No abstract

The effect of the occlusion of the pancreatic duct system with a new alcoholic solution of amino acids has been studied in animal experiments. The solution becomes solid in the duct system, is microbiologically indifferent and becomes disintegrated within 11 days. This time, however, is sufficient to keep a high-grade atrophy of the exocrine parenchyma. With this method one doesn't risk the provocation of an acute pancreatitis. The development of fistulas following exploratory excision is prevented by the filling of the duct system. The solution could be qualified for a therapeutical acceleration of the "burning-out" of the chronic pancreatitis.

Adenomas of the papilla of Vater are relatively rare tumours. They are of particular interest, not only because of their particular topography, but also because the adenoma-carcinoma sequence - accepted in the colorectum - has also been postulated to apply to the papilla of Vater. In fact, ampullary adenoma is often considered to be a precancerous lesion. To investigate this hypothesis, we reviewed the surgical specimens obtained during Whipple's procedures carried out to treat histologically confirmed carcinoma of the ampulla. A total of 37 surgical specimens obtained since January 1991 were reexamined for the presence of coexisting adenomatous structures. Such adenomatous residues were confirmed in 24/37 (65 %) cases. In 13/37 (35 %) cases, no residual adenoma was found. A comparison of the two groups revealed that detection of coexisting adenomatous structures decreased with increasing tumour progression. In similar manner, this also applied to the degree of malignancy: with increasing grade of malignancy the rate of detectable adenomatous structures decreased significantly. It may be assumed that these observations are due to the 'overgrowth' of preexisting adenomas by carcinomatous tissue. Further evidence is provided by the histological observation of transitional stages from adenoma with mild, moderate and severe cellular atypia to invasive carcinoma. These findings support the hypothesis of an adenoma-carcinoma sequence.

The management of pulmonary aspergilloma is still a topic of discussion. Demonstrating several cases of pulmonary aspergilloma, their clinical course and their follow-up, we try to contribute some arguments for the preference of an early operation. Between 1992 and 1998, 18 patients underwent thoracotomy for treatment of pulmonary aspergilloma. The most common indication for operation were hemoptysis [6] and indeterminate mass [6]. Lobectomy was the most frequent operation [11]. Underlying diseases were bronchiectasis [10], tuberculosis [3], carcinoma [2], blebs [2], and epitheloid granuloma. Two patients had postoperative complications, another three died later in the clinical course because of liver failure, septicemia, and persisting air leakage and sepsis. We recommend early resection of symptomatic, cavitating aspergilloma in the simple form and even with an inflammatory reaction of the surrounding tissue. Especially low-risk patients profit highly from an early operation. High-risk patients should be operated on only in cases of life-threatening complications.

In 6 patients with chronic pancreatitis the exocrine function was inhibited by occlusion of the pancreatic exocrine ducts leading to atrophy of the glands. The function of the pancreatic islets remained intact. This procedure can be combined to advantage with partial resections. Preliminary clinical results are promising and in all cases pancreatic pains disappeared immediately after the operation.