Mandred W. Comfort

HEREDITARY PANCREATITIS: REPORT ON TWO ADDITIONAL FAMILIES

Summary The pedigrees of two additional, unrelated families in which the hereditary form of chronic relapsing pancreatitis and sequelae have occurred have been described. These additional observations tend to confirm the original impression that in certain families chronic relapsing pancreatitis is transmitted as an autosomal dominant gene. The hereditary form of the disease appears to resemble the sporadic form in most respects. However, the hereditary form of the disease does appear to begin earlier in life and appears so far to involve females predominantly, whereas males seem more often affected in the usual form of chronic pancreatitis. The cause and pathogenesis of the disease are not known. Alcohol and hyperlipemia appear to be unimportant factors in the etiology of the hereditary form of the disease, nor have gallstones been associated. It is suspected that the inherited defect predisposing to recurring bouts of pancreatitis and sequelae is metabolic in nature. It appears quite probable that the hereditary form of chronic relapsing pancreatitis occurs more frequently than has been realized in the past and that increasing awareness of the entity will result in the discovery of many more families so affected.

The effect of cortisone on nontropical sprue (idiopathic steatorrhea).

Summary The effect of cortisone on 6 patients with nontropical sprue has been studied. Metabolic balance data were obtained on 2 patients while the other patients underwent clinical studies only. Cortisone was administered with equal effectiveness both by the intramuscular and by the oral route in doses varying usually between 25 and 100 mg. a day. In every case definite subjective and objective improvement was observed. Stools decreased in number and became more nearly normal in consistency; appetite and strength improved, and the symptoms of abdominal cramping and distention virtually or completely disappeared. Decreases in the amount of solids, water, fat and nitrogen in the feces followed administration of cortisone and were coincident with a return of prothrombin time to normal The improvement observed would seem in large part attributable to more efficient intestinal absorption although some of the improvement is ascribed to better systemic metabolism. Hypertension developed in 1 patient and edema occurred frequently when the hormone was given in 100 mg. doses. To date it would appear that cortisone offers the most effective means of treating nontropical sprue in exacerbation, though its importance in the long-term management of the disease remains to be evaluated.

GASTRIC ACIDITY BEFORE AND AFTER DEVELOPMENT OF GASTRIC CANCER: ITS ETIOLOGIC, DIAGNOSTIC AND PROGNOSTIC SIGNIFICANCE

Excerpt Everyone knows that in gastric cancer the mean gastric secretory activity is subnormal, but to what extent is it subnormal? What factors influence gastric acidity in gastric cancer? Does ca...

PRIMARY ATROPHY AND LIPOMATOSIS OF THE PANCREAS

Summary Primary atrophy of the pancreas is an unusual pancreatic disease characterized pathologically by almost complete disappearance of the acinar cells and by disappearance of the islets of Langerhans to a lesser extent. Fatty replacement varying from mild fatty infiltration to massive replacement of the organ by adipose tissue may accompany this atrophy. No specific causative factors have been demonstrated. The possible relationship to other systemic diseases, to malnutrition and dietary deficiencies, or to an unusual form of chronic pancreatitis has been considered. The characteristic clinical state is one of a deficiency syndrome associated with steatorrhea, loss of weight, normal or increased appetite, and occasionally edema, anasarca, and diabetes mellitus. Although the disease may possibly develop in childhood, it appears to be more frequent after the fifth decade of life. Surgical exploration of the pancreas may be necessary to establish the diagnosis. Recognition of this syndrome is important since it represents a benign pancreatic disease that responds to adequate replacement therapy.

ACINAR CELL CARCINOMA OF PANCREAS: REPORT OF CASE IN WHICH FUNCTION OF CARCINOMATOUS CELLS WAS SUSPECTED

Excerpt We are reporting a case of acinar cell carcinoma of the pancreas in which values for enzymatic activity in the serum were many times greater than those usually encountered in cases of carci...

UNTOWARD EFFECTS FROM THE USE OF ERGOT AND ERGOTAMINE TARTRATE

Excerpt Ergot preparations have enjoyed a time-honored place in obstetrical practice. In properly standardized dosage they have come to be accepted as useful oxytocics when administered after expre...

Nontropical Sprue: Diagnosis and Therapy

Summary Nontropical sprue may be defined as a disease of unknown cause, without specific anatomicopathologic changes, which occurs in adults living in temperate climates and in which absorption from and motility of the small bowel are impaired. Nontropical sprue includes celiac disease when it persists into adult life. Impairment of absorption in nontropical sprue, contrary to early beliefs, affects all nutrients including fats, proteins, carbohydrates, minerals, vitamins, and even water. Impaired absorption causes deficiency states which together with the symptoms and signs of impaired bowel function are the essential clinical features of the syndrome. The diagnosis of nontropical sprue rests, first, upon the demonstration of malabsorption with its associated deficiency states and, secondly, upon exclusion of specific pathologic abnormalities that may also produce the syndrome. Until a specific remedy is discovered, therapy must be directed toward control of malabsorption and correction of the several deficiency states. The corticosteroids and a gluten free diet are promising adjuncts to standard forms of therapy.

The Association of Chronic Ulcerative Colitis and Multiple Polyps

Excerpt It has been shown that in 10 per cent of cases of chronic ulcerative colitis multiple polyps of the large intestine develop eventually. This estimate is based on a statistical study of 693 ...

Painless Single Stone in Pancreatic Duct: Report of a Case with Steatorrheal Diarrhea

Summary We have reported the case of a 67-year-old white man with a four-month history of passing fat and oil per rectum, this being his sole complaint originally. The lesion was an isolated calculus occluding the duct of Wirsung, with associated pancreatic atrophy and fibrosis. The calculus was removed, with lessening, but not disappearance, of steatorrhea postoperatively. Two years after removal of the calculus, more calculi were visible in roentgenograms of the pancreatic area, apparently in the main pancreatic duct. Three years postoperatively, roentgenograms revealed that the stones in the duct had increased in size and number, extending throughout the length of the gland. Although the possibility that this case represents an instance of painless chronic pancreatitis cannot be excluded, it is perhaps more likely that the primary event was formation of a stone in the duct of Wirsung. Removal of a solitary stone in the pancreatic duct seems advisable in an effort to restore ductal patency and to prevent secondary pancreatic parenchymal atrophy and fibrosis. Although encountered infrequently, pancreatic duct calculus must be kept in mind as one of the more unusual causes of steatorrhea and azotorrhea.