The effect of oral dissolution therapy for pancreatic stones was evaluated in patients with chronic calcific pancreatitis. The anti-epileptic agent trimethadione was given orally to 30 outpatients at a dose of 0.9-1.5 g daily. On plain X-ray films and CT scans of the abdomen, pancreatic stones began to be dissolved around 8 months of treatment, and diminished in size and number or disappeared in 21 patients (70%) during the mean follow-up period of 32 months. The effect of trimethadione treatment on dissolution of stones was not closely related to the aetiology of the disease, distribution and size of stones, previous history of surgical interventions, or the degree of pancreatic dysfunctions. In three patients who stopped this medication of their own accord, pancreatic stones re-increased or reappeared about 6 months later. During trimethadione treatment, impaired exocrine pancreatic function returned to normal in four of nine patients examined, and diabetes mellitus was well controlled by either diet therapy alone or oral hypoglycaemic agents in eight of 10 patients who did not need insulin before trimethadione treatment. Complete relief of pain was noted in 73% of patients during the treatment. Overall gains and no change in bodyweight were observed in 83% of patients. Mild photophobia was the most common side effect, but could be easily overcome by wearing sunglasses. No severe side effects were observed in the liver, kidney, blood or the eyeground. Pancreatic stones in 30 patients not treated with trimethadione neither disappeared nor diminished spontaneously. Trimethadione treatment may be a useful tool for chemical dissolution of pancreatic stones.

A 33-year-old male was admitted to Takano Hospital with fainting spell and diaphoresis due to massive terry stool. He had been working and in good health until 2 days before admission. Urgent duodenal endoscopy disclosed hemorrhage from an angiomatous lesion of the duodenum. A duodenal resection with duodenojejunostomy was performed. Pathologic examination revealed a cavernous hemangiomatosis of the duodenum. The patient had a good postoperative course. Hemangioma of the intestinal tract is rare. To our knowledge, the present case is the first case in which urgent endoscopy has succeeded in establishing the preoperative diagnosis of this lesion and ascertaining the bleeding point.

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It is generally accepted that the main constituent of pancreatic stones is calcium carbonate (CaCO3) . In order to detect the mechanism of dissolution of pancreatic stones by two types of organic acid, dimethadione (DMO) and citric acid, comparative in vitro experiments were performed by using the chemical agent of CaCO3. Bicarbonate aqueous solution, nonboiled and boiled canine pancreatic juice (bicarbonate concentration: 0 to 104 mmol/L) were used as the solvent for the organic acid. Concentration of organic acid was adjusted to 0, 0.77, 1.54, 3.08, 6.16, and 7.70 mmol/L. The amount of 0.2 g CaCO3 was added in the powder form to respective 100 ml solutions, which were then filtered at the appropriate interval up to 120 min. Calcium concentration in the filtrate reached the plateau (i. e. the saturated concentration) about 5 min after adding CaCO3 to the solu tion. The solubility of CaCO3, when expressed as a logarithmic scale of the saturated calcium concentration, correlated positively with the concentration of the organic acid, and negatively to both the bicarbonate concentration and pH. In addition, the solubility of CaCo3 was higher in citric acid solution than in DMO solution, and was suppressed in nonboiled pancreatic juice. These results suggest that the solubility of CaCO3 can be regulated by two major factors; dissociation of protons from these organic acids, and buffer action of bicarbonate ion or pancreatic protein on protons.

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