review of literature on clinical pancreatology - The Pancreapedia

first randomized trial evaluating the role <strong>of</strong> endoscopic sphincterotomy was performed byNeoptolemos et al [099] and reported an overall reduction in the complication rate in thegroup randomized to endoscopic treatment. Several studies followed, and it graduallybecame clear that not all patients with biliary pancreatitis need emergent endoscopicsphincterotomy, and currently, this approach is advocated for patients with concomitantcholangitis, biliary obstruction, or severe organ dysfunction [010].John BeardThe British developmental biologist John Beard, DSc (1858-1924) is little remembered today.Yet, he made outstanding contributions to the life sciences. Beard deserves to be includedamong the leading biologists <strong>of</strong> the late 19th and early 20th century. He has been hailed as aforerunner <strong>of</strong> the present-day theory <strong>of</strong> the cancer stem cell. He was the first to point to theparallels between cancer and the trophoblastic cells that envelop and nourish the embryo,characterizing cancer as "irresponsible trophoblast." He pointed out that the initiation <strong>of</strong> fetalpancreatic function coincided with a reduction in the invasiveness <strong>of</strong> trophoblast, whichotherwise might progress to clinical cancer (i.e. choriocarcinoma). Based on the abovepropositions, he recommended the therapeutic use <strong>of</strong> pancreatic enzymes in treating cancerand other diseases. This therapy created a worldwide controversy, and although rejected inhis day, persists in the world <strong>of</strong> complementary and alternative medicine today [100].In the early 20th century, advocacy <strong>of</strong> the enzyme therapy <strong>of</strong> cancer was primarily the work<strong>of</strong> one man, John Beard, DSc (1858-1924). He and his collaborators made a determinedeffort to establish this mode <strong>of</strong> therapy, especially in the years 1905 to 1911. Despite a briefflowering <strong>of</strong> international interest, Beard's efforts came to naught. During the 20th century,there was a succession <strong>of</strong> American researchers who continued to investigate this topic. Thisincluded Marshall William McDuffie, MD (1882-1945), Frank LeForest Morse, MD (1876-1953), Franklin Lloyd Shively, MD (1887-1971), and William Donald Kelley (1926-2005). Incentral Europe, India, and other parts <strong>of</strong> the globe, the use <strong>of</strong> pancreatic enzymes as anadjuvant treatment for cancer has become a fairly routine practice, at least among thosedoctors who utilize complementary and alternative medicine (CAM). It is also a wellestablishedmethod for reducing inflammation and mitigating the adverse effects <strong>of</strong> cytotoxictreatment [101].Pancreatic surgeryThe first reliable report <strong>of</strong> pancreatic surgery in man and the cases that followed for the nextyears thereafter were confined to treatment <strong>of</strong> large pancreatic cysts with the usualpreoperative misdiagnosis <strong>of</strong> the underlying disease. Fiedrich Wilhelm Wandesleben, ageneral physician in Stromberg, German, reporter a previous healthy 28 year old male whosuffered blunt trauma to the abdomen in November 1844. The patient seemed to recoverwith the existing treatment, however, developed a palpable abdominal mass in two weeks.On December 4, 1844, an incision was made into the mass through the abdominal wall. Afterinitial evacuation <strong>of</strong> pus, a clear watery substance welled up from the wound. Probingsuggested a narrow channel trackning deep into the body cavity. Over the next 5 monthsclear fluid continued to exit from the wound. The fistulous tract started to close, but thepatient developed malaise and died eventually <strong>of</strong> respiratory failure. Examination <strong>of</strong> theabdominal cavity demonstrated a smooth surfaced cavity within the head <strong>of</strong> pancreas with anarrow tract to the abdominal incision site.Between 1860 and 1880, with the availability <strong>of</strong> ether anesthesia and Lister antisepsis, moreabdominal operations in general and few incidental operations on the pancreas were