This report summarizes the course of a patient with asymptomatic chronic pancreatitis associated with hemorrhage into the pancreatic duct and metastatic fat necrosis. Retrograde cannulation of the pancreatic duct and superior mesenteric arteriography established the presence of a pseudocyst with a pancreatic duct-arteriovenous (DAV) fistula as the cause of the syndrome. Ligation of feeder vessels with external drainage of the cyst as the initial surgical procedure stopped the bleeding but failed to prevent recurrence of the pancreatic duct-venous fistula. A pancreaticoduodenectomy with resection of the cyst and fistula was required to arrest destruction of distant tissues. Although serum and urine amylase concentrations were markedly elevated, serum lipase levels were normal throughout the patient's course. Elevation of serum lipase does not seem to be a necessary condition for the development of the metastatic fat necrosis syndrome.

Three surface methods for measuring lumbar sagittal motion (LSM) were tested for reliability. The three methods used were the Pleurimeter V double inclinometer, the carpenter double inclinometer, and the computerized single sensor inclinometer. In this study, 30 volunteers were examined independently by three occupational health professionals. Each volunteer rotated twice through three stations at which LSM was measured by each of the three methods. The intra- and interexaminer reliabilities in identifying the skin levels of T12 and S1 were acceptable, having intraclass correlation coefficients (ICC) greater than or equal to 0.75. With a single exception, all ICC values for the intraexaminer reliability of LSM measurements fell below 0.90 (a clinically desirable level). The interexaminer reliability was poor, with all ICC values below 0.75. The largest source of measurement error was attributable to the examiner and its associated factors. We concluded that the intra- and interexaminer reliabilities varied greatly, limiting the clinical usefulness of the three surface methods.