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A B Lowenfels

Publications and source records attributed to A B Lowenfels.

At least 19 recordsLinked to original sources
PubMed2005

Cigarette smoking accelerates progression of alcoholic chronic pancreatitis.

BACKGROUND: Smoking is a recognised risk factor for pancreatic cancer and has been associated with chronic pancreatitis and also with type II diabetes. AIMS: The aim of this study was to investigate the effect of tobacco on the age of diagnosis of pancreatitis and progression of disease, as measured by the appearance of calcification and diabetes. PATIENTS: We used data from a retrospective cohort of 934 patients with chronic alcoholic pancreatitis where information on smoking was available, who were diagnosed and followed in clinical centres in five countries. METHODS: We compared age at diagnosis of pancreatitis in smokers versus non-smokers, and used the Cox proportional hazards model to evaluate the effects of tobacco on the development of calcification and diabetes, after adjustment for age, sex, centre, and alcohol consumption. RESULTS: The diagnosis of pancreatitis was made, on average, 4.7 years earlier in smokers than in non-smokers (p = 0.001). Tobacco smoking increased significantly the risk of pancreatic calcifications (hazard ratio (HR) 4.9 (95% confidence interval (CI) 2.3-10.5) for smokers v non-smokers) and to a lesser extent the risk of diabetes (HR 2.3 (95% CI 1.2-4.2)) during the course of pancreatitis. CONCLUSIONS: In this study, tobacco smoking was associated with earlier diagnosis of chronic alcoholic pancreatitis and with the appearance of calcifications and diabetes, independent of alcohol consumption.

Adult↗
PubMed2002

Epidemiology of pancreatic diseases in Lüneburg County. A study in a defined german population.

BACKGROUND/AIMS: Worldwide, the incidence of pancreatic cancer is very well known, that of acute pancreatitis and chronic pancreatitis not. Our study sought to determine the incidence of all three pancreatic diseases in a well-defined population in Germany. METHODS: Records of all patients treated for acute (first attacks only) and chronic pancreatitis as well as pancreatic cancer from 1988 to 1995 and who resided in the county of Lüneburg were evaluated. RESULTS: The crude incidence rates for acute pancreatitis, chronic pancreatitis and pancreatic cancer per 100,000 inhabitants/year were 19.7, 6.4, and 7.8. In acute and chronic pancreatitis the male gender dominated, whereas in pancreatic carcinoma the gender ratio was almost even. Peak incidence for acute pancreatitis was in the age group of 35-44 years, for chronic pancreatitis 45-54, and for pancreatic cancer 65-75. Etiology of acute pancreatitis was biliary in 40%, alcohol abuse in 32%, unknown in 20%, and other in 8% of the patients. In chronic pancreatitis alcohol abuse was the etiology in 72% and unknown (idiopathic) in 28%. CONCLUSION: For the first time, epidemiological data obtained in a well-defined German population are being published relating to all three pancreatic diseases: acute pancreatitis (incidence rate, etiology and severity), chronic pancreatitis (incidence rate and etiology), and pancreatic carcinoma (incidence rate). A peak incidence of chronic pancreatitis occurring in an age group 10 years older than the peak age group for acute pancreatitis suggests that chronic pancreatitis develops during this time-frame following first attacks of acute pancreatitis.

Acute Disease↗
PubMed2001

Acute pancreatitis: does gender matter?

In a number of gastrointestinal and nongastrointestinal diseases, gender has been proven to be an independent risk factor for severity. To determine whether this holds true for severity in acute pancreatitis is the aim of our study. This paper derives from a prospective study on the epidemiology of acute pancreatitis, which included 274 patients (172 male and 102 female) with a first attack of the disease. Severity parameters were: Atlanta criteria (arterial Po2 < or = 60 mm Hg, and serum creatinine on admission >2 mg/dl after rehydration); Ranson's and Imrie's prognostic factors; APACHE II score; Balthazar-scored contrast-enhanced computed tomography (CT) results obtained within 72 hr of admission; days spent in the intensive care unit and total hospital stay; the necessity for artificial ventilation, dialysis, or surgery; and mortality. As already known, there is a significant association between gender and etiology of pancreatitis in general. Not surprisingly, the men in our study had alcohol-induced acute pancreatitis more frequently than women, whereas biliary pancreatitis predominated among the women. As for severity, there was no significant association between gender and any of the severity parameters with a few minor exceptions: longer hospital stays, higher Imrie scores and more pseudocysts for women, and more necroses in women with idiopathic pancreatitis. Thus, gender is no independent risk factor for the severity and outcome of acute pancreatitis.

Acute Disease↗
PubMed2001

Do we need a computed tomography examination in all patients with acute pancreatitis within 72 h after admission to hospital for the detection of pancreatic necrosis?

BACKGROUND: The aim of this prospective study was to define the role of an initial contrast-enhanced computed tomography (CT) obtained within 72 h after admission to hospital for determining the prognosis of acute pancreatitis and to investigate whether CT scans can be replaced by conventional prognostic parameters. METHODS: The study involves 231 patients admitted to the Lüneburg clinic with a first attack of acute pancreatitis from 1988 to 1995. In all of them, a contrast-enhanced CT was performed within 72 h of admission and scored according to Balthazar. The results were compared with the Ranson and Imrie laboratory prognostic scores and with parameters of the severity of the disease: the initial organ failure according to the Atlanta classification; days spent on intensive care unit or altogether in hospital; indication for artificial ventilation, dialysis and surgical intervention (necrosectomy); development of pancreatic pseudocysts; and mortality. RESULTS: Although there was a good statistical correlation between Ranson, Imrie, and Balthazar scores with the severity of the disease (P < 0.001 to P = 0.03), low and moderately raised Ranson (0-2, 0-5 points) and Imrie scores (0-1.0-3 points) failed to identify all patients with pancreatic necrosis with sufficient sensitivity rates (31.7; 78.0 and 39.0; 78.0%), positive (32.6; 25.3 and 75.0; 45.0%) and negative (91.0; 87.9 and 85.4; 84.8%) predictive values. CONCLUSIONS: A contrast-enhanced CT on admission correlates significantly with the severity of the disease and cannot be replaced by conventional laboratory prognostic scores. The decision to use a CT cannot depend on the results of the Ranson/Imrie scores.

Acute Disease↗
PubMed2001

A longitudinal study of former trauma center patients: the association between toxicology status and subsequent injury mortality.

BACKGROUND: Despite the current emphasis on injury prevention, little has been done to incorporate alcohol intervention programs into the care of the injured patient. The purpose of this study was to determine whether patients admitted to a trauma center with positive toxicology findings (TOX+) have a higher subsequent injury mortality than those without such findings (TOX-). METHODS: We followed a cohort of 27,399 trauma patients discharged alive between 1983 and 1995 to determine subsequent mortality. Death certificates were obtained to identify the cause of death. RESULTS: TOX+ patients had an injury mortality rate approximately twice that of the TOX- group (1.9% vs. 1.0%, p < 0.001). Overall, 22.7% of the deaths were due to injury; the TOX+ rate was 34.7% versus 15.4% for the TOX-. CONCLUSION: These data add strength to the premise that untreated substance abuse-related injury remains an untapped injury prevention opportunity.

Adolescent↗
PubMed2001

Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? A critical appraisal.

OBJECTIVE: A study was designed to reevaluate hemoconcentration as an early marker of severe and/or necrotizing pancreatitis and compare it against contrast-enhanced CT, the gold standard to diagnose acute necrotizing pancreatitis. METHODS: This prospective study covers the years 1988-1999 for 316 patients (202 male, 114 female) with a first attack of acute pancreatitis. The role of the hematocrit as an early marker of severe and/or necrotizing pancreatitis has been retrospectively evaluated against the prospectively obtained data. They all underwent a CT within 72 h after admission. In addition to the CT-controlled diagnosis of interstitial/necrotizing pancreatitis, the following variables were used to assess severity: initial organ failure according to the Atlanta classification; indication for artificial ventilation and/or dialysis; Ranson score adjusted for etiology; Imrie score; Balthazar score; length of stay in intensive care unit (ICU); total hospital stay; development of pancreatic pseudocysts; indication for operation (necrosectomy); and mortality. Hemoconcentration on admission was defined as a hematocrit level >43.0% for male and >39.6% for female patients. Logistic regression was used to assess the correlation between hemoconcentration and the severity of variables. RESULTS: Hematocrit, as a single parameter measured on admission, had the same sensitivity and negative predictive value as the more complicated Ranson and Imrie scores obtained only after 48 h. However, its specificity, positive predictive value, and total accuracy were lower. Hemoconcentration significantly correlated with the Balthazar score (differential diagnosis between interstitial and necrotizing pancreatitis), stay in ICU, and total hospital stay. Sensitivity and specificity of the hematocrit cut-off level of 43.0% for male and 39.6% for female patients to detect necrotizing pancreatitis were 74% and 45%, respectively. The positive predictive value was 24% and the negative predictive value 88%. Receiver operation characteristics (ROC) curve values for several cut-offs did not result in more ideal levels. CONCLUSION: Hemoconcentration does not significantly correlate with important clinical outcome variables of acute pancreatitis including organ failure and mortality rate. Its prognostic value is comparable to the more complicated Ranson and Imrie scores obtained only after 48 h. The major value of this single easily obtainable and cheap parameter on admission lies in its high negative predictive value. In the absence of hemoconcentration, contrast-enhanced CT may be unnecessary on admission unless the patient does not improve.

Adolescent↗
PubMed2001

Has blood glucose level measured on admission to hospital in a patient with acute pancreatitis any prognostic value?

BACKGROUND: Early detection of pancreatic necrosis allows better management of the disease. Contrast-enhanced computed tomography (CT) as the gold standard for detecting pancreatic necrosis is expensive. AIM OF THE STUDY: This study was to evaluate for the first time whether blood glucose estimation on hospital admission--a simple, cheap, readily available laboratory parameter--may detect pancreatic necrosis and have prognostic value in acute pancreatitis. METHODS: Single blood glucose estimation upon hospital admission was evaluated prospectively for detecting pancreatic necrosis and as a prognostic indicator. The study included 241 nondiabetic patients with a first attack of acute pancreatitis. All underwent CT within 72 h of admission. RESULTS: High blood glucose (> 125 mg/dl) correlated significantly with complex high clinical and biochemical prognostic scores (Ranson, Imrie), a high Balthazar score, pancreatic pseudocysts, and a long hospital stay, but not with organ failure, indication for artificial ventilation, dialysis, surgery, length of intensive care, and mortality. Pancreatic necrosis detection sensitivity of high blood glucose was 83%, specificity 49%, positive predictive value 28%, and negative predictive value 92%. CONCLUSION: A patient with normal blood glucose on admission is unlikely to have pancreatic necrosis. Contrast-enhanced CT would not be needed unless the patient fails to improve.

Acute Disease↗
PubMed2001

Fatal outcome in acute pancreatitis: its occurrence and early prediction.

BACKGROUND/AIMS: This study aims to determine predictability of death in acute pancreatitis at a secondary-care hospital in Germany. METHODS: This study is part of an ongoing study on the epidemiology of acute pancreatitis and covers 368 patients with a first attack of acute pancreatitis in Lüneburg county from 1988 to 1999. Early and late mortality were defined as < or = 1 weeks and > 1 week after admission. The following parameters were used to establish on admission likelihood of death: admission within 24 h or later with an acute attack, abdominal tenderness, signs of peritonitis, amylase and lipase in serum, leukocytes, hematocrit, potassium, sodium, calcium, creatinine after rehydration, blood glucose, bilirubin, serum glutamate-oxalacetate transaminase (SGOT), serum lactate dehydrogenase (SLDH), arterial pO2, APACHE II score, Ranson and Imrie scores. RESULTS: Of the 368 patients 17 (5%) died, 7 early because of multiple organ failure and 10 late because of septic complications. Mortality rates in interstitial and necrotising pancreatitis were 3 and 17%, respectively. Only an elevated serum creatinine (> 2.0 mg/dl) and a blood glucose > 250 mg significantly correlated with mortality. Ranson and Imrie scores were also significantly correlated with mortality; however, they were not obtained on admission, but only after 48 h. In univariate analysis, APACHE II score > or = 6 on admission and lipase > 1,000 U/l on admission provided a high sensitivity and negative predictive value for early and late mortality patients. CONCLUSION: Approximately half of the deaths in acute pancreatitis occur because of multiple organ failure or septic complications. New approaches have to be found to counteract these severe complications. A fatal outcome may be predicted by simple laboratory parameters such as a high serum creatinine and blood glucose. An APACHE II score > or = 6 and a lipase level on admission > or = 1,000 U/l indicate severe pancreatitis.

APACHE↗
PubMed2000

Risk factors for cancer in hereditary pancreatitis. International Hereditary Pancreatitis Study Group.

Hereditary pancreatitis is a rare form of pancreatitis, accounting for approximately 1% of all types of pancreatitis. It is inherited as an autosomal dominant disease, with incomplete penetrance. The genetic defect is believed to be caused by mutations in the trypsinogen gene. Patients who inherit the disorder suffer from a form of pancreatitis that resembles other types of pancreatitis, but the age of onset is much earlier. Sixteen biopsy-proven pancreatic cancers have developed in a cohort of 412 patients with a median follow-up period of 18 years (interquartile range, 7 to 30 years) since the onset of symptoms. Compared with the background population, the risk of pancreatic cancer is approximately 50 to 60 times greater than expected. Smoking appears to be an additional risk factor in these patients: Smoking increases the risk of developing pancreatic cancer and lowers the age of onset by approximately 20 years. Patients with hereditary pancreatitis are urged to avoid smoking because it greatly increases the risk of pancreatic cancer and to avoid alcohol, a known risk factor for all forms of pancreatitis.

Adolescent↗
PubMed2000

Distribution of primary renal diseases leading to end-stage renal failure in the United States, Europe, and Australia/New Zealand: results from an international comparative study.

This report notes the differences in the classification of the primary renal disease (PRD) used in different renal dialysis and transplant registries worldwide. The heterogeneity of coding systems complicates the comparative analysis of end-stage renal disease from different regions. Using data collected over two decades in the United States, Europe, and Australia/New Zealand, we present a method for reorganization of the classes of PRD that allows a straightforward comparison of retrospective data from these registries.

Adult↗