Since Bayliss and Starling demonstrated the presence of humoral regulation of the external secretion of pancreas in 1902, a large body of knowiedge of the external secretion of pancreas is available in the literature. Recently, in conscious dogs equipped with a pancreatic fistula and a Thiry-Vella loop of the duodenum, Magee and Hong found that HCI, milk, or methionine solution when introduced into the loop increased both the volume and the enzyme content of the pancreatic juice. Furthermore they found that the intravenous injection of hexamethonium either decreased or abolished the responses to milk or methionine.
Inaccessibility of human pancreatic duct by the ordinary measures, however, made direct experimental investigation on the secretion of human pancreas difficult, and the greater part of the information regarding the external secretion of the pancreas has been driven either from experiments conducted on lower animals or by indirect experiments on human being. An opportunity of experimental investigation of the human pancreatic secretion by direct cannulation of main pancreatic duct (Duct of Wirsung) is obtained following operative treatment of Korean gall-stone patients. Patients in whom pancreatic cannulation was performed permit the collection and analysis of pancreatic juice under various experimental conditions. Rationale of clinical indications of the pancreatic cannulation and the effects of hexame thonium and some dietary factors on human pancreatic secretion consitute the following reports.
A statistical review of biliary surgery done at the Severance Hospital for the past 5 years period. showed 74 gall-stone patients among total 122 cases of all kind . of biliary tract diseases includingmalignant tumors. Further analysis of the 74 cases, according to location of the gall-stones found during the operative intervention disclosed that only 12 cases had gall-stones in gall-bladder, 41 cases had. no stones in the gall-bladder but in the commonbile duct, and 18 cases had them in both gallbladder and common bile duct. Three others were intra-hepatic calculi. Preference of patients for medical treatment and reluctancy of early surgicaltreatment, in spite of the far advanced picture of biliary symptoms were present, are well illustrated by high incidence of acute suppurative cholangitis (9 cases in the series). Subsequently it developed, into unusual and complex pathology associated with the gall-stone impacted in the terminal portion of the common bile duct. Trans-duodenal sphinctero-tomy was done 29 times for effective removal of the stones, and pancreatic cannulation was indicated in 9 patients in order to overcome complicated pathological changes due to either surgical trauma. and bleeding induced by repeated instrumentation from the initial choledochal approch or. mucosala edema from the longstanding irritation of gall stones around the orif ice of the pancreatic duct and. the ampullary region.
Of the 9 cases studied, 7 pancreatic cannulation& were done by the method described by Doubilet and Mulholland and 2 cannulations were done by author´s modification. During the experiments the pancreatic juice was collected for consecutive 20 min. period. The volume was recorded and the total quantities o1 lipase and amylase activity in pancreatic juice were estimated in each sample. The Nelson´s method was used to determine amylase, and the method of Cherry and Crandall was used for lipase. The experimental procedures consisted of the administration of whole milk
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