Clinical Evaluation of the Results of the Secretin Test and of Duodenal Cytology in the Diagnosis of Pancreatic Disease

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THE early diagnosis of pancreatic disease remains a challenging and perplexing problem. Clinical signs and symptoms may be minimal or misleading in the presence either of inflammatory or of neoplastic disease. The retroperitoneal location of the pancreas renders it almost inaccessible to the usual methods of physical diagnosis, except in instances of large carcinomatous masses and pancreatic cysts. Even at operation, carcinoma of the pancreas may be difficult to diagnose unless there are metastatic nodes. Some surgeons are reluctant to biopsy the pancreas, even with the Vim-Silverman or the Menghini needle, because of the possibility of producing a pancreatic fistula; others believe that needle biopsy is a safe procedure, particularly when it is done transduodenally. However, the findings on needle biopsy may be negative for neoplasm, even when a neoplasm is present. Since pancreatitis may simulate carcinoma, the diagnosis can be proved only by a study of pathologic sections.

An early diagnosis of carcinoma of the pancreas is essential for successful surgical treatment, which is the only hope for a cure available now. An accurate diagnosis of neoplasm of the pancreas is also helpful in the medical treatment of the patient, in the prognosis, and in discussions with the family regarding treatment and prognosis. All possible means of treatment are indicated, because the outcome is always in doubt. However, in cases of neoplasm of the pancreas, with its poor prognosis, extensive efforts may prolong life only for a few hours or days.

The symptoms of carcinoma of the pancreas are. . .



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