Topics in Acute and Chronic Pancreatitis

264 Pages·1981·13.01 MB·English

by  Professor Dr. A. Dagradi, Prof. C. Banterle (eds.)

Topics in Acute and
Chronic Pancreatitis
Editors
L. A. Scuro and A. Dagradi
Co-Editors
G. P. Marzoli, P. Pederzoli, G. Cavallini,
and C. Banterle
With 95 Figures and 64 Tables
Springer-Verlag
Berlin Heidelberg New York 1981
Proceedings of the International Meeting
held in Padenghe suI Garda (Italy),
14-15th September, 1979
Professor Dr. L. A. Scuro
Istituto Clinica Medica dell'Universita di Padova
Sede in Verona, Policlinico di Borgo Roma
1-37100 Verona (Italy)
Professor Dr. A. Dagradi
Istituto Clinica Chirurgica dell'Universita di Padova
Sede in Verona, Policlinico di Borgo Roma
1-37100 Verona (Italy)
ISBN-13: 978-3-540- I 0439- I e-ISBN-l3: 978-3-642-67879-0
DOl: 10.1007/978-3-642-67879-0
Library of Congress Cataloging in Publication Data. Main entry under title: Topics
in acute and chronic pancreatitis. Proceedings of the international meeting held in
Padenghe sui Garda, Italy, Sept. 14-15, 1979. 1. Pancreatitis-Congresses. I. Scuro,
L.A. (Ludovico Antonio), 1924- . II. Degradi, Adamo. [DNLM: 1. Pancreatitis.
WI 805 T674]
RC858.P35T66 616.3'7 81-5618 AACR2
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Preface
The increasing incidence of both chronic pancreatitis and pan-
creatic cancer was the primary impetus for the organization of this
meeting, an additional factor being the widespread existence of
pancreatic disease within Italy itself.
It is well known that the treatment of chronic and particularly of
acute pancreatitis is still a matter of controversy, and it seemed
useful to compare our own experience with that of other centers
working in the same field. Consequently, in addition to numerous
Italian specialists in the field, doctors from the Federal Republic
of Germany, Denmark, Great Britain, France, and Austria were
invited to attend the meeting.
The symposium lasted two days and comprised eight sessions
dealing with the anatomy and physiology of the pancreas and the
pathophysiology, diagnosis, and treatment of pancreatic diseases.
A central feature of the discussion on the surgical treatment of
chronic pancreatitis was the debate between those who favor the
use of drainage and those who believe resection to be the best
treatment.
Finally, I would like to thank Dr. Cavallini and Dr. Pederzoli very
much for their help in organizing the meeting and also the local
authorities for their aid.
Professor Adamo Dagradi
Director of the Institute
of Clinica Chirurgica,
Verona
Opening Address
I am pleased to welcome all partlclpants and particularly the
guests from abroad, to this meeting on the clinical evaluation of
pancreatitis.
A word about this undertaking, which has two main goals: First,
to state how far we have advanced in our knowledge of pancreati-
tis, from both the pathologic and pathophysiologic points of view,
and to debate questions of diagnosis and medical or surgical thera-
py. Second to compare ideas, views, and information; this also ap-
plies to the sessions, which hopefully will be profitable.
Over the past years interest in pancreatic disease has been increas-
ing, and no doubt the improvement of diagnostic procedures has
enhanced diagnosis, chiefly through radiologic and functional
studies of the pancreas. Such interest is also justified both by the
actual increase in the incidence of pancreatitis and, even more, of
pancreatic cancer, which ranks fourth among neoplasms in several
countries, and by the severity of clinical findings and complica-
tions of acute and chronic pancreatitis. Since in Italy pancreatitis
is mainly related to chronic alcohol abuse, which is a problem at
least as big as drug addiction, a continuons effort should be made to
reduce alcohol consumption to acceptable levels. Also, all alcohol-
related diseases constitute a heavy social burden from the econom-
ic point of view. A deep knowledge of alcohol related diseases and
health education programs should help in facing this problem.
In summing up, this symposium is meant to make some contribu-
tion to the advancement of the study of acute and chronic pan-
creatitis.
Professor Ludovico A. Scuro
Director of the Institute
of Clinica Medica, Verona
Table of Contents
Radiographic Study of the Anatomy ofthe Pancreas (Ho An-
acker) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
Elements of Surgical Anatomy of the Pancreas (Go Po Mar-
zoli, So Vesentini, and Go Mangiante) 0 0 0 0 0 0 0 0 0 0 0 0 11
Physiologic Control of the External Pancreatic Secretion in
Man (Ho W orning) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23
Pancreatic Malfunction - When, How, Why? (Ko Go
Wormsley) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 37
Pancreatic Extracts in Chronic Pancreatitis: Which, How,
and When? (Go Dobrilla, Mo Felder, and Go de Pretis) 55
Radiological Approach to Acute and Chronic Pancreatitis
(Go Fo Pistolesi, C. Fugazzola, C. Procacci, Fo Frasson, and
L. Mazzi) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63
Diagnostic Algorithm for Pancreatic Disease (Go Fontana,
Po L. Costa, A. Vandelli, Go Silvani, Po Maiolo, Mo Melan-
dri, and C. Camporesi) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 85
Morphogenesis of Acute Pancreatitis (Mo Wanke) 0 0 0 0 0 93
The Role of Total Parenteral Nutrition in the Treatment of
Pancreatic Diseases (Ro Dionigi, Uo Prati, C. Tibaldeschi,
and L. Dominioni) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 115
Conservative Surgical Treatment of Acute Necrotic-Haem-
orrhagic Pancreatitis (Po Pederzoli) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 125
Pancreatic Abscess (Po Pederzoli, To Pilon, Co Bassi, and Go
Po Marzoli) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 133
One-Year Follow-Up to Acute Necrotic-Haemorrhagic
Pancreatitis (Go Angelini) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 137
Surgical Treatment of Acute Pancreatitis (A. Fritsch) 0 0 0 143
Surgical Treatment of Acute Pancreatitis (Yo Staudacher, Ro
Chiesa, and Vo Di Carlo) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 153
VIII Table of Contents
Morphology of Chronic Pancreatitis (Y. Becker) . . . . .. 161
Indications for Surgical Treatment of Chronic Pancreatitis
(I. Vantini and C. Cavallini) ................. 173
Intraoperative Cytodiagnosis in Pancreas Disease (E. Bod-
ner) ............................ 183
General Remarks to Chapters 19-21 (F. Gschnitzer) 189
The Pancreas-jejunal shunts (G. P. Marzoli) ..... 191
The Use of Resection in the Treatment of Chronic Pancrea-
titis (R. Pichimayr and K. D. Rumpf) . . . . . . . . . . .. 205
Chronic Pancreatitis: Surgical Indications, Procedures and
Limitations (A. Dagradi) ................... 223
Long Term Results of Pancreaticoduodenalresection (PDR)
in Chronic Pancreatitis (G. Serio) .............. 241
The Endocrine Function of the Pancreatic Residue Mter
Partial Duodenopancreatectomy (K. D. Rumpf) ...... 245
Follow-up of Chronic Pancreatitis. Methodological Consid-
erations. (G. Bianchi Porro, A. Prada and M. Petrillo) 253
Longterm Evolution of Chronic Pancreatitis: The Italian
Experience (L. A. Scuro) .................. .
List of Contributors
Prof. H. Anacker, Direktor des Instituts fUr Rontgendiagnostik am
Klinikum rechts der Isar der TU Miinchen, Ismaningerstr. 22, D-
8000 Miinchen 80
Dr. G. P. Angelini, Istituto Clinica Medica, Universita di Padova,
Sede in Verona, Policlinico B. Roma, 1-37100 Verona
Dr. J. Antonschmidt, Klinik fUr Abdominal- und Trans-
plantationschirurgie, Karl-Wiechert-Allee 9, D-3000 Hannover
61
Prof. C. Banterle, Primario Divisione Medicina Intema, Ospedale
Zonale, I-Besenzano (Brescia)
Dr. C. Bassi, Istituto Clinica Chirurgica, Universita di Padova,
Sede in Verona, Policlinico B. Roma, 1-37100 Verona
Prof. V. Becker, Direktor des Pathologischen Instituts der Univer-
sitat Erlangen-Niimberg, Krankenhausstr. 8-10, D-8520 Erlan-
gen
Prof. E. Bodner, Vorstand der II. Universitatsklinik fUr Chirurgie,
Anichstr. 35, A-6020 Innsbruck
Dr. C. Camporesi, Divisione di Medicina Generale, Ospedale G.
B. Morgagni, 1-47100 Forli
Dr. G. Cavallini, Istituto Clinica Medica, Universita di Padova,
Sede in Verona, Policlinico B. Rom, 1-37100 Verona
Dr. R. Chiesa, Clinica Chirurgica, Universita di Milano, Policlini-
co, 1-20100 Milano
Dr. P. L. Costa, Divisione di Medicina Generale, Ospedale G. B.
Morgagni, 1-47100 Forli
Prof. A. Dagradi, Direttore di Istituto di Clinica Chirurgica Uni-
versita di Padova, Sede in Verona, Policlinico B. Roma, 1-37100
Verona
Dr. Ch. Datan, Klinik fUr Abdominal- und Transplantationschir-
urgie, Karl-Wiechert-Allee 9, D-3000 Hannover 61
x List of Contributors
Dr. G. de Pretis, Ospedale Generale Regionale di Bolzano, Divi-
sione di Gastroenterologia, Via Sernesi 1, 1-39100 Bolzano
Dr. V. Di Carlo, Clinica Chirurgica, Universita di Milano, Policli-
nico, 1-20100 Milano
Prof. R. Dionigi, Istituto di Patologia Chirurgica, Policlinico San
Matteo, 1-27100 Pavia
Prof. G. Dobrilla, Ospedale Generale Regionale di Bolzano, Divi-
sione di Gastroenterologia, Via Sernesi 1, 1-39100 Bolzano
Dr. L. Oominioni, Istituto di Patologia Chirurgica, Polic1inico San
Matteo, 1-27100 Pavia
Dr. M. Felder, Ospedale Generale Regionale di Bolzano, Divisio-
ne di Gastroenterologia, Via Sernesi 1, 1-39100 Bolzano
Prof. G. Fontana, Divisione di Medicina Generale, Ospedale G.
B. Morgagni, 1-47100 Forli
Dr. F. Frasson, Istituto Radiologia, Universita di Padova, Sede in
Verona, Polic1inico B. Roma, 1-37100 Verona
Prof. A. Fritsch, Vorstand der I. Chirurgischen Universitatsklinik,
Allgemeines Krankenhaus der Stadt Wien, Aiserstr. 4, A-1090
Wien IX
Dr. C. Fugazzola, Istituto Radiologia, Universita di Padova, Sede
in Verona, Polic1inico B. Roma, 1-37100 Verona
Prof. F. Gschnitzer, Vorstand der I. Universitatsklinik fUr Chirur-
gie, Allgemeines Krankenhaus, A-6020 Innsbruck
Dr. P. Maiolo, Divisione di Medicina Generale, Ospedale G. B.
Morgagni, 1-47100 Forli
Dr. G. Mangiante, Istituto di Clinica Chirurgica, Universita di Pa-
dova, Sede in Verona, Polic1inico B. Roma, 1-37100 Verona
Dr. L. Mazzi, Istituto Radiologia, Universita di Padova, Sede in
Verona, Polic1inico B. Roma, 1-37100 Verona
Prof. G. P. Marzoli, Istituto di Clinica Chirurgica, Universita di
Padova, Sede in Verona, Polic1inico B. Roma, 1-37100 Verona
Prof. H.-J. Mitzkat, Arbeitsgruppe Oiabetologie, Medizinische Po-
liklinik der Medizinischen Hochschule Hannover, 0-3000 Hanno-
ver 61
Dr. M. Melandri, Divisione di Medicina Generale, Ospedale G. B.
Morgagni, 1-47100 Forli
Dr. P. Pederzoli, Istituto Clinica Chirurgica, Universita di Padova,
Sede in Verona Polic1inico B. Roma, 1-37100 Verona
List of Contributors XI
Dr. M. Petrillo, Servizio di Gastroenterologia, Ospedale L. Sacco,
Via G. B. Grassi 74,1-20157 Milano
Prof. R. Pichlmayr, Klinik fur Abdominal- und Transplantations-
chirurgie, Karl-Wiechert-Allee 9, D-3000 Hannover 61
Dr. T. Pilon, Istituto Clinica Chirurgica. Universita di Padova,
Sede in Verona, Policlinico B. Roma, 1-37100 Verona
Prof. G. F. Pistolesi, Direttore Istituto Radiologia, Universita di
Padova, Sede in Verona, Policlinico B. Roma, 1-37100 Verona
Dr. G. Bianchi Porro, Servizio di Gastroenterologia, Ospedale L.
Sacco, Via G. B. Grassi 74, 1-20157 Milano
Dr. A. Prada, Servizio di Gastroenterologia, Ospedale L. Sacco,
Via G. B. Grassi 74, 1-20157 Milano
Dr. U. Prati, Istituto di Patologia Chirurgica, Policlinico San Mat-
teo, 1-27100 Pavia.
Dr. C. Procacci Istituto Radiologia, Universita di Padova, Sede in
Verona, Policlinico B. Roma, 1-37100 Verona
PD Dr. K.-D. Rumpf, Klinik fUr Abdominal- und
Transplantationschirurgie, Karl-Wiechert-Allee 9, D-30oo Han-
nover 61
Prof. L. A. Scuro, Direttore Istituto Clinica Medica, Universita di
Padova, Sede in Verona, Policlinico B. Roma, 1-37100 Verona
Prof. G. Serio, Istituto Clinica Chirurgica, Universita di Padova,
Sede in Verona, Policlinico B. Roma, 1-37100 Verona
Dr. G. Silvani, Divisione di Medicina Generale, Ospedale G. B.
Morgagni, 1-47100 Forli
Prof. V. Staudacher, Direttore Clinica Chirurgica, Universita di
Milano, Policlinico, 1-20100 Milano
Dr. C. Tibaldeschi, Istituto di Patologia Chirurgica, Policlinico
San Matteo, 1-27100 Pavia
Dr. A. Vandelli, Divisione di Medicina Generale, Ospedale G. B.
Morgagni, 1-47100 Forli
Dr. I. Vantini, Clinica Medica, Universita di Padova, Sede in Ve-
rona, Policlinico B. Roma, 1-37100 Verona
Dr. S. Vesentini, Istituto di Clinica Chirurgica, Universita di Pa-
dova, Sede in Verona, Policlinico B. Roma, 1-37100 Verona
Prof. M. Wanke, Chefarzt des Pathologischen Instituts, Stadtkran-
kenhaus Rendsburg, Akademisches Lehrkrankenhaus der Univer-
siHit Kiel, Lilienstrasse, D-2370 Rendsburg