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Summary In 403 patients suspected of having pancreatic cancer, we prospectively studied a combination assay of various serum tumor markers: CA19-9, DUPAN2, tissue polypeptide antigen, elastase 1, γ-glutamyltranspepti-dase, lactate dehydrogenase, lipase, amylase, and alkaline phosphatase. The diagnostic value of each marker was compared with a multivariate analysis (computer-aided multivariate and pattern analysis system for pancreatic cancer examine-1: CAMPAS-PX1). Pancreatic cancer was subsequently identified in 47 patients. CAM-PAS-PX1 had higher negative in health and positive predictability than those of each marker used alone in the diagnosis of pancreatic cancer. CAMPAS-PX1 proved the most effective marker for diagnosing pancreatic cancer, but in terms of its codbenefit ration CAMPAS-PX1 was not superior to CA19-9 used alone. In this prospective trial, we experienced poor generalizability in the statistical models (CAMPAS-PX1). We believe that selection bias was present in samples used for model building. Based on this study a new model has been designed.

Chemical studies were performed on all or part of four X-ray translucent (nonopaque) concretions and one protein plug to investigate a possible relationship between these substances, and to find the similarities and differences between these materials and pancreatic stone protein. Through elemental analysis, infrared absorption spectrometry, quantitative analysis of protein, and amino acid analysis, nonopaque concretions and protein plug were found to consist mainly of protein. One nonopaque concretion contained a very small amount of crystalline which differed greatly from calcite type calcium carbonate as observed in pancreatic calcified stones. The pattern of amino acid composition was very similar between the concentrations and the protein plug: rich in acidic amino acids, but poor in basic and aromatic residues. The aspartic acid content was the highest among detected amino acids. Comparison of amino acid composition between the nonopaque concretions which we analyzed and the pancreatic stone protein reported from Sarles' laboratory suggested that the concretions seem to contain some stone protein.

In a 42 year old female, a fistula developed between the splenic vein and the pancreatic duct through the cavity of a pseudocyst in the tail of the pancreas and resulted in an extrahepatic portal hypertension. The fistula was visualized by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic portography, then was successfully resected by surgery. The possible etiology of extended obstruction of both splenic and portal veins in chronic pancreatitis with pseudocyst was discussed.

肝疾患診断におけるcomputed tomography(以下CTと略す)の意義と限界を明らかにする目的で,瀰漫性肝疾患90例と腫瘤性肝疾患37例を対象として第3世後半のCT装置(GECT/T 8800)を用いて各疾患のCT像を比較検討した.肝硬変症ではRIスキャンで認められる右葉萎縮や左葉肥大などの所見は明らかで無く,脾臓前後径の増大,肝表面の凹凸,腹水の存在が特異的な所見であった.脂肪肝は全例で肝臓のCT値が低値を示し,肝臓と脾臓のCT値の比が0.9以下という基準は脂肪肝のスクリーニングとして有用と言えた.急性肝炎では肝内胆管拡張を認めない点が肝外閉塞性黄疸との鑑別に役立つと考えられた.SOLの存在診断能はRIスキャンより優れており,嚢胞に関しては質的診断も可能であった.現段階ではCTにより高度の脂肪,鉄沈着や広汎な壊死以外の肝組織学的変化を知ることは不可能であり,また固形腫瘤の質的診断も困難な場合が多い.

組織学的に確定診断された肝瀰漫性脂肪化56例,慢性肝炎41例,肝硬変39例のCT像を対比して,CTによる脂肪化の診断能と診断基準を検討した.軽度脂肪化は診断困難であったが,高度脂肪化(脂肪肝)に関しては肝CT値/脾CT値比が0.85未満という診断基準の設定が可能であった.上腹部CT 6,800件中,197件(2.9%),実数169例(瀰漫性141例,限局性28例)がこれに該当した.成因としては瀰漫性,限局牲いずれも肥満,糖尿病,多飲酒の順に多かった.血液生化学検査正常例が肝生検にもとづく従来の報告よりも高率にみられた.反復施行37例の検討では,肝CT値の推移は各成因の改善度をよく反映し,CTは治療効果判定にも有用であった.瀰漫性,限局性脂肪肝は相互に移行がみられたので,限局性脂肪肝は脂肪肝の進展や改善途中で生ずる一過性の病態と考えられる.

The pancreatic excretion test with a weak acid of 5, 5-dimethyl-2, 4-oxazolidinedione (DMO) was performed concomitantly with the pancreozymin-secretin test in 28 patients with pancreatolithiasis, 14 patients with pancreatic carcinoma, and 67 healthy subjects. The DMO concentration and total output of duodenal content after secretin stimulation, when corrected to the simultaneously determined plasma DMO concentration, were significantly reduced in the patients. While the pancreozymin-secretin test was abnormal in 96% of patients with pancreatolithiasis and in 86% of those with pancreatic carcinoma, the pancreatic DMO excretion test gave abnormal results in 100% of the patients. This suggests that the new test may well become effective in detecting early stages of pancreatic disease including carcinoma and chronic pancreatitis. (Arch Intern Med137:754-760, 1977)