ADENOCARCINOMA OF THE HEAD OF THE PANCREAS

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To the Editor: —I have read with great interest the article by Dr. Elmer Hess on this subject inThe Journal, January 3. Dr. Hess is to be commended for calling attention to the difficulties of diagnosis of lesions in the region of the head of the pancreas. I wish to call attention to several diagnostic aids which have been found useful in a consideration of these lesions. The duodenum has approximately the same shape as that of a horseshoe magnet, the pyloric end of the stomach forming the bar between the poles of the magnet. A tumor mass within the loop tends to expand the latter, often to such an extent that the horseshoe becomes a circle. Clarence Bird has emphasized the value of repeated series of roentgenograms over a period of time. Any expansion is suggestive of a growing tumor mass within the duodenal loop. This expansion can

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