Contributions of Magnetic Resonance Imaging to Gastroenterological Practice: MRIs for GIs.

MRI has transformed from the theoretical, investigative realm to mainstream clinical medicine over the past four decades and has become a core component of the diagnostic toolbox in the practice of gastroenterology (GI). Its success is attributable to exquisite contrast and the ability to isolate specific proton species through the use of different pulse sequences (i.e., T1-weighted, T2-weighted, diffusion-weighted) and exploiting extracellular and hepatobiliary contrast agents. Consequently, MRI has gained preeminence in various GI clinical applications: liver and pancreatic lesion evaluation and detection, liver transplantation evaluation, pancreatitis evaluation, Crohn's disease evaluation (using MR enterography) rectal cancer staging and perianal fistula evaluation. MR elastography, in concert with technical innovations allowing for fat and iron quantification, provides a noninvasive approach, or "MRI virtual liver biopsy" for diagnosis and management of chronic liver diseases. In the future, the arrival of ultra-high-field MR systems (7 T) and the ability to perform magnetic resonance spectroscopy in the abdomen promise even greater diagnostic insight into chronic liver disease.

Innovation and hard work: The 2015 George E. Palade Medal Award Lecture.

The George E Palade Medal is the highest honor awarded by the International Association of Pancreatology and is given to an individual who has made outstanding contributions to the understanding of the pancreas and pancreatic diseases. Professor David C Whitcomb, University of Pittsburgh, is the 2015 recipient. The Palade Lecture, presented in Shanghai, China on August 28, 2015, included 5 personal stories that provide perspective from a life-time of achievement: "My life in a nutshell"; "Two old ladies"; "7777"; "I helped put a man on the moon"; and "Rugby". Together, the stories provide encouragement to a younger generation, struggling to find their way as physicians and scientists who are working on pancreatic or other diseases in a challenging world.

A semicentennial of pancreatic pathology: the genetic revolution is here, but don't throw the baby out with the bath water!

The last 50 years have witnessed an explosion in our understanding of the pathology of pancreatic diseases. Entities known to exist 50 years ago have been defined more precisely and are now better classified. New entities, previously not recognized, have been discovered and can now be treated. Importantly, new tools have been developed that have unraveled the fundamental biological drivers of a number of pancreatic diseases. Many of these same tools have also been applied clinically, supplementing the tried and true hematoxylin and eosin stained slide with a plethora of new, highly sensitive and specific tests that improve diagnostic accuracy and delineate best treatments. As exciting as these many advances are, our knowledge of pancreatic pathology remains incomplete, and there is much to be learned.

Congress presidential address to the 30th meeting of the JSHBPS: the second opening of Japan on the way to a bright future.

The 30th meeting of the JSHBPS is the first domestic meeting of our society to have been organized completely in English. In that sense, we have established the theme of the 30th meeting of the JSHBPS as "The Second Opening of Japan on the Way to a Bright Future". Last 30 years, several strategies have been undertaken to battle hepatobiliary (HPB) malignancies, such as aggressive operative procedures, operative planning using state-of-the-art technologies, neoadjuvant therapy, conversion surgery for initially unresectable diseases, and immunomodulation. According to the rapid development of precision medicine, HBP surgeons should have a literacy for individualized therapy. Here, I review recent improvements in regard to HBP surgery. In addition, education for the next generations should be our highest priority. Collaboration with foreign researchers is the most effective tool to promote personal growth.

'Do research with seriousness and perseverance'. An interview with Prof. Lucio Gullo. Interview by Martin E. Fernandez-Zapico.

In the current interview Prof. Lucio Gullo, a worldwide-recognized pancreatologist for his contribution on the understanding of the pathogenesis and clinical aspects of a number of pancreatic diseases including benign pancreatic hyperenzymemia, shares with Pancreatology his life experiences as a scientist in pancreatic research.

'In a certain sense Dr. William Osler has been my best mentor'. An interview with Prof. Tadashi Takeuchi by Martin E. Fernandez-Zapico.

Tadashi Takeuchi is a Professor Emeritus of the Tokyo Women's Hospital University, one of the founders of the Japan Pancreas Society and first Editor-in-Chief of its official journal. His research contributed enormously to the understanding of the role of gastrointestinal hormones in pancreatic physiology as well as disease. In this interview, Professor Takeuchi discusses the importance of mentorship during career development.

Professor HT (Harry) Howat: prime leader in pancreatology development in the UK.

Positioned in the posterior abdomen, the pancreas remained little observed until nineteenth century advances in physiology, followed later in the century by abdominal surgery, brought the organ into the clinical domain. The discovery of pancreatic stimulating hormones during the twentieth century culminated in the description of pancreozymin by Harper and Raper in Manchester in 1943. After World War II, Henry T Howat was appointed physician in that city and was able to analyse the results of hormonal stimulation in pancreatic disorders. He became the first doctor in Britain to specialise in pancreatology. His collaboration with colleagues in Britain and in Europe, through the evolution of specialist societies, encouraged the coordination of basic science, medicine, pathology, radiology and surgery, to further research in, and management of, pancreatic disease. Academic recognition by Manchester University resulted in his being appointed its first Professor of Gastroenterology and originator of a gastrointestinal research unit. As he pointed out, continuing scientific and technological advances influenced the concepts of disease, and moved the management of pancreatic disease from the general physician and surgeon to gastroenterologists. Howat's career illustrates the continuing specialisation witnessed in the latter half of the twentieth century.

A history of diabetes mellitus or how a disease of the kidneys evolved into a kidney disease.

Diabetes mellitus has a long history during which it was considered to be a disease of the kidneys well into the middle of the 19th century. Recognized in antiquity from its excessive urine output and described as a disease of the urinary tract, its clinical features and fatal outcome were quite accurately recorded by the 1st century ad . Galen (129-200) described it as a disease specific to the kidneys because of a weakness in their retentive faculties. The sweet taste of diabetic urine, which is described in ancient Indian texts and noted by Avicenna (980-1037) and Morgagni (1635-1683), was attributed to the passage of absorbed water and nutrients unchanged into the urine. In 1674, Thomas Willis (1621-1675) first differentiated diabetes from other causes of polyuria by the sweet taste (quasi melle) of diabetic urine and suggested that the sweetness first appears in the blood. A century later, Matthew Dobson (1732-1784) showed that the urine sweetness was because of sugar and was preceded and accompanied by sugar in the blood. Although diabetes then came to be ascribed to increased sugar in the blood, the presence of sugar in the urine continued to be attributed to the decreased retentive properties of the kidneys. The experimental production of diabetes in pancreatectomized dogs that could be reversed by subcutaneous pancreatic transplantation in 1889, and ultimate isolation of insulin in 1922 clearly established diabetes as an endocrine disease. The stage of diabetes as a disease of the kidneys was now over but that of diabetes as a cause of kidney disease was yet to come. Diabetes as a cause of end stage kidney disease was first described in 1936 and extensively documented shortly thereafter, whereas the evidence of its increasing prevalence as a cause of chronic kidney disease continues to accrue.

The Beginnings of Pancreatology as a Field of Experimental and Clinical Medicine.

This review presents the history of discoveries concerning the pancreas. In antiquity and the Middle Ages knowledge about the anatomy of the pancreas was very limited and its function was completely unknown. Significant progress was first made in the seventeenth and eighteenth centuries. Johann Georg Wirsüng, the prosector of the University of Padua, discovered the main pancreatic duct, and Giovanni Santorini discovered the accessory duct. Regnier de Graaf was the first to perform pancreatic exocrine studies, and Paul Langerhans's 1869 discovery of pancreatic islets was the first step toward recognizing the pancreas as an endocrine gland. The twentieth century brought the discovery of insulin and other pancreatic hormones. To date, histochemical staining, transmission electron microscopy, and immunohistochemistry enabled the discovery of five cell types with identified hormonal products in adult human pancreatic islets. Twentieth-century pancreatic studies led to crucial advances in scientific knowledge and were recognized, among other things, with seven Nobel Prizes. The first of these went to Ivan Pavlov in 1904 for his work on the physiology of digestion. The most recent was awarded to Günter Blobel in 1999 for discovering signaling mechanisms that govern the transport and localization of proteins within pancreatic acinar cells.

Pancreatic diseases past and present: a historical examination of exhibition specimens from the Collectio Rokitansky in Vienna.

The Viennese collection of pathological specimens (Collectio Rokitansky) comprises a large number of objects from all fields of pathological anatomy and is one of the largest historical collections in the entire world. We reviewed the original diagnoses in a series of pancreatic specimens using modern histopathological techniques. It was found that the histological structure of eleven pancreatic specimens was surprisingly well preserved. In three cases of extrapancreatic pseudocysts, we identified chronic pancreatitis as the underlying disease. Two specimens contained tumours that proved to be ductal adenocarcinomas. A third, rather large tumour was identified as a solid-pseudopapillary carcinoma and a fourth one as a neuroendocrine carcinoma. The remaining cases were classified as fibrotic atrophy, congenital cysts, microcystic serous cystadenoma, and necrotic sequestration of the pancreas. The application of immunohistochemical methods failed. In conclusion, the surprisingly well-preserved exhibits from the Collectio Rokitansky, which have been on display for more than 100 years, are accessible to modern histopathological investigation without the use of immunohistochemical techniques. Such examinations allow us to assess the occurrence of diseases and tumours in the sociocultural environment of the 19th century.

History of the pancreas.

The pancreas was generally ignored in antiquity, both as an organ and as a seat of disease. The first description of the pancreas is attributed to Herophilus. It was in the 17th century that the main duct of the organ was described and its significance demonstrated. At that time, Brunner thought that the pancreas was not essential to digestion, and he failed to associate the pancreas with diabetes. Claude Bernard discovered the function of the pancreas in digestion. In 1922, Banting and Best obtained isletin and demonstrated the capacity of the substance to cause a dog to recover from diabetic coma. In 1889, Reginald Fitz firmly established pancreatitis as a disease entity. In 1927, the first case of hyperinsulinism due to a tumor of the islet cells was reported. Twenty-eight years later, Zollinger and Ellison described two patients with unusually severe peptic ulcer disease, both of whom had noninsulin-secreting tumors of the pancreatic islets. Subsequently, gastrin was isolated as the hormone responsible for this syndrome. In March 1940, Dr. O. Whipple performed the first recorded one-stage pancreaticoduodenectomy. Much progress has been made since then and today transplantation of isolated islets and portions of whole pancreas is a reality.

The pancreas.

Pancreatic secretion was first studied at The Mount Sinai Hospital by Crohn in 1912, but measurements of pancreatic enzymes in duodenal aspirate or feces were found unhelpful in diagnosis. Such pancreatic tests fell into disuse because of advances in radiology of the biliary tree in the 1920s. Once extracts of secretin and cholecystokinin-pancreozymin became available from Sweden in the 1930s, it became possible for the biochemist Franklin Hollander and the surgeon David Dreiling to develop pancreatic secretion tests into practical procedures for the diagnosis of benign and malignant diseases of the pancreas and biliary tree, and produce physiological studies of the mechanisms of ion transport. With more purified hormones, it became possible to measure maximum (alkaline) bicarbonate output of the pancreas analogous to the maximal acid response of the stomach to an augmented histamine test, and to determine whether patients with duodenal ulcer had decreased neutralization of gastric acid in the duodenum. Clinical studies were also directed to the pathophysiology of acute relapsing and chronic pancreatitis and carcinoma. However, advances in imaging and endoscopy have now shifted the thrust of pancreatology.

Los premios Nobel y el conocimiento pancreático / Nobel prizes and the pancreatic knowledge

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