The ideal operation is the complete removal of the cyst from the abdominal cavity. Personal case in which this lat ter operation was successfully performed. P. F. Eve (Med. and Reporter, May 9, '96).
Tumors of the Pancreas.
Of the tumors of the pancreas, cancer is by far the most frequent and impor tant. The head is the usual seat, rarely the body and tail. The cancer is usually of the scirrhous variety, but cases of soft and of colloid growths are occasionally met with. Wirsung's duct is often ob structed and not infrequently the com mon bile-duct also, causing intense and persistent jaundice. By the size of the tumor or on account of implication of the wall of the intestine, it may cause obstruction of the duodenum. It occurs most frequently between the ages of 30 and 50, but may be met with at any age, even in infancy. cancer of the gall-bladder, it rarely occurs with cal culi. It is usually primary, but the pan creas may be the seat of secondary metastatic tumors when the disease be comes generalized. Carcinoma of the stomach or duodenum rarely extends to the pancreas.
Pancreas examined post-mortem in one hundred cases for fat-necrosis, but found none. The only disease discovered was carcinoma, and in one or two of these the gross appearance was that of fat necrosis, but the microscope showed can cer. Blaisbrook (Med. Record, July 10, '97).
The symptoms are very indefinite and rarely sufficiently distinctive to render a diagnosis possible. There is not rarely a long history of disturbed digestion. Of the disease itself there may be such suggestive symptoms as epigastric pain from time to time, loss of flesh and vigor, the presence of a tremor in the epigas trium, the occurrence of jaundice with enlargement of the gall-bladder, and ascites from pressure on the portal vein. Such symptoms are present only in a minority of cases. There may be gly cosuria, and undigested meat-fibres may appear in the stools. The most impor tant evidence consists in the presence of a fixed tumor, the occurrence of extreme and persistent jaundice, an enlarged gall bladder, and the development of ca chexia and emaciation.
When a patient suffers from deeply seated pain in the epigastric or hepatic region, with progressive emaciation, but without signs definitely indicating gas tric cancer, with jaundice and dilatation of the gall-bladder, without a history of biliary colic, by far the most probable diagnosis is primary cancer of the pan creas. This diagnosis is not much af
fected by the state of the liver, which may be large or small and may or may not contain palpable cancerous growths. if the gall-bladder is not dilated the di agnosis must remain uncertain. These views are based on the post-mortem ex amination of seventeen cases. P. Herringham (St. Bartholomew's Hosp. Reports, London, vol. xxx, p. 5, '94).
In an inoperable case of carcinoma of the pancreas the effect of pancreatic juice upon the absorption of fat was studied. When the patient was on a milk diet, a decidedly excessive quantity of the ingested fat was lost, or, in other words, fat-absorption was distinctly im paired. The fat-splitting process was accomplished as fully as in health, prob ably by micro-organisms, as it was shown that the bacterial activity of the intestine was Inure pronounced than in health. The putrefaction of proteids in the intestine was excessive. W. P. Northrup and C. A. Herter (Amer. Jour. Med. Sci., Feb., '99).
Conclusions that when cancer of the pancreas is surely diagnosed operative treatment is either useless or harmful; when the diagnosis is doubtful, especially in young or middle-aged subjects, ex ploratory operation should be seriously considered, since much may be hoped from surgical treatment in inflammatory conditions. A. W. Mayo Robson (Lan cet, July 28, 1900).
The outlook is, of course, hopeless, death occurring usually within a few weeks after the occurrence of the more grave symptoms.
Of other tumors, sarcoma, lymphoma. adenoma, and gumma are occasionally met with; syphilis more often causes In a study of 128 cases of tuberculosis the pancreas was found tuberculous in 13, or in 9.37 per cent. The pancreatic disease seems to be always secondary, either by extension from neighboring organs or haematogenous in miliary tuberculosis. Sex plays no role; age, on the contrary, is an important factor, 44.44 per cent. of the bodies of children examined presenting tuberculosis of the pancreas. Kudrewetski (Zeits. f. IIeilk., B. 13, H. 2, 3, '93).