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Despite recent diagnostic improvements and the possibility of benefiting from a more sophisticated form of intensive therapy, acute pancreatitis (AP) is still a major clinical problem with an overall mortality rate of 10 %, as has been the case now for the past 40 years or so [1,2].

Acute pancreatitis, like most conditions whose etiology and pathogenesis are not fully understood in detail, is not easily amenable to a satisfying and comprehensive classification. Generally speaking, some diseases are classified according to a staging which is the result of essentially “morphologic” or “pathologic” data; this is the case, for example, with cancer whose classification is aimed at a detailed description of the “intensity” and of the anatomical extension of the disease. On the other hand, one can focus on “clinical” issues classifying the disease according to the severity of the clinical conditions of the individual patient. In fact the latter assumes that the clinical conditions of a given patient suffering from AP are the actual effects of the pancreatitis itself, without considering that a high APACHE score could also be attained in a patient with an anatomically mild pancreatitis and inherited or acquired conditions reducing the physiological reserves of various organs.

Ductal adenocarcinoma of the pancreas is one of the most malignant neoplastic diesease in humans. Large variations in its incidence are found among different Countries [1]. In Italy, regional variations ranging from 2–10 per 100000 individuals can be observed. Epidemiologial studies have failed to strictly correlate specific environmental factors, such as diet and occupational exposure to particular chemicals [1]. One reason for such failures may be linked to the fact that pancreatic cancer cannot be efficiently sub classified on the basis of morphologic critera alone. In addition, morphologic study of pancreatic cancers do not provide sufficient information to predict their clinical behaviour. Chromosomal and gene alterations associated with specific types of tumors may provide important information for understanding aetiology and pathogenesis of cancers as well as for establishing a better classification with prognostic significance.

The past decade has witnessed a steady increase in surgical operations on the pancreas for a variety of diseases. This has transformed the external pancreatic fistula (EPF) from a rare complication into a relatively frequent event: fistulas are a complication to be expected in any surgical procedure on the gland [1, 2].

The development of infective complications in patients with acute pancreatitits and pancreatic fistula is an unfavorable prognistic factor [1–4]. These complications are frequent (from 1 % [4] to 29 % [ 1]) and imply a high rate of morbidity and mortality [2–4]. The therapeutic management of such infections has been the subject of previous reviews [5–7]; however, the problem of the selection of appropriate antimicrobial agents in acute pancreatitis and its complications has not recently been addressed specifically, although new antibiotics have been introduced which are potentially useful for this indication. The present article summarizes the pharmacokinetic data on the penetration of antibiotics in pancreatic tissue and reviews the current information on the bacterial strains involved in this disease.

The possibility of exerting some kind of effect, whether pharmacologically or otherwise, on exocrine pancreatic secretion dates back to the time when the very first ideas regarding pancreatic physiology were proposed. In actual fact, our knowledge of the complexity of the mechanisms regulating pancreatic function has run parallel to the discovery of substances, mainly hormones, capable of inhibiting or potentiating such function. Moreover, the search for compounds or other measures capable of inhibiting pancreatic secretion is also the result of attempts to deal with diseases such as acute pancreatitis and external pancreatic fistulas, in which inhibition of secretion is the therapeutic goal. It is no accident that all drugs potentially capable of inhibiting pancreatic secretion have been tested to confirm their therapeutic and clinical validity in these diseases. It thus appears only logical to include a chapter on the subject in this monographic study.

In the words of a well-know Italian pop song, “the future is a hypothesis”. It is very difficult to find fault with this reasoning; hypotheses, however, are based on rational analysis stemming from established research findings.

Three paths have been followed in the attempt to propose the ideal treatment for acute necrotic-hemorrhagic pancreatitis (ANHP): Conservative surgical treatment, Medical treatment, Radical surgical treatmen.

The therapy of acute necrotic pancreatitis is chiefly surgical, but medical treatment of the associated shock and nutritional deficiences, and the reduction of pancreatic secretions are generally claimed as helpful or even life saving.

Radiographic Study of the Anatomy of the Pancreas.- Elements of Surgical Anatomy of the Pancreas.- Physiologic Control of the External Pancreatic Secretion in Man.- Pancreatic Malfunction - When, How, Why?.- Pancreatic Extracts in Chronic Pancreatitis: Which, How and When?.- Radiological Approach to Acute and Chronic Pancreatitis.- Diagnostic Algorithm for Pancreatic Disease.- Morphogenesis of Acute Pancreatitis.- The Role of Total Parenteral Nutrition in the Treatment of Pancreatic Diseases.- Conservative Surgical Treatment of Acute Necrotic-Haemorrhagic Pancreatitis.- Pancreatic Abscess.- One-Year Follow-Up to Acute Necrotic-Haemorrhagic Pancreatitis.- Surgical Treatment of Acute Pancreatitis.- Surgical Treatment of Acute Pancreatitis.- Morphology of Chronic Pancreatitis.- Indications for Surgical Treatment of Chronic Pancreatitis.- Intraoperative Cytodiagnosis in Pancreas Disease.- General Remarks to Chapters 19-21.- The Pancreas-jejunal shunts.- The Use of Resection in the Treatment of Chronic Pancreatitis.- Chronic Pancreatitis: Surgical Indications, Procedures and Limitations.- Long Term Results of Pancreaticoduodenalresection (PDR) in Chronic Pancreatitis.- The Endocrine Function of the Pancreatic Residue After Partial Duodenopancreatectomy.- Follow-up of Chronic Pancreatitis. Methodological Considerations.- Longterm Evolution of Chronic Pancreatitis: The Italian Experience.

Opinions about the natural history of the pancreas years after an attack of necrotizing hemorrhagic pancreatitis (NHP) are contradictory. One side suggests development towards chronic pancreatitis, the other rejects this. In this study we want to evaluate the course of the disease according to functional and clinical findings. Thirty-one patients operated on because of NHP were followed up over a period of 1–5 years. The results of this study were partly published in 1984 [1].