Surgery for chronic pancreatitis: what quality of life ahead?

We attempted to evaluate the quality of life of patients with proved long-lasting chronic pancreatitis. We measured the clinical and psychological status of 60 patients who had undergone various surgical treatments for their disease. The presence and severity of depression and other symptoms of distress were assessed, as were disease-specific functional and physical problems. Few patients had serious conditions, such as pain, malnutrition, or psychoneurotic complaints. The relation between depression and the time of onset of symptoms and of surgery appeared doubtful, and no statistically significant correlations were found between severity of emotional disturbance and other functional characteristics. Insulin-dependent diabetes and correlated diseases had the most negative influence on everyday well-being. Postoperative follow-up and the need for recurrent medical control and care did not lead to negative feelings.

Effect of octreotide acetate on pancreatic exocrine and endocrine functions after pancreatoduodenal resection.

In view of forecasting the effect of octreotide acetate (Sandostatin) in preventing fistula formation after pancreatic surgery, 9 patients, who had pancreatoduodenectomy 8-12 days before, underwent a 2-day study. The first day, by means of a catheter located in the jejunal loop separately anastomosed to the pancreatic remnant, basal and after secretin stimulation pancreatic secretion was evaluated. During the 2nd day the possible inhibitory effect of octreotide on basal and stimulated secretion was investigated. Under the experimental conditions of the study Sandostatin showed little effect on the water and bicarbonate increase as stimulated by secretin. A greater hormone inhibitory effect on amylase production and pancreatic endocrine function was seen. On the basis of these results the use of Sandostatin can hardly be seen as useful in preventing fistula formation after pancreatic resection.

[Malignant mesenchymal tumors of the breast. Report of 3 new cases]. / Tumori mesenchiamali maligni della mammella. A proposito di tre nuovi casi.

Malignant tumors of the breast arising from the connective tissue of the gland are rare and underestimated. Three new cases are here reported: 1 malignant fibrous histiocytoma and 2 malignant phylloides tumors. Tumor size, mammographic findings and cytologic aspect of the needlebiopsy lead to the correct diagnosis. Large excision or radical mastectomy are treatments of choice, while axillary lymph nodes dissection does not appear justified, since metastatic spread via lymphatics is rare. Postoperative radiation and chemotherapy seem not effective in preventing local recurrences.

[Adrenal cystic masses. Our experience]. / Formazioni cistiche surrenaliche. Nostra esperienza.

Cystic masses of the adrenal gland are clinically and pathologically rare findings and few cases have been reported up to now in the medical literature. In the present work 5 new cases are reported: 3 adrenal pseudocysts, 1 lymphangioma, 1 cystic pheochromocytoma. In 3 cases there were clinical symptoms of retroperitoneal mass (lumbar pain, palpable mass, digestive symptoms); in 3 cases conventional radiology was helpful; ultrasonography was used for diagnosis in 1, CT scan in 2. In the pheochromocytoma case the real nature of the mass was determined through fluid hormone determination after fine needle puncture. All cases were treated by surgery.

[Clinical course of diabetes in patients operated upon for chronic pancreatitis]. / Evoluzione del diabete nei pazienti operati per pancreatite cronica.

Diabetes evolution among patients who underwent surgery for chronic pancreatitis has been evaluated (10 had left pancreatectomy, 23 pancreatoduodenectomy, 39 pancreaticojejunostomy, 13 other operations not on the pancreas). On the basis of insulin needs for achieving a normal glycemic status, left pancreatectomy proves to cause or at least to hasten the development of diabetes which appears hardly kept under control and easily followed by complications. The choice of such surgical treatment should be justified, besides the local pathologicoanatomic situation, by a well established endocrine impairment.