Subject(s)
Angiography , Arteries/anatomy & histology , Adolescent , Adult , Animals , Anthropometry , Aorta, Abdominal/anatomy & histology , Aortography , Autopsy , Child , Dogs , Fingers/blood supply , Humans , Hypertension/diagnostic imaging , Iliac Artery/anatomy & histology , Iliac Artery/diagnostic imaging , Mesenteric Arteries/diagnostic imaging , Middle Aged , Regional Blood Flow , Renal Artery/diagnostic imagingABSTRACT
Endoscopic retrograde cholangiopancreatography (E.R.C.P.) was attempted in 31 patients suffering from repeated attacks of acute pancreatitis. Pancreatograms were obtained in 25 patients. Twelve showed definite "surgical lesions" (obstructions, strictures, or pseudocysts). In at least three patients failure to obtain a pancreatogram was due to obstruction of pancreatic duct close to the papilla. Two patients, both with pseudocysts, developed a mild relapse of pancreatitis after the procedure. Surgical intervention based on the x-ray findings seemed beneficial in the short follow-up period.Endoscopic pancreatography can be of value in deciding when surgery is advisable for patients with relapsing acute pancreatitis and in determining the operative appreach. It is an advance in the management of a difficult clinical condition.
Subject(s)
Pancreatitis/diagnostic imaging , Acute Disease , Adult , Aged , Alcohol Drinking , Cholangiography , Common Bile Duct/diagnostic imaging , Endoscopy , Female , Humans , Male , Methods , Middle Aged , Pancreatic Cyst/diagnostic imaging , Pancreatic Ducts/diagnostic imaging , RecurrenceABSTRACT
Difficulty in excluding duodenal ulceration by standard radiology has hampered investigation of duodenitis; endoscopy and biopsy add a new dimension. We have studied 51 patients with dyspeptic symptoms or bleeding in whom endoscopy revealed congested and irregular areas of duodenal bulb mucosa in the absence of ulcer or scar. Biopsy revealed unequivocal active inflammation-epithelial cell atypia and neutrophil infiltration-in 22 of these patients, but in none of 29 "control" patients with an endoscopically normal bulb. There were no reliable radiological markers of active duodenitis. These patients, and a group of 25 with known duodenal ulcers, shared similar clinical characteristics and a high incidence of gastric metaplasia in the bulb. In the short follow-up period most patients with active duodenitis remained symptomatic; two developed ulcers, and two others have undergone vagotomy and pyloroplasty, with poor short-term results. The clinical significance of visual and histological mucosal changes, and their relationship with ulcer disease, merit long-term study.
Subject(s)
Duodenal Diseases/diagnosis , Adolescent , Adult , Aged , Biopsy , Child , Duodenal Diseases/complications , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/pathology , Duodenal Diseases/surgery , Duodenal Ulcer/etiology , Duodenum/pathology , Endoscopy , Epithelial Cells , Follow-Up Studies , Humans , Inflammation/complications , Inflammation/diagnosis , Inflammation/diagnostic imaging , Inflammation/pathology , Inflammation/surgery , Intestinal Mucosa/pathology , Middle Aged , Neutrophils , RadiographyABSTRACT
A simultaneous combined pancreatic test can be performed in one morning with only one intubation of the duodenum. The test includes the measurement of exocrine pancreatic secretion of bicarbonate, enzymes, and radioactive selenium, pancreatic scanning, hypotonic duodenography, and cytology of the duodenal aspirate. In the first 70 patients it was found that a single secretion test was of only limited value in detecting pancreatic disease; cytology was the most reliable and scanning the least reliable single test; and that the combined test provided near-complete discrimination between patients with no pancreatic disease, with chronic pancreatitis, and with carcinoma of the pancreas.