SUMMARY The salivary and pancreatic isoamylases of serum were determined separately in 234 cases ofduodenoscopy and retrograde cholangiopancreatography. Successful pancreatic opacification was associated with pathologically high pancreatic serum amylase activities in 60% of the cases.Extensive opacification was associated with large increases of pancreatic serum isoamylases, the maximal rise recorded was 40 times the initial value. In spite of these striking chemical events only two patients developed clinical acute pancreatitis. There were some variations in pancreatic opacification and in the elevation of pancreatic serum amylase which seemed to depend upon the particular contrast material used. A rise of the salivary serum isoamylases caused pathologically high total serum amylase activities in 7% of the cases. High levels of pancreatic serum isoamylase activity before the time of examination did not result in any different pattern of hyperamylasaemia.

Gastroduodenal erosions were observed endoscopically and shown by double-contrast radiology in nine of 38 patients who had established Crohn's disease elsewhere in the intestinal tract. One of the nine patients was known to have duodenal involvement by Crohn's disease, but in the other eight there was no clinical suspicion of upper gastrointestinal disease. The possible significance of this finding is discussed.

The concentrations of pancreatic amylase, immunoreactive trypsin, and immunoreactive pancreatic specific trypsin inhibitor have been studied in serum drawn from 258 patients before an endoscopic retrograde cholangiopancreatography (ERCP) examination, in which both ducts were successfully filled. The results are correlated to the morphology of the ducts and the diagnosis given at the ERCP examination. One third of the patients with normal morphology of both ducts showed an abnormal concentration of at least one of the measured specific pancreatic proteins. Sixteen out of 38 patients with changes suggestive of chronic pancreatitis and 6 out of 23 patients with changes suggestive of pancreatic cancer showed normal levels of all variables measured. The sensitivity and specificity for pancreatic disease evident by ERCP were around 0.40 and 0.80, respectively, for all three proteins.

SUMMARY It has been difficult, employing clinical methods, to establish whether pancreaticoenteric drainage shunts for chronic pancreatitis have remained patent and how the operation has affected the inflammatory changes and ductal pathological morphology. In an attempt objectively to evaluate postoperative results, 13 patients with two different types of pancreatico-jejunostomies were examined with endoscopic pancreatography. Progress of the inflammatory changes was noted to a varying degree in the majority of cases. In four patients subjected to longitudinal split of the pancreatic duct, shunt patency was evidenced. In the remaining nine patients with caudal pancreaticojejunostomy, no contrast medium could be made to pass the shunts in six cases, whereas passage was clearly demonstrated in one and uncertain in two. All the patients reported clinical improvement after operation. This paper reports an attempt at objective evaluation of postoperative results utilizing ERCP in a series of patients operated upon for chronic and acute relapsing pancreatitis, with various types of pancreatico-jejunostomy.The main interest will be focused on three issues:

In an autopsy series comprising 235 clinically unrecognized renal cell carcinoma metastatic spread was revealed in 24%. The number of metastasizing tumours increased significantly with the size of the primary tumour. Local aggressiveness of the primary tumour was more common for large tumours but was much more closely correlated to metastatic spread than to size. Tumours ingrowth in the renal vein was significantly commoner in metastasizing tumours as compared to non-metastasizing tumours. The study confirmed that an analysis as to local aggressiveness was prognostically valuable and might be useful to define the group of patients that may benefit from adjuvant therapy such as radiation therapy, chemotherapy or immunotherapy.