[Detailed analysis of human pancreatic secretions collected by retrograde catheterization. Parallel or non-parallel excretion of digestive enzymes?]. / Analyse détaillée de sécrétions pancréatiques humaines récoltées par cathétérisme rétrograde. Excrétion parallèle ou non parallèle des enzymes digestives?

Pancreatic juices were collected by selective reverse catherism of the chief pancreatic duct in two patients, one free from pancreatic disease and the other having a pancreas cancer. They were analysed in detail especially in order to get information on the mechanism of enzyme excretion. The variations of the digestive enzyme activities (amylase, lipase, trypsin, chymotrypsin, carboxypeptidase A and B) were not superimposable among them or with the fluctuations of the protein concentration in the pancreatic juice samples. These results agree with a non-parallel enzyme-excretion mechanism by the pancreas. However deep electrophoresis analyses of pancreatic juice samples showed that the ratio of each digestive enzyme concentration remained almost constant in the same patient. This observation disagrees with the above conclusion and suggests that the data obtained by using classical methods for estimating digestive enzyme activities have to be considered prudently. By another way, two main significant differences were reported by analysing the ionic composition of the pancreatic juice samples following their origin. The pancreatic juice samples of the patient having a pancreas cancer had a lower and more variable Na+ concentration than those coming from the patient who was free from pancreas disease. They had a HCO3- concentration which was almost constant, contrary to what was observed for the pancreatic juice secreted by the other patient.

Mucinous cystadenocarcinoma of the pancreas. Ultrasonographic findings in 5 cases.

The ultrasonographic findings in 5 patients (4 males, 1 female, mean age 70 years) presenting with mucinous cystadenocarcinoma of the pancreas are described. The lesion was located in the head and body of the pancreas in 2 cases, in the head alone in 2 others, and in the tail in one. The size ranged from 40 to 85 mm (mean 64 mm). Internal septa were seen in 5 patients, endocystic proliferation in 2, parietal calcifications in 1 and mixed cystic-solid areas in 3. The estimation of CEA in the fluid collected by sonographic guided puncture may be useful in diagnosis. Guided microbiopsy and fine needle cytology performed in 3 cases confirmed the diagnosis. Moreover, ultrasonography clearly showed the modifications of the vessels (splenic and portal veins, inferior vena cava) secondary to the tumor. It is concluded that ultrasonography with guided puncture is a simple, inexpensive and effective method for the diagnosis of mucinous cystadenocarcinoma of the pancreas.

Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases.

This paper reports on the technique and results of 20 endoscopic diversions into the duodenum of cysts complicating chronic pancreatitis in 19 patients. The procedure, performed safely on the condition of visualization of a compression of the duodenal wall by the cyst, was successful 18 times in 17 patients. Complications occurred in four patients: two with bleeding (resulting in the death of one patient), two perforations treated successfully, and one transient cholangitis. Long-term results (average = 20.7 months) in 13 patients who were followed more than 6 months were good nine times, fair three times, and bad in one case. Endoscopic cysto-digestive diversion appears as an interesting alternative to surgery in selected patients with chronic pancreatitis.