As 75Se-selenomethionine is incorporated into newly synthesized protein components of the pancreas (Hansson and Blau, 1963) and appears rapidly in secreted enzymes (Van Goidsenhoven, Denk, and Knight, 1965), it seemed logical to compare with the scan the result of a test of enzyme synthesis, and therefore acinar cell function, rath-r than a test of the volume and bicarbonate secretory capacity of the gland in which acinar function may be less important. The Lundh test (Lundh, 1962;Bramwell Cook, Lennard-Jones, Sherif, and Wiggins, 1967) seemed to satisfy this requirement. It is simple to perfotm and furthermore employs only the physiological stimulus of a standard meal before the test.

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A 36 year old man presented with chest symptoms had a radiological left upper mediastinal lesion, that was interpreted as an anterior mediastinal tumour, consistent with a thymoma. At operation an inflammatory pseudotumour was found in the left upper lobe of the lung, that was projecting across and in front of the mediastinum. The investigation and surgical management of these tumours are reviewed in the light of the presenting symptoms and radiological imaging.

SUMMARYThe results ofpancreatic scanning with 75Se-selenomethionine in 393 carefully documented patients over a two-year period are presented. On follow up 50 patients had operatively proven malignant tumours in the gland and a further 22 had similar tumours in adjacent organs, clinically mimicking carcinoma of the pancreas and in many cases causing scan abnormalities. Five patients had pancreatic adenomata. Remote tumours rarely affected the scan. Examination of the role of scanning in patients with neoplastic disease revealed that the test was effective in screening and in detection; false negative diagnoses were rare. By contrast, survival following diagnosis was extremely poor with only 8 % of pancreatic tumours resectable and 50 % metastasized at the time of surgery. Causes of pancreatic dysfunction, other than pancreatitis or carcinoma, which were associated with abnormalities on the scan are described and general aspects of reporting on the scan are discussed. The patterns seen in abnormal scans, while non-specific with regard to aetiology, were anatomically meaningful and useful adjuncts to the diagnosis of pancreatic disease. A normal scan excluded pancreatic cancer with a probability greater than 95 %.Following the development of successful pancreatic scanning in human subjects injected with 75Se-selenomethionine (Blau and Bender, 1962)