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To examine previous work carried out at a single center, i.e., France, on the pathologic features of chronic pancreatitis and to examine geographic differences, 359 cases of chronic pancreatitis from five centers were studied pathologically and the results analyzed according to appropriate statistical methods. It was found that it was easy to separate chronic calcifying pancreatitis from obstructive pancreatitis occurring distal to obstruction to the pancreatic duct by pathological means. On the other hand, geographic differences between France, Italy, Brazil, and South Africa, although present, were not sufficient for identification of a specific profile for each of the countries studied, and it was found that the minor differences were probably dependent on environmental rather than racial factors.

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A prospective statistical study of clinical symptoms, radiological modifications of the colon and small bowel as judged by a morphometric method and dietary habits was performed in 106 patients who presented with functional intestinal disorders. Four different associations of symptoms and signs were found: a) pain, sometimes heavy, in the left upper quadrant and the ombilical region was associated with morphometric modifications of the small bowel: increased diameter of the upper part, decreased diameter and increased number of folds in the lower part of ileum; b) slight pain of the two upper quadrants and the two flanks was associated with flatulence, and was not correlated with modifications of the radiological aspect of the small bowel and colon; c) constipation and diarrhea were not correlated with any type of morphometric modifications of the colon; d) constipation was significantly correlated with low fiber diet.

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It is difficult to select and combine the nutritional parameters most useful in predicting the outcome of major gastrointestinal surgery. The aim of this study was to define retrospectively a multifactorial prognostic nutritional index adapted to this purpose. Seventy-eight patients on whom one or more total or partial visceral resection were performed in nonemergency conditions were included in this study. Statistical analysis was carried out to determine correlations between the preoperative nutritional parameters and the postoperative complications such as: a) wound rupture and anastomotic leakage; b) severe sepsis; c) death. Delayed hypersensitivity, assessed as normal or abnormal, together with plasmatic albumin and transferrin levels, the thresholds of which were respectively determined at 35 g/l and 2.2 g/l, were selected as the factors with the greatest predictive value. For the prognosis of postoperative severe complications and death, the sensitivity and specificity of an index using the association of these three parameters were respectively 82.7 p. 100 and 51 p. 100 with positive and negative predictive values of 50 p. 100 and 83.3 p. 100.

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Nonfusion of the pancreatic ducts (pancreas divisum) was diagnosed in 41 of 812 patients in whom ERCP provided a definite diagnosis (5.04% of cases). Pancreas divisum was significantly associated with diseases of the pancreas. Chronic pancreatitis was less frequently observed in cases of pancreas divisum whereas acute pancreatitis, especially acute recurrent pancreatitis, was statistically more frequently seen in patients in whom the anomaly was present. These results support the hypothesis that pancreas divisum favours the development of acute pancreatitis.

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A multicenter study on the etiology and diet of patients with pancreatic diseases has been realized with the collaboration of 36 centers in 19 countries having widely different climatic and racial conditions. 2,478 cases were studied: acute pancreatitis (AP), 222 males, 208 females; calcified chronic pancreatitis (CCP), 801 males, 134 females; non-calcified chronic pancreatitis (NCCP), 525 males, 155 females; pancreatic cancer (PK), 69 males, 14 females; controls, 281 males, 62 females. The analysis of mutual information and the factorial analysis of correspondences have been used. With regard to chronic pancreatitis, the 19 countries could be classified into 4 classes presenting relative similarities. (A) Southern Europe: The diet is rich in carbohydrates, protein and lipids, alcohol intake is primarily in the form of wine and the pathology is dominated by CCP. There are much fewer women than men with chronic pancreatitis. (B) Northern Europe, to which may be added Argentina and Chile, is characterized by a protein- and lipid-rich diet, a beer-based alcohol consumption and a distinct prevalence of AP and NCCP. The prevalence of males with chronic pancreatitis is less marked than in southern Europe. (C) Japan has a lipid-poor diet and a low frequency of CCP and NCCP. (D) A fourth group is mostly composed of tropical countries with mixed races. It may be divided into 2 subclasses: (a) India is the most characteristic country of the first type with low fat, low protein diet, no alcoholism, high frequency of CCP (at an early age); (b) Brasil and South Africa are representative of the second subclass with very high alcohol intake in the form of spirits and a high frequency of CCP.

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In this paper we propose a method allowing the representation of time-dependent changes in symptomatology. In algorithm, which automatically generates the sequence of stable states in patient's symptomatology evolution, describes slow, as well as fast, variations of diseases. This sequential representation of data can then be analysed by classical statistical procedures in a population of patients suffering from pancreatic diseases, to estimate the rate of global modification of clinical symptomatology in time.

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In France, changes in the incidence of gallstones during the 20 years following World War II paralleled the changes in total calories, protein and lipid of the diet. The incidence of gallstones in autopsy statistics has been compared to the diets in different countries: France, India, Japan, Portugal, South Africa, Sweden and Uganda. Low calorie, low protein, low lipid intake and vegetable diet are associated with a low incidence of gallstones. A positive correlation between calorie intake and gallstones incidence was found at necropsy for calorie intakes lower than 3,000 kcal. In countries with high calorie, high protein and high lipid intakes, such a correlation was not found. These results suggest that a hypocaloric diet associated with a low intake of fat and protein mostly of vegetable origin, is protective against cholelithiasis.

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