The pancreas from Aristotle to Galen.

BACKGROUND/PURPOSE: The first description of the pancreas in literature is found in Aristotle's Historia Animalium, but it is modified by "so-called". Therefore, the origin is pursued more extensively. METHODS: The Greek-English Lexicon recommends three treatises as a possible original source. These three and Galen's other papers are investigated. In 2005, Sachs et al. suggested an origin of the pancreas might have derived from the intestinal divination using the avian pancreas. This report is evaluated. RESULTS: The avian pancreas which is the intraperitoneal organ, might have been well known by the intestinal divination, and people have called the organ pankreas or kallikreas. Anatomical dissection on human body was not accepted before the Aristotle's time. "So-called pancreas" in Historia must have been interpolated by Theophrastus. He was the most faithful and reliable disciple of Aristotle and succeeded the Aristotle's school. He and Macedonian ruler of Egypt Ptolemy I had known each other and there had been a strong link between them. The contemporary Herophilus performed many public dissections on both human and animal bodies in Alexandria. He named the various parts of the human body and designated the beginning intestine as duodenum. Yet in his extant works, the pancreas is not found. It is surmised that Herophilus may be the first to recognize the human pancreas, which is fixed with retroperitoneal tissue, and he named it "so-called pancreas". Theophrastus might have interpolated Herophilus' designation in Historia Animalium. Galen also uses "so-called pancreas" to designate the human pancreas. CONCLUSION: Galen's descriptions, that is, "Nature created 'so-called pancreas 'and spread it beneath all vessels" are not generally acceptable but propose the very rare portal vein anomalies. Since the early years of the 20th century, cases with a preduodenal portal vein or a prepancreatic portal vein have been reported. Although the incidence is very rare, its surgical importance is emphasized.

[Surgery of the liver and pancreas in Japan--message to the special symposium commemorating Dr. Ichio Honjo].

About half a century ago, Ichio Honjo performed successful right hepatic lobectomy following ligation of the right hepatic artery and the right branch of the portal vein. That was the world's first successful case of right hepatic lobectomy with preliminary hilar ligation of the right branches of both the hepatic artery and portal vein. In the same year, Honjo carried out a total pancreatectomy for pancreatic cancer for the first time in Japan. Since then, marked progress in the surgical fields of the liver and pancreas has been made and appear to have nearly reached the pinnacle. Surgeons in the late half of the 20th century attempted to extend operative interventions and expand surgical fields while devoting themselves to treating incurable diseases. Therefore the period may be called the "challenging era." We are entering the era of evaluation and selection of the procedures most suitable to both the disease stage and each individual patient.