Analysis of hyperamylasemia in patients with severe head injury |
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| Authors: | G C Vitale G M Larson P R Davidson D L Bouwman D W Weaver |
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| Affiliation: | 1. Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA;2. Department of Surgery, Wayne State University, Detroit, Michigan USA;1. Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13084-971, Brazil;2. Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas 13083-862, Brazil;3. Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas 13083-878, Brazil;1. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Dana 501, Boston, MA 02215, United States;2. Division of Gastroenterology, Boston Medical Center, 85E. Concord Street, Suite 7720, Boston, MA 02118, United States;3. Division of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States;4. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States;1. IFREMER Centre de Bretagne, REM/EEP, Laboratoire Environnement Profond, 29280 Plouzané, France;2. Laboratoire des Sciences du Climat et de l’Environnement, Laboratoire mixte CNRS-CEA, Av. de la Terrasse, 91190 Gif sur Yvette, France;3. UMR 6112, Université d’Angers, LPGN BIAF Lab Bioindicateurs Actuels & Fossiles, CNRS, 49045 Angers, France;4. School of Marine Science and Policy, University of Delaware, Lewes, DE 19958, USA;5. UMR 7154, Géochimie des Eaux, Institut de Physique du Globe de Paris, Sorbonne Paris Cité, Université Paris Diderot, 75005 Paris, France;6. UMR 5805 EPOC – OASU, Université de Bordeaux, Allée Geoffroy St. Hilaire CS50023, 33615 Pessac cedex, France;1. Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy;2. Department of Neuroradiology, Niguarda Hospital, Milan, Italy;3. Department of Medical Physics, Niguarda Hospital, Milan, Italy;4. Department of Neurosurgery, Niguarda Hospital, Milan, Italy;1. Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;2. Department of Surgery, Division of Pediatric Surgery, New York University Grossman School of Medicine, New York, NY, USA;3. Department of Medicine, Division of Gastroenterology, New York University Grossman School of Medicine, New York, NY, USA;4. Department of Medicine, Division of Gastroenterology, Duke University, Durham, NC, USA;5. Department of Surgery, Division of General Surgery, New York University Grossman School of Medicine, New York, NY, USA |
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| Abstract: | ![]()
To evaluate the influence of severe head injury (SHI) on amylase activity, we studied the amylase profile of 60 patients with SHIs and Glasgow Coma Scores less than 10. Fourteen additional multiple trauma patients without head injuries were studied as a control group. We excluded patients with pancreatic injury and abdominal trauma. Total serum amylase (TA), pancreatic isoamylase (PA), and nonpancreatic isoamylase (NPA) levels were measured on Days 0, 2, 4, 7, and 14 postinjury. Values greater than 2 SD above the normal mean were considered elevated. All SHI patients were comatose; 14 died. In the SHI group, TA increased in 23 patients, PA increased in 40, and NPA increased in 14. The source of hyperamylasemia was PA in 14, NPA in one, and mixed in 8 patients. While PA increases occurred throughout the study, NPA elevations occurred early. These increases did not correlate with shock (BP less than 80 mm Hg; 17 patients), facial trauma (24 patients), or associated injury (29 patients). On Day 7 postinjury, the mean TA (215 du%) and the mean PA (203.8 du%) were significantly elevated in the SHI patients compared to controls (122.1 du%, P less than 0.05, Wilcoxon's rank sum test). These data indicate that serum amylase is not a reliable index of pancreatic injury in patients with SHI. Severe head injury and multiple trauma activate pathways that increase amylase levels in the blood, suggesting a central nervous system regulation of serum amylase levels. |
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