先天性胆管扩张症血清淀粉酶同工酶谱异常

目的　观察先天性胆管扩张症 (CBD)血清淀粉酶同工酶谱变化 ,探讨其临床意义。方法　采集 2 1例存在胰胆管连接异常 (PBM)的CBD患儿术前血清 ,取其中 13例术后血清、14例胆汁。另取 14例正常儿童和 7例急性胰腺炎成人血清。应用不连续缓冲系统薄膜电泳法行酶谱分析。结果　CBD患儿术前血清和胆汁胰型淀粉酶 (P)同工酶波峰出现率及构成比具相似性 ,除有P1和P2外 ,均出现P3、P4、P5等“老化”波峰 ,无优势波峰。正常组仅存在P1和P2。急性胰腺炎组P4少见 ,无P5 ,P2为优势波峰。该CBD血清酶学异常在胰胆分流术后基本消失。结论　CBD血清淀粉酶同工酶谱存在异常 ,具一定特异性。该异常证实PBM畸形存在胆 血反流 ,有助于PBM的诊断。     

Ca2+ dependence of the release of noradrenaline during nerve degeneration in the parotid gland

Summary Amylase secretion in vitro was used as an indication of the degeneration activity of sympathetically denervated parotid glands. Seventeen and a half hours after sympathetic denervation, slices of parotid gland released amylase into the incubation medium at a rate higher than that observed for non-denervated glands. The time course of amylase release from denervated glands followed a bellshaped pattern similar to that observed in other denervated structures. Lowering extracellular Ca²⁺ to 0.25 mmol/l diminished significantly the release of amylase. Low Ca²⁺ however, did not decrease the amylase release in response to added noradrenaline.These results indicate that Ca²⁺ is required for the release of noradrenaline from degenerating nerve endings.     

柴芩承气汤对急性重症胰腺炎的疗效观察及部分机制

目的:探究柴芩承气汤加减联合西医治疗急性重症胰腺炎的临床效果,并对其作用机制进行研究,以期丰富治疗方法,降低急性重症胰腺炎并发症,提高疗效。方法:选取2017年1月至2018年2月绵阳市中心医院收治的急性重症胰腺炎患者62例作为研究对象,按照就诊顺序编号,采用数字随机表法分为对照组和观察组,每组31例。对照组给予心电监护、禁食禁饮、胃肠减压、抑酸、维持内环境稳定、抗菌、抑制胰腺分泌和胰腺活性、止痛等治疗,观察组在对照组基础上加用柴芩承气汤加减治疗,且经胃管给药,均同时治疗2周。观察2组治疗前、治疗后血清淀粉酶、脂肪酶变化并比较;观察治疗前、治疗后在白细胞(WBC)、超敏C反应蛋白(hs-CRP)、内毒素、白细胞介素-6(IL-6)变化并比较;观察治疗前、治疗后在免疫功能指标CD4~+、CD8~+、CD4~+/CD8~+情况并比较;治疗过程中进行不良反应观察并比较;治疗后进行疗效比较。结果:1)2组患者治疗前血淀粉酶、尿淀粉酶、脂肪酶比较,差异无统计学意义(P0.05),治疗后2组以上指标较治疗前显著下降,差异有统计学意义(P0.05),治疗后观察组患者以上指标显著低于对照组,差异有统计学意义(P0.05);2)2组患者治疗前WBC、CRP、内毒素、IL-6指标比较,差异无统计学意义(P0.05),治疗后以上指标2组较治疗前均显著下降,差异有统计学意义(P0.05),治疗后观察组患者以上指标显著低于对照组,差异有统计学意义(P0.05)。3)2组患者治疗前CD4~+、CD8~+、CD4~+/CD8~+比较,差异无统计学意义(P0.05),治疗后CD4~+、CD8~+、CD4~+/CD8~+2组较治疗前显著升高,CD8~+则显著下降,差异有统计学意义(P0.05),治疗后观察组患者以上指标显著优于对照组,差异有统计学意义(P0.05)。4)完成治疗后观察组患者治愈率、总有效率明显高于对照组,差异有统计学意义(P0.05)。5)2组恶心呕吐、腹痛腹泻、头晕不良反应发生率比较,差异无统计学意义(P0.05)。结论:柴芩承气汤能抑制急性重症胰腺炎血清淀粉酶和脂肪酶,抑制炎性反应,改善免疫力,提高疗效。     

Acute pancreatitis coincident with valproate use: a critical review

PURPOSE: Acute pancreatitis has been associated with a number of medications, including valproate (VPA). Valproate-coincident pancreatitis is uncommon and is usually associated with other risk factors; however, the United States Food and Drug Administration has issued a box warning for risk of acute pancreatitis with VPA products. We reviewed cases of pancreatitis in VPA-treated patients from the clinical database of VPA/divalproex trials and compared the incidence of elevated amylase levels between VPA- and placebo-treated patients. METHODS: Report rates of acute pancreatitis coincident with VPA use in 34 clinical trials were calculated. Incidence rates of amylase elevations above the normal range in three clinical placebo-controlled migraine trials were compared between VPA- and placebo-treated patients. RESULTS: Among 3,007 VPA-treated patients in 34 clinical trials, two reports of pancreatitis were considered by investigators to be probably related to VPA. Both patients recovered. Similar rates of amylase elevations were observed in VPA- (5.9%) and placebo-treated (6.1%) patients in the three migraine headache trials. CONCLUSIONS: VPA-coincident acute pancreatitis is uncommon and idiosyncratic. Checking amylase levels in the absence of other clinical signs and symptoms provides little value for predicting pancreatitis. Physicians should be guided by clinical symptoms of pancreatitis to identify cases.     

Immunoelectron microscopy of amylase in the human parotid gland

Summary Specimens of the human parotid gland were studied by immuno-electron microscopy for the presence of amylase. Both the protein A-gold technique and the biotin-avidin-gold technique were used on the same specimens. Different fixations were tried. Amylase was detected in the zymogen granules in high amounts. This enzyme could even be seen in glutaraldehyde fixed and routinely embedded material. The subcellular localization of this enzyme opens a new field of functional morphological studies and studies in special tumours including acinic cell carcinomas.Supported by the Deutsche Forschungsgemeinschaft and by the Hamburger Stiftung zur Förderung der KrebsbekämpfungDedicated to Prof Dr. med. Dres. h.c. Wilhelm Doerr, Heidelberg, in honour of his 70th birthday     

Decreased pancreatic CCK receptor binding and CCK-stimulated amylase release in Zucker obese rats

In Zucker obese rats the response to the effects of CCK on food intake and pancreatic exocrine function are decreased. However, it is unknown whether the decreased responsiveness is due to decreased receptor number and/or sensitivity or abnormal circulating concentrations of CCK. In these experiments percent total binding of 125I-CCK-33 to pancreatic acini from obese rats was one-half that in lean rats when data was expressed on a per microgram DNA basis (19.6 +/- 5.1 vs. 47.4 +/- 11.4, p less than 0.01). In a second experiment while the maximally effective dose of CCK for stimulating amylase secretion from dispersed pancreatic acini was similar in obese and lean rats (10(-10) M), less amylase was secreted in obese rats across the dose range tested (p less than 0.001). In contrast, carbachol had similar potency and efficacy in stimulating amylase release from obese and lean pancreatic acini. The increase of pancreas size by use of a trypsin inhibitor was greater in lean than obese rats (p less than 0.03). In addition, stimulation of amylase release by CCK from obese trypsin inhibitor-treated compared with control obese rats was greater than that from lean trypsin inhibitor-treated compared with control lean rats (p less than 0.002). However, overall, stimulation of amylase secretion by CCK was only 36% of control (p less than 0.001) and by carbachol was only 20% of control (p less than 0.001). Thus, increased size by increased cell number was associated with decreased response per cell.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dynamics of beta adrenoceptor induced amylase release and cyclic AMP accumulation in the guinea pig submandibular gland

The dynamics of amylase release from the guinea pig submandibular gland were studied in vitro by applying a multi-channel microperifusion set. This technique makes it possible to measure time related enzyme release more accurately and to take samples of perifused tissue at short intervals. Stimulation of the ^-adrenoceptor with norepinephrine gives rise to a rapid initial enzyme discharge, detectable within 15 s. Administration of propranolol inhibits enzyme release, which is not restored after removal of the agent. Simultaneous measurements of tissue cyclic AMP during norepinephrine stimulation at various time intervals display a significant increase of cAMP as early as 15 s after stimulation of secretion. This increase of cAMP thus coincides with the discharge of amylase. In addition, cAMP continuously accumulates during 30 min of norepinephrine perifusion of the slices. The present study describes a valuable tool with high sensitivity for visualizing the relations between enzyme secretion from the salivary gland and the intracellular biochemical processes. The data obtained further indicate a close correlation between amylase and cAMP during the initial phase of enzyme discharge.     

中医辨证四联疗法联合常规西药治疗急性胰腺炎临床研究

目的:观察中医辨证四联疗法联合常规西药治疗急性胰腺炎肝胆湿热证与胃肠实热证的临床疗效。方法:选取急性胰腺炎肝胆湿热证和胃肠实热证患者80例作为研究对象,按随机数字表法分为研究组和对照组各40例。对照组采用常规西药进行治疗,研究组采用中医辨证四联治疗联合常规西药进行治疗,治疗时间均为14 d。评定2组患者的临床疗效,统计分析2组患者的腹痛消失时间、腹胀消失时间,肠功能恢复时间,血淀粉酶(AMS)、C-反应蛋白(CRP)、白细胞计数(WBC)恢复时间。评价2组CT严重指数(MCTSI)、腹腔内压力评分(IAP)。结果:研究组总有效率为95.0%,高于对照组77.5%(P<0.05)。治疗后,研究组的腹痛消失时间、腹胀消失时间、肠功能恢复时间、AMS恢复时间、CRP恢复时间、WBC恢复时间均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组MCTSI评分、IAP评分比较,差异无统计学意义(P>0.05)。治疗后,2组MCTSI评分、IAP评分较治疗前降低(P<0.05),且研究组MCTSI评分、IAP评分低于对照组(P<0.05)。结论:中医辨证四联疗法联合常规西药治疗急性胰腺炎肝胆湿热证与胃肠实热证,改善了患者的临床症状,提高了治疗效果,值得在临床上推广。     

In Vivo Healing Effects of Ankaferd Blood Stopper on the Residual Pancreatic Tissue in a Swine Model of Distal Pancreatectomy

The aim of this study was to determine whether intraoperative Ankaferd blood stopper (ABS) application into the pancreatic channel and to the pancreatic remnant surface following distal pancreatectomy can or cannot prevent postoperative pancreatic fistula formation. Three pigs underwent distal pancreatectomy under general anesthesia. In two of the pigs, 0.5 ml of ABS was applied to the stump surface area after adding 0.5 ml of ABS into the pancreatic channel. The remaining one animal served as the control. The pigs were sacrificed on the seventh postoperative day for autopsy. The pancreatic remnants from the animals were then taken for histopathological analyses. It was observed that the oral intake had been broken and abdominal distention had developed in the control pig following on the third postoperative day. However, no significant clinical changes were observed in the ABS-applied pigs. In the autopsy, it was found that the control pig had generalized peritonitis with pancreatic necrosis. On the other hand, the ABS-applied pigs had either macroscopically and microscopically normal pancreatic tissue architecture with an occluded Wirsung duct at the pancreatic stump. It was concluded that application of ABS on the transected surface and into the pancreatic channel could prevent pancreatic fistula formation and improve wound healing in the residual pancreatic tissue following distal pancreatectomy.