Exocrine pancreatic function has been evaluated in 24 controls and 29 patients with confirmed chronic pancreatitis by continuous infusion (90 min) of synthetic caerulein, 100 ng/kg/h, plus GIH secretin, 1 CU/kg/h. Mean secretory values of the controls were comparable to those obtained by others using maximal doses of secretin and CCK. Unlike the controls, patients suffering from chronic pancreatitis demonstrated a progressive reduction in secretion during infusion. Thus, the comparison of responses for the final 30-min period gave much clearer and more complete discrimination between normal and abnormal pancreatic function than the preceding 30-min period.
A new endoscopic method for retrograde cholangiography in cases of unsuccessful cannulation of the papilla is described. In 1 patient with obstructive jaundice, severe diabetes and a previous history of biliary pain traditional ERC failed. An endoscopic artificial choledocho-duodenal fistula by means of a diathermic cutter (needle type) was performed at the lower end of the intramural portion of the common bile duct for retrograde cholangiography. X-ray showed an obstruction of the common bile duct due to a carcinoma of the head of the pancreas. Complications did not occur during the procedure and in the post-operative period. It is concluded that the described method may be helpful when traditional selective ERC fails, moreover it may permit an endoscopic choledocho-duodenostomy for choledocholithiasis in cases of unsuccessful endoscopic papillo-sphincterotomy.
Echography is a fairly recent addition to the methods available for the diagnosis of pancreatic disease and as little work has been reported in this field its diagnostic value has yet to be fully evaluated.The normal pancreas is not always well visualized by echography and it is often difficult to distinguish from the surrounding structure; on the other hand, the diseased pancreas, which is usually enlarged and structurally altered, gives a well-defined picture which may be of great assistance in diagnosis (Engelhardt and Blauenstein, 1970;Filly and Freimanis, 1970;Templeton and Stuber, 1971;Weill et al., 1971;Stuber et al., 1972). In chronic pancreatitis, the characteristic feature of the echogram is total or partial enlargement of the gland and areas of non-homogeneous structure consisting of low echo zones alternating irregularly with high echo zones which may involve the entire pancreas or be confined to certain sections (Filly and Freimanis, 1970). In carcinoma of the pancreas echography reveals enlargement generally confined to one section of the gland, fairly uniform structure, and irregular outlines (Rettenmaier, 1975;Weill et al., 1975). However, it is in the diagnosis of pancreatic cysts that echography gives the clearest picture Received for publication 9 January 1976 showing up transonic areas (typical of fluid collection) which appear as zones completely devoid of echos (Leopold, 1972).In the present study, we describe our experience with this technique in disorders of the pancreas, attempting to assess its value as a diagnostic tool and comparing the results with those obtained from other diagnostic techniques.
Method
The clinical and pathological features of 2 8 lung cysts resected in the period 1980-1989, excluding those from patients with emphysema elsewhere in their lungs, have been reviewed. In 1 2 children aged 8 days to 1 7 years, five cysts were congenital adenomatoid malformations. three were bronchogenic cysts. two were intralobar sequestrations, one was a cystic haemangioma and one resembled the cysts excised from 16 adult patients. This latter group ranged in age from 2 0 to 62 years and included 1 1 cigarette smokers and five asthmatics. Twelve of these cysts were intralobar and four were attached by a pedicle to the pleural surface of the lung. All these cysts had a fibromuscular wall showing varying degrees of acute and chronic inflammation. The presence of at least a partial lining of epithelial cells in all the cysts was confirmed using a n immunocytochemical marker. The surrounding lung did not show any significant pathology. These cysts are labelled as simple fibromuscular pulmonary cysts. In the childhood cases, a congenital cause could be established in the majority. The pathogenesis of the adult cysts remains unclear. The presence of inflammation in the cyst walls does not necessarily suggest a role for infection, as secondary infection of cysts cannot be ruled out. An aetiological role for local damage due to cigarette smoking or asthma must be taken into consideration.
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