Background: The pancreas undergoes a continuous aging process leading to alterations such as atrophy, fatty infiltration and fibrosis. Objective: The aim of this study was to determine the normal ultrasonic aspect of the pancreas and any relationship to age with special regard to pancreatic echogenicity and pancreatic duct diameter. Methods: In the study on pancreatic echogenicity 131 patients (56 male, 75 female), aged 18–92 (median 52) years, with normal weight were examined prospectively. The echogenicity of the pancreas was compared with the normal liver and divided into four different categories. The prospective investigation into any age relationship of pancreatic duct diameter was performed on 101 patients (44 male, 57 female), ages 18–91 (median 53) years, with normal weight. In both studies, the patients were split into seven age groups. For statistical analysis the chi-square test for independence was used. Results: With advancing age, ultrasonography demonstrated an increasing echogenicity of the pancreas, beginning in the 4th decade of life. Most patients over 50 years, and all patients over 80 had a marked echogenicity, distinctly higher than that found in the liver. The mean pancreatic duct diameter of all patients in the second study was 1.9 mm. Younger subjects had a smaller diameter – average 1.5 mm in the group 18–29 years – but with advancing age a distinct duct enlargement was observed: mean 1.9 mm in the group 40–49 years, mean 2.3 mm in patients over 80 years, but not exceeding 3 mm. Conclusion: On ultrasonography, the aging process of the pancreas leads to an increase of echogenicity. In the aged, a very high echogenicity is a normal ultrasonic finding. The pancreatic duct diameter also increases with advancing age. Even in advanced age, a diameter of more than 3 mm, however, should be regarded as a pathological finding.

Computed tomography (CT) now enables the early diagnosis of pituitary apoplexy. Since CT can detect blood, it can document acute or chronic hemorrhage in pituitary adenomas. In addition, CT can discriminate between densities other than blood and can therefore be used to diagnose those cases of pituitary apoplexy in which infarction and necrosis predominate. These conclusions were verified by a review of 10 apoplectic patients studied by CT. Although nine diagnostic delays occurred tissue confirmation by surgery in eight cases and autopsy on one made us familiar with the CT findings which should be useful in future diagnosis.

Summary In a prospective study, 178 patients with fever > 38.4 °C and newly diagnosed pulmonary infiltrates underwent bronchoscopy with bronchoalveolar lavage (BAL), aspiration of bronchial secretions (BS) and, in 71 cases, protected specimen brushing (PSB). In 42/143 immunocom‐promised patients (haematological malignancies, n= 92; AIDS, n = 22; immunosuppressant therapy, n = 29) and in 4/35 patients with no defined underlying disease fungal pneumonia was present (candidosis, n= 35; aspergillosis, n = 8 mixed fungal infection, n = 3). Candidosis was combined, in 17 cases, with Aspergillus (n=3), bacterial (n= 15) or cytomegalovirus (n=2) infection. Aspergillosis was combined in eight cases with infection with Candida (n = 3), Pneumocystis carinii (n=1) or bacteria (n = 5). The sensitivity of BAL and PSB in Candida pneumonia was 48% and 50%, respectively; specificity was 75% and 74% respectively. Bronchial secretions were more sensitive in detecting Candida pneumonia, but specificity was only 55%. In aspergillosis, the specificity of BAL, BS and PSB in each case was 100%; the sensitivity of BAL, BS and PSB was 38%, 64% and 100%. Twenty‐four fungal infections were fatal. Unfavourable prognostic factors were respiratory failure needing mechanical ventilation, diffuse bilateral pulmonary infiltrates, mixed fungal infections and start of i.v. antifungal treatment > 14 days after fever onset, which were associated with a mortality rate of 74%, 67%, 67% and 63% respectively.

The pancreatic duct or at least parts of this structure can be demonstrated today by sonography in 75-85% of all persons examined. In 84 persons we have now measured the caliber of the sonographically visualized pancreatic duct in the region of the proximal body of the pancreas with special attention to dependence on age. The diameter of Wirsung's duct ranged from 1 to 3 mm (mean 1.9 mm) and increased significantly from the fifth decade of life onwards. After intravenous injection of the hormone secretin, healthy persons usually show a distinct duct enlargement, which also depends on age. Nine persons aged 19 through 35 (median 28) years showed a dilatation of the main pancreatic duct by about 110% following secretion injection. Nine further probands, 50-74 (median 58) years old, had a dilatation of about 70%. Eighteen patients with confirmed chronic pancreatitis and a pancreatic duct diameter not exceeding 4 mm generally showed no duct enlargement after secretin stimulation. We believe that periductal fibrosis, which is common in chronic pancreatitis, is the most important reason for these results. The use of the sonographic secretin test in the diagnosis of chronic pancreatitis should be considered.

In a prospective study the pancreatic duct diameter was measured sonographically before and after secretin stimulation in 20 healthy controls and 59 patients with upper abdominal pain, weight loss, and/or diarrhea. Whereas healthy controls and patients without pancreatic disease after secretin stimulation showed a distinct pancreatic duct dilatation of more than 90% of basal duct diameter, no distinct secretin-induced duct enlargement was observed in most patients with chronic pancreatitis. Patients with circumscript pancreatic duct stenosis even had a marked and longer-lasting duct dilatation after stimulation. In patients with anomalies of the pancreatic duct system, no uniform response was found after secretin injection. In this study the sonographic secretin test showed a sensitivity of 92% and a specificity of 95% for diagnosis of chronic pancreatitis. The results confirm that this diagnostic method can be recommended as a reliable screening test for pancreatic disease.