained pain relief in half the patients who undergo it. The surgical procedures of 95 percent distal pancreatectomy was abandoned because of the high incidence of exocrine and endocrine insufficiency. From 50 to 60 percent distal pancreatectomy is applicable to a small percentage of patients with chronic pancreatitis who have ducts measuring 3 mm or less and disease limited to the body and tail of the pancreas. Pancreaticoduodenectomy, with or without pylorus preservation, is associated with sustained pain relief in 80 percent of patients, but it has not been embraced by many surgeons as their primary operation for pain relief because simpler procedures give promise of providing equivalent degrees of relief. These newer procedures, local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy, and duodenum preserving resection of the head of the pancreas, have been reported to provide sustained pain relief in about 80 percent of patients followed for an average of 37 months and 46 months, respectively. Further followup will be required to determine whether this degree of pain relief is maintained for 5 years or longer. 8 figures. 2 tables. 17 references. (AA-M).

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Surgery for Acute and Chronic Pancreatitis Source: Practical Gastroenterology. 21(1): 30-34, 37-40, 42-43. January 1997. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, the ninth in a series on surgery of the gastrointestinal (GI) tract, describes surgery for acute and chronic pancreatitis. The authors note that the clinical management of acute pancreatitis has been evolving during the last decade because of advances in critical care and better understanding of the natural history of the disease. Bacterial infection of pancreatic necrosis now plays a crucial role in the outcome of severe acute pancreatitis. Surgical intervention is concentrated in dealing with infection of the necrosed pancreas during the acute phase. In the late phase, the indications for surgery include prolonged ventilator dependency, intractable pain, biliary disease, and complications related to the gastrointestinal tract or the pancreatic ductal system. For chronic pancreatitis, major advances include better diagnostic modalities (endoscopy, computed tomography, and magnetic resonance imaging) and newer surgical procedures (the Beger and Frey procedures). Although there is no single operation that can deal with all the complications associated with chronic pancreatitis, surgical intervention, when appropriately chosen and properly performed, can be effective in relieving pain and potentially preserving organ function. 1 figure. 1 table. 33 references. (AA-M).

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Chronic Pancreatitis: Medical Management Source: Practical Gastroenterology. 20(8): 6-8, 14-16, 18, 20-21. August 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, the seventh in a series on pancreatic disease, considers the medical management of patients with chronic pancreatitis. The authors classify patients with chronic pancreatitis into two categories: those with big duct disease and those with small duct disease. The diagnostic approach to and medical management of the patient with chronic pancreatitis are greatly influenced by the degree of damage to the exocrine pancreas (i.e., the size of the involved ducts). Patients with chronic pancreatitis come to medical attention primarily because of abdominal pain and or maldigestion. The cornerstone of medical management for either of these complaints is the employment of pancreatic enzyme formulations. If severe damage to the pancreas is present (big duct disease), surgical decompression of the main duct or experimental suppression of pancreatic secretion with octreotide may afford pain relief. The authors conclude by reiterating the need for the clinician to consider duct size when designing appropriate management plans for patients with chronic pancreatitis. 4 figures. 4 tables. 30 references. (AA-M).

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Chronic Pancreatitis: Selective Use of Diagnostic Laboratory Procedures Source: Practical Gastroenterology. 20(7): 54-59. July 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, the sixth in a series on pancreatic disease, considers the selective use of diagnostic laboratory procedures in chronic pancreatitis (CP). The authors stress that the ease of diagnosing CP depends on the etiology, severity, and duration of the disease. In patients with severe CP due to alcohol, the diagnosis can be achieved through the characteristic history, plain abdominal xrays, and measurement of serum enzymes. Difficulties arise when, as in early idiopathic CP, the suspicion of CP is high but routine tests are negative. The use of more complex tests may not yield the diagnosis of CP because imaging tests (ultrasonography, computed tomography, and endoscopic retrograde pancreatography) and exocrine pancreative function tests may not yield abnormal findings until the disease is far advanced. The authors focus on providing practical points regarding the currently available tests that may be required to diagnose CP. 5 tables. 15 references. (AA-M).

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Chronic Pancreatitis: Diagnosis, Classification, and New Genetic Developments Source: Gastroenterology. 120(3): 682-707. February 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.gastrojournal.org. Summary: This review article focuses on the definitions and classification of chronic pancreatitis, on structural and genetic analysis, and on risk factors. Recent advances in molecular and genomic technologies and progress in pancreatic imaging techniques provided remarkable insight into genetic, environmental, immunologic, and pathobiological factors leading to chronic pancreatitis. Translation of these advances into clinical practice demands a reassessment of current approaches to diagnosis, classification, and staging. The authors maintain that an adequate pancreatic biopsy

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must be the gold standard against which all diagnostic approaches are judged. Although computed tomography (CT) remains the initial test of choice for the diagnosis of chronic pancreatitis, the roles of endoscopic retrograde pancreatography, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are considered. Once chronic pancreatitis is diagnosed, proper classification become important. Major predisposing risk factors to chronic pancreatitis may be categorized as either toxic metabolic, idiopathic (unknown), genetic, autoimmune, recurrent and severe acute pancreatitis, or obstructive (TIGAR O system). After classification, staging of pancreatic function, injury, and fibrosis becomes the next major concern. Further research is needed to determine the clinical and natural history of chronic pancreatitis developing in the context of various risk factors. New methods are needed for early diagnosis of chronic pancreatitis, and new therapies are needed to determine whether interventions will delay or prevent the progression of the irreversible damage characterizing end stage chronic pancreatitis. 8 figures. 5 tables. 242 references.

Federally Funded Research on Chronic Pancreatitis The U.S. Government supports a variety of research studies relating to chronic pancreatitis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to chronic pancreatitis. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore chronic pancreatitis. The following is typical of the type of information found when searching the CRISP database for chronic pancreatitis: •

Project Title: MUTATIONS

A

SEQUENCING

MICROARRAY

FOR

MITOCHONDRIAL

Principal Investigator & Institution: Maitra, Anirban; Pathology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2005 Summary: (provided by applicant): Pancreatic cancer is a lethal disease, with the vast majority of patients presenting in an advanced, inoperable stage. There is an urgent need to develop sensitive and specific molecular biomarkers for early detection of pancreatic cancers. Somatic mitochondrial DNA mutations are common in cancers, but their usefulness as a biomarker for early diagnosis has been impeded by lowthroughput and lack of adequate sensitivity of direct sequencing technologies. An oligonucleotide-based mitochondrial sequencing microarray ("MitoChip") has been designed that can sequence approximately 29kb of double stranded DNA in a single 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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assay. Both strands of the entire human mitochondrial coding sequence (15,451bp) are arrayed on the MitoChip; both strands of an additional 12,935 bp (84% of coding DNA) are arrayed in duplicate, providing internal validation of sequence data. 1.6 million bp of mitochondrial DNA have been sequenced, with intra- and inter-chip sequence reproducibility of >99.99%. In serial dilution experiments using mixed normal and tumor DNA, the MitoChip was able to detect an aberrant clonal population in as much as 50-fold diluted samples. The eventual goal of this proposal is to enable early diagnosis of pancreas cancer using endoscopically-obtained pancreatic juice samples. The central hypothesis is that array-based sequencing can reliably detect mitochondrial DNA mutations from pancreatic juice samples containing shed neoplastic cells. The R21 phase will therefore (a) identify the frequency and patterns of any confounding tissuespecific coding sequence variations that may occur in non-neoplastic pancreata compared to lymphocyte DNA, (b) determine the frequency of mitochondrial coding sequence mutations in a series of primary pancreatic cancers (using matched lymphocyte DNA as control), and (c) establish the conditions for long PCR amplification and MitoChip assay from pancreatic juice DNA. In the R33 phase, endoscopically obtained pancreatic juice from patients with pancreatic cancer, non-neoplastic pancreatic disease (e.g., chronic pancreatitis), and non-diseased controls (n=40 in each category) will be analyzed for mitochondrial DNA mutations. Juice samples from a specific subset of patients with localized, node-negative pancreatic cancer will also be examined to confirm the utility of the MitoChip in detecting early stage, and hence potentially curable, disease. This study will serve as a model for array-based diagnosis of cancer in clinical samples. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--GHC POPULATION AND SURVEILLANCE Principal Investigator & Institution: Chu, Susan; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2002 Summary: The Overall goal of this Core is to support individual projects and overall objectives by identifying and recruiting patients for participation in Program Project Studies, by collecting gastrointestinal cancer tissues from cases that arise in a population of approximately 400,000 enrollees, and by enhancing the ability of Program Project investigators to conduct longitudinal studies in colon and pancreas cancer. Through the Center for Health Studies, the GHC Population Core will facilitate access to a health care delivery system that has distinct advantages as a setting for translational research that include a large defined patient population and a rich array of information systems; established programs in cancer screening with linkage to risk factors and pathologic outcomes; and experience in the design, conduct, and analysis of intervention and observational studies of cancer prevention, control and treatment. The specific aims of the GHC Population Core are: 1) To identify and collect specimens from patients with chronic pancreatitis, pancreatic cancer, and colon cancer for proposed projects 1 and 4; 2) To recruit patients undergoing colonoscopy and collect risk factor data, fecal and blood samples, and biopsy results, and tissue specimens for longitudinal studies of colon cancer risk and development; and 4) To establish a surveillance system to monitor changes in gastrointestinal cancer incidence, morbidity, and mortality in our defined population. The GHC Population Core will build and maintain a retrospective registry with linked pathology results of more than 9800 patients who underwent colonoscopy between 1991 and 1996 and will add risk factor data for the anticipated 4800 patients who will be colonoscopied during the project period. Group Health Cooperative (GHC)

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Chronic Pancreatitis

is a staff-model managed care organization that serves over 400,000 enrollees in the western Washington Puget Sound region. The GHC Population Core will operate within the GHC Center for Health Studies, a research organization dedicated to the conduct of studies that contribute to scientific knowledge in the public domain and to the quality of health care at GHC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FATTY PANCREATITIS

ACID

ETHYL

ESTERS

IN

ETHANOL-INDUCED

Principal Investigator & Institution: Kaphalia, Bhupendra; Associate Professor; Pathology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Pancreatitis is a major health problem in alcoholics that causes high mortality and morbidity, and after biliary duct diseases, chronic alcohol abuse is the second major cause of chronic pancreatitis. However, the mechanism of alcohol-induced pancreatitis is poorly understood. Oxidative metabolism of ethanol catalyzed by alcohol dehydrogenase (ADH) is negligible in the pancreas, while nonoxidative metabolism of ethanol to fatty acid ethyl esters (FAEEs), catalyzed by FAEE synthase, appears to be the major mechanism of ethanol disposition in the pancreas during chronic alcohol abuse. Surprisingly, very little is known regarding the role of endogenously formed FAEEs in ethanol-induced pancreatitis. Based upon our preliminary studies showing - 14-fold increase in FAEE levels in the pancreas of hepatic ADH-deficient (ADH-) deer mice as compared to those in ADH-normal deer mice, and a dose- and time-dependent formation of FAEEs and FAEE-induced apoptosis upon ethanol exposure of ADH-deficient human hepatocellular carcinoma (HepG2) cells in culture, we hypothesize that increased formation of FAEEs is a triggering event in ethanol-induced pancreatitis, and that FAEEs and FAEE synthase can be early markers of pancreatic injury. Our preliminary studies also indicate that FAEEs are formed in rat pancreatic tumor (AR42J) cells in culture. Therefore, to investigate the toxic potential of endogenously formed FAEEs and elucidate their role in ethanol-induced pancreatic injury, we will use ADH- deer mice and AR42J cells. In Aim 1, we will determine the levels of FAEEs in the plasma and pancreas of ADH- deer mice after ethanol exposure in a dose- and time-dependent manner, and evaluate the biochemical and morphological parameters associated with pancreatic injury. We will evaluate apoptosis in the pancreas of ADH- deer mice, and in AR42J cells, after ethanol exposure (Aim 2). Inhibitors or inducers of FAEE synthase to attenuate or augment formation of FAEEs in AR42J cells, respectively, will be used to further examine the role of endogenously formed FAEEs in ethanol-induced apoptosis and toxicity (Aim 3). Achieving our Specific Aims 1-3 should establish the role of FAEEs in ethanol-induced pancreatic injury, lay the foundation for future human studies to develop these parameters as early markers for ethanol-induced pancreatic damage, and ultimately benefit us in developing new preventive/therapeutic strategies for early intervention before irreversible damage to pancreas occurs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPOXIA AND FREE RADICALS IN ALCOHOLIC PANCREATITIS Principal Investigator & Institution: Arteel, Gavin E.; Assistant Professor; Pharmacology and Toxicology; University of Louisville Jouett Hall, Belknap Campus Louisville, Ky 40292

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Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JUL-2006 Summary: APPLICANT'S ABSTRACT: We hypothesize that ethanol-induced chronic pancreatitis is triggered by hypoxia/reoxygenation injury, leading to stimulation of inflammatory cell recruitment and activation of these cells by circulating endotoxins. We recently showed pancreatic injury characteristic of chronic pancreatitis in humans in an enteral model modified to deliver higher amounts of ethanol. Our first goal is to characterize this new model. Wistar rats will receive alcohol internally using our modified protocol for up to 6 months. Pancreatic function and injury will be determined and compared to changes in key molecular events. We expect that alcohol will cause progressive, irreversible changes in pancreatic morphology and function, similar to clinical observations. We will next test the hypothesis that alcohol causes hypoxia in pancreas in vivo. Initially, we will determine if the hypoxia marker pimonidazole can be used to index pancreatic hypoxia in rats. We will then determine the effect of alcohol on pancreatic hypoxia in our enteral model. We expect that chronic ethanol will cause early increases in hypoxia, suggesting that hypoxia might play a key early role in the initiation of damage. The effect of removing endotoxin by lactobacillus treatment to displace Gram-negative bacteria, or killing macrophages with silica will next be studied. We expect pancreatic damage will be blunted by these treatments, suggesting a role of endotoxin and macrophages in chronic alcoholic pancreatitis. Next, the hypothesis that free radicals play a causative role in chronic alcoholic pancreatitis will be tested. This question will be addressed using adeno-associated virus (RAAV) to deliver superoxide dismutase (SOD) and cause stable long-term pancreatic expression. First, optimal conditions to confer pancreatic transgene expression will be determined. The effect of RAAV containing superoxide dismutase (SOD) on pancreatic injury will be determined. Free radical formation and oxidative stress will also be quantitated. We expect that preventing oxidative stress with SOD will protect against chronic alcoholic pancreatitis, indicating that free radicals play an important role in the progression of chronic alcoholic pancreatitis. This work will lay the mechanistic foundation for future studies of targeted therapies to prevent alcoholic pancreatitis that can applied in the clinic, where such therapy is desperately needed. Further, through didactic training and interactions with his mentor and key faculty in the enteral model of alcohol exposure, molecular biology, and viral vector gene therapy, the applicant will acquire new skills that will greatly enhance his career development and bridge the gap to becoming a successful member of the academic and scientific community. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDICAL HISTORY, MEDICATIONS, AND PANCREATIC CANCER RISK Principal Investigator & Institution: Mandelson, Margaret T.; Associate Investigator; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Risk factors for pancreatic cancer are not well established. The goal of this pilot study is to investigate the relation between medical history, medication use and pancreatic cancer in a case-control study based on medical record abstraction and electronic laboratory and pharmacy data. Our specific aims are: 1. To investigate the relation between medical conditions and pancreatic cancer risk, focusing on: a. Diabetes mellitus, including disease duration, therapy, and glycemic control. b. Pancreatic inflammation, including acute and chronic pancreatitis. c. History of peptic ulcer disease and/or infection with Helicobacter pylori (H. pylori). d. History of cholecystectomy and/or cholelithiasis. 2. To investigate the relation between the use

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Chronic Pancreatitis

of medications and pancreatic cancer, focusing on nonsteroidal anti-inflammatory drugs, cholesterol lowering agents including HMG-CoA reductase inhibitors and acid suppressive medications including histamine receptor antagonists and proton pump inhibitors. As a secondary specific aim we propose to examine additional medical conditions and medications in order to generate hypotheses for future studies of the epidemiology and prevention of pancreatic cancer. These include evaluation of medical conditions such as irritable bowel syndrome, allergies and asthma as well as medications including immunosuppressive medications and angiotensin converting enzyme inhibitors. To meet these specific aims we propose to conduct a case-control study of pancreatic cancer comprised of 250 newly diagnosed cases and 1,000 controls in the defined population of Group Health Cooperative, a large health maintenance organization. Data on prior medical conditions and medications will be collected through abstraction of traditional and computerized medical records, including electronic laboratory and pharmacy data. Study strengths include the availability of uniformly collected, long-term medical and pharmacy data and the availability of data on important covariates, including smoking. The proposed study will provide a unique opportunity to investigate the role of medical conditions and medications in pancreatic tumorigenesis and to generate new insights into the mechanisms that result in pancreatic cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MMP-7 IN PACREATIC CANCER AND CHRONIC PANCREATITIS Principal Investigator & Institution: Crawford, Howard C.; Pharmacology; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2004; Project Start 01-MAR-2004; Project End 28-FEB-2009 Summary: (provided by applicant): Pancreatic cancer is the 5th most common cause of cancer-related death in the United States, partly due to difficulties with early detection and partly due to its resistance to conventional cancer therapies. As such, an initiative has been put forth in the Program Research Group Report: "Pancreatic Cancer: An Agenda for Action" to encourage study of pancreatic tumor biology and reliable methods for detection and treatment. With this in mind, we have begun to explore some of the fundamental tumor biology of pancreatic cancer, focusing on the function and expression of matrix metalloproteinase-7 (MMP-7). It is known that epithelial metaplasia in the context of chronic pancreatitis (CP) increases the risk for pancreatic ductal adenocarcinoma (PDAC) by 16-50 fold. Matrix metalloproteinase-7 (MMP-7) is expressed in metaplastic duct-like epithelium in 93% and 100% of chronic pancreatitis and pancreatic ductal adenocarcinoma (PDAC) samples, respectively, and in tumor cells in 98% of PDAC samples. This striking association between MMP- 7 and pancreatic disease has led to the discovery that CP is severely inhibited in MMP-7 null mice, including an almost complete abrogation of ductal metaplasia. In this application, we propose to test the overall hypothesis that MMP-7 and proteins that regulate its expression are both necessary and sufficient to induce pancreatic ductal metaplasia, contributing to PDAC initiation and progression. Specifically, we will test if MMP-7 activity is necessary and sufficient for ductal metaplasia both in vitro. We will also analyze if MMP-7 function is necessary for PDAC formation, progression and invasion in mouse PDAC models. Finally, we will study the activity of two putative activators of MMP-7 expression, the pancreatic/duodenal homeobox protein (Pdx-1) and the AP-1 factor c-Jun, to study their ability to regulate MMP-7 and alter tumor cell behavior in immortal pancreatic duct cells and in human PDAC cell lines. We will also examine the role of Pdx-1 in regulating MMP-7 expression in mouse models of metaplasia in vivo.

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Overall, we expect these studies to contribute significantly to our knowledge of pancreatic tumor biology with immediate implications with regards to detection and treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODELS OF TYPE 1 AND TYPE II HEREDITARY PANCREATITIS Principal Investigator & Institution: Ulrich, Charles D.; Internal Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 31-MAR-2003 Summary: (Applicant's Abstract): Acute and chronic pancreatitis remain major healthcare problems. The lack of effective preventive and therapeutic strategies in these disease states stems from a lack of understanding regarding disease pathogenesis. The investigator's group has identified mutations responsible for two delayed-onset, autosomal dominant inherited forms of acute and chronic pancreatitis. An RI 17H mutation in the human cationic trypsinogen gene links with type I hereditary pancreatitis (HP I). An N211 mutation in the same gene links with type II hereditary pancreatitis (HP II). Biochemical data from other groups when combined with the results of there preliminary studies support the hypothesis that the HP I mutation in cationic trypsin renders the molecule resistant to proteolytic digestion, the persistence of mutant trypsin activity resulting in the creation of a "milieu" sufficient for clinicallyapparent acute pancreatitis. The alterations in protein biochemistry responsible for the HP II phenotype remain unclear. In an initial attempt to develop an animal model of HP I, the investigator generated transgenic mice containing a diet-inducible pancreatic acinar cell-specific promoter coupled to either wild-type or HP I mutant human cationic trypsinogen. Unfortunately, these mice fail to develop pancreatitis spontaneously, and all available antibodies to human cationic trypsin cross-react with an identically sized mouse trypsin. The investigator believes that enhanced expression of antibody epitopetagged human cationic trypsinogens will provide him with the best opportunity to develop a successful animal model of hereditary pancreatitis. Toward this end, the investigator proposes (1) studies comparing the biochemical properties of affinitypurified recombinant wild-type, R117H, and N21I human cationic trypsinogen/trypsin (+ I- epitope tag) utilizing a validated in vitro assay system. By design, these studies will also further test the investigator's hypothesis with regard to HP I mutant trypsin, and discern the biochemical alterations induced by the HP II mutation. The investigator will then (2) characterize murine pancreata and acinar cells expressing varying levels of epitope-tagged wild-type, R117H, and N2 11 human cationic trypsinogen/trypsin. The development of these animal models, in combination with the experimental design, should provide him with important insights into the events underlying the delayedonset and pathophysiology of HP I, HP II and non-hereditary forms of acute and chronic pancreatitis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOLECULAR GENETICS OF HEREDITARY PANCREATITIS Principal Investigator & Institution: Whitcomb, David C.; Chief, Div of Gastroenterology, Hepatolo; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 30-NOV-2003 Summary: Acute and chronic pancreatitis are major health-care problems in the United States causing years of pain and disability. Despite the impact of these diseases, mystery

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Chronic Pancreatitis

surrounds many of the predisposing causes and early molecular events. Furthermore, the devastating effects of acute pancreatitis and chronic pancreatitis, once established, cannot be reversed. We believe that in the future, advances in the treatment of pancreatic disease rest in the early identification of at-risk individuals as well as in the prevention of limitation of pancreatic injury. Thus, the goal of our program is to determine the molecular mechanisms that predispose to acute and chronic pancreatitis and to identify targets for disrupting pathophysiological processes. We believe that effective preemptive actions will prevent or limit pancreatic injury and thus, result in the reduction of he incidence and severity of acute and chronic pancreatitis. To understand the mechanisms of pancreatitis we will identify previously uncharacterized hereditary pancreatitis families and investigate several striking features of this disease including incomplete penetrance and the mechanisms causing pancreatitis with trypsinogen RR117H and N21I mutations. Answering this question may provide insight into the pathophysiology of acute and chronic pancreatitis and identify targets for new therapies, and help identify individuals at risk through genetic testing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR MECHANISMS OF PANCREATIC FIBROGENESIS Principal Investigator & Institution: Neuschwander-Tetri, Brent A.; Internal Medicine; St. Louis University St. Louis, Mo 63110 Timing: Fiscal Year 2004; Project Start 01-MAY-2004; Project End 30-APR-2008 Summary: (provided by applicant): Extensive experimental work over the past four decades has led to a better understanding of acute and chronic pancreatitis at the morphological and biochemical level. However, these advances have not led to effective preventive and therapeutic strategies. The broad goal of this work is to better understand the pathophysiology of chronic pancreatitis at the molecular level in order to guide future preventive and therapeutic strategies. This goal will be accomplished by focusing on key extracellular events that lead to activation of the pancreatic stellate cell, the key mediator of pancreatic fibrogenesis. The aims of this proposal represent logical extensions of the preliminary work undertaken by the principal investigator to develop a mouse model that recapitulates the morphological changes of chronic pancreatitis, develop the necessary tools to measure meaningful endpoints of pancreatic fibrogenesis, and seek novel genes expressed in the pancreas during repetitive injury. The specific aims are to establish the role of angiotensin II and its receptors in the activation of pancreatic stellate cells and development of chronic pancreatitis and to establish the functional significance of thrombospondin-1 and thrombospondin-2 in the activation of pancreatic stellate cells during repetitive injury. The first aim will be accomplished by using mice with genetic deletions of angiotensinogen and angiotensin II receptors as well as highly specific receptor antagonists in mice and cultured pancreatic stellate cells. The second aim will be accomplished by using thrombospondin knockout mice to establish the role of thrombospondin-1 and thrombospondin-2 in pancreatic stellate cell activation. Accomplishing these aims will fill significant gaps in the understanding of chronic pancreatitis and this new knowledge may help identify effective treatment approaches to this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PANCREATITIS

MOLECULAR

PATHOMECHANISM

OF

17

HEREDITARY

Principal Investigator & Institution: Sahin-Toth, Miklos; Associate Professor; Physiology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 31-JUL-2002 Summary: (Applicant's abstract): The broad, long-term objectives of this application are to understand the mechanism by which mutations in the human cationic trypsinogen gene (PRSS1) lead to hereditary pancreatitis (HP). HP is an autosomal dominant genetic disorder characterized by early-onset recurrent attacks of acute pancreatitis with frequent progression to chronic pancreatitis and occasionally to pancreatic cancer. HP belongs to the inherited forms of idiopathic chronic pancreatitis, a genetically heterogeneous disease group, where mutations have been found not only in PRSS1, but also in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and in the pancreatic secretory trypsin inhibitor gene (SPINK1). HP has been widely recognized as a highly relevant model system for all forms of human pancreatitis. In the majority of cases, three mutations, Arg117-His, Asn2l-,lle, and Ala8-Val, have been identified in PRSSI. The molecular defects caused by the HP mutations will be studied within the context of a current pathogenesis model, which suggests that HP is caused by excessive intrapancreatic trypsin activity via one of 3 mechanisms: (i) increased trypsinogen activation, (ii) decreased trypsin degradation; or (iii) impaired inhibition by pancreatic secretory trypsin inhibitor (PSTI). The principal objective of the experimental design is to study the effects of the HP-mutations in vitro, using recombinant human trypsinogens. Wild-type and mutant trypsinogens will be expressed in Escherichia coli, and purified to homogeneity with ecotin affinity chromatography. Catalytic properties and autocatalytic degradation (autolysis) of trypsins and autoactivation and autocatalytic degradation (zymogenolysis) of trypsinogens will be characterized. In addition, interactions between wild-type and mutant forms of cationic trypsin(ogen) with anionic trypsin(ogen) and mesotrypsin(ogen) will be examined. Finally, inhibition of human trypsin isoforms and HP mutant trypsins by wild-type and mutant PSTI proteins will be studied. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTION

NEUROPEPTIDE

REGULATION

OF

ENTEROPANCREATIC

Principal Investigator & Institution: Mulholland, Michael W.; Professor of Surgery; Surgery; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-JAN-1991; Project End 31-DEC-2003 Summary: The intrinsic nervous system of the gastrointestinal tract affects nearly aspect of digestive activity. While dysfunction of the autonomic nervous system has been postulated to cause or exacerbate several pancreatic diseases, little is known of the factors influencing signal processing and function of the enteropancreatic nervous system. As one of example, chronic pancreatitis is a devastating condition characterized by pain and exocrine insufficiency, in which abnormalities of neural function have been postulated to play a role. The current treatment of chronic pancreatitis is impiric, palliative and unsatisfactory, reflecting our lack of basic information. The following research project is designed to investigate on a fundamental level neural control mechanisms that have relevance to human health. We have hypothesized that: 1.

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Chronic Pancreatitis

Pancreatic nerves activate a functional domain consisting of multiple acini innervated by a single neuron; 2. Pancreatic neurotransmission is acutely regulated by presynaptic modulation of calcium-dependent signaling pathways; 3. For enteropancreatic neurons, long-term function is regulated, at the transcriptional level, by the duration and intensity of signaling activities; 4. In acinar cells, both enzyme secretion and gene expression are regulated via neural mechanisms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL PROTEASE FORMULATION BASED ON CROSSLINKED CRYSTALS Principal Investigator & Institution: Shenoy, Bhami C.; Altus Biologics, Inc. 625 Putnam Ave Cambridge, Ma 021394807 Timing: Fiscal Year 2003; Project Start 01-JUL-2000; Project End 31-MAR-2005 Summary: (provided by applicant): Design of stable and efficient formulation of proteins for therapeutic use as drugs has been a major focus of biotechnology and pharmaceutical companies. In the Phase I grant, we developed a stable, active formulation of protease from Aspergillus melleus, TheraCLEC-Protease, for use in the treatment of chronic abdominal pain in chronic pancreatitis and also along with TheraCLEC-Lipase and amylase for the treatment of malabsorption as a result of pancreatic insufficiency in cystic fibrosis and chronic pancreatitis. TheraCLEC-Protease exhibited product characteristics superior to commercially available pancreatic enzyme products. TheraCLEC-Protease exhibited a very high level of activity against casein and stability under low pH and towards various proteases present in the intestine. Moreover, in the preliminary investigations, the TheraCLEC-Protease did not show any toxicity. Based on these results in Phase II, we will prepare a drug product prototype for use in the treatment of abdominal pain in chronic pancreatitis and along with TheraCLEC-Lipase for use in the treatment of pancreatic insufficiency, azotorrhea and steatorrhea in cystic fibrosis and chronic pancreatitis patients. As a first step, we will crystallize and crosslink the protease with methods developed in Phase I Subsequently, we will mix TheraCLEC-Protease with TheraCLEC-Lipase and amylase for use in a final formulation or alone depending on the disease and type of treatment. The final formulation will be tested for efficacy in digesting proteins and fats in dogs with ligated pancreatic ducts. Using radiolabeled TheraCLEC-Protease, we will follow the lack of absorption into the systemic circulation. In addition, we will test the subacute, subchronic and long-term effects of feeding TheraCLEC-Protease in two species. If successful, a TheraCLEC-Protease prototype will provide an efficient treatment for abdominal pain. TheraCLEC-Protease will be ready to enter clinical trials, and will provide a novel treatment for pancreatic insufficiency in chronic pancreatitis and cystic fibrosis along with TheraCLECLipase. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OXIDATIVE DAMAGE IN PANCREATITIS AND PANCREATIC NEOPLASIA Principal Investigator & Institution: Bell, Richard; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2002 Summary: Carcinoma of the pancreas if the fifth leading cause of cancer death in the United States; treatment for established carcinoma is largely ineffective, with mean survival measured in months. The possibility of detection of early neoplasms in a high-

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risk group forms the rationale for the current proposal. Chronic pancreatitis is the most significant risk factor for pancreatic cancer yet identified. Acute and chronic pancreatitis are associated with injury from reactive oxygen radicals. Oxidative damage to DNA during the development of chronic pancreatitis may lead to mutations which ultimately cause the development of subsequent pancreatic cancer. The eventual fate of oxidatively damaged cells may depend on anti-oxidant defense against further injury, changes in the ability of cells to undergo apoptosis, or changes in cell proliferation. These further changes may be a result of continued oxidative damage. In the first specific aim of the current proposal, normal pancreas and tissue with chronic pancreatitis and pancreatic cancer will be examined for markers of oxidative DNA damage, antioxidant defense, apoptosis, and proliferation. The second specific aim will address whether oxidative damage sensitizes the pancreatic duct epithelium to further changes in antioxidant defense, apoptosis and proliferation. We will determine whether antioxidant treatment can prevent these changes. This aim will also determine if cells exposed to oxidative stress are more sensitive to carcinogen challenge than normal duct cells. To examine similar questions in an in vivo model, chronic pancreatitis will be induced in hamsters and the resultant oxidative damage in pancreatic tissue measured, as well as changes in antioxidant defense, apoptosis, and proliferation. These animals will be observed for the development of spontaneous tumors and tested for the development of cancer in response to low doses of the carcinogen N-nitrosobis (2oxopropyl) amine (BOP). Animals with chronic pancreatitis will be treated with antioxidants during the course of pancreatitis will be analyzed for markers of oxidative damage, antioxidant defense, apoptosis or proliferation which are found to be associated with neoplastic change in Aims 1 and 2. Aim 2, we will establish the feasibility of measuring these markers in pancreatic juice and brushing, determine the incidence of marker positivity in patients with chronic pancreatitis, validate the markers, and develop a cohort of chronic pancreatitis patients for long=term cancer surveillance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PAIN RELIEF FROM ADL 10-0101 IN CHRONIC PANCREATITIS Principal Investigator & Institution: Eisenach, James C.; Professor; Wake Forest University 1834 Wake Forest Road Winston-Salem, Nc 27106 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PATHOGENIC MECHANISMS OF PANCREATITIS Principal Investigator & Institution: Liddle, Rodger A.; Professor; Medicine; Duke University Durham, Nc 27710 Timing: Fiscal Year 2004; Project Start 21-FEB-2004; Project End 31-JAN-2009 Summary: (provided by applicant): Pancreatitis can be a devastating clinical condition associated with considerable morbidity and mortality that is believed to result from premature activation of pancreatic enzymes within the parenchyma of the gland, leading to tissue autodigestion, subsequent inflammation, and ultimately tissue destruction. It is apparent that a number of complex and interrelated processes involving activation of pancreatic enzymes and inflammatory mediators participate in a cascade of events that produce pancreatitis. However, the precise pathogenic steps producing the final manifestations of the disease are not established. Neurogenic

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Chronic Pancreatitis

inflammation is a well established principle in some inflammatory conditions where neurotransmitters such as substance P are key mediators of pain sensation, neutrophil infiltration, edema, and local proteolysis. Mice deficient in the neurokinin-1 (NK-1) receptor have been shown to have less severe experimental pancreatitis compared to normal mice suggesting that substance P is important for the full inflammatory response. Recent studies by the PI and others have linked substance P release from primary sensory neurons to pancreatic inflammation and pancreatitis and suggest that primary sensory neuronal activation is an important upstream event in the development of pancreatitis. Primary afferent neurons are capsaicin-sensitive and express the capsaicin receptor [known as the vanilloid receptor-1 (VR1)]. The PI's preliminary pharmacological data indicate that VR1 inhibition reduces the severity of experimental pancreatitis. The current application is designed to test the hypothesis that primary sensory innervation is a necessary component of acute and chronic pancreatitis. The goal of this project is to define the upstream events from NK-1 receptor activation that initiate pancreatitis. These studies will utilize recently developed mouse models to examine the following Specific Aims: (1) To establish the critical role of VR1 in pancreatic inflammation and pancreatitis by determining if VR1 knock-out mice are protected against acute and/or chronic pancreatitis; (2) To determine if intrapancreatic trypsin inhibition, through the pancreatic specific expression of PSTI-I in transgenic mice, protects against pancreatitis through a VR1-mediated mechanism; (3) To characterize the endogenous ligands for the VR1 receptor responsible for mediating the inflammatory response in pancreatitis. These results should help both elucidate the importance of primary sensory innervation in the pathogenesis of pancreatitis and provide possible new strategies for the treatment of pancreatitis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESEARCH TRAINING IN ALIMENTARY TRACT SURGERY Principal Investigator & Institution: Soybel, David I.; Associate Professor of Surgery; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2004; Project Start 18-JUL-1997; Project End 30-JUN-2009 Summary: (provided by applicant): This Program provides research training for young surgeons who plan careers for patient care and investigation in surgical problems of the alimentary tract. Its primary purpose is to prepare these individuals to become independently funded investigators. The program provides intensive, coordinated research training in fundamental aspects of molecular and cell biology, biochemistry and biophysics, organ physiology and pathophysiology, and immunology, as they apply to diseases of the alimentary tract, hepatobiliary system and pancreas. First funded in 1997 as a collaboration between the Departments of Surgery at the Brigham and Women's Hospital and the former Beth Israel Hospital, this program is now expanded to include NIH-funded surgical research laboratories at all major adult teaching hospital affiliates of Harvard Medical School. Current areas of investigation by core preceptor group include: 1) gastro-intestinal mucosal secretion and barrier function (Soybel, Hofer, Hagen); 2) energetics and metabolic derangements of liver in sepsis and shock (Fischer, Hasselgren); 3) gut differentiation and growth responses to starvation or massive resection (Hodin, Ashley, Zinner); 4) cell biology and pathophysiology of acute and chronic pancreatitis (Warshaw); 5) molecular basis of pancreatic cancer growth and metastasis (Callery); 6) tissue engineering as applied to reconstruction and rehabilitation of the alimentary tract (Vacanti, Whang); and 7) evaluation of outcomes and introduction of new technologies in operations on the Digestive System (Zinner, Warshaw, Daley). In addition, a number of young faculty have been recruited to the

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different Departments of Surgery at HMS, with intention of their development as surgeon-investigators in the field of GI and HPB Surgery. We propose to include these young faculty, under clearly specified circumstances, as comentors of our research fellows, thereby enhancing the environment for learning and providing an environment of mentoring for future mentors. The program will be enriched by opportunities for formal coursework in basic sciences and experimental techniques at Harvard's Medical School and School of Public Health, by interactions with core labs and investigators of the NIH-funded Digestive Diseases Centers (HMS-based and MGH-based), and by participation in clinical and research conferences offered at each institution. The training Program Executive Committee (Soybel, Hodin, Hasselgren) oversees selection of trainees, designation of preceptors, prescription of formal coursework, and participation of trainees in programs teaching ethics and responsible conduct in research. Trainees are selected through a process open to surgical residents or fellows in accredited U.S. Surgical Residency Training Programs. A pro-active process for seeking applications from individuals belonging to under-represented minority groups is coordinated through the Offices for Diversity at HMS and each of the participating institutions Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SURGICAL STUDIES OF PANCREATIC STEM CELLS Principal Investigator & Institution: Leach, Steven D.; The Paul Neumann Professor in Pancreatic; Surgery; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 15-AUG-1999; Project End 30-JUN-2004 Summary: Pancreatic ductal proliferation is a frequent hallmark of surgical pancreatic disease. However, the epithelial stem cells responsible for pancreatic duct proliferation remain unknown. The long-term objective of this research program is to identify the "cell of origin" from which ductal proliferation originates during chronic pancreatitis and pancreatic cancer, potentially allowing therapeutic intervention to be directed to precursor cells. Using both surgical and transgenic models of ductal proliferation, preliminary experiments have been performed suggesting that pancreatic stem cells can be identified based on the following criteria: 1) ductal location, 2) enhanced proliferative capacity, 3) expression of the anti-apoptotic protein Bcl-2, and 4) expression of the Pdx1 and Pax6 homeobox transcription factors. Based on these studies, the following specific aims are proposed: First, to characterize the role of Pdx1- and Pax6- expressing pancreatic stem cells in benign pancreatic ductal proliferation induced by surgical pancreatic duct ligation. Second, to characterize the role of Pdx1- and Pax6-expressing stem cells in premalignant pancreatic duct proliferation induced by TGFalpha overexpression in MT-TGFalpha transgenic mice. Third, to isolate and propagate Pdx1expressing pancreatic stem cells in long-term tissue culture, and to investigate the effects of TGFalpha and transforming oncogenes on their growth and differentiation. These investigations will be pursued utilizing a novel in vivo reporter gene approach which takes advantage of pre-existing mouse lines in which one copy of either the endogenous Pdx1 locus or the endogenous Pax6 locus has been replaced with a lacZ cassette. This allows precise tracing of candidate stem cells expressing these homeobox genes. In addition, a strategy for isolation of pancreatic stem cells is proposed using the Pdx1 promoter to target expression of the neomycin antibiotic resistance gene to the embryonic pancreatic ductal epithelium. Together, these investigations will provide important new insight regarding the pancreatic cell lineages participating in ductal proliferation, and potentially lead to novel therapeutic strategies for surgical pancreatic disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE PANINS OF PANCREATITIS,PANCREAS CANCER AND CONTROLS Principal Investigator & Institution: Goggins, Michael G.; Associate Professor; Pathology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 30-JUN-2003 Summary: Pancreatic cancer is the fifth leading cause of cancer death in the USA. Unfortunately, there is currently no effective screening test for asymptomatic disease and the vast majority of patients with pancreatic cancer present with advanced incurable disease. An effective method to detect early pancreatic cancers is urgently needed. This need is perhaps greatest in groups known to have an increased risk of developing pancreatic cancer. For example, patients with sporadic chronic pancreatitis have a lifetime risk of developing pancreatic cancer that approaches 4% and for patients with hereditary pancreatitis, the lifetime risk of pancreatic cancer is very high (approximately 50%). An improved understanding of early neoplasia in patients with chronic pancreatitis should form the foundation on which novel approaches to the early identification of invasive cancer could be developed. Several lines of evidence suggests that the precursor lesions of pancreatic carcinoma are the duct lesions known as pancreatic intraepithelial neoplasias (PanINs). First, PanINs are more common in pancreata with cancer than they were in pancreata without cancer. Second, PanINs found in pancreata with pancreatic cancer harbor many of the same genetic alterations as are found in pancreatic cancer such as activation of K-ras and inactivation of p16, DPC4, p53, and BRCA2. Third, several case studies report patients with PanINs progressing to invasive pancreatic cancer. Despite the risk of pancreatic cancer among patients with chronic pancreatitis, the genetic alterations in the PanINs from patients with chronic pancreatitis have not been well-studied. The aim of this study is to compare the frequency, timing and mechanism of several molecular events important for neoplastic progression in PanINs found in the setting of pancreatic cancer with PanINs found in the setting of chronic pancreatitis- associated and with PanINs from other benign pancreatic conditions. Specifically, using genetic, DNA methylation, and immunohistochemical techniques to compare the rates of a) genetic inactivation of DPC4 and b) genetic and epigenetic inactivation of p16 in 40 PanINs that arose in the setting of chronic pancreatitis 40 PanINs that arose in the setting of pancreatic cancer and 40 PanINs that arose in pancreata resected for benign pancreatic conditions without malignant potential. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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and type “chronic pancreatitis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for chronic pancreatitis in the PubMed Central database: •

A novel mutation of the calcium sensing receptor gene is associated with chronic pancreatitis in a family with heterozygous SPINK1 mutations. by Felderbauer P, Hoffmann P, Einwachter H, Bulut K, Ansorge N, Schmitz F, Schmidt WE.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=317302

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with chronic pancreatitis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “chronic pancreatitis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for chronic pancreatitis (hyperlinks lead to article summaries): •

A better pain evaluation could achieve more in the audit of endoscopic therapy in chronic pancreatitis. Author(s): Dumitrascu DL. Source: Rom J Gastroenterol. 2002 September; 11(3): 265-6; Author Reply 266-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12368947

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A case of chronic pancreatitis associated with liver infarction and acrodermatitis enteropathica. Author(s): Kim BC, Joo KR, Lee HS, Jeong YK, Suh HS, Kim do H, Park NH, Park JH. Source: Korean J Intern Med. 2002 December; 17(4): 263-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12647643

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A case of inferior vena cava thrombosis and pulmonary embolism secondary to acute exacerbation of chronic pancreatitis: a rare finding in radionuclide venography. Author(s): Ohta H, Hachiya T. Source: Ann Nucl Med. 2002 April; 16(2): 147-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12043910

6

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A finger sweat chloride test for the detection of a high-risk group of chronic pancreatitis. Author(s): Naruse S, Ishiguro H, Suzuki Y, Fujiki K, Ko SB, Mizuno N, Takemura T, Yamamoto A, Yoshikawa T, Jin C, Suzuki R, Kitagawa M, Tsuda T, Kondo T, Hayakawa T. Source: Pancreas. 2004 April; 28(3): E80-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15084988

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A novel mutation of the calcium sensing receptor gene is associated with chronic pancreatitis in a family with heterozygous SPINK1 mutations. Author(s): Felderbauer P, Hoffmann P, Einwachter H, Bulut K, Ansorge N, Schmitz F, Schmidt WE. Source: Bmc Gastroenterology [electronic Resource]. 2003 November 29; 3(1): 34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14641934

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A novel treatment for chronic pancreatitis. Author(s): Connolly EM, Osborne H, Hickey DP. Source: Ir J Med Sci. 2003 October-December; 172(4): 202-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15029990

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A pancreatic abscess 7 years after a pancreatojejunostomy for calcifying chronic pancreatitis. Author(s): Suzuki A, Matsunaga T, Aoki S, Hirayama T, Nakagawa N, Shibata K, Yabana T, Kawasaki H, Takasaka H, Sasaki K, Katsuramaki T, Mukaiya M, Hirata K, Imai K. Source: Journal of Gastroenterology. 2002; 37(12): 1062-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12522540

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A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Author(s): Dite P, Ruzicka M, Zboril V, Novotny I. Source: Endoscopy. 2003 July; 35(7): 553-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12822088

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Absence of PRSS1 mutations and association of SPINK1 trypsin inhibitor mutations in hereditary and non-hereditary chronic pancreatitis. Author(s): Chandak GR, Idris MM, Reddy DN, Mani KR, Bhaskar S, Rao GV, Singh L. Source: Gut. 2004 May; 53(5): 723-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15082592

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Acute and chronic pancreatitis. Author(s): Davenport M. Source: Indian J Pediatr. 2002 September; 69(9): 801-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12420914

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Acute and chronic pancreatitis--diseases on the rise: a study of hospital admissions in England 1989/90-1999/2000. Author(s): Tinto A, Lloyd DA, Kang JY, Majeed A, Ellis C, Williamson RC, Maxwell JD. Source: Alimentary Pharmacology & Therapeutics. 2002 December; 16(12): 2097-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12452943

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Alcoholic chronic pancreatitis involves displacement of Munc18c from the pancreatic acinar basal membrane surface. Author(s): Gaisano HY, Sheu L, Whitcomb D. Source: Pancreas. 2004 May; 28(4): 395-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15097857

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Alterations of bone mineral density and bone metabolism in patients with various grades of chronic pancreatitis. Author(s): Mann ST, Stracke H, Lange U, Klor HU, Teichmann J. Source: Metabolism: Clinical and Experimental. 2003 May; 52(5): 579-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12759887

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An endoscopic pancreatic function test with cholecystokinin-octapeptide for the diagnosis of chronic pancreatitis. Author(s): Conwell DL, Zuccaro G Jr, Vargo JJ, Morrow JB, Obuchowski N, Dumot JA, Trolli PA, Burton A, O'laughlin C, Van Lente F. Source: Clin Gastroenterol Hepatol. 2003 May; 1(3): 189-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15017490

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An endoscopic pancreatic function test with synthetic porcine secretin for the evaluation of chronic abdominal pain and suspected chronic pancreatitis. Author(s): Conwell DL, Zuccaro G Jr, Vargo JJ, Trolli PA, Vanlente F, Obuchowski N, Dumot JA, O'laughlin C. Source: Gastrointestinal Endoscopy. 2003 January; 57(1): 37-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12518128

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An enteral therapy containing medium-chain triglycerides and hydrolyzed peptides reduces postprandial pain associated with chronic pancreatitis. Author(s): Shea JC, Bishop MD, Parker EM, Gelrud A, Freedman SD. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2003; 3(1): 36-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12649562

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Analgesia from a peripherally active kappa-opioid receptor agonist in patients with chronic pancreatitis. Author(s): Eisenach JC, Carpenter R, Curry R. Source: Pain. 2003 January; 101(1-2): 89-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12507703

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Association of HLA-DRB1*0401 allele with chronic pancreatitis. Author(s): Cavestro GM, Frulloni L, Neri TM, Seghini P, Nouvenne A, Zanetti A, Bovo P, Di Mario F, Okolicsanyi L, Cavallini G. Source: Pancreas. 2003 May; 26(4): 388-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12717273

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Association of keratin 8 gene mutation with chronic pancreatitis. Author(s): Cavestro GM, Frulloni L, Nouvenne A, Neri TM, Calore B, Ferri B, Bovo P, Okolicsanyi L, Di Mario F, Cavallini G. Source: Dig Liver Dis. 2003 June; 35(6): 416-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12868678

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Autoimmune chronic pancreatitis: a plea for simplification and consistency. Author(s): DiMagno EP. Source: Clin Gastroenterol Hepatol. 2003 November; 1(6): 421-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15017639

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Balance of expression of genes coding for extracellular matrix proteins and extracellular matrix degrading proteases in chronic pancreatitis. Author(s): Gress TM, Muller-Pillasch F, Lerch MM, Friess H, Buchler M, Beger HG, Adler G. Source: Zeitschrift Fur Gastroenterologie. 1994 April; 32(4): 221-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8017097

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Basal and postprandial cholecystokinin values in chronic pancreatitis with and without abdominal pain. Author(s): Gomez Cerezo J, Codoceo R, Fernandez Calle P, Molina F, Tenias JM, Vazquez JJ. Source: Digestion. 1991; 48(3): 134-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1916033

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Behaviour of serum pancreatic enzymes in chronic pancreatitis. Author(s): Pezzilli R, Talamini G, Gullo L. Source: Dig Liver Dis. 2000 April; 32(3): 233-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10975774

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Bilateral recurrent haemorrhagic pleural effusion in asymptomatic chronic pancreatitis. Author(s): Tewari SC, Jayaswal R, Chauhan MS, Kaul SK, Narayanan VA. Source: Thorax. 1989 October; 44(10): 824-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2595625

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Bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Author(s): Buscher HC, Jansen JJ, van Goor H. Source: Scandinavian Journal of Gastroenterology. Supplement. 1999; 230: 29-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10499459

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Bile acid malabsorption as a cause of hypocholesterolemia seen in patients with chronic pancreatitis. Author(s): Nakamura T, Takebe K, Yamada N, Arai Y, Tando Y, Terada A, Ishii M, Kikuchi H, Machida K, Imamura K. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1994 October-December; 16(2-3): 165-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7868942

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Biliary lipid metabolism in chronic pancreatitis: influence of steatorrhoea. Author(s): Einarsson K, Angelin B, Johansson C. Source: Gut. 1987 November; 28(11): 1495-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3428677

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Biliary strictures are not the cause of pain in patients with chronic pancreatitis. Author(s): Kahl S, Zimmermann S, Genz I, Schmidt U, Pross M, Schulz HU, Malfertheiner P. Source: Pancreas. 2004 May; 28(4): 387-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15097855

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Biliary tract dilatation in chronic pancreatitis: CT and sonographic findings. Author(s): Huntington DK, Hill MC, Steinberg W. Source: Radiology. 1989 July; 172(1): 47-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2662256

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Biochemical tests in the diagnosis of chronic pancreatitis and in the evaluation of pancreatic insufficiency. Author(s): Goldberg DM, Durie PR. Source: Clinical Biochemistry. 1993 August; 26(4): 253-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8242888

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Bleeding duodenal varix in splenic vein thrombosis and chronic pancreatitis. Author(s): Dhadphale S, Sawant P, Rathi P, Shirhatti RG, Gupta R, Gopanpallikar A, Patrawala V. Source: Indian J Gastroenterol. 1998 January; 17(1): 29-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9465513

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Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis. Author(s): Heath DI, Reid AW, Murray WR. Source: The British Journal of Surgery. 1992 March; 79(3): 281. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1637385

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Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis. Author(s): Burgess NA, Scriven MW, Lewis MH. Source: The British Journal of Surgery. 1992 February; 79(2): 182. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1555076

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Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis. Author(s): el Hamel A, Parc R, Adda G, Bouteloup PY, Huguet C, Malafosse M. Source: The British Journal of Surgery. 1991 September; 78(9): 1059-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1933185

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Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Author(s): Haaber AB, Rosenfalck AM, Hansen B, Hilsted J, Larsen S. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 2000 February; 27(1): 21-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10811020

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Brain-derived neurotrophic factor (BDNF) is upregulated and associated with pain in chronic pancreatitis. Author(s): Zhu ZW, Friess H, Wang L, Zimmermann A, Buchler MW. Source: Digestive Diseases and Sciences. 2001 August; 46(8): 1633-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11508661

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Breath-hold MR cholangiopancreatography with a long-echo-train fast spin-echo sequence and a surface coil in chronic pancreatitis. Author(s): Takehara Y, Ichijo K, Tooyama N, Kodaira N, Yamamoto H, Tatami M, Saito M, Watahiki H, Takahashi M. Source: Radiology. 1994 July; 192(1): 73-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8208969

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Bronchobiliary fistula in chronic pancreatitis. Case report. Author(s): Genell SN, Fork FT, Jiborn H. Source: Acta Chir Scand. 1987 July-August; 153(7-8): 473-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3673459

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Bronchobiliary fistula. A rare complication of chronic pancreatitis. Author(s): Eck BD, Passinault WJ. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1996 December; 20(3): 213-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9013283

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Carcinoma of the head of the pancreas versus chronic pancreatitis: diagnostic dilemma with significant consequences. Author(s): Taylor B. Source: World Journal of Surgery. 2003 November; 27(11): 1249-57. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14502404

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Case of chronic pancreatitis involving an autoimmune mechanism that extended to retroperitoneal fibrosis. Author(s): Uchida K, Okazaki K, Asada M, Yazumi S, Ohana M, Chiba T, Inoue T. Source: Pancreas. 2003 January; 26(1): 92-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499924

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Celiac axis stenosis in pancreatic head resection for chronic pancreatitis. Author(s): Pfeiffenberger J, Adam U, Drognitz O, Kroger JC, Makowiec F, Schareck W, Hopt UT. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2002 October; 387(5-6): 210-5. Epub 2002 September 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12410356

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Chromosomal instability in pancreatic ductal cells from patients with chronic pancreatitis and pancreatic adenocarcinoma. Author(s): Moskovitz AH, Linford NJ, Brentnall TA, Bronner MP, Storer BE, Potter JD, Bell RH Jr, Rabinovitch PS. Source: Genes, Chromosomes & Cancer. 2003 June; 37(2): 201-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12696069

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Chronic pancreatitis and cystic fibrosis. Author(s): Witt H. Source: Gut. 2003 May; 52 Suppl 2: Ii31-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12651880

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Chronic pancreatitis and maldigestion. Author(s): Petersen JM, Forsmark CE. Source: Semin Gastrointest Dis. 2002 October; 13(4): 191-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12462705

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Chronic pancreatitis associated with systemic lupus erythematosus in a young girl. Author(s): Penalva JC, Martinez J, Pascual E, Palanca VM, Lluis F, Peiro F, Perez H, Perez-Mateo M. Source: Pancreas. 2003 October; 27(3): 275-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508137

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Chronic pancreatitis in Japan: epidemiology, prognosis, diagnostic criteria, and future problems. Author(s): Otsuki M. Source: Journal of Gastroenterology. 2003; 38(4): 315-26. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12743770

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Chronic pancreatitis. Author(s): Tsirambidis JV, Conwell DL, Zuccaro G. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2003 January 9; 5(1): 17. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12827078

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Chronic pancreatitis. Long-term pain relief with or without surgery, cancer risk, and mortality. Author(s): Thuluvath PJ, Imperio D, Nair S, Cameron JL. Source: Journal of Clinical Gastroenterology. 2003 February; 36(2): 159-65. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544201

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Chronic pancreatitis: diagnostic role of computed tomography and magnetic resonance imaging. Author(s): De Backer AI, Mortele KJ, Ros RR, Vanbeckevoort D, Vanschoubroeck I, De Keulenaer B. Source: Jbr-Btr. 2002 December; 85(6): 304-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12553661

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Chronic pancreatitis: etiology, pathogenesis, diagnosis, and treatment. Author(s): Strate T, Knoefel WT, Yekebas E, Izbicki JR. Source: International Journal of Colorectal Disease. 2003 March; 18(2): 97-106. Epub 2002 September 05. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12548409

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Chronic pancreatitis: relation between function and morphology. Author(s): Maartense S, Ledeboer M, Masclee AA. Source: Dig Liver Dis. 2004 January; 36(1): 61-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14971817

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Chronic pancreatitis: the perspective of pain generation by neuroimmune interaction. Author(s): Di Sebastiano P, di Mola FF, Bockman DE, Friess H, Buchler MW. Source: Gut. 2003 June; 52(6): 907-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12740353

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Clinical evidence of pathogenesis in chronic pancreatitis. Author(s): Hayakawa T, Naruse S, Kitagawa M, Ishiguro H, Jin CX, Kondo T. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2002; 9(6): 669-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12658399

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Clinical study of chronic pancreatitis with focal irregular narrowing of the main pancreatic duct and mass formation: comparison with chronic pancreatitis showing diffuse irregular narrowing of the main pancreatic duct. Author(s): Wakabayashi T, Kawaura Y, Satomura Y, Fujii T, Motoo Y, Okai T, Sawabu N. Source: Pancreas. 2002 October; 25(3): 283-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12370540

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COMP is selectively up-regulated in degenerating acinar cells in chronic pancreatitis and in chronic-pancreatitis-like lesions in pancreatic cancer. Author(s): Liao Q, Kleeff J, Xiao Y, Di Cesare PE, Korc M, Zimmermann A, Buchler MW, Friess H. Source: Scandinavian Journal of Gastroenterology. 2003 February; 38(2): 207-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12678339

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Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Author(s): Fritscher-Ravens A, Brand L, Knofel WT, Bobrowski C, Topalidis T, Thonke F, de Werth A, Soehendra N. Source: The American Journal of Gastroenterology. 2002 November; 97(11): 2768-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12425546

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Comparison of histological features and inflammatory cell reaction in alcoholic, idiopathic and tropical chronic pancreatitis. Author(s): Shrikhande SV, Martignoni ME, Shrikhande M, Kappeler A, Ramesh H, Zimmermann A, Buchler MW, Friess H. Source: The British Journal of Surgery. 2003 December; 90(12): 1565-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14648737

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Cystic fibrosis: an unusual cause of chronic pancreatitis. Author(s): Vanderbruggen K, De Waele K, Van Biervliet S, Van Der Cruyssen G, Robberecht E. Source: Acta Gastroenterol Belg. 2003 July-September; 66(3): 260-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618962

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Definition and classification of chronic pancreatitis. Author(s): Keith RG. Source: World Journal of Surgery. 2003 November; 27(11): 1172-4. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14534817

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Definitions of acute and chronic pancreatitis. Author(s): Sarner M, Cotton PB. Source: Clin Gastroenterol. 1984 September; 13(3): 865-70. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6386242

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Detailed tissue expression of bcl-2, bax, bak and bcl-x in the normal human pancreas and in chronic pancreatitis, ampullary and pancreatic ductal adenocarcinomas. Author(s): Evans JD, Cornford PA, Dodson A, Greenhalf W, Foster CS, Neoptolemos JP. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2001; 1(3): 254-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12120204

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Determination of the relative contribution of three genes-the cystic fibrosis transmembrane conductance regulator gene, the cationic trypsinogen gene, and the pancreatic secretory trypsin inhibitor gene-to the etiology of idiopathic chronic pancreatitis. Author(s): Audrezet MP, Chen JM, Le Marechal C, Ruszniewski P, Robaszkiewicz M, Raguenes O, Quere I, Scotet V, Ferec C. Source: European Journal of Human Genetics : Ejhg. 2002 February; 10(2): 100-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11938439

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Diagnosis and treatment of chronic pancreatitis. Author(s): Liao Q, Zhao YP, Wu WW, Li BL, Li JY. Source: Hepatobiliary Pancreat Dis Int. 2003 August; 2(3): 445-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14599957

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Diagnosis of chronic pancreatitis. Is a gold standard necessary? Author(s): Clain JE, Pearson RK. Source: The Surgical Clinics of North America. 1999 August; 79(4): 829-45. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10470330

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Diagnosis of early chronic pancreatitis by endoscopic ultrasound. Are we there yet? Author(s): Raimondo M, Wallace MB. Source: Jop [electronic Resource] : Journal of the Pancreas. 2004 January; 5(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14730117

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Diagnostic value of endoscopic retrograde pancreatography in chronic pancreatitis based on the new criteria proposed by the Japan Pancreas Society in 1995: comparison with the criteria proposed by the Japanese Society of Gastroenterology in 1983. Author(s): Wakabayashi T, Hayakawa Y, Morimoto H, Sugioka G, Watanabe H, Sawabu N. Source: Pancreas. 1999 January; 18(1): 13-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9888655

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Differences in immunohistochemical expression of xenobiotic-metabolizing enzymes between normal pancreas, chronic pancreatitis and pancreatic cancer. Author(s): Standop J, Schneider M, Ulrich A, Buchler MW, Pour PM. Source: Toxicologic Pathology. 2003 September-October; 31(5): 506-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14692619

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Differences in the expression of glutathione S-transferases in normal pancreas, chronic pancreatitis, secondary chronic pancreatitis, and pancreatic cancer. Author(s): Ulrich AB, Schmied BM, Standop J, Schneider MB, Lawson TA, Friess H, Andren-Sandberg A, Buchler MW, Pour PM. Source: Pancreas. 2002 April; 24(3): 291-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11893938

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Different CFTR mutational spectrum in alcoholic and idiopathic chronic pancreatitis? Author(s): Casals T, Aparisi L, Martinez-Costa C, Gimenez J, Ramos MD, Mora J, Diaz J, Boadas J, Estivill X, Farre A. Source: Pancreas. 2004 May; 28(4): 374-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15097853

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Differential diagnosis between chronic pancreatitis and pancreatic cancer: value of the detection of KRAS2 mutations in circulating DNA. Author(s): Maire F, Micard S, Hammel P, Voitot H, Levy P, Cugnenc PH, Ruszniewski P, Puig PL. Source: British Journal of Cancer. 2002 August 27; 87(5): 551-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12189555

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Differentiating pancreatic cancer from pseudotumorous chronic pancreatitis. Author(s): Yusuf TE, Bhutani MS. Source: Current Gastroenterology Reports. 2002 April; 4(2): 135-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11900678

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Distal pancreatectomy in chronic pancreatitis. Author(s): Schoenberg MH, Schlosser W, Ruck W, Beger HG. Source: Digestive Surgery. 1999; 16(2): 130-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10207239

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Distribution of Indian hedgehog and its receptors patched and smoothened in human chronic pancreatitis. Author(s): Kayed H, Kleeff J, Keleg S, Buchler MW, Friess H. Source: The Journal of Endocrinology. 2003 September; 178(3): 467-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12967338

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Does acute alcoholic pancreatitis exist with preexisting chronic pancreatitis? Author(s): Brunner R, Xie J, Bank S. Source: Journal of Clinical Gastroenterology. 2004 March; 38(3): 201-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15128062

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Duct drainage alone is sufficient in the operative management of pancreatic pseudocyst in patients with chronic pancreatitis. Author(s): Nealon WH, Walser E. Source: Annals of Surgery. 2003 May; 237(5): 614-20; Discussion 620-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12724627

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Ductal drainage with head coring in chronic pancreatitis with small-duct disease. Author(s): Ramesh H, Jacob G, Lekha V, Venugopal A. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2003; 10(5): 366-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14598137

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Duodenum- and spleen-preserving total pancreatectomy for end-stage chronic pancreatitis. Author(s): Alexakis N, Ghaneh P, Connor S, Raraty M, Sutton R, Neoptolemos JP. Source: The British Journal of Surgery. 2003 November; 90(11): 1401-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14598422

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Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial. Author(s): Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Source: Annals of Surgery. 1995 April; 221(4): 350-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7726670

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Early onset idiopathic chronic pancreatitis: Is there a role for endoscopic treatment? Author(s): Gabbrielli A. Source: Jop [electronic Resource] : Journal of the Pancreas. 2003 July; 4(4): 133-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12853680

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Effect of surgery for chronic pancreatitis on pancreatic function: pancreaticojejunostomy and duodenum-preserving resection of the head of the pancreas. Author(s): Maartense S, Ledeboer M, Bemelman WA, Ringers J, Frolich M, Masclee AA. Source: Surgery. 2004 February; 135(2): 125-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14739846

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Emergency complications of acute and chronic pancreatitis. Author(s): Law NM, Freeman ML. Source: Gastroenterology Clinics of North America. 2003 December; 32(4): 1169-94, Ix. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14696302

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Endocrine and intermediate cells in pancreatic ductal carcinoma and in chronic pancreatitis. Author(s): Szynaka B, Zimnoch L, Puchalski Z, Szynaka P. Source: Rocz Akad Med Bialymst. 2002; 47: 21-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12533945

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Endoscopic management of chronic pancreatitis. Author(s): Delhaye M, Matos C, Deviere J. Source: Gastrointest Endosc Clin N Am. 2003 October; 13(4): 717-42. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14986795

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Endoscopic retrograde cholangiopancreatography in chronic pancreatitis. Author(s): Bolan PJ, Fink AS. Source: World Journal of Surgery. 2003 November; 27(11): 1183-91. Epub 2003 October 16. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14716502

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Endoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency. Author(s): Morgan DE, Smith JK, Hawkins K, Wilcox CM. Source: The American Journal of Gastroenterology. 2003 April; 98(4): 821-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738462

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Endoscopic therapy of chronic pancreatitis. Author(s): Deviere J. Source: Acta Gastroenterol Belg. 2003 April-June; 66(2): 184-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12891930

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Endoscopic treatment of chronic pancreatitis. Author(s): Kozarek RA. Source: Indian J Gastroenterol. 2002 March-April; 21(2): 67-73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11990330

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Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Author(s): Rosch T, Daniel S, Scholz M, Huibregtse K, Smits M, Schneider T, Ell C, Haber G, Riemann JF, Jakobs R, Hintze R, Adler A, Neuhaus H, Zavoral M, Zavada F, Schusdziarra V, Soehendra N; European Society of Gastrointestinal Endoscopy Research Group. Source: Endoscopy. 2002 October; 34(10): 765-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12244496

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End-stage chronic pancreatitis: a practical disease-descriptor. Author(s): Siriwardana HP, Siriwardena AK. Source: International Journal of Gastrointestinal Cancer. 2001; 30(3): 171-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540030

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Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Author(s): Banks PA. Source: Gastrointestinal Endoscopy. 2002 December; 56(6 Suppl): S226-30. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12447272

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EUS and chronic pancreatitis. Author(s): Sahai AV. Source: Gastrointestinal Endoscopy. 2002 October; 56(4 Suppl): S76-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12297754

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Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Author(s): Schafer M, Mullhaupt B, Clavien PA. Source: Annals of Surgery. 2002 August; 236(2): 137-48. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12170018

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Evidence-based surgery in chronic pancreatitis. Author(s): Hartel M, Tempia-Caliera AA, Wente MN, Z'graggen K, Friess H, Buchler MW. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2003 April; 388(2): 132-9. Epub 2003 March 18. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12712343

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Expression of antioxidant enzymes in diseases of the human pancreas: another link between chronic pancreatitis and pancreatic cancer. Author(s): Cullen JJ, Mitros FA, Oberley LW. Source: Pancreas. 2003 January; 26(1): 23-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499913

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Expression of cancer testis antigens in pancreatic carcinoma cell lines, pancreatic adenocarcinoma and chronic pancreatitis. Author(s): Kubuschok B, Xie X, Jesnowski R, Preuss KD, Romeike BF, Neumann F, Regitz E, Pistorius G, Schilling M, Scheunemann P, Izbicki JR, Lohr JM, Pfreundschuh M. Source: International Journal of Cancer. Journal International Du Cancer. 2004 April 20; 109(4): 568-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14991579

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Expression of multidrug resistance proteins in rat and human chronic pancreatitis. Author(s): Schaarschmidt T, Merkord J, Adam U, Schroeder E, Kunert-Keil C, Sperker B, Drewelow B, Wacke R. Source: Pancreas. 2004 January; 28(1): 45-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14707729

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Expression of transforming growth factor-beta 1 by pancreatic stellate cells and its implications for matrix secretion and turnover in chronic pancreatitis. Author(s): Shek FW, Benyon RC, Walker FM, McCrudden PR, Pender SL, Williams EJ, Johnson PA, Johnson CD, Bateman AC, Fine DR, Iredale JP. Source: American Journal of Pathology. 2002 May; 160(5): 1787-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12000730

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Expression patterns of protein kinase C isoenzymes are characteristically modulated in chronic pancreatitis and pancreatic cancer. Author(s): Evans JD, Cornford PA, Dodson A, Neoptolemos JP, Foster CS. Source: American Journal of Clinical Pathology. 2003 March; 119(3): 392-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12645342

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Factors associated with health-related quality of life in chronic pancreatitis. Author(s): Wehler M, Nichterlein R, Fischer B, Farnbacher M, Reulbach U, Hahn EG, Schneider T. Source: The American Journal of Gastroenterology. 2004 January; 99(1): 138-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687155

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Faecal chymotrypsin assay in tropical and alcoholic chronic pancreatitis. Author(s): Chari S, Mohan V, Snehalatha C, Jayanthi V, Malathi S, Madanagopalan N, Viswanathan M. Source: Trop Gastroenterol. 1990 July-September; 11(3): 144-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2267672

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Faecal elastase 1 in chronic pancreatitis. Author(s): Gullo L. Source: Gut. 1999 February; 44(2): 291-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10336335

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Faecal elastase 1: not helpful in diagnosing chronic pancreatitis associated with mild to moderate exocrine pancreatic insufficiency. Author(s): Lankisch PG, Schmidt I, Konig H, Lehnick D, Knollmann R, Lohr M, Liebe S. Source: Gut. 1998 April; 42(4): 551-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9616319

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Failure of symptomatic relief after pancreaticojejunal decompression for chronic pancreatitis. Strategies for salvage. Author(s): Markowitz JS, Rattner DW, Warshaw AL. Source: Archives of Surgery (Chicago, Ill. : 1960). 1994 April; 129(4): 374-9; Discussion 379-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8154964

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Fatal splenic arterial aneurysmal rupture associated with chronic pancreatitis. Author(s): Lamba M, Veinot JP, Acharya V, Moyana T. Source: The American Journal of Forensic Medicine and Pathology : Official Publication of the National Association of Medical Examiners. 2002 September; 23(3): 281-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12198358

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Fat-soluble vitamins in patients with chronic pancreatitis (pancreatic insufficiency). Author(s): Nakamura T, Takebe K, Imamura K, Tando Y, Yamada N, Arai Y, Terada A, Ishii M, Kikuchi H, Suda T. Source: Acta Gastroenterol Belg. 1996 January-March; 59(1): 10-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8686411

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Fatty acid abnormalities in chronic pancreatitis: effect of concomitant diabetes mellitus. Author(s): Quilliot D, Walters E, Bohme P, Lacroix B, Bonte JP, Fruchart JC, Drouin P, Duriez P, Ziegler O. Source: European Journal of Clinical Nutrition. 2003 March; 57(3): 496-503. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12627189

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Feasibility study using a new small electronic pancreatoscope: description of findings in chronic pancreatitis. Author(s): Kodama T, Imamura Y, Sato H, Koshitani T, Abe M, Kato K, Uehira H, Horii Y, Yamane Y, Kashima K, Yamagishi H. Source: Endoscopy. 2003 April; 35(4): 305-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12664386

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Fecal chymotrypsin assay in chronic pancreatitis. Author(s): Arora A, Tandon RK. Source: Trop Gastroenterol. 1991 January-March; 12(1): 51. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2058012

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Fecal elastase 1 determination in chronic pancreatitis. Author(s): Gullo L, Ventrucci M, Tomassetti P, Migliori M, Pezzilli R. Source: Digestive Diseases and Sciences. 1999 January; 44(1): 210-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9952246

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Fecal elastase 1 measurement compared with endoscopic retrograde cholangiopancreatography for the diagnosis of chronic pancreatitis. Author(s): Hardt PD, Marzeion AM, Schnell-Kretschmer H, Wusten O, Nalop J, Zekorn T, Klor HU. Source: Pancreas. 2002 July; 25(1): E6-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12131782

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Fecal pancreatic elastase 1 is inaccurate in the diagnosis of chronic pancreatitis. Author(s): Amann ST, Bishop M, Curington C, Toskes PP. Source: Pancreas. 1996 October; 13(3): 226-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8884841

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Feedback control of pancreatic exocrine secretion: its relationship to the management of the abdominal pain associated with chronic pancreatitis. Author(s): Toskes PP. Source: Trans Am Clin Climatol Assoc. 2001; 112: 61-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11413783

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First report of association of chronic pancreatitis, primary biliary cirrhosis, and systemic sclerosis. Author(s): Hastier P, Buckley MJ, Le Gall P, Bellon S, Dumas R, Delmont J. Source: Digestive Diseases and Sciences. 1998 November; 43(11): 2426-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9824129

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Focal chronic pancreatitis: false-positive fine-needle biopsy. Author(s): Vergote G, De Man R, Rutgeerts L. Source: J Belge Radiol. 1994 October; 77(5): 229. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7961386

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Follow-up of the serum levels of extracellular matrix components in acute and chronic pancreatitis. Author(s): Adler G, Kropf J, Grobe E, Gressner AM. Source: European Journal of Clinical Investigation. 1990 October; 20(5): 494-501. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2124979

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Food intake of patients with chronic pancreatitis after onset of the disease. Author(s): Vaona B, Armellini F, Bovo P, Rigo L, Zamboni M, Brunori MP, Dall'O E, Filippini M, Talamini G, Di Francesco V, Frulloni L, Micciolo R, Cavallini G. Source: The American Journal of Clinical Nutrition. 1997 March; 65(3): 851-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9062539

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From acute to chronic pancreatitis: the role of mutations in the pancreatic secretory trypsin inhibitor gene. Author(s): Hirota M, Kuwata K, Ohmuraya M, Ogawa M. Source: Jop [electronic Resource] : Journal of the Pancreas. 2003 March; 4(2): 83-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12629264

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Function tests in the diagnosis of chronic pancreatitis. Critical evaluation. Author(s): Lankisch PG. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1993 August; 14(1): 9-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8409575

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Galectin-1 and galectin-3 in chronic pancreatitis. Author(s): Wang L, Friess H, Zhu Z, Frigeri L, Zimmermann A, Korc M, Berberat PO, Buchler MW. Source: Laboratory Investigation; a Journal of Technical Methods and Pathology. 2000 August; 80(8): 1233-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10950114

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Gelatinase B is diabetogenic in acute and chronic pancreatitis by cleaving insulin. Author(s): Descamps FJ, Van den Steen PE, Martens E, Ballaux F, Geboes K, Opdenakker G. Source: The Faseb Journal : Official Publication of the Federation of American Societies for Experimental Biology. 2003 May; 17(8): 887-9. Epub 2003 March 05. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12626433

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Gene mutations and idiopathic chronic pancreatitis: clinical implications and testing. Author(s): DiMagno EP. Source: Gastroenterology. 2001 December; 121(6): 1508-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11729132

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Gene mutations in children with chronic pancreatitis. Author(s): Witt H. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2001; 1(5): 432-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12120220

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Genetic aspects of chronic pancreatitis, and the exploration of an association with keratin 8/18. Author(s): Drenth JP, Verlaan M. Source: Dig Liver Dis. 2003 June; 35(6): 386-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12868673

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Genetic aspects of chronic pancreatitis: insights into aetiopathogenesis and clinical implications. Author(s): Truninger K, Ammann RW, Blum HE, Witt H. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2001 October 6; 131(39-40): 565-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11775491

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Genetic basis of chronic pancreatitis. Author(s): Jansen JB, te Morsche R, van Goor H, Drenth JP. Source: Scandinavian Journal of Gastroenterology. Supplement. 2002; (236): 91-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12408512

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Genetic disorders in pancreatitis: Implications in the pathogenesis of acute and chronic pancreatitis. Author(s): Mossner J, Teich N. Source: Surgery. 2002 September; 132(3): 421-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12324754

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Genetic polymorphisms in alcohol-metabolizing enzymes and chronic pancreatitis. Author(s): Verlaan M, Te Morsche RH, Roelofs HM, Laheij RJ, Jansen JB, Peters WH, Drenth JP. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 2004 January-February; 39(1): 20-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14691069

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Genetic predisposition to alcoholic chronic pancreatitis. Author(s): Whitcomb DC. Source: Pancreas. 2003 November; 27(4): 321-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14576495

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Genetic risk factors in chronic pancreatitis. Author(s): Teich N, Ockenga J, Keim V, Mossner J. Source: Journal of Gastroenterology. 2002 January; 37(1): 1-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11824793

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Genetic testing in acute and chronic pancreatitis. Author(s): Rolston RK, Kant JA. Source: Current Gastroenterology Reports. 2001 April; 3(2): 115-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11276378

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Genetic testing in chronic pancreatitis. Author(s): Tazelaar JP, Kant JA. Source: Expert Review of Molecular Diagnostics. 2003 November; 3(6): 799-809. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14628907

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Genetics of chronic pancreatitis. Author(s): Arduino C, Gaia E. Source: Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2000 August; 54(7): 394-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10989979

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Genetics of chronic pancreatitis. Author(s): Witt H, Becker M. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 February; 34(2): 12536. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11840029

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Genotypes of alcohol-metabolizing enzymes in relation to alcoholic chronic pancreatitis in Japan. Author(s): Maruyama K, Takahashi H, Matsushita S, Nakano M, Harada H, Otsuki M, Ogawa M, Suda K, Baba T, Honma T, Moroboshi T, Matsuno M. Source: Alcoholism, Clinical and Experimental Research. 1999 April; 23(4 Suppl): 85S91S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10235286

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Germline mutations in CFTR and PSTI genes in chronic pancreatitis patients. Author(s): Gaia E, Salacone P, Gallo M, Promis GG, Brusco A, Bancone C, Carlo A. Source: Digestive Diseases and Sciences. 2002 November; 47(11): 2416-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12452372

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Giant splenic artery aneurysm associated with chronic pancreatitis. Author(s): Iki K, Tsunoda T. Source: Digestive Surgery. 2003; 20(1): 10-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12637798

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Glucose homeostasis and endocrine pancreatic function in patients with chronic pancreatitis before and after surgical therapy. Author(s): Bittner R, Butters M, Buchler M, Nagele S, Roscher R, Beger HG. Source: Pancreas. 1994 January; 9(1): 47-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8108371

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Glutathione S-transferase Mu null genotype affords protection against alcohol induced chronic pancreatitis. Author(s): Verlaan M, te Morsche RH, Roelofs HM, Laheij RJ, Jansen JB, Peters WH, Drenth JP. Source: American Journal of Medical Genetics. 2003 July 1; 120A(1): 34-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12794689

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Health-related quality of life in chronic pancreatitis: a psychometric assessment. Author(s): Wehler M, Reulbach U, Nichterlein R, Lange K, Fischer B, Farnbacher M, Hahn EG, Schneider T. Source: Scandinavian Journal of Gastroenterology. 2003 October; 38(10): 1083-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14621285

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Heightened free radical activity in blacks with chronic pancreatitis at Johannesburg, South Africa. Author(s): Gut A, Shiel N, Kay PM, Segal I, Braganza JM. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1994 October 31; 230(2): 189-99. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7834869

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Helicobacter pylori infection in patients with chronic pancreatitis and duodenal ulcer. Author(s): Niemann T, Larsen S, Mouritsen EA, Thorsgaard N. Source: Scandinavian Journal of Gastroenterology. 1997 December; 32(12): 1201-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9438316

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Hemosuccus pancreaticus complicating chronic pancreatitis: an obscure cause of upper gastrointestinal bleeding. Author(s): Sakorafas GH, Sarr MG, Farley DR, Que FG, Andrews JC, Farnell MB. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2000 March; 385(2): 124-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796050

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Hemosuccus pancreaticus: rare complication of chronic pancreatitis. Author(s): Kuganeswaran E, Smith OJ, Goldman ML, Clarkston WK. Source: Gastrointestinal Endoscopy. 2000 April; 51(4 Pt 1): 464-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10744821

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Hereditary chronic pancreatitis with radiolucent protein calculi. Author(s): Sarles H. Source: Pancreas. 1998 October; 17(3): 321-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9788552

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Hereditary chronic pancreatitis: implications for surgical treatment and follow-up. Author(s): Cowles RA, Eckhauser FE, Knol JA. Source: The American Surgeon. 2001 February; 67(2): 182-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11243547

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Hereditary pancreatitis: a model for understanding the genetic basis of acute and chronic pancreatitis. Author(s): Whitcomb DC. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2001; 1(6): 565-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12120237

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Hereditary pancreatitis: new insights into acute and chronic pancreatitis. Author(s): Whitcomb DC. Source: Gut. 1999 September; 45(3): 317-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10446089

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Hereditary, familial, and idiopathic chronic pancreatitis are not associated with polymorphisms in the tumor necrosis factor alpha (TNF-alpha) promoter region or the TNF receptor 1 (TNFR1) gene. Author(s): Schneider A, Pogue-Geile K, Barmada MM, Myers-Fong E, Thompson BS, Whitcomb DC. Source: Genetics in Medicine : Official Journal of the American College of Medical Genetics. 2003 March-April; 5(2): 120-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12644782

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Heterotopic autotransplantation of a pancreas segment with enteric drainage after total or subtotal pancreatectomy for chronic pancreatitis. Author(s): Tamura K, Yano S, Kin S, Nagami H, Itakura M, Nakagawa M, Nakase A, Tsuchiya R. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1993 April; 13(2): 119-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8501353

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High frequency of the N34S mutation in the SPINK1 gene in chronic pancreatitis detected by a new PCR-RFLP assay. Author(s): Plendl H, Siebert R, Steinemann D, Grote W. Source: American Journal of Medical Genetics. 2001 May 1; 100(3): 252-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11343313

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High serum levels of secretory immunoglobullin A in chronic pancreatitis. Author(s): Frulloni L, Negri M, Brunelli S, Bovo P, Vaona B, Calore B, Liani C, Di Francesco V, Cavallini G. Source: Dig Liver Dis. 2000 May; 32(4): 329-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11515631

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Histological assessment of chronic pancreatitis at necropsy. Author(s): Shimizu M, Hirokawa M, Manabe T. Source: Journal of Clinical Pathology. 1996 November; 49(11): 913-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8944611

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Histological findings in chronic pancreatitis after abdominal radiotherapy. Author(s): Schoonbroodt D, Zipf A, Herrmann G, Jung M. Source: Pancreas. 1996 April; 12(3): 313-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8830341

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Histopathologic difference between chronic pancreatitis animal models and human chronic pancreatitis. Author(s): Suda K, Takase M, Fukumura Y, Suzuki F, Jim A, Kakinuma C, Tanaka T, Matsugu Y, Miyasaka K, Funakoshi A. Source: Pancreas. 2004 April; 28(3): E86-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15084989

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Hot-water-bottle rash: not only a sign of chronic pancreatitis. Author(s): Rudolph CM, Soyer HP, Wolf P, Kerl H. Source: Lancet. 1998 February 28; 351(9103): 677. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9500360

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How far are we from the most accurate classification system for chronic pancreatitis ? Author(s): Uomo G. Source: Jop [electronic Resource] : Journal of the Pancreas. 2002 May; 3(3): 62-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12004162

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How good is sphincter of Oddi manometry for chronic pancreatitis? Author(s): Guelrud M. Source: Endoscopy. 1994 February; 26(2): 265-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8026380

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Hyperparathyroidism and chronic pancreatitis. Author(s): Smith MD, Pawlak M, Pantanowitz DP, Botha RJ. Source: S Afr J Surg. 1999 February; 37(1): 12-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10222803

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Id-1 and Id-2 are overexpressed in pancreatic cancer and in dysplastic lesions in chronic pancreatitis. Author(s): Maruyama H, Kleeff J, Wildi S, Friess H, Buchler MW, Israel MA, Korc M. Source: American Journal of Pathology. 1999 September; 155(3): 815-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10487839

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Idiopathic "senile" chronic pancreatitis and pancreatic lithiasis in the aged. Author(s): Ammann RW. Source: Gastroenterology. 1984 July; 87(1): 253. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6724273

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Idiopathic chronic pancreatitis in children: MR cholangiopancreatography after secretin administration. Author(s): Manfredi R, Lucidi V, Gui B, Brizi MG, Vecchioli A, Maresca G, Dall'Oglio L, Costamagna G, Marano P. Source: Radiology. 2002 September; 224(3): 675-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12202699

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Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Author(s): Notohara K, Burgart LJ, Yadav D, Chari S, Smyrk TC. Source: The American Journal of Surgical Pathology. 2003 August; 27(8): 1119-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12883244

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Idiopathic tumefactive chronic pancreatitis: clinical profile, histology, and natural history after resection. Author(s): Yadav D, Notahara K, Smyrk TC, Clain JE, Pearson RK, Farnell MB, Chari ST. Source: Clin Gastroenterol Hepatol. 2003 March; 1(2): 129-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15017505

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Imaging of chronic pancreatitis. Author(s): Remer EM, Baker ME. Source: Radiologic Clinics of North America. 2002 December; 40(6): 1229-42, V. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12479708

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Imaging of chronic pancreatitis. Author(s): Manfredi R, Brizi MG, Masselli G, Gui B, Vecchioli A, Marano P. Source: Rays. 2001 April-June; 26(2): 143-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11925785

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Immunoglobulin E production in chronic pancreatitis. Author(s): Raithel M, Dormann H, Harsch IA, Winterkamp S, Weidenhiller M, Fischer B, Hahn EG, Schneider T. Source: European Journal of Gastroenterology & Hepatology. 2003 July; 15(7): 801-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811311

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Immunological findings in acute and chronic pancreatitis. Author(s): Bhatnagar A, Wig JD, Majumdar S. Source: Anz Journal of Surgery. 2003 January-February; 73(1-2): 59-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12534743

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In chronic pancreatitis, widespread emergence of TRAIL receptors in epithelia coincides with neoexpression of TRAIL by pancreatic stellate cells of early fibrotic areas. Author(s): Hasel C, Durr S, Rau B, Strater J, Schmid RM, Walczak H, Bachem MG, Moller P. Source: Laboratory Investigation; a Journal of Technical Methods and Pathology. 2003 June; 83(6): 825-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12808117

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Incapacitating pain of chronic pancreatitis: a surgical perspective of what is known and what needs to be known. Author(s): Sarr MG, Sakorafas GH. Source: Gastrointestinal Endoscopy. 1999 March; 49(3 Pt 2): S85-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10049457

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Incidence of cancer in the course of chronic pancreatitis. Author(s): Talamini G, Falconi M, Bassi C, Sartori N, Salvia R, Caldiron E, Frulloni L, Di Francesco V, Vaona B, Bovo P, Vantini I, Pederzoli P, Cavallini G. Source: The American Journal of Gastroenterology. 1999 May; 94(5): 1253-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10235203

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Increased angiogenin expression in obstructive chronic pancreatitis surrounding pancreatic cancer but not in pure chronic pancreatitis. Author(s): Shimoyama S, Gansauge F, Gansauge S, Oohara T, Kaminishi M, Beger HG. Source: Pancreas. 1999 April; 18(3): 225-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10206479

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Interdigestive cycling in chronic pancreatitis: altered coordination among pancreatic secretion, motility, and hormones. Author(s): Pieramico O, Dominguez-Munoz JE, Nelson DK, Bock W, Buchler M, Malfertheiner P. Source: Gastroenterology. 1995 July; 109(1): 224-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7540998

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Interventional treatment of acute and chronic pancreatitis. Endoscopic procedures. Author(s): Norton ID, Petersen BT. Source: The Surgical Clinics of North America. 1999 August; 79(4): 895-911, Xii. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10470334

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Interventional treatment of chronic pancreatitis. Author(s): Laugier R, Grandval P. Source: European Journal of Gastroenterology & Hepatology. 2002 September; 14(9): 951-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12352214

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Intestinal bacterial overgrowth during chronic pancreatitis. Author(s): Trespi E, Ferrieri A. Source: Current Medical Research and Opinion. 1999; 15(1): 47-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10216811

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Is a 15-minute collection of duodenal secretions after secretin stimulation sufficient to diagnose chronic pancreatitis? Author(s): Draganov P, George S, Toskes PP, Forsmark CE. Source: Pancreas. 2004 January; 28(1): 89-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14707736

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Is pancreaticoduodenectomy justified for chronic pancreatitis masquerading as periampullary tumor? Author(s): Shyr YM, Su CH, Wu CW, Lui WY. Source: Hepatogastroenterology. 2003 July-August; 50(52): 1163-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846005

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Isolated idiopathic chronic pancreatitis associated with a compound heterozygosity for two mutations of the CFTR gene. Author(s): Reboul MP, Laharie D, Amouretti M, Lacombe D, Iron A. Source: Gastroenterologie Clinique Et Biologique. 2003 August-September; 27(8-9): 8214. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14586256

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Jejunal feeding in chronic pancreatitis with severe necrosis. Author(s): Hamvas J, Schwab R, Pap A. Source: Jop [electronic Resource] : Journal of the Pancreas. 2001 May; 2(3): 112-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11870333

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Juvenile chronic pancreatitis--a cause of painless jaundice in a patient with multiple somatic abnormalities. Author(s): Isaacs JD, Keshavarzian A, Blumgart LH, Hodgson HJ. Source: Journal of Clinical Gastroenterology. 1985 December; 7(6): 533-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4086750

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Ki-ras mutations in chronic pancreatitis: which relevance? Author(s): Van Laethem JL, Deviere J. Source: Gastroenterology. 1996 August; 111(2): 566-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8690228

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Ki-ras oncogene mutations in chronic pancreatitis: which discriminating ability for malignant potential? Author(s): van Laethem JL. Source: Annals of the New York Academy of Sciences. 1999 June 30; 880: 210-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10415866

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K-ras mutations at codon 12 are rare events in chronic pancreatitis. Author(s): Orth M, Gansauge F, Gansauge S, Beger HG, Adler G, Schmid RM. Source: Digestion. 1998; 59(2): 120-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9586823

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K-ras mutations in tissue and stool samples from patients with pancreatic cancer and chronic pancreatitis. Author(s): Wenger FA, Zieren J, Peter FJ, Jacobi CA, Muller JM. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 1999 April; 384(2): 181-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10328172

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Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Author(s): Fernandez-Cruz L, Saenz A, Astudillo E, Pantoja JP, Uzcategui E, Navarro S. Source: Surgical Endoscopy. 2002 June; 16(6): 996-1003. Epub 2002 March 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12163971

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Laser microdissection of small tissue samples--application to chronic pancreatitis tissues. Author(s): Heinmoller E, Bockholt A, Werther M, Ziemer M, Muller A, Ghadimi BM, Ruschoff J. Source: Pathology, Research and Practice. 2003; 199(6): 363-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12924436

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Lateral pancreaticojejunostomy for chronic pancreatitis. Author(s): O'Neil SJ, Aranha GV. Source: World Journal of Surgery. 2003 November; 27(11): 1196-202. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14534819

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Limited contribution of the SPINK1 N34S mutation to the risk and severity of alcoholic chronic pancreatitis: a report from the United States. Author(s): Schneider A, Pfutzer RH, Barmada MM, Slivka A, Martin J, Whitcomb DC. Source: Digestive Diseases and Sciences. 2003 June; 48(6): 1110-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12822871

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Liquid pancreatic enzyme therapy for a patient with short bowel syndrome and chronic pancreatitis in a complicated case of Crohn's disease. Author(s): Hardt PD, Helfrich C, Klauke T, Klor HU. Source: European Journal of Medical Research. 1999 August 25; 4(8): 345-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10471547

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Liver, pancreas and biliary tract enhanced lipoperoxidation products in pure pancreatic juice: evidence for organ-specific oxidative stress in chronic pancreatitis. Author(s): Santini SA, Spada C, Bononi F, Foschia F, Mutignani M, Perri V, Giardina B, Silveri NG, Costamagna G. Source: Dig Liver Dis. 2003 December; 35(12): 888-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14703885

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Localization of transforming growth factor beta 1 and its latent binding protein in human chronic pancreatitis. Author(s): van Laethem JL, Deviere J, Resibois A, Rickaert F, Vertongen P, Ohtani H, Cremer M, Miyazono K, Robberecht P. Source: Gastroenterology. 1995 June; 108(6): 1873-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7768393

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Long-term metabolic results after pancreatic resection for severe chronic pancreatitis. Author(s): Berney T, Rudisuhli T, Oberholzer J, Caulfield A, Morel P. Source: Archives of Surgery (Chicago, Ill. : 1960). 2000 September; 135(9): 1106-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10982519

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Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Author(s): Buscher HC, Jansen JB, van Dongen R, Bleichrodt RP, van Goor H. Source: The British Journal of Surgery. 2002 February; 89(2): 158-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11856127

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Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Author(s): Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RC. Source: Annals of Surgery. 2002 November; 236(5): 612-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12409667

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Low-avidity antibodies to carbonic anhydrase-I and -II in autoimmune chronic pancreatitis. Author(s): Bartolome MJ, de las Heras G, Lopez-Hoyos M. Source: Scientificworldjournal. 2002 June 11; 2: 1560-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12806141

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Management of biliary and duodenal complications of chronic pancreatitis. Author(s): Vijungco JD, Prinz RA. Source: World Journal of Surgery. 2003 November; 27(11): 1258-70. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14534824

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Management of pain in chronic pancreatitis: medical or surgical. Author(s): Agarwal N, Pitchumoni CS. Source: Journal of Clinical Gastroenterology. 2003 February; 36(2): 98-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544189

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Medical therapy for chronic pancreatitis pain. Author(s): Singh VV, Toskes PP. Source: Current Gastroenterology Reports. 2003 April; 5(2): 110-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12631450

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Microvascular density in chronic pancreatitis and pancreatic ductal adenocarcinoma. Author(s): Rzepko R, Jaskiewicz K, Klimkowska M, Nalecz A, Izycka-Swieszewska E. Source: Folia Histochem Cytobiol. 2003; 41(4): 237-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14677765

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Molecular alterations in chronic pancreatitis. Author(s): Kayed H, Muller M, Kleeff J, Bockman DE, Buchler MW, Friess H. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2002; 9(6): 653-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12658397

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Molecular pathophysiology of chronic pancreatitis--an update. Author(s): Friess H, Kleeff J, Buchler MW. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2003 December; 7(8): 943-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14675702

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Molecular profiling of pancreatic adenocarcinoma and chronic pancreatitis identifies multiple genes differentially regulated in pancreatic cancer. Author(s): Logsdon CD, Simeone DM, Binkley C, Arumugam T, Greenson JK, Giordano TJ, Misek DE, Kuick R, Hanash S. Source: Cancer Research. 2003 May 15; 63(10): 2649-57. Erratum In: Cancer Res. 2003 June 15; 63(12): 3445. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12750293

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Motion--pancreatic endoscopy is useful for the pain of chronic pancreatitis: arguments against the motion. Author(s): Conwell DL. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2003 January; 17(1): 61-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12560858

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Motion--pancreatic endoscopy is useful for the pain of chronic pancreatitis: arguments for the motion. Author(s): Branch SM. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2003 January; 17(1): 57-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12560857

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Mutation analysis of the cystic fibrosis transmembrane conductance regulator (CFTR) gene, the cationic trypsinogen (PRSS1) gene, and the serine protease inhibitor, Kazal type 1 (SPINK1) gene in patients with alcoholic chronic pancreatitis. Author(s): Perri F, Piepoli A, Stanziale P, Merla A, Zelante L, Andriulli A. Source: European Journal of Human Genetics : Ejhg. 2003 September; 11(9): 687-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12939655

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Natural course of chronic pancreatitis. Author(s): Lankisch PG. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2001; 1(1): 3-14. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12120264

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Natural course of operated pseudocysts in chronic pancreatitis. Author(s): Gottlieb K, Lehman GA. Source: Gastrointestinal Endoscopy. 1995 June; 41(6): 620-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7672570

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Near-total pancreatectomy for chronic pancreatitis. Author(s): Eckhauser FE, Strodel WE, Knol JA, Harper M, Turcotte JG. Source: Surgery. 1984 October; 96(4): 599-607. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6484804

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Nerve blocks and neuroablative surgery for chronic pancreatitis. Author(s): Bradley EL 3rd, Bem J. Source: World Journal of Surgery. 2003 November; 27(11): 1241-8. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14534823

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Neural alterations in surgical stage chronic pancreatitis are independent of the underlying aetiology. Author(s): Friess H, Shrikhande S, Shrikhande M, Martignoni M, Kulli C, Zimmermann A, Kappeler A, Ramesh H, Buchler M. Source: Gut. 2002 May; 50(5): 682-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950816

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New concepts in understanding the pathophysiology of chronic pancreatitis. Author(s): Bimmler D, Graf R, Frick TW. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1999 June; 25(3): 252-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10453426

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No hypoglycemia after subcutaneous administration of glucagon-like peptide-1 in lean type 2 diabetic patients and in patients with diabetes secondary to chronic pancreatitis. Author(s): Knop FK, Vilsboll T, Larsen S, Madsbad S, Holst JJ, Krarup T. Source: Diabetes Care. 2003 September; 26(9): 2581-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12941722

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Non-surgical treatments for chronic pancreatitis. Author(s): Suga T. Source: Hokkaido Igaku Zasshi. 1999 March; 74(2): 105-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10386160

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Nuclear DNA distribution pattern of the parenchymal cells in adenocarcinomas of the pancreas and in chronic pancreatitis. A study of archival specimens using both image and flow cytometry. Author(s): Weger AR, Falkmer UG, Schwab G, Glaser K, Kemmler G, Bodner E, Auer GU, Mikuz G. Source: Gastroenterology. 1990 July; 99(1): 237-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2188872

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On the role of CFTR, PSSR1 and PST1/SPINK1 in idiopathic chronic pancreatitis. Author(s): Perri F, Piepoli A, Andriulli A. Source: European Journal of Human Genetics : Ejhg. 2003 February; 11(2): 107; Author Reply 108. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12634855

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Opioid treatment of painful chronic pancreatitis. Author(s): Niemann T, Madsen LG, Larsen S, Thorsgaard N. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 2000 June; 27(3): 235-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10952406

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Optimizing surgical therapy for chronic pancreatitis. Author(s): Knoefel WT, Eisenberger CF, Strate T, Izbicki JR. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2002; 2(4): 379-84; Discussion 385. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12138226

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Organ-preserving pancreatic head resection in chronic pancreatitis. Author(s): Farkas G, Leindler L, Daroczi M, Farkas G Jr. Source: The British Journal of Surgery. 2003 January; 90(1): 29-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12520571

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Osteopontin expression in chronic pancreatitis. Author(s): Nakamura M, Oka M, Iizuka N, Kawauchi S, Gondo T, Ueno T, Tangoku A. Source: Pancreas. 2002 August; 25(2): 182-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12142743

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Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis. Author(s): Witzigmann H, Max D, Uhlmann D, Geissler F, Schwarz R, Ludwig S, Lohmann T, Caca K, Keim V, Tannapfel A, Hauss J. Source: Surgery. 2003 July; 134(1): 53-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12874583

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Outcome after lateral pancreaticojejunostomy in patients with chronic pancreatitis associated with pancreas divisum. Author(s): Schnelldorfer T, Adams DB. Source: The American Surgeon. 2003 December; 69(12): 1041-4; Discussion 1045-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14700288

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Outcome and quality of life in chronic pancreatitis. Author(s): Talamini G, Bassi C, Butturini G, Falconi M, Casetti L, Gumbus AA, Carrara S, Fantin A, Pederzoli P. Source: Jop [electronic Resource] : Journal of the Pancreas. 2001 July; 2(4): 117-23. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11875248

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Outcome of pancreaticojejunostomy after previous endoscopic stenting in patients with chronic pancreatitis. Author(s): Boerma D, van Gulik TM, Rauws EA, Obertop H, Gouma DJ. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(4): 223-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12440760

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Overexpression of Caspase-1 in adenocarcinoma of pancreas and chronic pancreatitis. Author(s): Yang YM, Ramadani M, Huang YT. Source: World Journal of Gastroenterology : Wjg. 2003 December; 9(12): 2828-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14669344

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p16 Inactivation in pancreatic intraepithelial neoplasias (PanINs) arising in patients with chronic pancreatitis. Author(s): Rosty C, Geradts J, Sato N, Wilentz RE, Roberts H, Sohn T, Cameron JL, Yeo CJ, Hruban RH, Goggins M. Source: The American Journal of Surgical Pathology. 2003 December; 27(12): 1495-501. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14657708

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Pain in chronic pancreatitis: assessment and relief through treatment. Author(s): Seicean A, Grigorescu M, Tantau M, Dumitrascu DL, Pop D, Mocan T. Source: Rom J Gastroenterol. 2004 March; 13(1): 9-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15054520

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Pancreatic autotransplantation in chronic pancreatitis. Author(s): Watkins JG, Krebs A, Rossi RL. Source: World Journal of Surgery. 2003 November; 27(11): 1235-40. Epub 2003 October 27. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14574491

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Pancreatic head resection for chronic pancreatitis in patients with extrahepatic generalized portal hypertension. Author(s): Adam U, Makowiec F, Riediger H, Keck T, Kroger JC, Uhrmeister P, Hopt UT. Source: Surgery. 2004 April; 135(4): 411-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15041965

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Pancreatico-pericardial fistula: a rare complication of chronic pancreatitis. Author(s): Balasubramanian P, Jeyamani R, Govil S, Chacko A, Kurian G, Subhash HS, Govil S, Thomas K. Source: Indian J Gastroenterol. 2004 January-February; 23(1): 31-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15106719

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Pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head: preoperative and postoperative functional assessment. Author(s): Chen HM, Jan YY, Chao TC, Hwang TL, Chen MF. Source: Hepatogastroenterology. 2003 November-December; 50(54): 2213-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14696501

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Pancreatoduodenectomy in the treatment of chronic pancreatitis. Author(s): Russell RC, Theis BA. Source: World Journal of Surgery. 2003 November; 27(11): 1203-10. Epub 2003 October 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14534820

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Patency of the accessory pancreatic duct in chronic pancreatitis. Author(s): Kamisawa T. Source: Jop [electronic Resource] : Journal of the Pancreas. 2004 March; 5(2): 107-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15007194

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Pathogenesis of pain in chronic pancreatitis: ongoing enigma. Author(s): Bornman PC, Marks IN, Girdwood AW, Berberat PO, Gulbinas A, Buchler MW. Source: World Journal of Surgery. 2003 November; 27(11): 1175-82. Epub 2003 October 27. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14574490

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Pylorus-preserving pancreaticoduodenectomy in the treatment of chronic pancreatitis. Author(s): Jimenez RE, Fernandez-Del Castillo C, Rattner DW, Warshaw AL. Source: World Journal of Surgery. 2003 November; 27(11): 1211-6. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508610

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Quality of life after bilateral thoracoscopic splanchnicectomy: long-term evaluation in patients with chronic pancreatitis. Author(s): Howard TJ, Swofford JB, Wagner DL, Sherman S, Lehman GA. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 November-December; 6(6): 845-52; Discussion 853-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12504223

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Quality of life and long-term survival after surgery for chronic pancreatitis. Author(s): Sohn TA, Campbell KA, Pitt HA, Sauter PK, Coleman JA, Lillemo KD, Yeo CJ, Cameron JL. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2000 July-August; 4(4): 355-64; Discussion 364-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11058853

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Quality of life assessment after pancreatic enzyme replacement therapy in chronic pancreatitis. Author(s): Czako L, Takacs T, Hegyi P, Pronai L, Tulassay Z, Lakner L, Dobronte Z, Boda K, Lonovics J. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2003 October; 17(10): 597-603. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571298

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Quality of life assessment in chronic pancreatitis. Author(s): Johnson CD, Fitzsimmons D. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1998 August; 24(1): 63-4, Author Reply 65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9746892

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Quality of life improvement after videothoracoscopic splanchnicectomy in chronic pancreatitis patients: case control study. Author(s): Makarewicz W, Stefaniak T, Kossakowska M, Basinski A, Suchorzewski M, Stanek A, Gruca ZB. Source: World Journal of Surgery. 2003 August; 27(8): 906-11. Epub 2003 June 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12822048

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Quality of life in chronic pancreatitis: a prospective trial comparing classical whipple procedure and duodenum-preserving pancreatic head resection. Author(s): Witzigmann H, Max D, Uhlmann D, Geissler F, Ludwig S, Schwarz R, Krauss O, Lohmann T, Keim V, Hauss J. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 March-April; 6(2): 173-9; Discussion 179-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11992802

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Quality of life in chronic pancreatitis--results after duodenum-preserving resection of the head of the pancreas. Author(s): Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch CE. Source: Pancreas. 1995 July; 11(1): 77-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7667246

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Quantitation of tryptic responses to endogenous and exogenous stimulation in chronic pancreatitis. Author(s): Klass HJ, Sandle GI, Kay PM, Davies P, Braganza JM. Source: Digestion. 1986; 35(2): 95-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3770323

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Quantitative analysis of collagen and collagen subtypes I, III, and V in human pancreatic cancer, tumor-associated chronic pancreatitis, and alcoholic chronic pancreatitis. Author(s): Imamura T, Iguchi H, Manabe T, Ohshio G, Yoshimura T, Wang ZH, Suwa H, Ishigami S, Imamura M. Source: Pancreas. 1995 November; 11(4): 357-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8532652

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Rapid endoscopic secretin stimulation test and discrimination of chronic pancreatitis and pancreatic cancer from disease controls. Author(s): Raimondo M, Imoto M, DiMagno EP. Source: Clin Gastroenterol Hepatol. 2003 September; 1(5): 397-403. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15017660

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Re: Fefferman et al.--"Recurrence" of chronic pancreatitis appearing on a patient with underlying Crohn's disease. Author(s): Triantafillidis JK, Cheracakis P. Source: The American Journal of Gastroenterology. 2002 March; 97(3): 761-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11922579

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Recurrent gastrointestinal bleeding associated with chronic pancreatitis. Author(s): Jenkins AP, el-Omar MM, Booth JC, Banerjee AK, Burnand KG, Thompson RP. Source: Gut. 1995 February; 36(2): 314-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7883237

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Relationship between K-ras mutation and the expression of p21WAF1/CIP1 and p53 in chronic pancreatitis and pancreatic adenocarcinoma. Author(s): Hermanova M, Lukas Z, Kroupova I, Kleibl Z, Novotny J, Nenutil R, Pazourkova M, Brazdil J, Kren L, Dite P. Source: Neoplasma. 2003; 50(5): 319-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14628083

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Relevance of variants in serum antiproteinases for the course of chronic pancreatitis. Author(s): Teich N, Walther K, Bodeker H, Mossner J, Keim V. Source: Scandinavian Journal of Gastroenterology. 2002 March; 37(3): 360-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11916201

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Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Author(s): Kahl S, Zimmermann S, Genz I, Glasbrenner B, Pross M, Schulz HU, Mc Namara D, Schmidt U, Malfertheiner P. Source: The American Journal of Gastroenterology. 2003 November; 98(11): 2448-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14638347

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Risk of pancreatic adenocarcinoma in chronic pancreatitis. Author(s): Malka D, Hammel P, Maire F, Rufat P, Madeira I, Pessione F, Levy P, Ruszniewski P. Source: Gut. 2002 December; 51(6): 849-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12427788

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Risk of pancreatic ductal adenocarcinoma in chronic pancreatitis. Author(s): Howes N, Neoptolemos JP. Source: Gut. 2002 December; 51(6): 765-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12427771

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Role of ERCP and other endoscopic modalities in chronic pancreatitis. Author(s): Lehman GA. Source: Gastrointestinal Endoscopy. 2002 December; 56(6 Suppl): S237-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12447274

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Ruptured subcapsular giant hematoma of the spleen as a complication of chronic pancreatitis. Author(s): Kuramitsu T, Komatsu M, Ono T, Nakajima K, Funaoka M, Kato J, Naganuma H, Ishida H, Masamune O. Source: Intern Med. 1995 June; 34(6): 564-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7549144

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Self-expandable metal mesh stents for common bile duct stenosis in chronic pancreatitis: retrospective evaluation of long-term follow-up and clinical outcome pilot study. Author(s): Eickhoff A, Jakobs R, Leonhardt A, Eickhoff JC, Riemann JF. Source: Zeitschrift Fur Gastroenterologie. 2003 July; 41(7): 649-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12908456

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Severe localized stenosis and marked dilatation of the main pancreatic duct are indicators of pancreatic cancer instead of chronic pancreatitis on endoscopic retrograde balloon pancreatography. Author(s): Inoue K, Ohuchida J, Ohtsuka T, Nabae T, Yokohata K, Ogawa Y, Yamaguchi K, Tanaka M. Source: Gastrointestinal Endoscopy. 2003 October; 58(4): 510-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520282

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SIR 2003 film panel case 6: hemosuccus pancreaticus secondary to chronic pancreatitis. Author(s): Feng DH, Mauro MA. Source: Journal of Vascular and Interventional Radiology : Jvir. 2003 June; 14(6): 803-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12817051

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Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. Author(s): Weber SM, Rikkers LF. Source: World Journal of Surgery. 2003 November; 27(11): 1271-4. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14502405

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Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis. Author(s): Holm M, Matzen P. Source: Scandinavian Journal of Gastroenterology. 2003 March; 38(3): 328-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12737450

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Subtotal pancreatectomy for chronic pancreatitis. Author(s): Eckhauser F, Cowles R, Colletti L. Source: World Journal of Surgery. 2003 November; 27(11): 1231-4. Epub 2003 October 13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14534822

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Surgical management of chronic pancreatitis and the role of islet cell autotransplantation. Author(s): Helling TS. Source: Current Surgery. 2003 July-August; 60(4): 463-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14972242

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Surgical management of chronic pancreatitis: current concepts and future perspectives. Author(s): Sakorafas GH, Anagnostopoulos G. Source: Int Surg. 2003 October-December; 88(4): 211-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14717527

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Surgical management of intractable pain in chronic pancreatitis: past and present. Author(s): Morrison CP, Wemyss-Holden SA, Partensky C, Maddern GJ. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2002; 9(6): 675-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12658400

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Surgical treatment of chronic pancreatitis. Author(s): Liao Q, Wu WW, Li BL, Zhang TP, Zhao YP. Source: Hepatobiliary Pancreat Dis Int. 2002 August; 1(3): 462-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14607728

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The course of genetically determined chronic pancreatitis. Author(s): Keim V, Witt H, Bauer N, Bodeker H, Rosendahl J, Teich N, Mossner J. Source: Jop [electronic Resource] : Journal of the Pancreas. 2003 July; 4(4): 146-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12853682

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The diagnostic dilemmas in discrimination between pancreatic carcinoma and chronic pancreatitis. Author(s): Ruszniewski P, Malka D, Hammel P, Maire F, Rufat P, Madeira I, Pessione F, Levy P. Source: Gut. 2004 May; 53(5): 771. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15082603

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The diagnostic dilemmas in discrimination between pancreatic carcinoma and chronic pancreatitis. Author(s): Harlozinska-Szmyrka A, Strutynska-Karpinska M. Source: Gut. 2004 March; 53(3): 469-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14960539

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The Lundh test and faecal elastase 1 determination in chronic pancreatitis: a comparative study. Author(s): Gredal C, Madsen LG, Larsen S. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2003; 3(5): 389-94. Epub 2003 September 24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14526148

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The problem of diagnosing chronic pancreatitis. Author(s): Lankisch PG. Source: Dig Liver Dis. 2003 March; 35(3): 131-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12779064

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The race from chronic pancreatitis to pancreatic cancer. Author(s): Cavestro GM, Comparato G, Nouvenne A, Sianesi M, Di Mario F. Source: Jop [electronic Resource] : Journal of the Pancreas. 2003 September; 4(5): 165-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14526127

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The value of a pancreatogram in chronic pancreatitis diagnosed by endoscopic retrograde cholangiopancreatography. Author(s): Hernandez Garces HR, Lazo del Vallin S, Moutary I. Source: Jop [electronic Resource] : Journal of the Pancreas. 2004 January; 5(1): 25-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14730119

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Total pancreatectomy and autologous islet cell transplantation as a means to treat severe chronic pancreatitis. Author(s): Rodriguez Rilo HL, Ahmad SA, D'Alessio D, Iwanaga Y, Kim J, Choe KA, Moulton JS, Martin J, Pennington LJ, Soldano DA, Biliter J, Martin SP, Ulrich CD, Somogyi L, Welge J, Matthews JB, Lowy AM. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2003 December; 7(8): 978-89. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14675707

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Transplant options for patients undergoing total pancreatectomy for chronic pancreatitis. Author(s): Gruessner RW, Sutherland DE, Dunn DL, Najarian JS, Jie T, Hering BJ, Gruessner AC. Source: Journal of the American College of Surgeons. 2004 April; 198(4): 559-67; Discussion 568-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15051008

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Tropical chronic pancreatitis. Author(s): Barman KK, Premalatha G, Mohan V. Source: Postgraduate Medical Journal. 2003 November; 79(937): 606-15. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14654569

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UDP glucuronosyltransferase (UGT1A7) gene polymorphisms increase the risk of chronic pancreatitis and pancreatic cancer. Author(s): Ockenga J, Vogel A, Teich N, Keim V, Manns MP, Strassburg CP. Source: Gastroenterology. 2003 June; 124(7): 1802-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12806614

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Ulcerative colitis, primary biliary cirrhosis, and chronic pancreatitis: coincident or coexistent? Author(s): Veloso FT, Dias LM, Carvalho J, Fraga J, Saleiro J. Source: Journal of Clinical Gastroenterology. 1993 January; 16(1): 55-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8421148

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Ultrasonography in the preoperative diagnosis of chronic pancreatitis causing severe obstruction, and in indication for surgery. Author(s): Szebeni A, Kalasz G, Malyi I, Juhasz M. Source: Acta Chir Hung. 1990; 31(2): 105-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2082632

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Ultrasound guided thrombin injection to treat a pseudoaneurysm secondary to chronic pancreatitis. Author(s): Armstrong EM, Edwards A, Kingsnorth AN, Freeman S, Roobottom CA. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 October; 26(4): 448-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14512011

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Ultrastructural observations of intermediate cells in chronic pancreatitis. Author(s): Szynaka B, Zimnoch L, Puchalski Z. Source: Hepatogastroenterology. 2002 July-August; 49(46): 1120-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12143217

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Update on diagnosis and management of chronic pancreatitis. Author(s): Toskes PP. Source: Current Gastroenterology Reports. 1999 April; 1(2): 145-53. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10980942

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Up-regulation of cytochrome P450 1A2, 2C9, and 2E1 in chronic pancreatitis. Author(s): Wacke R, Kirchner A, Prall F, Nizze H, Schmidt W, Fischer U, Nitschke FP, Adam U, Fritz P, Belloc C, Drewelow B. Source: Pancreas. 1998 May; 16(4): 521-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9598815

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Up-regulation of p75 neurotrophin receptor (p75NTR) is associated with apoptosis in chronic pancreatitis. Author(s): Zhu Z, Friess H, Shi X, Wang L, di Mola FF, Wirtz M, Hartel M, Wagner M, Zimmermann A, Muller M, Buchler MW. Source: Digestive Diseases and Sciences. 2003 April; 48(4): 717-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12741461

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Urea synthesis in patients with chronic pancreatitis: relation to glucagon secretion and dietary protein intake. Author(s): Hamberg O, Andersen V, Sonne J, Larsen S, Vilstrup H. Source: Clinical Nutrition (Edinburgh, Lothian). 2001 December; 20(6): 493-501. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11883997

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Use of antioxidants to treat pain in chronic pancreatitis. Author(s): De las Heras Castano G, Garcia de la Paz A, Fernandez MD, Fernandez Forcelledo JL. Source: Rev Esp Enferm Dig. 2000 June; 92(6): 375-85. English, Spanish. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10985097

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Value of combinations of pancreatic function tests to predict mild or moderate chronic pancreatitis. Author(s): Gunkel U, Bitterlich N, Keim V. Source: Zeitschrift Fur Gastroenterologie. 2001 March; 39(3): 207-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11324137

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Value of MR pancreatography in the evaluation of patients with chronic pancreatitis. Author(s): Varghese JC, Masterson A, Lee MJ. Source: Clinical Radiology. 2002 May; 57(5): 393-401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12014938

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Value of splenic preservation during distal pancreatectomy for chronic pancreatitis. Author(s): Govil S, Imrie CW. Source: The British Journal of Surgery. 1999 July; 86(7): 895-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10417561

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Value of splenic preservation during distal pancreatectomy for chronic pancreatitis. Author(s): White SA, Sutton CD, Berry DP, Dennison AR. Source: The British Journal of Surgery. 2000 January; 87(1): 124. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10660352

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Variations in time of serum pancreatic enzyme levels in chronic pancreatitis and clinical course of the disease. Author(s): Benini L, Caliari S, Vaona B, Brocco G, Micciolo R, Rizzotti P, Fioretta A, Castellani G, Cavallini G, Scuro LA, et al. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1991 May; 8(4): 279-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1724259

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Variceal bleeding due to segmental portal hypertension caused by chronic pancreatitis. Author(s): Lin YL, Yang PM, Huang GT, Lee TH, Chau SH, Tsang YM, Wang SM. Source: The American Journal of Emergency Medicine. 1995 November; 13(6): 676-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7575812

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Vascular changes of pancreatic ducts and vessels in acute necrotizing, and in chronic pancreatitis in humans. Author(s): Pitkaranta P, Kivisaari L, Nordling S, Nuutinen P, Schroder T. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1991 January; 8(1): 13-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2033315

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Vertebral osteomyelitis mimicking chronic pancreatitis. Author(s): Kortas DY, Gates LK Jr. Source: Digestive Diseases and Sciences. 1996 July; 41(7): 1527-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8689935

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Vitamin B12 and folic acid deficiency in chronic pancreatitis: a relevant disorder? Author(s): Glasbrenner B, Malfertheiner P, Buchler M, Kuhn K, Ditschuneit H. Source: Klin Wochenschr. 1991 February 26; 69(4): 168-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2041378

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Vitamin D3 in patients with various grades of chronic pancreatitis, according to morphological and functional criteria of the pancreas. Author(s): Mann ST, Stracke H, Lange U, Klor HU, Teichmann J. Source: Digestive Diseases and Sciences. 2003 March; 48(3): 533-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12757166

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What should be the standard operation in chronic pancreatitis: Whipple or duodenum-preserving pancreatic head resection? Author(s): Berberat PO, Friess H, Martignoni ME, Tempia A, Buchler MW. Source: Ann Ital Chir. 2000 January-February; 71(1): 81-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10829528

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Whipple's procedure plus intraoperative pancreatic duct occlusion for severe chronic pancreatitis: clinical, exocrine, and endocrine consequences during a 3-year followup. Author(s): Schneider MU, Meister R, Domschke S, Zirngibl H, Strebl H, Heptner G, Gebhardt C, Gall FP, Domschke W. Source: Pancreas. 1987; 2(6): 715-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3438310

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Xenobiotic metabolism, oxidant stress and chronic pancreatitis. Focus on glutathione. Author(s): Wallig MA. Source: Digestion. 1998; 59 Suppl 4: 13-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9832632

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Zurich workshop on alcoholic chronic pancreatitis. Author(s): Ammann RW. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 1998 February; 23(1): 81-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9520095

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CHAPTER 2. NUTRITION AND CHRONIC PANCREATITIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and chronic pancreatitis.

Finding Nutrition Studies on Chronic Pancreatitis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “chronic pancreatitis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “chronic pancreatitis” (or a synonym): •

Cholecystokinin secretion in patients with chronic pancreatitis and after different types of pancreatic surgery. Author(s): Department of General Surgery, Leiden University Medical Center, The Netherlands. Source: Eddes, E H Masclee, A A Gielkens, H A Verkijk, M Vecht, J Biemond, I Lamers, C B Pancreas. 1999 August; 19(2): 119-25 0885-3177

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Citrate and calcium secretion in the pure human pancreatic juice of alcoholic and nonalcoholic men and of chronic pancreatitis patients. Source: Boustiere, C. Sarles, H. Lohse, J. Durbec, J.P. Sahel, J. Digestion. Basel : S. Karger. 1985. volume 32 (1) page 1-9. ill. 0012-2823

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Clinical and immunological indicators in patients with chronic pancreatitis and their dynamics in the process of diet therapy. Source: Kiseleva, O.A. Budagovskaia, VolumeN. Voitko, N.E. Vopr-Pitan. Moskva : “Meditsina”. Jan/February 1984. (1) page 21-26. 0042-8833

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Dietary analysis of Japanese patients with chronic pancreatitis in stable conditions. Author(s): Third Department of Internal Medicine, Hirosaki University School of Medicine, Aomori, Japan. Source: Nakamura, T Arai, Y Terada, A Kudoh, K Imamura, K Machida, K Kikuchi, H Takebe, K J-Gastroenterol. 1994 December; 29(6): 756-62 0944-1174

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Evaluation of common bile duct stenosis in chronic pancreatitis using cholescintigraphy. Author(s): Department of Radiology, Ehime University School of Medicine, Japan. Source: Itoh, H Shimono, R Hamamoto, K Eur-J-Nucl-Med. 1988; 14(3): 137-40 0340-6997

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Expression of transforming growth factor-beta in spontaneous chronic pancreatitis in the WBN/Kob rat. Author(s): Department of Internal Medicine and Medical Oncology, Cancer Research Institute, Kanazawa University, Japan. Source: Su, S B Motoo, Y Xie, M J Miyazono, K Sawabu, N Dig-Dis-Sci. 2000 January; 45(1): 151-9 0163-2116

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Expression of tumor necrosis factor-alpha, interleukin-6, and interferon-gamma in spontaneous chronic pancreatitis in the WBN/Kob rat. Author(s): Department of Internal Medicine and Medical Oncology, Cancer Research Institute, Kanazawa University, Japan. Source: Xie, M J Motoo, Y Su, S B Sawabu, N Pancreas. 2001 May; 22(4): 400-8 0885-3177

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Pancreatic polypeptide secretion in patients with chronic pancreatitis and after pancreatic surgery. Author(s): Department of General Surgery, Leiden University Medical Center, The Netherlands. Source: Eddes, E H Verkijk, M Gielkens, H A Biemond, I Bemelman, W Lamers, C B Masclee, A A Int-J-Pancreatol. 2001; 29(3): 173-80 0169-4197

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Xanthine oxidase-derived oxygen radicals play significant roles in the development of chronic pancreatitis in WBN/Kob rats. Author(s): Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan. Source: Zeki, S Miura, S Suzuki, H Watanabe, N Adachi, M Yokoyama, H Horie, Y Saito, H Kato, S Ishii, H J-Gastroenterol-Hepatol. 2002 May; 17(5): 606-16 0815-9319

Nutrition

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to chronic pancreatitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Food and Diet High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CHRONIC PANCREATITIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to chronic pancreatitis. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to chronic pancreatitis and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “chronic pancreatitis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to chronic pancreatitis: •

Acupuncture and transcutaneous electric nerve stimulation in the treatment of pain associated with chronic pancreatitis. A randomized study. Author(s): Ballegaard S, Christophersen SJ, Dawids SG, Hesse J, Olsen NV. Source: Scandinavian Journal of Gastroenterology. 1985 December; 20(10): 1249-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3912961

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Alexithymic features of the patients with chronic pancreatitis. Author(s): Nakai Y, Sugita M, Nakagawa T, Araki T, Ikemi Y. Source: Psychotherapy and Psychosomatics. 1979; 31(1-4): 205-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=482541

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Analysis of occluded pancreatic stents and juices in patients with chronic pancreatitis. Author(s): Smits ME, Groen AK, Mok KS, van Marle J, Tytgat GN, Huibregtse K. Source: Gastrointestinal Endoscopy. 1997 January; 45(1): 52-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9013170

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Antifibrotic effect of the herbal medicine Saiko-keishi-to (TJ-10) on chronic pancreatitis in the WBN/Kob rat. Author(s): Su SB, Motoo Y, Xie MJ, Taga H, Sawabu N. Source: Pancreas. 2001 January; 22(1): 8-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11138977

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Beneficial effect of a soy flour diet in chronic pancreatitis. Author(s): Pap A, Berger Z, Varro V. Source: The Mount Sinai Journal of Medicine, New York. 1983 May-June; 50(3): 208-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6312297

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Beneficial effects of a novel IH636 grape seed proanthocyanidin extract in the treatment of chronic pancreatitis. Author(s): Banerjee B, Bagchi D. Source: Digestion. 2001; 63(3): 203-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11351148

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Changes in plasma fatty acid profile in Japanese patients with chronic pancreatitis. Author(s): Nakamura T, Takebe K, Imamura K, Arai Y, Kudoh K, Terada A, Ishii M, Yamada N, Tandoh Y, Machida K, et al. Source: J Int Med Res. 1995 January-February; 23(1): 27-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7774756

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Complementary effect of cholecystokinin-octapeptide and soy flour treatment in chronic pancreatitis. Author(s): Pap A, Berger Z, Varro V. Source: The Mount Sinai Journal of Medicine, New York. 1984 June; 51(3): 254-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6087129

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Dietary analysis of Japanese patients with chronic pancreatitis in stable conditions. Author(s): Nakamura T, Arai Y, Terada A, Kudoh K, Imamura K, Machida K, Kikuchi H, Takebe K. Source: Journal of Gastroenterology. 1994 December; 29(6): 756-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7874272

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Dietary antioxidants and chronic pancreatitis. Author(s): Rose P, Fraine E, Hunt LP, Acheson DW, Braganza JM.

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Source: Hum Nutr Clin Nutr. 1986 March; 40(2): 151-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3957720 •

Effect of herbal medicine Saiko-keishi-to (TJ-10) on rat spontaneous chronic pancreatitis: comparison with other herbal medicines. Author(s): Motoo Y, Su SB, Xie MJ, Taga H, Sawabu N. Source: International Journal of Pancreatology : Official Journal of the International Association of Pancreatology. 2000 April; 27(2): 123-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10862511

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Electrical stimulation of the celiac plexus for pain relief in chronic pancreatitis. A clinical note. Author(s): Srikantha K, Choi JJ, Wu WH. Source: Acupuncture & Electro-Therapeutics Research. 1986; 11(2): 111-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2879414

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Expression of pancreatitis-associated protein (PAP) in rat spontaneous chronic pancreatitis: effect of herbal medicine Saiko-keishi-to (TJ-10). Author(s): Su SB, Motoo Y, Xie MJ, Sakai J, Taga H, Sawabu N. Source: Pancreas. 1999 October; 19(3): 239-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10505754

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Is there a place for pancreatic enzymes in the treatment of pain in chronic pancreatitis? Author(s): Mossner J. Source: Digestion. 1993; 54 Suppl 2: 35-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7693533

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No effect of long-term treatment with pancreatic extract on recurrent abdominal pain in patients with chronic pancreatitis. Author(s): Malesci A, Gaia E, Fioretta A, Bocchia P, Ciravegna G, Cantor P, Vantini I. Source: Scandinavian Journal of Gastroenterology. 1995 April; 30(4): 392-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7610357

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Nutrition supplementation in patients with acute and chronic pancreatitis. Author(s): Scolapio JS, Malhi-Chowla N, Ukleja A. Source: Gastroenterology Clinics of North America. 1999 September; 28(3): 695-707. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10503145

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Pancreatic steatorrhea, malabsorption, and nutrition biochemistry: a comparison of Japanese, European, and American patients with chronic pancreatitis. Author(s): Nakamura T, Takeuchi T.

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Source: Pancreas. 1997 May; 14(4): 323-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9163777 •

Zinc in mononuclear leucocytes in alcoholics with liver cirrhosis or chronic pancreatitis and in patients with Crohn's disease before and after zinc supplementation. Author(s): Bro S, Stokholm M, Jorgensen PJ. Source: J Trace Elem Electrolytes Health Dis. 1989 December; 3(4): 243-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2535348

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to chronic pancreatitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Malabsorption Source: Healthnotes, Inc.; www.healthnotes.com Pancreatic Insufficiency Source: Healthnotes, Inc.; www.healthnotes.com

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Pancreatitis Source: Integrative Medicine Communications; www.drkoop.com •

Herbs and Supplements Digestive Enzymes Source: Healthnotes, Inc.; www.healthnotes.com Medium-Chain Triglycerides Source: Prima Communications, Inc.www.personalhealthzone.com Methionine Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. BOOKS ON CHRONIC PANCREATITIS Overview This chapter provides bibliographic book references relating to chronic pancreatitis. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on chronic pancreatitis include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “chronic pancreatitis” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on chronic pancreatitis: •

ABC of Liver, Pancreas and Gall Bladder Source: London, UK: BMJ Publishing Group. 2001. 54 p. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-mail: [email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. ISBN: 0727915312. Summary: Diseases of the liver, pancreas, and biliary system affect a substantial proportion of the world's population and involve doctors and health care workers across many disciplines. Many of these disease produce great misery and distress and are economically important requiring much time off work. This atlas of the liver, pancreas and gallbladder provides an overview of these diseases and enable the busy clinician to keep abreast of advances in diagnosis and management of not only the common but also the rarer, but none the less important, conditions. The atlas includes

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fourteen chapters: investigation of liver and biliary disease, gallstone disease, acute hepatitis, chronic viral hepatitis, other causes of parenchymal liver disease, portal hypertension and ascites, portal hypertension and encephalopathy, liver tumors, liver abscesses and hydatid disease, acute pancreatitis, chronic pancreatitis, pancreatic tumors, liver and pancreatic trauma, and transplantation of the liver and pancreas. Each chapter covers the symptoms, diagnosis, etiology, natural course, and treatment of the disease under consideration. Each chapter is illustrated with full-color diagrams, charts, and clinical photographs. A subject index concludes the book. •

Hepatobiliary and Pancreatic Disease: The Team Approach to Management Source: Boston, MA: Little, Brown and Company. 1995. 493 p. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $99.95. ISBN: 0316709158. Summary: In this book, the editors identify 42 hepatobiliary and pancreatic problems that require a team approach to management. For each of the 42 chapters, a surgeon, gastroenterologist, or radiologist is the lead author, and physicians from different specialties are coauthors. The authors discuss etiology, pathogenesis, and diagnosis, but focus on patient management and results. The chapters cover hepatitis, hepatic failure, cirrhosis, portal hypertension, primary biliary cirrhosis, Budd-Chiari syndrome, noninflammatory cysts, hepatic abscesses, hydatid disease, hemobilia, hepatic trauma, benign hepatic tumors, hepatocellular carcinoma, hepatic metastases, biliary atresia, biliary cysts, gallbladder stones, choledocholithiasis, hepatolithiasis, acute cholecystitis, acute cholangitis, biliary parasites, sclerosing cholangitis, benign strictures, motility disorders, gallbladder cancer, cholangiocarcinoma, acute pancreatitis, gallstone pancreatitis, pseudocysts, pancreatic abscesses, pancreatic necrosis, pancreatic hemorrhage, pancreas divisum, chronic pancreatitis, pancreatic fistulas, pancreatic trauma, islet cell tumors, cystic neoplasms, ampullary carcinoma, and pancreatic cancer. Each chapter includes numerous black-and-white photographs, and a subject index concludes the volume.

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Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 8: Pancreas Source: Philadelphia, PA: Current Medicine. 1998. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 574-2270. E-mail: [email protected]. Website: current-medicine.com. PRICE: $125.00 plus shipping and handling. ISBN: 0443078629. Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 10 chapters on the pancreas. Topics covered include neurohormonal control of the pancreas, pathogenesis of pancreatic diseases, acute pancreatitis, chronic pancreatitis, surgery for chronic pancreatitis, developmental anomalies of the pancreas, pancreatic cancer, the rationale and application of radioligand imaging in gastroenterology, cystic fibrosis, and hereditary pancreatitis. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively. A subject index concludes the volume.

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Mayo Clinic Gastrointestinal Surgery Source: St. Louis, MO: Elsevier Science. 2004. 1020 p. Contact: Available from Elsevier Science. Customer Service Department, 11830 Westline Industrial Drive, St. Louis, MO 63146 (800) 545-2522. Fax (800) 535-9935. Email: [email protected]. Website: www.elsevierhealth.com. PRICE: $195.00. ISBN: 721692877. Summary: This book focuses on the major diseases treated by gastrointestinal surgeons, from the esophagus to the anal canal. The presentation has a definite clinical orientation and a major emphasis on practical applications as they are applied at the Mayo Clinic. Sections on etiology, pathophysiology, pathology, and diagnosis are also included by are purposely not the emphasis of the chapters. The book offers 49 chapters: the experience of being a Mayo Clinic surgeon; gastroesophageal reflux disease (GERD) and esophageal hiatal hernia; achalasia and other esophageal motility disorders; epiphrenic esophageal diverticula; cancer of the esophagus; gastric adenocarcinoma, primary gastric lymphoma; peptic ulcer; disorders of gastrointestinal motility and emptying after gastric operations; morbid obesity; hepatocellular carcinoma and intrahepatic cholangiocarcinoma; hepatic metastases from extrahepatic cancers; benign tumors and cysts of the liver; liver diseases necessitating liver transplantation; biliary stone disease; benign biliary strictures; cancer of the gallbladder; pancreatic and periampullary carcinoma; islet cell tumors; acute and chronic pancreatitis; pancreas transplantation after complications of diabetes mellitus; cystic tumors of the pancreas; thrombocytopenia and other hematologic disorders; malignant tumors of the small intestine; villous tumors of the duodenum; small intestinal diverticula; Crohn's disease; small bowel obstruction; acute mesenteric ischemia; acute mesenteric venous thrombosis; chronic mesenteric ischemia; visceral artery aneurysms; colonic motor disorders (constipation); diverticular disease of the colon; colon cancer; ischemic colitis; appendicitis; chronic ulcerative colitis; colonic volvulus; familial adenomatous polyposis; cancer of the rectum; common anorectal problems; rectal prolapse and solitary rectal ulcer syndrome; abdominal trauma; unclosable abdomen and the dehisced wound; ventral and incisional hernias; open repair of inguinal hernia; endoscopic inguinal hernia repair; and common pediatric gastrointestinal disorders. Each chapter is illustrated with line drawings, black and white photographs, and some color plates. References are provided with each chapter and a detailed subject index concludes the text.

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Gastrointestinal and Hepatobiliary Pathophysiology Source: Madison, CT: Fence Creek Publishing. 1998. 475 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Malden, MA 02148. (800) 215-1000 or (781) 388-8250. Fax (781) 388-8270. E-mail: [email protected]. Website: www.blackwellscience.com. PRICE: $27.95 plus shipping and handling. ISBN: 1889325015. Summary: This book on gastrointestinal and hepatobiliary pathophysiology is one from a series designed to meet the second and third year medical students' needs for a concise but comprehensive resource that focuses on organ system pathophysiology. The test covers the pathogenesis, diagnosis, treatment, and management of common diseases, using a format that includes one or more clinical cases integrated throughout the chapters to foster direct application of clinical problem solving skills; extensive use of margin notes that concisely highlight important concepts, define key terms, and pinpoint clinical correlations; questions at the end of each chapter, using the NBME

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format, that offer a means for accurate self assessment; and wide margins to accommodate note taking by students as they study. Thirty chapters cover an overview of gastrointestinal and hepatobiliary function; regulation of the digestive system; the anatomy, histology, and embryology of the gastrointestinal tract; an overview of gastrointestinal motility; gastrointestinal electrolyte and fluid secretion; digestion and absorption; management of water and electrolytes; liver anatomy and physiology; liver metabolism, physiology of bile formation, and gallstones; normal and disordered swallowing; peptic ulcer disease; small bowel disorders; acute and chronic pancreatitis; functional bowel disorders; the mucosal immune system; inflammatory bowel disease; infectious disorders of the gastrointestinal tract; viral hepatitis; hereditary liver disease; autoimmune liver disease; pathogenesis and consequences of portal hypertension; disorders of cholestasis, bilirubin metabolism, and jaundice; orthotopic liver transplantation; alcohol and the gastrointestinal tract; the pathophysiology of abdominal pain and pain syndromes; gastrointestinal disorders in pregnancy; the molecular biology of gastrointestinal malignancies and overview of neoplasms of the gastrointestinal tract; pharmacology; principles of nutritional support in the gastrointestinal patient; and gastrointestinal bleeding. A subject index concludes the textbook. •

Clinical Practice of Gastroenterology. Volume Two Source: Philadelphia, PA: Current Medicine. 1999. 861 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: This lengthy textbook brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This second volume includes 113 chapters in five sections: liver, gallbladder and biliary tract, pancreas, pediatric gastroenterology, and special topics. Specific topics include hepatic (liver) structure and function, jaundice, viral hepatitis, alcoholic liver injury, liver tumors, parasitic diseases of the liver, Wilson's disease, hemochromatosis, the pregnancy patient with liver disease, portal hypertension, hepatic encephalopathy, fulminant hepatic failure, liver transplantation, the anatomy of the gallbladder and biliary tract, gallstones, laparoscopic cholecystectomy (gallbladder removal), cholecystitis (gallbladder infection), primary sclerosing cholangitis, biliary obstruction, pancreatic anatomy and physiology, acute pancreatitis, pancreatic fistulas and ascites (fluid accumulation), chronic pancreatitis, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, esophageal atresia, gastroesophageal reflux in infants and children, achalasia and esophageal motility disorders, caustic and foreign body ingestion, vomiting, chronic abdominal pain, gastritis and peptic ulcer disease in children, malabsorption syndromes in children, inflammatory bowel disease in children and adolescents, acute appendicitis, cystic fibrosis, constipation and fecal soiling (incontinence), hepatitis in children, liver transplantation in children, failure to thrive, pediatric AIDS, the gastrointestinal manifestations of AIDS, the evaluation and management of acute upper gastrointestinal bleeding, principles of endoscopy, eating disorders, nutritional assessment, enteral and parenteral nutrition, gastrointestinal diseases in the elderly and in pregnancy, nosocomial infections, and the psychosocial aspects of gastroenterology (doctor patient interactions). The chapters include figures, algorithms, charts, graphs, radiographs, endoscopic pictures, intraoperative

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photographs, photomicrographs, tables, and extensive references. The volume concludes with a detailed subject index and a section of color plates. •

Office Management of Digestive Diseases Source: Malvern, PA: Lea and Febiger. 1992. 246 p. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 19355-9725. (215) 2512230. PRICE: $39.50. ISBN: 0812114361. Summary: This medical textbook presents information for primary care physicians dealing with the office management of common gastrointestinal diseases. Twenty-one chapters, each written by experts in the field, cover reflux esophagitis, dysphagia, peptic ulcer disease, chronic abdominal pain, diarrhea, diverticular disease, inflammatory bowel disease, colonic neoplasms, flexible sigmoidoscopy, chronic pancreatitis, irritable bowel syndrome, gallstones, hepatitis, cirrhosis, perianal diseases, premalignant gastrointestinal lesions, liver chemistry abnormalities, and flexible endoscopy. Each chapter includes numerous references and a subject index concludes the volume.

Chapters on Chronic Pancreatitis In order to find chapters that specifically relate to chronic pancreatitis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and chronic pancreatitis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “chronic pancreatitis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on chronic pancreatitis: •

Diagnosis and Management of Chronic Pancreatitis Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 95-101. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 19355-9725. (215) 2512230. PRICE: $39.50. ISBN: 0812114361. Summary: This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the diagnosis and management of chronic pancreatitis. The author notes that the clinical presentation of chronic pancreatitis varies according to the stage of the disease and the amount of destruction of the exocrine and endocrine components of the gland. Topics include the pathogenesis of pancreatitis, including alcohol-related pancreatitis, diagnostic considerations, the metabolic diseases associated with chronic pancreatitis, screening tests and indicators of chronic pancreatitis, and the management of three main complications of chronic pancreatitis: insulin-dependent diabetes, cyst formation, and steatorrhea. 1 figure. 1 table. 14 references.

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CHAPTER 5. MULTIMEDIA ON CHRONIC PANCREATITIS Overview In this chapter, we show you how to keep current on multimedia sources of information on chronic pancreatitis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on chronic pancreatitis is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “chronic pancreatitis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “chronic pancreatitis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on chronic pancreatitis: •

Postgraduate Gastroenterology Program Source: Mt. Laurel, NJ: CME Conference Video, Inc. 1992. (videocassettes and syllabus). Contact: Available from P.O. Box 5077, Cherry Hill, NJ 08034-5077. (800) 284-8433. Fax (800) 284-5964. PRICE: $675. Group practice packages available. Summary: This continuing education video series is designed to enhance understanding of pathophysiology and patient management of gastrointestinal (GI) organ systems and GI disorders and to improve viewers' diagnostic and treatment abilities. Six sections cover gastroduodenal disorders; clinical applications of research; liver diseases; pancreatic and biliary tract diseases; inflammatory bowel syndrome (IBS); and esophageal disorders. Specific topics include helicobacter pylori and peptic ulcer disease; gastric emptying; gastroparesis; hormones and neuropeptides; interferon therapy of chronic liver disease; liver transplantation; hepatic encephalopathy; sclerosing cholangitis; chronic pancreatitis; endoscopic retrograde

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cholangiopancreatography (ECRP); colorectal polyps; surgical therapy for IBS; IBS and constipation; swallowing physiology; and Barrett's esophagus. The video includes interactive sessions between experts in the field of gastroenterology. (AA-M). •

Advanced Therapeutic Endoscopy XII Source: Mt. Laurel, NJ: CME Conference Video, Inc. 1993. (videocassettes and syllabus). Contact: Available from P.O. Box 5077, Cherry Hill, NJ 08034-5077. (800) 284-8433. Fax (800) 284-5964. PRICE: $625.00. Summary: This continuing education videotape is designed to help gastroenterologists sharpen their therapeutic endoscopy skills. Six main sections discuss the biliary tree, basic and advanced techniques; current topics in therapeutic endoscopy; the pancreas; the upper gastrointestinal (GI) tract; and the colon. Specific topics include manometry; the use of stents; management of the difficult bile duct stone; sphincterotomy; endoscopic ultrasonography; endoscopic retrograde cholangiopancreatography (ECRP); cholecystectomy; chronic pancreatitis; variceal bleeding; upper GI tumor; enteroscopy; difficult colonoscopy; polypectomy; and the bleeding angiodysplasia. The tape includes break-out sections featuring authorities in endoscopy.

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CHAPTER 6. PERIODICALS AND NEWS ON CHRONIC PANCREATITIS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover chronic pancreatitis.

News Services and Press Releases One of the simplest ways of tracking press releases on chronic pancreatitis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “chronic pancreatitis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to chronic pancreatitis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “chronic pancreatitis” (or synonyms). The following was recently listed in this archive for chronic pancreatitis: •

Idiopathic chronic pancreatitis linked to CFTR gene mutations Source: Reuters Medical News Date: September 03, 1998

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “chronic pancreatitis” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “chronic pancreatitis” (or synonyms). If you know the name of a company that is relevant to chronic pancreatitis, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “chronic pancreatitis” (or synonyms).

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “chronic pancreatitis” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on chronic pancreatitis: •

Sjogren's Syndrome and the Gastrointestinal Tract Source: Moisture Seekers Newsletter. 17(2): 1, 4-5. March 1999. Contact: Available from Sjogren's Syndrome Foundation, Inc. 8120 Woodmont Avenue, Suite 530, Bethesda, MD 20814-1437. (301) 718-0300 or (800) 475-6473. Fax (301) 718-0322. Website: www.sjogrens.org. Summary: This article on Sjogren's syndrome (SS) and the gastrointestinal tract is from a patient education newsletter for people with SS. The author outlines the areas where the gastroenterologist may play a role in caring for the person with SS, such as dealing with swallowing difficulties, dyspepsia (indigestion), diarrhea, and jaundice (usually due to primary biliary cirrhosis, or scarring). Difficulty in swallowing is usually due to the lack of saliva associated with SS, but occasionally it may be due to a blockage (postcricoid web) or a weakness of the muscle contractions involved in swallowing. In addition, those patients with SS are vulnerable to acid reflux, which causes heartburn symptoms. Children with SS are prone to achalasia, a type of muscle problem involving the lower esophageal sphincter. Dyspepsia (indigestion) is relatively common in patients with SS, as is inflammation of the stomach (gastritis). The author briefly discusses the role of the bacterium Helicobacter pylori in gastritis. There are at least two diseases associated with SS and diarrhea: chronic pancreatitis and celiac disease (gluten intolerance). The author notes that the link between SS and gastroenterological conditions is often via abnormal autoantibodies.

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Following Endoscopic Therapy. Pancreatitis Patients Report Pain Relief Source: Gastroenterology and Endoscopy News. 51(10): 1, 41. 2000. Contact: Available from McMahon Publishing Group. 545 West 45th Street, 8th Floor, New York, NY 10036. (212) 957-5300. Website: www.mcmahonmed.com. Summary: This news article reports on a retrospective study that has demonstrated that endoscopic therapy can have significant long term benefits on patients with chronic pancreatitis (inflammation of the pancreas), and that the technique offers similar success rates to those of surgery, while being minimally invasive for the patient. The study revealed that more than 60 percent of patients with chronic pancreatitis or unexplained abdominal pain resulting from pancreatic sphincter dysfunction reported a greater than 50 percent decrease in their pain 16 months after endoscopic therapy. Complications of endoscopic pancreatic sphincterotomy (EPS) included pancreatitis (9 percent of patients), bleeding (4 percent of patients), and early stent occlusion (blockage) in 9 percent of patients. There were no deaths related to the procedure and no patient developed severe acute pancreatitis. The study results need to be evaluated further in a prospective fashion. The article includes the comments of one expert who cautions that

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the role of endoscopic therapy in pancreatic disease has always been controversial, especially because pancreatitis is a 'dreaded complication' of endoscopic therapy to the pancreas. •

Pancreatitis: Painful Attacks Should Not Be Ignored Source: Mayo Clinic Health Letter. 17(10): 4-5. October 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This newsletter article from the Mayo Clinic reviews the problem of pancreatitis attacks, stressing that acute pancreatitis warrants immediate medical care to avoid complications that can be fatal. Acute pancreatitis attacks consist of a sudden pain in the upper abdomen that seems to go straight through to the back and that does not ease up. The author briefly reviews the physiology and functions of the pancreas, including production of the hormones insulin and glucagon, which help regulate metabolism; and production of pancreatic juices and enzymes that are delivered to the upper part of the small intestine (duodenum) to help digest fats, proteins, and carbohydrates. Inflammation of the pancreas disrupts these functions. Acute pancreatitis comes on suddenly when digestive juices from the pancreas escape the ducts leading to the small intestine and instead enter pancreas tissue itself, causing potentially severe damage. Acute pancreatitis is usually caused by either gallstones leaving the gallbladder and obstructing the pancreatic duct, or by excessive alcohol use. Most attacks of pancreatitis range from mild to moderate and may last only a couple of days. Treatment often involves a hospital stay and no food or drink by mouth (in order to rest the pancreas). By comparison, chronic pancreatitis (progressive inflammation and damage to the pancreas) is sometimes difficult to detect early. Most of the time it is caused by excessive alcohol use over many years. Treatment for chronic pancreatitis focuses on pain management and preventing attacks by avoiding alcohol, following a careful diet, and working closely with a health care provider. 1 figure.

Academic Periodicals covering Chronic Pancreatitis Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to chronic pancreatitis. In addition to these sources, you can search for articles covering chronic pancreatitis that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 7. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for chronic pancreatitis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with chronic pancreatitis. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to chronic pancreatitis: Insulin •

Systemic - U.S. Brands: Humulin 50/50; Humulin 70/30; Humulin 70/30 Pen; Humulin L; Humulin N; Humulin N Pen; Humulin R; Humulin R, Regular U500 (Concentrated); Humulin U; Lente; Lente Iletin II; Novolin 70/30; Novolin 70/30 PenFill; Novolin 70/30 Prefilled; Novolin L; Novolin N; Novolin N PenFill; Novolin N Prefilled; Novolin R; Novolin R PenFill; Novolin R Prefilled; NPH Iletin II; NPH Purified Insulin; Regular (Concentrated) Iletin II, U-500; Regular Iletin II; Regular Insulin; Velosulin BR http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203298.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

8

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:10 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

9 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 10 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway11 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “chronic pancreatitis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 11703 73 961 28 286 13051

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.15 Simply search by “chronic pancreatitis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

11

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

12

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 13 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 14 15

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists16 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.17 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.18 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

16 Adapted 17

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 18 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on chronic pancreatitis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to chronic pancreatitis. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to chronic pancreatitis. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “chronic pancreatitis”:

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Cancer http://www.nlm.nih.gov/medlineplus/cancer.html Crohn's Disease http://www.nlm.nih.gov/medlineplus/crohnsdisease.html Cystic Fibrosis http://www.nlm.nih.gov/medlineplus/cysticfibrosis.html Laboratory Tests http://www.nlm.nih.gov/medlineplus/laboratorytests.html Liver Diseases http://www.nlm.nih.gov/medlineplus/liverdiseases.html Lymphoma http://www.nlm.nih.gov/medlineplus/lymphoma.html Pancreatic Cancer http://www.nlm.nih.gov/medlineplus/pancreaticcancer.html Pancreatic Diseases http://www.nlm.nih.gov/medlineplus/pancreaticdiseases.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on chronic pancreatitis. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Chronic Pancreatitis and Hereditary Pancreatitis Source: Wexford, PA: National Pancreas Foundation. 200x. [4 p.]. Contact: Available from National Pancreas Foundation. P.O. Box 935, Wexford, PA 15090-0935. (866) 726-2737. Website: www.pancreasfoundation.org. PRICE: Single copy free. Summary: This brochure provides basic information about common disorders of the pancreas, notably chronic pancreatitis and hereditary pancreatitis. Chronic pancreatitis is a progressive disorder associated with destruction of the pancreas. The most common cause of chronic pancreatitis in the United States is chronic alcohol use. Chronic pancreatitis is characterized by repeated attacks of pain, or constant severe abdominal pain. As the disease progresses, malnutrition and significant weight loss are common. In

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some cases, pancreatitis is related to inherited abnormalities of the pancreas or intestine (hereditary pancreatitis). The treatment for chronic pancreatitis is based on pain management and nutritional support, including the use of oral pancreatic enzyme supplements. A low fat, low protein diet is essential in the treatment plan. Alcohol needs to be totally eliminated in all patients. The brochure concludes with the contact information for the National Pancreas Foundation (www.pancreasfoundation.org) and a tear-off coupon with which readers can join the Foundation. 1 figure. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to chronic pancreatitis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to chronic pancreatitis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with chronic pancreatitis. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about chronic pancreatitis. For more

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information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “chronic pancreatitis” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “chronic pancreatitis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “chronic pancreatitis” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “chronic pancreatitis” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.19

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

19

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)20: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

20

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on chronic pancreatitis: •

Basic Guidelines for Chronic Pancreatitis Alcoholism Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm Chronic pancreatitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000221.htm Pancreatic cancer Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000236.htm

•

Signs & Symptoms for Chronic Pancreatitis Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Indigestion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003260.htm

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Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm •

Diagnostics and Tests for Chronic Pancreatitis Abdominal CT scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003789.htm Abdominal ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003777.htm Blood-sugar levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm ERCP Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003893.htm Fecal fat test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003588.htm Glucagon Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003716.htm Serum amylase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003464.htm Serum lipase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003465.htm Serum trypsinogen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003560.htm Trypsinogen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003560.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm

•

Nutrition for Chronic Pancreatitis Calcium in diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002412.htm

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Fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Low-fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Vitamins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002399.htm •

Surgery and Procedures for Chronic Pancreatitis Exploratory laparotomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002928.htm

•

Background Topics for Chronic Pancreatitis Alcohol abuse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Bile Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002237.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Substance abuse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001945.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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CHRONIC PANCREATITIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abscess: A localized, circumscribed collection of pus. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetaldehyde: A colorless, flammable liquid used in the manufacture of acetic acid, perfumes, and flavors. It is also an intermediate in the metabolism of alcohol. It has a general narcotic action and also causes irritation of mucous membranes. Large doses may cause death from respiratory paralysis. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acrodermatitis: Inflammation involving the skin of the extremities, especially the hands and feet. Several forms are known, some idiopathic and some hereditary. The infantile form is called Gianotti-Crosti syndrome. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acupuncture Analgesia: Analgesia produced by the insertion of acupuncture needles at certain points in the body. These activate the small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary hypothalamus - to produce analgesia. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aetiology: Study of the causes of disease. [EU] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean

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intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Affinity Chromatography: In affinity chromatography, a ligand attached to a column binds specifically to the molecule to be purified. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alcohol Dehydrogenase: An enzyme that catalyzes reversibly the final step of alcoholic fermentation by reducing an aldehyde to an alcohol. In the case of ethanol, acetaldehyde is reduced to ethanol in the presence of NADH and hydrogen. The enzyme is a zinc protein which acts on primary and secondary alcohols or hemiacetals. EC 1.1.1.1. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha-helix: One of the secondary element of protein. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form

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proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amylase: An enzyme that helps the body digest starches. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiodysplasia: Degenerative, acquired lesions consisting of distorted, dilated, thin-walled vessels lined by vascular endothelium. This pathological state is seen especially in the gastrointestinal tract and is frequently a cause of upper and lower gastrointestinal hemorrhage in the elderly. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of

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which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiserum: The blood serum obtained from an animal after it has been immunized with a particular antigen. It will contain antibodies which are specific for that antigen as well as antibodies specific for any other antigen with which the animal has previously been immunized. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH]

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Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune Hepatitis: A liver disease caused when the body's immune system destroys liver cells for no known reason. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autolysis: The spontaneous disintegration of tissues or cells by the action of their own autogenous enzymes. [NIH] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Avidity: The strength of the interaction of an antiserum with a multivalent antigen. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in

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the treatment of gallstones. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Atresia: Atresia of the biliary tract, most commonly of the extrahepatic bile ducts. [NIH]

Biliary Stricture: A narrowing of the biliary tract from scar tissue. The scar tissue may result from injury, disease, pancreatitis, infection, or gallstones. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biophysics: The science of physical phenomena and processes in living organisms. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH]

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Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [NIH] Celiac Plexus: A complex network of nerve fibers including sympathetic and parasympathetic efferents and visceral afferents. The celiac plexus is the largest of the autonomic plexuses and is located in the abdomen surrounding the celiac and superior mesenteric arteries. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH]

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Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell Lineage: The developmental history of cells as traced from the first division of the original cell or cells in the embryo. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Cell Transplantation: Transference of cells within an individual, between individuals of the same species, or between individuals of different species. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [NIH] Choledocholithiasis: Gallstones in the bile ducts. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH]

Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chymotrypsin: A serine endopeptidase secreted by the pancreas as its zymogen, chymotrypsinogen and carried in the pancreatic juice to the duodenum where it is activated by trypsin. It selectively cleaves aromatic amino acids on the carboxyl side. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH]

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Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colonic Neoplasms: Tumors or cancer of the colon. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in

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addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to

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stress. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cystic Duct: The tube that carries bile from the gallbladder into the common bile duct and the small intestine. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH]

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Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity

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of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dyspnea: Difficult or labored breathing. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU]

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Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enteropeptidase: A specialized proteolytic enzyme secreted by intestinal cells. It converts trypsinogen into its active form trypsin by removing the N-terminal peptide. EC 3.4.21.9. [NIH]

Enteroscopy: An examination of the small intestine with an endoscope. The endoscope is inserted through the mouth and stomach into the small intestine. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit.

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[NIH]

Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Atresia: Congenital failure of the full esophageal lumen to develop that commonly occurs with tracheoesophageal fistula. Symptoms include excessive salivation, gagging, cyanosis, and dyspnea. [NIH] Esophageal Motility Disorders: Disorders affecting the motor function of the upper or lower esophageal sphincters, the esophageal body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in the impeding of the passage of food, regurgitation of food, or reflux of gastric acid into the esophagus. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH]

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Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibronectins: Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called

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folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Fulminant Hepatic Failure: Liver failure that occurs suddenly in a previously healthy person. The most common causes of FHF are acute hepatitis, acetaminophen overdose, and liver damage from prescription drugs. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH]

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Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH]

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Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]

Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Helicobacter pylori: A spiral bacterium active as a human gastric pathogen. It is a gramnegative, urease-positive, curved or slightly spiral organism initially isolated in 1982 from patients with lesions of gastritis or peptic ulcers in Western Australia. Helicobacter pylori was originally classified in the genus Campylobacter, but RNA sequencing, cellular fatty acid profiles, growth patterns, and other taxonomic characteristics indicate that the microorganism should be included in the genus Helicobacter. It has been officially transferred to Helicobacter gen. nov. (see Int J Syst Bacteriol 1989 Oct;39(4):297-405). [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemobilia: Hemorrhage in or through the biliary tract, due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasms. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to

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hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct. [NIH] Hepatic Encephalopathy: A condition that may cause loss of consciousness and coma. It is usually the result of advanced liver disease. Also called hepatic coma. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis, Chronic: A collective term for a clinical and pathological syndrome which has several causes and is characterized by varying degrees of hepatocellular necrosis and inflammation. Specific forms of chronic hepatitis include autoimmune hepatitis, chronic hepatitis B, chronic hepatitis C, chronic hepatitis D, indeterminate chronic viral hepatitis, cryptogenic chronic hepatitis, and drug-related chronic hepatitis. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocyte: A liver cell. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histology: The study of tissues and cells under a microscope. [NIH]

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Homeobox: Distinctive sequence of DNA bases. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Idiopathic: Describes a disease of unknown cause. [NIH] Immortal: Stage when the mother cell and its descendants will multiply indefinitely. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH]

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Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisional: The removal of a sample of tissue for examination under a microscope. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] Infiltrating cancer: Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called invasive cancer. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Information Systems: Integrated set of files, procedures, and equipment for the storage, manipulation, and retrieval of information. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the

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groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inoperable: Not suitable to be operated upon. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intrahepatic: Within the liver. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques.

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[EU]

Invasive cancer: Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic Colitis: Decreased blood flow to the colon. Causes fever, pain, and bloody diarrhea. [NIH] Isoenzymes: One of various structurally related forms of an enzyme, each having the same mechanism but with differing chemical, physical, or immunological characteristics. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large

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intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipodystrophy: A collection of rare conditions resulting from defective fat metabolism and characterized by atrophy of the subcutaneous fat. They include total, congenital or acquired, partial, abdominal infantile, and localized lipodystrophy. [NIH] Lithiasis: A condition characterized by the formation of calculi and concretions in the hollow organs or ducts of the body. They occur most often in the gallbladder, kidney, and lower urinary tract. [NIH] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

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Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammogram: An x-ray of the breast. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen

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with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metaplasia: A condition in which there is a change of one adult cell type to another similar adult cell type. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH]

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Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multidrug resistance: Adaptation of tumor cells to anticancer drugs in ways that make the drugs less effective. [NIH] Multiple Organ Failure: A progressive condition usually characterized by combined failure of several organs such as the lungs, liver, kidney, along with some clotting mechanisms, usually postinjury or postoperative. [NIH] Multivalent: Pertaining to a group of 5 or more homologous or partly homologous chromosomes during the zygotene stage of prophase to first metaphasis in meiosis. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH]

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Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: A type of white blood cell. [NIH] Neutrophil Infiltration: The diffusion or accumulation of neutrophils in tissues or cells in response to a wide variety of substances released at the sites of inflammatory reactions. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Node-negative: Cancer that has not spread to the lymph nodes. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH]

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Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Office Management: Planning, organizing, and administering activities in an office. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase (H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar

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gland that secretes digestive enzymes. [NIH] Pancreas Transplant: A surgical procedure that involves replacing the pancreas of a person who has diabetes with a healthy pancreas that can make insulin. The healthy pancreas comes from a donor who has just died or from a living relative. A person can donate half a pancreas and still live normally. [NIH] Pancreas Transplantation: The transference of a pancreas from one human or animal to another. [NIH] Pancreatectomy: Surgery to remove the pancreas. In a total pancreatectomy, a portion of the stomach, the duodenum, common bile duct, gallbladder, spleen, and nearby lymph nodes also are removed. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the duodenum. [NIH] Pancreatic Elastase: A protease of broad specificity, obtained from dried pancreas. Molecular weight is approximately 25,000. The enzyme breaks down elastin, the specific protein of elastic fibers, and digests other proteins such as fibrin, hemoglobin, and albumin. EC 3.4.21.36. [NIH] Pancreatic enzymes: A group of proteins secreted by the pancreas which aid in the digestion of food. [NIH] Pancreatic Fistula: Abnormal passage communicating with the pancreas. [NIH] Pancreatic Function Tests: Tests based on the biochemistry and physiology of the exocrine pancreas and involving analysis of blood, duodenal contents, feces, or urine for products of pancreatic secretion. [NIH] Pancreatic Insufficiency: Absence of or reduced pancreatic exocrine secretion into the duodenum and resultant poor digestion of lipids, vitamins, nitrogen, and carbohydrates. [NIH]

Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatic Pseudocyst: Cyst-like space not lined by epithelium and contained within the pancreas. [NIH] Pancreaticoduodenectomy: The excision of the head of the pancreas and the encircling loop of the duodenum to which it is connected. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parasitic Diseases: Infections or infestations with parasitic organisms. They are often contracted through contact with an intermediate vector, but may occur as the result of direct exposure. [NIH] Parenchyma: The essential elements of an organ; used in anatomical nomenclature as a general term to designate the functional elements of an organ, as distinguished from its framework, or stroma. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other

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route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perianal: Located around the anus. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perineural: Around a nerve or group of nerves. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the

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peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Pleura: The thin serous membrane enveloping the lungs and lining the thoracic cavity. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Pleural Effusion: Presence of fluid in the pleural cavity resulting from excessive transudation or exudation from the pleural surfaces. It is a sign of disease and not a

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diagnosis in itself. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Portal Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Biliary Cirrhosis: A chronic liver disease. Slowly destroys the bile ducts in the liver. This prevents release of bile. Long-term irritation of the liver may cause scarring and cirrhosis in later stages of the disease. [NIH] Primary Sclerosing Cholangitis: Irritation, scarring, and narrowing of the bile ducts inside and outside the liver. Bile builds up in the liver and may damage its cells. Many people with this condition also have ulcerative colitis. [NIH] Problem Solving: A learning situation involving more than one alternative from which a

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selection is made in order to attain a specific goal. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Proton Pump Inhibitors: Medicines that stop the stomach's acid pump. Examples are omeprazole (oh-MEH-prah-zol) (Prilosec) and lansoprazole (lan-SOH-prah-zol) (Prevacid). [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH]

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Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudocysts: A collection of enzyme-rich pancreatic fluid and tissue debris arising within areas of necrosis or an obstructed smaller duct. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Pylorus: The opening in a vertebrate from the stomach into the intestine. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy.

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[NIH]

Radiolucent: Partly or wholly permeable to X-rays or other forms of radiation contrasted with radiopaque. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Prolapse: Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Resected: Surgical removal of part of an organ. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH]

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Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retroperitoneal Fibrosis: A slowly progressive condition of unknown etiology, characterized by deposition of fibrous tissue in the retroperitoneal space compressing the ureters, great vessels, bile duct, and other structures. When associated with abdominal aortic aneurysm, it may be called chronic periaortitis or inflammatory perianeurysmal fibrosis. [NIH]

Retroperitoneal Space: An area occupying the most posterior aspect of the abdominal cavity. It is bounded laterally by the borders of the quadratus lumborum muscles and extends from the diaphragm to the brim of the true pelvis, where it continues as the pelvic extraperitoneal space. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Scleroproteins: Simple proteins characterized by their insolubility and fibrous structure. Within the body, they perform a supportive or protective function. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Secretin: A hormone made in the duodenum. Causes the stomach to make pepsin, the liver to make bile, and the pancreas to make a digestive juice. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU]

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Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solitary Rectal Ulcer: A rare type of ulcer in the rectum. May develop because of straining

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to have a bowel movement. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenic Artery: The largest branch of the celiac trunk with distribution to the spleen, pancreas, stomach and greater omentum. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steatorrhea: A condition in which the body cannot absorb fat. Causes a buildup of fat in the stool and loose, greasy, and foul bowel movements. [NIH] Steatorrhoea: Excessive amounts of fats in the feces, as in malabsorption syndromes. [EU] Stellate: Star shaped. [NIH]

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Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subcapsular: Situated below a capsule. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium

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chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH]

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Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Total pancreatectomy: Surgery to remove the entire pancreas. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Tracheoesophageal Fistula: Abnormal communication between the esophagus and the trachea, acquired or congenital, often associated with esophageal atresia. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transcutaneous: Transdermal. [EU] Transcutaneous Electric Nerve Stimulation: Electrical stimulation of nerves and/or muscles to relieve pain; it is used less frequently to produce anesthesia. The optimal placements of electrodes or "trigger points" may correspond with acupuncture analgesia points. TENS is sometimes referred to as acupuncture-like when using a low frequency stimulus. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development,

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cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGFbeta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the

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deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Varix: An enlarged, dilated, and tortuous venous channel. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Venter: Belly. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Villous: Of a surface, covered with villi. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Viral vector: A type of virus used in cancer therapy. The virus is changed in the laboratory and cannot cause disease. Viral vectors produce tumor antigens (proteins found on a tumor cell) and can stimulate an antitumor immune response in the body. Viral vectors may also be used to carry genes that can change cancer cells back to normal cells. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the

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tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] Whipple: An intestinal lipodystrophy; occurs in men and usually is associated with arthritis, diarrhea, and fat malabsorption. [NIH] Whipple procedure: A type of surgery used to treat pancreatic cancer. The head of the pancreas, the duodenum, a portion of the stomach, and other nearby tissues are removed. [NIH]

White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX A Abdominal Pain, 4, 5, 9, 18, 25, 26, 40, 75, 82, 83, 89, 102, 115, 138, 140, 147, 158 Aberrant, 11, 115 Abscess, 24, 115 Acceptor, 115, 139, 144, 157 Acetaldehyde, 115, 116 Acetaminophen, 115, 131 Acrodermatitis, 23, 115 Actin, 115, 142 Acupuncture Analgesia, 115, 157 Adenocarcinoma, 14, 29, 37, 52, 53, 56, 59, 60, 81, 115, 134 Adverse Effect, 115, 153 Aetiology, 54, 115 Afferent, 20, 115 Affinity, 15, 17, 115, 116, 153 Affinity Chromatography, 17, 116 Agonist, 26, 116 Albumin, 5, 116, 145, 147 Alcohol Dehydrogenase, 12, 116 Algorithms, 82, 116, 120 Alimentary, 20, 25, 52, 57, 58, 63, 116, 145, 146 Alkaline, 116, 117, 121 Alkaloid, 116, 121 Allylamine, 116 Alpha-helix, 116, 138 Alternative medicine, 88, 116 Amine, 19, 116, 134 Amino Acid Sequence, 116, 117 Amino Acids, 116, 117, 122, 123, 146, 148, 149, 153, 155, 158, 159 Ammonia, 116, 117, 156, 158, 159 Amplification, 11, 117 Ampulla, 117, 122, 128 Amylase, 18, 112, 117 Anal, 81, 117, 151 Analgesics, 4, 113, 117 Analog, 117, 144 Anaplasia, 117, 143 Anastomosis, 4, 117 Anatomical, 117, 127, 136, 145, 152 Anemia, 117, 131 Anesthesia, 117, 157 Aneurysm, 43, 117, 118 Angiodysplasia, 86, 117

Angiotensin converting enzyme inhibitor, 14, 117 Angiotensinogen, 16, 117, 151 Animal model, 15, 46, 117 Anionic, 17, 117 Anions, 116, 117, 138, 153, 155 Anomalies, 80, 117 Anorectal, 81, 117 Antibacterial, 117, 154 Antibiotic, 21, 117, 143, 154 Antibodies, 15, 52, 117, 118, 119, 133, 135, 147, 150 Antibody, 15, 115, 118, 123, 128, 133, 135, 136, 141, 150, 151, 154 Anticoagulant, 118, 149 Antigen, 115, 118, 119, 123, 135, 136, 140 Anti-inflammatory, 14, 115, 118 Antioxidant, 19, 37, 118, 144 Antiserum, 118, 119 Anus, 117, 118, 121, 123, 146, 151 Aortic Aneurysm, 118, 152 Apoptosis, 12, 19, 64, 118 Appendicitis, 81, 82, 118 Arginine, 118, 158 Arterial, 38, 116, 118, 135, 149, 156 Arteries, 118, 120, 121 Artery, 81, 117, 118, 127, 150 Ascites, 6, 80, 82, 118 Aspiration, 31, 118 Assay, 11, 15, 38, 39, 45, 118 Asymptomatic, 22, 27, 118 Attenuated, 118, 126 Autoantibodies, 89, 119 Autoantigens, 119 Autodigestion, 19, 119 Autoimmune Hepatitis, 119, 134 Autologous, 63, 119 Autolysis, 17, 119 Autonomic Nervous System, 17, 119, 153, 156 Avidity, 52, 119 B Bacteria, 13, 117, 118, 119, 127, 128, 129, 130, 131, 133, 138, 141, 153, 154, 159 Bactericidal, 119, 129 Bacterium, 89, 119, 133 Base, 119, 138, 158 Basement Membrane, 119, 129, 138

162

Chronic Pancreatitis

Benign, 21, 22, 80, 81, 119, 143, 151 Benign tumor, 81, 119 Bilateral, 27, 51, 57, 119 Bile, 3, 7, 27, 82, 86, 113, 119, 120, 122, 125, 128, 131, 134, 138, 139, 148, 152 Bile Acids, 119, 131 Bile Acids and Salts, 119 Bile duct, 3, 7, 86, 120, 122, 128, 134, 148, 152 Bile Pigments, 120, 138 Biliary Atresia, 80, 120 Biliary Stricture, 60, 81, 120 Biliary Tract, 4, 51, 82, 85, 120, 121, 133 Bilirubin, 82, 116, 120, 135 Biochemical, 12, 15, 16, 27, 120, 130 Biological response modifier, 120, 137 Biomarkers, 10, 120 Biophysics, 20, 120 Biopsy, 3, 9, 11, 120, 146 Biopsy specimen, 3, 120 Biosynthesis, 120, 153 Biotechnology, 18, 22, 23, 88, 97, 120 Bladder, 79, 120, 136, 139, 149, 159 Bloating, 120, 132, 136, 138, 140 Blood Coagulation, 120, 121, 130, 156 Blood Glucose, 120, 134, 135, 137 Blood Platelets, 120, 156 Blood pressure, 120, 135, 142, 148, 153 Blood vessel, 117, 120, 128, 138, 140, 141, 146, 153, 155, 156, 159 Body Composition, 28, 121 Body Fluids, 120, 121, 127, 130, 144, 153, 158 Bone Marrow, 121, 132, 140, 142 Bowel, 81, 82, 85, 117, 121, 126, 136, 137, 144, 146, 151, 153, 154, 155, 158 Bowel Movement, 121, 126, 154, 155 Bronchial, 121, 134 C Calcification, 4, 7, 121 Calcium, 18, 23, 24, 70, 112, 121, 123, 140, 141, 149 Calculi, 121, 139 Capsaicin, 20, 121 Carbohydrates, 90, 121, 145 Carcinogen, 19, 121 Carcinogenic, 121, 137, 149 Carcinoma, 18, 22, 29, 35, 37, 62, 80, 81, 121 Catheter, 121, 128, 139 Caustic, 82, 121 Celiac Disease, 89, 121

Celiac Plexus, 75, 121 Cell Death, 118, 122, 142 Cell Division, 119, 122, 142, 147 Cell Lineage, 21, 122 Cell proliferation, 19, 122 Cell Size, 122, 130 Cell Transplantation, 63, 122 Central Nervous System, 119, 122, 131, 132 Character, 122, 125, 132 Cholangitis, 80, 85, 122 Cholecystectomy, 13, 82, 86, 122 Cholecystitis, 80, 82, 122 Cholecystokinin, 25, 26, 70, 74, 122 Choledocholithiasis, 80, 122 Cholelithiasis, 13, 122, 133 Cholestasis, 82, 122 Cholesterol, 14, 119, 122 Chromatin, 118, 122, 140 Chromosomal, 29, 117, 122 Chromosome, 122, 139 Chymotrypsin, 38, 39, 122 Cirrhosis, 3, 4, 80, 83, 122, 133, 148 Clinical Medicine, 122, 148 Clinical study, 31, 122, 124 Clinical trial, 10, 18, 97, 122, 142, 149, 151 Cloning, 120, 123 Codon, 50, 123 Colitis, 123, 138 Collagen, 59, 119, 123, 129, 130, 140, 149 Colloidal, 116, 123, 153 Colon, 11, 81, 86, 123, 136, 138, 139, 153, 158 Colonic Neoplasms, 83, 123 Colonoscopy, 11, 86, 123 Colorectal, 30, 86, 123 Common Bile Duct, 3, 60, 70, 123, 125, 134, 145 Complement, 123, 124, 147 Complementary and alternative medicine, 73, 77, 123 Complementary medicine, 73, 124 Computational Biology, 97, 124 Computed tomography, 8, 9, 10, 30, 124 Computerized axial tomography, 124 Computerized tomography, 124 Concomitant, 39, 124 Confounding, 11, 124 Conjugated, 119, 124, 125 Connective Tissue, 121, 123, 124, 130, 131, 140, 156 Consciousness, 117, 124, 126, 134

163

Constipation, 81, 82, 86, 124, 138, 147 Constriction, 124, 138 Contraindications, ii, 124 Controlled clinical trial, 4, 124 Coordination, 48, 124 Cortex, 124, 144 Cortisol, 116, 124 Critical Care, 8, 125 Curative, 125, 156 Cyanosis, 125, 129 Cyst, 83, 125, 145 Cystic Duct, 123, 125, 134 Cytochrome, 64, 125 Cytoplasm, 118, 125, 140, 142 Cytotoxic, 121, 125, 150, 151 D Decarboxylation, 125, 134 Decompression, 3, 8, 9, 38, 125 Decompression Sickness, 125 Degenerative, 117, 125, 134 Deletion, 118, 125 Dendrites, 125, 143 Diabetes Mellitus, 5, 7, 39, 81, 125, 132, 134, 144 Diagnostic procedure, 88, 125 Diaphragm, 126, 134, 147, 152 Diarrhea, 83, 89, 126, 138, 140, 160 Diastolic, 126, 135 Dietary Fats, 126, 139 Diffusion, 126, 136, 143 Digestive system, 82, 126, 131 Digestive tract, 126, 153 Dihydrotestosterone, 126, 151 Dilution, 11, 126 Direct, iii, 10, 81, 91, 122, 126, 145, 151, 156 Discrimination, 59, 62, 126 Disease Progression, 5, 126 Disinfectant, 126, 129 Disposition, 12, 126 Dissociation, 115, 126 Distal, 6, 8, 34, 51, 65, 126, 131, 150 Diverticula, 81, 126 Diverticulum, 126 Drug Interactions, 92, 126 Duct, 4, 6, 8, 9, 12, 14, 19, 21, 22, 31, 34, 57, 61, 66, 90, 117, 123, 127, 128, 129, 150, 152, 155, 156 Duodenal Ulcer, 44, 127 Duodenum, 8, 34, 35, 55, 58, 66, 81, 90, 119, 122, 127, 128, 131, 138, 145, 146, 152, 155, 160 Dyspepsia, 89, 127, 136

Dysphagia, 83, 127 Dyspnea, 127, 129 E Eating Disorders, 82, 127 Edema, 20, 127, 158 Effector, 123, 127 Effector cell, 127 Efficacy, 4, 5, 18, 127 Elastic, 127, 132, 145, 154 Elastin, 123, 127, 129, 145 Elective, 6, 127 Electrolyte, 82, 127, 130, 144, 153, 158 Electrons, 118, 119, 127, 138, 144, 150, 151 Embolus, 127, 136 Embryo, 122, 127 Embryology, 82, 127 Enamel, 127, 138 Encephalopathy, 80, 127 Endemic, 127, 154 Endocrine Glands, 128 Endogenous, 20, 21, 59, 119, 128, 157 Endoscope, 128 Endoscopic retrograde cholangiopancreatography, 35, 39, 63, 82, 86, 128 Endoscopy, 8, 24, 25, 36, 39, 44, 46, 48, 50, 53, 60, 61, 74, 82, 83, 86, 89, 128 Endothelium, 117, 128 Endotoxin, 13, 128, 158 Enteropeptidase, 128, 158 Enteroscopy, 86, 128 Environmental Exposure, 128, 144 Environmental Health, 96, 98, 128 Enzymatic, 121, 123, 128, 134 Epidemic, 128, 154 Epidermis, 128, 138 Epigastric, 128, 144 Epithelial, 14, 21, 115, 128, 138 Epithelial Cells, 128, 138 Epithelium, 14, 19, 21, 119, 128, 145 Epitope, 15, 128 Esophageal, 81, 82, 85, 129, 131, 157 Esophageal Atresia, 82, 129, 157 Esophageal Motility Disorders, 81, 82, 129 Esophagitis, 83, 129, 131 Esophagus, 81, 86, 126, 129, 131, 133, 139, 146, 147, 151, 155, 157 Ethanol, 12, 13, 116, 129, 130 Evacuation, 124, 129, 131 Excitation, 129, 130, 143 Exocrine, 4, 7, 8, 9, 17, 28, 38, 40, 66, 83, 122, 129, 144, 145

164

Chronic Pancreatitis

Exogenous, 59, 128, 129 Extracellular, 16, 26, 40, 124, 129, 130, 140, 153 Extracellular Matrix, 26, 40, 124, 129, 130, 140 Extracellular Matrix Proteins, 26, 129, 140 Extracellular Space, 129 Extracorporeal, 61, 129 Extravasation, 129, 133 F Faecal, 38, 62, 129 Failure to Thrive, 82, 129 Family Planning, 97, 129 Fat, 39, 103, 112, 113, 119, 121, 127, 129, 139, 154, 160 Fatty acids, 116, 130 Feces, 6, 124, 129, 130, 145, 154, 155 Fermentation, 116, 130 Fibrin, 120, 130, 145, 147, 156 Fibrinogen, 130, 147, 156 Fibroblasts, 130, 137 Fibronectins, 129, 130 Fibrosis, 3, 10, 17, 18, 29, 32, 53, 80, 82, 102, 116, 130, 152 Fine-needle aspiration, 130, 143 Fistula, 29, 57, 130, 131, 144 Flow Cytometry, 54, 130 Fluid Therapy, 130, 144 Fluorescence, 130 Fluorescent Dyes, 130 Folate, 130, 131 Fold, 6, 11, 12, 14, 131, 141, 144 Folic Acid, 66, 131 Free Radicals, 13, 118, 126, 131 Fulminant Hepatic Failure, 82, 131 G Gallbladder, 79, 80, 81, 82, 90, 115, 120, 122, 125, 126, 128, 131, 139, 145 Gamma Rays, 131, 151 Ganglia, 131, 143, 156 Gas, 117, 125, 126, 131, 135, 136, 138, 140, 143, 159 Gastric, 81, 85, 119, 129, 131, 132, 133, 134, 144, 146 Gastric Acid, 129, 131, 144 Gastric Emptying, 85, 131, 132 Gastric Juices, 131, 146 Gastritis, 82, 89, 131, 133 Gastroduodenal, 85, 131 Gastroenterologist, 80, 89, 131 Gastroesophageal Reflux, 81, 82, 131 Gastroesophageal Reflux Disease, 81, 131

Gastrointestinal tract, 8, 17, 80, 82, 89, 117, 129, 132, 155, 158 Gastroparesis, 85, 132 Gene, 13, 15, 17, 18, 21, 23, 24, 26, 32, 40, 41, 45, 49, 53, 63, 87, 120, 132, 144, 158 Gene Expression, 18, 132 Gene Therapy, 13, 132 Genetic testing, 16, 42, 132 Genotype, 43, 132, 147 Germ Cells, 132, 154, 156 Gland, 19, 83, 132, 140, 144, 145, 149, 152, 155, 156 Glucose, 7, 43, 120, 125, 132, 133, 137 Glucose Intolerance, 7, 125, 132 Glucose tolerance, 132 Glucose Tolerance Test, 132 Glutamic Acid, 131, 132, 143, 149 Gluten, 89, 121, 132 Glycine, 119, 132, 143, 153 Glycoprotein, 130, 133, 138, 156, 158 Glycosaminoglycans, 129, 133 Governing Board, 133, 148 Grade, 4, 133 Grading, 4, 133 Gram-negative, 13, 133 Gram-positive, 133, 138 Grasses, 131, 133 Groin, 133, 136, 137 H Haptens, 115, 133 Heartburn, 89, 133, 134, 136 Helicobacter, 13, 44, 85, 89, 133 Helicobacter pylori, 13, 44, 85, 89, 133 Hematoma, 60, 133 Hemobilia, 80, 133 Hemochromatosis, 82, 133 Hemoglobin, 117, 125, 133, 134, 145 Hemoglobinopathies, 132, 134 Hemorrhage, 80, 117, 133, 134 Hepatic, 3, 12, 80, 81, 82, 85, 116, 123, 128, 132, 134, 139 Hepatic Duct, Common, 128, 134 Hepatic Encephalopathy, 82, 85, 134 Hepatitis, 80, 82, 83, 131, 134, 159 Hepatitis, Chronic, 80, 134 Hepatobiliary, 20, 32, 62, 80, 81, 134 Hepatocellular, 12, 80, 81, 134 Hepatocellular carcinoma, 12, 80, 81, 134 Hepatocyte, 122, 134 Hereditary, 7, 15, 16, 17, 22, 24, 44, 45, 80, 82, 102, 115, 134 Heredity, 132, 134

165

Hernia, 81, 134 Heterogeneity, 115, 134 Hiatal Hernia, 81, 134 Histamine, 14, 134 Histidine, 134 Histology, 7, 47, 82, 134 Homeobox, 14, 21, 135 Homeostasis, 43, 135, 153 Homodimer, 135, 158 Homologous, 132, 135, 142 Hormone, 124, 135, 137, 141, 144, 152, 156, 158 Hybridomas, 135, 137 Hydrogen, 115, 116, 119, 121, 129, 135, 139, 142, 144, 149, 155 Hydrogen Peroxide, 135, 139, 155 Hydrolysis, 135, 148, 149, 158 Hydroxylysine, 123, 135 Hydroxyproline, 123, 135 Hyperbilirubinemia, 135, 138 Hypertension, 80, 135, 144, 148, 158 Hypoglycemia, 54, 135 Hypoglycemic, 4, 135 Hypothalamus, 115, 119, 135 Hypoxia, 13, 135 I Idiopathic, 4, 7, 9, 10, 17, 31, 32, 33, 35, 41, 45, 47, 49, 55, 87, 115, 135 Immortal, 14, 135 Immune response, 118, 119, 133, 135, 155, 159, 160 Immune system, 82, 119, 127, 135, 136, 159, 160 Immunologic, 9, 136, 151 Immunology, 20, 115, 130, 136 Immunosuppressive, 14, 136 Impairment, 7, 122, 136 In vitro, 14, 15, 17, 132, 136, 157 In vivo, 13, 14, 19, 21, 132, 136 Incision, 136, 137, 138 Incisional, 81, 136 Incompetence, 131, 136 Incontinence, 82, 136 Indigestion, 89, 111, 136 Infantile, 115, 136, 139 Infarction, 23, 136 Infection, 7, 8, 13, 44, 82, 120, 136, 140, 143, 155, 160 Inferior vena cava, 23, 136 Infiltrating cancer, 136, 138 Infiltration, 4, 47, 136 Inflammatory bowel disease, 82, 83, 136

Information Systems, 11, 136 Ingestion, 82, 132, 136 Inguinal, 81, 136 Inguinal Hernia, 81, 136 Initiation, 13, 14, 137, 157 Innervation, 20, 137 Inoperable, 10, 137 Insight, 9, 16, 21, 137 Insulin, 4, 6, 41, 83, 90, 92, 132, 137, 145 Insulin-dependent diabetes mellitus, 137 Interferon, 70, 85, 137 Interferon-alpha, 137 Interleukin-6, 70, 137 Internal Medicine, 15, 16, 41, 70, 131, 137 Intestinal, 20, 49, 81, 121, 122, 128, 132, 133, 137, 138, 140, 160 Intestinal Mucosa, 20, 121, 122, 137 Intestine, 18, 90, 103, 119, 121, 128, 137, 138, 150, 160 Intracellular, 136, 137, 141, 152 Intraepithelial, 22, 56, 137 Intrahepatic, 81, 134, 137 Intramuscular, 137, 146 Intravenous, 137, 146 Intrinsic, 17, 116, 119, 137 Intussusception, 137, 151 Invasive, 22, 89, 136, 137, 138, 140 Invasive cancer, 22, 136, 138 Ion Channels, 138 Ionizing, 128, 138, 151 Ions, 119, 126, 127, 135, 138, 149 Irritable Bowel Syndrome, 14, 83, 138 Ischemia, 81, 138 Ischemic Colitis, 81, 138 Isoenzymes, 38, 138 J Jaundice, 49, 82, 89, 135, 138 Jejunostomy, 35, 138 Jejunum, 138 K Kb, 96, 138 Keratin, 26, 41, 138 L Lactobacillus, 13, 138 Laminin, 119, 129, 138 Laparotomy, 113, 138 Large Intestine, 126, 137, 138, 151, 153, 160 Latent, 51, 139, 148 Lethal, 10, 119, 139 Leukemia, 132, 139 Ligands, 20, 139 Ligation, 21, 139

166

Chronic Pancreatitis

Linkage, 11, 139 Lipase, 4, 18, 112, 139 Lipid, 27, 137, 139, 144 Lipid Peroxidation, 139, 144 Lipodystrophy, 139, 160 Lithiasis, 47, 139 Lithotripsy, 61, 139 Liver, 3, 20, 23, 26, 31, 41, 45, 51, 62, 76, 79, 80, 81, 82, 83, 85, 102, 115, 116, 119, 120, 122, 126, 130, 131, 132, 133, 134, 137, 139, 142, 148, 152, 158 Liver Cirrhosis, 76, 139 Liver Transplantation, 81, 82, 85, 139 Localized, 11, 61, 115, 133, 136, 138, 139, 144, 147, 158 Longitudinal Studies, 11, 139 Loop, 134, 139, 145 Lower Esophageal Sphincter, 89, 129, 131, 139 Lupus, 140, 156 Lymph, 128, 140, 143, 145 Lymph node, 140, 143, 145 Lymphatic, 128, 136, 140, 148, 154 Lymphatic system, 140, 154 Lymphocytes, 118, 135, 140, 154, 160 Lymphoid, 118, 140 Lymphoma, 81, 102, 140 Lysine, 135, 140, 158 M Magnetic Resonance Imaging, 8, 10, 30, 140 Malabsorption, 4, 7, 18, 27, 75, 76, 82, 121, 140, 153, 154, 160 Malabsorption syndrome, 82, 140, 153, 154 Malignant, 22, 50, 81, 115, 140, 143, 151 Malignant tumor, 81, 140 Malnutrition, 5, 102, 116, 140 Mammogram, 121, 140, 141 Manometry, 46, 86, 140 Matrix metalloproteinase, 14, 140 Mediator, 16, 122, 140 Medical Records, 14, 141, 152 MEDLINE, 97, 141 Megaloblastic, 131, 141 Membrane, 25, 123, 133, 138, 141, 144, 146, 147, 148, 149, 151, 158 Membrane Proteins, 141, 149 Mental, iv, 10, 96, 98, 126, 136, 141, 158 Mentors, 21, 141 Mercury, 130, 141 Mesenteric, 81, 121, 141, 148

Mesentery, 141, 146, 154 Metaplasia, 14, 141 Metastasis, 20, 140, 141, 143 Microbe, 141, 157 Microcalcifications, 121, 141 Microcirculation, 139, 141 Micro-organism, 133, 141 Minority Groups, 21, 141 Mitochondrial Swelling, 141, 142 Mitosis, 118, 142 Modification, 142, 150 Molecular, 9, 10, 13, 16, 17, 20, 22, 42, 52, 53, 82, 97, 99, 120, 124, 130, 142, 145, 155, 158 Molecule, 15, 116, 118, 119, 123, 125, 126, 127, 128, 129, 134, 135, 142, 144, 151, 159 Monitor, 11, 142, 143 Monocytes, 137, 142 Mononuclear, 76, 142, 158 Morphological, 12, 16, 66, 127, 142 Morphology, 13, 31, 142 Motility, 48, 80, 81, 82, 142 Mucins, 142, 152 Mucus, 142, 158 Multicenter study, 36, 142 Multidrug resistance, 37, 142 Multiple Organ Failure, 7, 142 Multivalent, 119, 142 Muscle Contraction, 89, 142 Myosin, 142 N Nausea, 112, 132, 136, 142, 158 Necrosis, 6, 8, 49, 80, 118, 134, 136, 142, 150 Needle biopsy, 40, 130, 143 Neomycin, 21, 143 Neoplasia, 22, 143 Neoplasms, 18, 80, 82, 133, 143, 151 Nerve Fibers, 115, 121, 143 Nervous System, 17, 115, 119, 122, 140, 143, 155, 156 Neural, 17, 54, 115, 143 Neuronal, 20, 143 Neurons, 18, 20, 125, 131, 143, 156 Neuropeptides, 85, 143 Neurotransmitter, 132, 134, 138, 143, 152, 155 Neutrophil, 20, 143 Neutrophil Infiltration, 20, 143 Nitrogen, 116, 125, 129, 143, 145, 158 Node-negative, 11, 143 Nosocomial, 7, 82, 143

167

Nuclear, 54, 127, 131, 142, 143 Nuclei, 127, 132, 140, 142, 143, 149 Nucleus, 118, 122, 125, 131, 140, 142, 143, 149, 153 Nutritional Status, 4, 5, 143 Nutritional Support, 7, 82, 103, 144 O Octreotide, 9, 144 Office Management, 83, 144 Omentum, 144, 154 Omeprazole, 144, 149 Oncogene, 50, 144 Organ Culture, 144, 157 Orthostatic, 144 Osmotic, 116, 141, 144, 153 Osteomyelitis, 66, 144 Outpatient, 5, 7, 144 Overdose, 131, 144 Oxidation, 115, 118, 125, 139, 144 Oxidative Stress, 13, 19, 51, 144 P Palliative, 17, 144, 156 Pancreas Transplant, 81, 145 Pancreas Transplantation, 81, 145 Pancreatectomy, 6, 8, 34, 45, 51, 61, 65, 145 Pancreatic Ducts, 18, 66, 128, 145 Pancreatic Elastase, 39, 145 Pancreatic enzymes, 4, 19, 26, 75, 145 Pancreatic Fistula, 7, 80, 82, 145 Pancreatic Function Tests, 65, 145 Pancreatic Insufficiency, 7, 18, 27, 38, 39, 76, 145 Pancreatic Juice, 11, 19, 51, 70, 90, 122, 131, 145 Pancreatic Pseudocyst, 7, 34, 145 Pancreaticoduodenectomy, 6, 8, 49, 57, 145 Papilla, 128, 145 Parasite, 145 Parasitic, 82, 145 Parasitic Diseases, 82, 145 Parenchyma, 19, 31, 145 Parenteral, 82, 145, 146 Parenteral Nutrition, 82, 146 Parietal, 144, 146, 147 Pathogen, 133, 146 Pathologic, 11, 118, 120, 135, 146 Pathologic Processes, 118, 146 Pathophysiology, 6, 15, 16, 20, 52, 54, 81, 85, 146 Patient Education, 89, 102, 106, 108, 113, 146

Pelvis, 115, 136, 146, 152 Pepsin, 146, 152 Peptic, 13, 81, 82, 83, 85, 133, 146 Peptic Ulcer, 13, 81, 82, 83, 85, 133, 146 Peptide, 54, 122, 128, 138, 146, 148, 149 Percutaneous, 139, 146 Perforation, 146, 160 Perfusion, 135, 146 Perianal, 83, 146 Pericardium, 146, 156 Perineural, 4, 146 Peritoneal, 118, 146 Peritoneal Cavity, 118, 146 Peritoneum, 141, 144, 146, 152 Peritonitis, 146, 160 Pharmacologic, 117, 147, 157 Pharynx, 131, 147 Phenotype, 15, 147 Phospholipids, 129, 147 Phosphorus, 121, 147 Physiologic, 116, 120, 147, 151 Physiology, 6, 17, 20, 82, 86, 90, 131, 145, 147 Pigment, 120, 147 Pilot study, 13, 60, 147 Plants, 116, 132, 142, 147, 157 Plasma, 12, 74, 116, 118, 130, 132, 134, 147, 149, 151, 153 Plasma cells, 118, 147 Plasma protein, 116, 147, 149, 153 Pleated, 138, 147 Pleura, 147 Pleural, 27, 147 Pleural cavity, 147 Pleural Effusion, 27, 147 Plexus, 121, 148 Pneumonia, 124, 148 Polypeptide, 70, 116, 123, 130, 148, 160 Polyposis, 81, 148 Portal Hypertension, 56, 66, 80, 82, 148 Portal Vein, 148 Posterior, 117, 144, 148, 152 Postnatal, 148, 155 Postoperative, 57, 142, 148 Postprandial, 25, 26, 148 Practice Guidelines, 5, 98, 148 Precancerous, 148 Precursor, 21, 22, 117, 127, 128, 148, 149, 158 Predisposition, 42, 148 Premalignant, 21, 83, 148 Preoperative, 57, 64, 148

168

Chronic Pancreatitis

Presynaptic, 18, 143, 148 Prevalence, 6, 148 Primary Biliary Cirrhosis, 40, 64, 80, 89, 148 Primary Sclerosing Cholangitis, 82, 148 Problem Solving, 81, 148 Progression, 6, 10, 13, 14, 17, 22, 117, 149 Progressive, 4, 7, 13, 90, 102, 122, 142, 149, 152 Proline, 123, 135, 149 Promoter, 15, 21, 45, 149 Prone, 89, 149 Prospective study, 3, 149 Prostate, 120, 149, 158 Protease, 18, 53, 145, 149 Protein C, 5, 44, 116, 123, 138, 149, 159 Protein S, 120, 143, 149 Proteoglycans, 119, 129, 149 Proteolytic, 15, 123, 128, 130, 149 Prothrombin, 149, 156 Protocol, 13, 149 Proton Pump, 14, 144, 149 Proton Pump Inhibitors, 14, 149 Protons, 135, 138, 149, 150 Proximal, 126, 148, 150 Pseudocysts, 4, 28, 53, 80, 150 Public Policy, 97, 150 Publishing, 6, 8, 9, 22, 79, 81, 89, 150 Pulmonary, 23, 120, 150 Pulmonary Artery, 120, 150 Pulmonary Embolism, 23, 150 Pulse, 142, 150 Purines, 150, 153 Pylorus, 8, 57, 150 Pyogenic, 144, 150 Pyrimidines, 150, 153 Q Quality of Health Care, 12, 150 Quality of Life, 6, 38, 44, 56, 150 R Race, 63, 150 Radiation, 128, 130, 131, 138, 150, 151, 160 Radioactive, 135, 143, 150 Radioimmunotherapy, 150, 151 Radiolabeled, 18, 150 Radiologist, 80, 150 Radiolucent, 44, 151 Radiotherapy, 46, 150, 151 Randomized, 24, 35, 73, 127, 151 Receptor, 14, 16, 20, 23, 24, 26, 45, 64, 118, 151 Recombinant, 15, 17, 151, 159

Recombination, 132, 151 Rectal, 81, 151 Rectal Prolapse, 81, 151 Rectum, 81, 117, 118, 121, 123, 126, 131, 136, 138, 149, 151, 153 Reductase, 14, 151 Refer, 1, 123, 143, 150, 151 Reflux, 83, 89, 129, 131, 151 Refraction, 151, 154 Regimen, 127, 151 Regurgitation, 129, 131, 133, 151 Renin, 117, 151 Resected, 22, 151 Resection, 8, 20, 29, 35, 37, 47, 51, 55, 56, 58, 66, 151, 153 Respiration, 142, 151 Retrograde, 9, 10, 33, 61, 152 Retroperitoneal, 29, 152 Retroperitoneal Fibrosis, 29, 152 Retroperitoneal Space, 152 Retrospective, 5, 11, 60, 89, 152 Retrospective study, 89, 152 Retroviral vector, 132, 152 Risk factor, 5, 9, 11, 13, 19, 42, 60, 149, 152 Rod, 119, 138, 152 S Saliva, 89, 152 Salivary, 126, 145, 152 Salivary glands, 126, 152 Salivation, 129, 152 Scleroproteins, 138, 152 Sclerosis, 40, 152 Screening, 11, 22, 83, 122, 152 Second Messenger Systems, 152 Secondary tumor, 141, 152 Secretin, 25, 47, 49, 59, 152 Secretion, 4, 7, 9, 18, 20, 37, 40, 48, 65, 70, 82, 134, 137, 142, 144, 145, 152, 153, 158 Secretory, 17, 32, 40, 45, 144, 153 Segmental, 66, 153 Segmentation, 153 Senile, 47, 153 Sepsis, 20, 153 Sequencing, 10, 133, 153 Serine, 53, 122, 153, 158 Serum, 5, 9, 26, 40, 45, 59, 65, 112, 116, 118, 123, 147, 153, 158 Serum Albumin, 5, 153 Shock, 20, 61, 139, 153, 158 Short Bowel Syndrome, 51, 153 Side effect, 91, 115, 153, 157 Sigmoid, 153

169

Sigmoidoscopy, 83, 153 Small intestine, 81, 90, 125, 127, 128, 135, 136, 137, 138, 153, 158, 159 Smooth muscle, 116, 134, 153, 155 Social Environment, 150, 153 Sodium, 153, 155 Solitary Nucleus, 119, 153 Solitary Rectal Ulcer, 81, 153 Solvent, 129, 144, 154 Soma, 154 Somatic, 10, 49, 142, 154 Sound wave, 150, 154 Spastic, 138, 154 Specialist, 7, 104, 154 Species, 18, 121, 122, 138, 142, 145, 150, 154, 155, 158, 159, 160 Specificity, 115, 145, 154 Spectrum, 33, 154 Sphincter, 46, 89, 151, 154 Spinal cord, 115, 122, 143, 154, 156 Spleen, 34, 60, 140, 145, 154 Splenic Artery, 43, 154 Splenic Vein, 28, 148, 154 Sporadic, 22, 154 Staging, 9, 154 Steatorrhea, 6, 18, 75, 83, 154 Steatorrhoea, 27, 154 Stellate, 16, 37, 48, 154 Stem Cells, 21, 155 Stenosis, 3, 29, 60, 61, 70, 155 Stent, 36, 89, 155 Stimulant, 134, 155 Stimulus, 127, 129, 137, 138, 155, 156, 157 Stool, 50, 123, 136, 138, 154, 155 Stress, 7, 9, 13, 67, 119, 125, 138, 142, 144, 148, 155 Stricture, 155 Stroma, 145, 155 Subacute, 18, 136, 155 Subcapsular, 60, 155 Subclinical, 7, 136, 155 Subcutaneous, 54, 127, 139, 146, 155 Subspecies, 154, 155 Substance P, 152, 155 Sulfur, 129, 155 Superoxide, 13, 155 Superoxide Dismutase, 13, 155 Supplementation, 6, 75, 76, 155 Suppression, 9, 155 Suppressive, 14, 155 Sweat, 24, 155, 156 Sweat Glands, 155, 156

Sympathetic Nervous System, 119, 156 Symptomatic, 38, 156 Synapse, 148, 156, 158 Systemic, 18, 30, 40, 92, 120, 136, 156 Systemic lupus erythematosus, 30, 156 Systolic, 135, 156 T Terminator, 123, 156 Testis, 37, 156 Testosterone, 151, 156 Therapeutics, 25, 75, 92, 156 Threonine, 153, 156 Threshold, 135, 156 Thrombin, 64, 130, 149, 156 Thrombocytopenia, 81, 156 Thrombomodulin, 149, 156 Thromboses, 4, 156 Thrombosis, 7, 23, 28, 61, 149, 156 Thyroxine, 116, 156 Tissue Culture, 21, 157 Tomography, 157 Tone, 86, 157 Tonic, 129, 157 Tonus, 157 Topical, 129, 135, 157 Torsion, 136, 157 Total pancreatectomy, 34, 54, 63, 145, 157 Toxic, iv, 10, 12, 128, 133, 157 Toxicity, 12, 18, 126, 141, 157 Toxicology, 12, 98, 157 Toxins, 118, 136, 150, 157 Tracheoesophageal Fistula, 129, 157 Transcription Factors, 21, 157 Transcutaneous, 73, 157 Transcutaneous Electric Nerve Stimulation, 73, 157 Transfection, 120, 132, 157 Transferases, 33, 157 Transforming Growth Factor beta, 51, 157 Translation, 9, 143, 158 Translational, 11, 158 Transmitter, 138, 140, 158 Transplantation, 80, 82, 158 Trauma, 7, 80, 81, 129, 133, 142, 158 Trypsin, 15, 17, 20, 24, 32, 40, 122, 128, 158, 160 Tryptophan, 123, 158 Tumor marker, 120, 158 Tumor Necrosis Factor, 45, 70, 158 U Ulcer, 127, 153, 158 Ulceration, 146, 158

170

Chronic Pancreatitis

Ulcerative colitis, 64, 81, 136, 148, 158 Ultrasonography, 9, 10, 64, 86, 158 Uraemia, 158 Urea, 65, 156, 158, 159 Urease, 133, 159 Ureters, 152, 159 Urinary, 121, 136, 139, 159 Urinary tract, 139, 159 Urine, 120, 136, 145, 159 V Vaccine, 149, 159 Vagina, 138, 159 Varix, 28, 159 Vascular, 61, 64, 66, 116, 117, 128, 133, 136, 139, 141, 159 Vasculitis, 159 Vasodilator, 134, 159 VE, 23, 159 Vector, 145, 159 Vein, 7, 61, 117, 136, 137, 143, 148, 154, 159 Vena, 159 Venous, 4, 81, 149, 159 Venous Thrombosis, 81, 159 Venter, 159 Ventral, 81, 135, 159 Veterinary Medicine, 97, 159 Villi, 159

Villous, 81, 121, 159 Viral, 13, 80, 82, 130, 134, 159 Viral Hepatitis, 80, 82, 134, 159 Viral vector, 13, 159 Virulence, 118, 157, 159 Virus, 13, 137, 152, 159, 160 Viscera, 141, 154, 160 Visceral, 81, 119, 121, 146, 160 Visceral Afferents, 119, 121, 160 Vitro, 160 Vivo, 160 Volvulus, 81, 160 W Whipple, 55, 58, 66, 160 Whipple procedure, 55, 58, 160 White blood cell, 118, 140, 142, 143, 147, 160 Wound Healing, 140, 160 X Xenograft, 117, 160 X-ray, 124, 128, 130, 131, 140, 143, 150, 151, 160 Y Yeasts, 147, 160 Z Zymogen, 122, 149, 160

171

172

Chronic Pancreatitis