The clinical diagnosis of disease of the pancreas1 has always been fraught with great difficulty. Whether one is dealing with the dramatic suddenness of an acute hemorrhagic pancreatitis, the silent jaundice in carcinoma at the head of the pancreas, the variable and indefinite symptomatology of chronic pancreatitis or the insidiously developing pancreatic cyst, a large proportion of pancreatic lesions remain unrecognized clinically and are first diagnosed at laparotomy or at postmortem examination. This is not because the pancreas is so rarely the seat of disease, for it is diseased far more frequently than is generally supposed. Among the 60,000 patients admitted to Barnes Hospital but 150, or 0.25 per cent of the cases, bore a diagnosis of pancreatic disease of one kind or another, exclusive of diabetes mellitus, while among the last 3,600 autopsies performed at the Washington University School of Medicine, gross or microscopic lesions of the acinar
ELMAN R, ARNESON N, GRAHAM EA. VALUE OF BLOOD AMYLASE ESTIMATIONS IN THE DIAGNOSIS OF PANCREATIC DISEASE: A CLINICAL STUDY. Arch Surg. 1929;19(6):943–967. doi:10.1001/archsurg.1929.01150060005001
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