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This volume is a compendium of the lectures, presentations, and
workshops of the International Congress entitled "Facing the
Pancreatic Dilemma" and of the 17th Meeting of the Italian
Association for the Study of the Pancreas, held in Verona on 16 -19
June 1993. Pancreatology is still a relatively young science. Many
pathophysiological aspects of pancreatic disease are as yet
obscure, and a fair number of the etio pathogenetic mechanisms
adduced are no more than hypothetical. We have therefore chosen to
compare and contrast in a single volume the various hypo theses and
interpretations put forward by leading experts in the field. In
view of the swift evolution of this branch of medical science, it
is sound policy to bear in mind that yesterday's heresies have
become today's orthodoxy, and that todays's heresies may well turn
out to be accepted orthodoxy in a not too distant future. The
various "pancreatic dilemmas" are addressed systematically in these
pages, and we believe that the book will prove an invaluable tool
for the special ist and for any physician dealing with pancreatic
disease. The book also represents a tribute by the Verona School of
Pancreatology to the memory of Prof. L. A. Scuro, founder of the
School and one of the outstanding Italian pioneers of
pancreatology."
Introducing this monograph by expressing our heartfeIt thanks to
all those who have contributed to its success may seem no more than
a rhetorical exercise. However, at the same time we feel duty bound
to add our sincere apologies, for we know that many of the dis
tinguished authors of the various chapters have been hard put to
find any relevant information in the existing literature. The plain
fact is that very little has been said and written about pancreatic
fistulas compared with other aspects of pancreatic disease. Why is
this? Essentially, we believe there may be two main reasons: one
practical explanation may be their relative rarity, while the other
reas on is, as it were, "psychological," i. e., pancreatic fistulas
tend almost invariably to be regarded as complications of an
imperfectly performed surgical procedure. However useful it might
be if we were to do it more often, it goes against the grain to
public1y admit one's own mistakes. Ever since I (P. P. ) started
practising in medicine, it has been my destiny and privilege to
work alongside Professor Dagradi, the pioneer ofpancreatic
surgeryin Italy, and to assist him over the years in something like
2000 operations on the pancreatic gland. Clearly, then, any
complication due or related to such surgery however rare, has
become part and parcel of my practical day-to-day c1inical
experience and scientific interests."
The increasing incidence of both chronic pancreatitis and pan
creatic cancer was the primary impetus for the organization of this
meeting, an additional factor being the widespread existence of
pancreatic disease within Italy itself. It is well known that the
treatment of chronic and particularly of acute pancreatitis is
still a matter of controversy, and it seemed useful to compare our
own experience with that of other centers working in the same
field. Consequently, in addition to numerous Italian specialists in
the field, doctors from the Federal Republic of Germany, Denmark,
Great Britain, France, and Austria were invited to attend the
meeting. The symposium lasted two days and comprised eight sessions
dealing with the anatomy and physiology of the pancreas and the
pathophysiology, diagnosis, and treatment of pancreatic diseases. A
central feature of the discussion on the surgical treatment of
chronic pancreatitis was the debate between those who favor the use
of drainage and those who believe resection to be the best
treatment. Finally, I would like to thank Dr. Cavallini and Dr.
Pederzoli very much for their help in organizing the meeting and
also the local authorities for their aid. Professor Adamo Dagradi
Director of the Institute of Clinica Chirurgica, Verona Opening
Address I am pleased to welcome all partlclpants and particularly
the guests from abroad, to this meeting on the clinical evaluation
of pancreatitis."
Uncommon tumors of the pancreas are of increasing interest for
clinicians: cross imaging techniques development makes it possible
to detect small lesions in the pancreatic gland of asymptomatic
patients, and in the last decades a more detailed and specific
pathological classification definitivelyopened an unexpected world
of more or less rare pancreatic tumors. As a matter of fact,
nowadays most surgical procedures deal with these so called
uncommon pancreatic tumors such as cystic, endocrine and others
unfrequent histotypes, and many patientsexperiencing an accidental
discovery of this type of tumor need therefore a specialistic
evaluation. The concept behind this volume is the need to give the
correct clinical relevance to these "uncommon" tumors, that are
ranked at the first place among pancreatic tumors, and that are
definitively curable with a multimodal approach. Aim of the book is
therefore to get clinicians closer to these pathologies, describing
their complexity and the current state of the art in diagnostic,
therapeutic and pathological classification strategy, thus
providing them with the tools for a modern and updated clinical
management of these patients.
Uncommon tumors of the pancreas are of increasing interest for
clinicians: cross imaging techniques development makes it possible
to detect small lesions in the pancreatic gland of asymptomatic
patients, and in the last decades a more detailed and specific
pathological classification definitivelyopened an unexpected world
of more or less rare pancreatic tumors. As a matter of fact,
nowadays most surgical procedures deal with these so called
uncommon pancreatic tumors such as cystic, endocrine and others
unfrequent histotypes, and many patientsexperiencing an accidental
discovery of this type of tumor need therefore a specialistic
evaluation. The concept behind this volume is the need to give the
correct clinical relevance to these "uncommon" tumors, that are
ranked at the first place among pancreatic tumors, and that are
definitively curable with a multimodal approach. Aim of the book is
therefore to get clinicians closer to these pathologies, describing
their complexity and the current state of the art in diagnostic,
therapeutic and pathological classification strategy, thus
providing them with the tools for a modern and updated clinical
management of these patients.
The second edition of this atlas focuses on imaging methods and
techniques, new diagnostic concepts and therapeutic approaches in
management of pancreatic neoplasms. Although interest in pancreatic
pathology is very high in the radiological and gastroenterological
communities, less is known about it than about, for example, liver
pathology. Diagnosis depends on the structure of the pancreatic
lesion, which can be directly visualized in US, CT or MR images.
The book's focus is very much on the imaging and pathological
appearances, with most of the text concentrated at the beginning of
the book followed by images gallery. A comprehensive overview is
provided of typical and atypical presentations and diverse aspects
of common and rare pancreatic tumors, including ductal
adenocarcinomas with dedicated chapter to ductal adenocarcinoma
downstaging, neuroendocrine neoplasms, cystic pancreatic neoplasms
and intraductal papillary mucinous neoplasms. The Verona "Pancreas
Centre," the first institute of its kind in Italy and one of very
few in the world, pursues an interdisciplinary approach to treating
the problems of this organ, focusing on the patient, on research,
and on teaching. A dedicated center that can look back on 40 years
of tradition, many of its respected specialists have made essential
contributions in surgery, gastroenterology, oncology, pathology,
and radiology. Given its scope, this atlas will be an invaluable
asset, helping radiologists understand the underlying pathology and
helping pancreatic pathologists understand the imaging translation.
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