Isoamylases in diabetes mellitus

Summary We have evaluated the relationship between diabetes mellitus and exocrine pancreatic insufficiency in diabetic subjects by measuring a specific isoamylase arising from the pancreas. The pancreatic- and salivary-type isoamylase activity in serum and urine were evaluated and related to duration of disease, sex, age, weight, blood glucose level and glycosuria in 153 diabetics. In the insulin-dependent diabetics diagnosed between 15 and 24 years of age, a significant decrease in pancreatic isoamylase activity was found in serum and urine (means with 2 SD range, 50 U/l, 19–137 U/l, and 47 U/l, 4–607 U/l, respectively), as compared with control subjects (79 U/l, 45–140 U/l, and 183 U/l, 43–789 U/l, respectively). In this group of patients a low stimulated output of amylase into the duodenum was also observed (mean with range, 537 U, 87–1808 U), compared with controls (the lower limit of normal 2183 U). A significant positive correlation was found between stimulated output of amylase into the duodenum and pancreatic isoamylase activity in serum (r = 0.84, p < 0.01). In the non-insulin dependent diabetics, a significant negative correlation was found between blood glucose levels and pancreatic isoamylase activity in serum (r = -0.46, p < 0.01). In the diet-treated non-insulin dependent diabetics the pancreatic isoamylase activity in serum was increased compared with controls (mean and 2 SD range, 102 U/l, 49–211 U/l). In patients with blood glucose level above 12 mmol/l, however, a lowered pancreatic isoamylase activity in serum, and no apparent rise in serum immunoreactive insulin in glucose loading test was observed. The results suggest that production of pancreatic amylase is related to endocrine pancreatic function in diabetes mellitus.     

Latent period for symptomatic sensitization in bakeries

AIM: To describe the latent period for symptomatic sensitization in bread bakery workers. METHODS: Data on the latent period for symptomatic sensitization, resulting in either asthma or rhinitis, were obtained from an in-house health surveillance programme in a single large organization. RESULTS: Over a period of 10 years, 90 employees were identified with symptoms attributable to sensitization. The mean latent period was 7.3 years, with three employees describing the onset of symptoms in their first year of exposure. CONCLUSIONS: The long latent period, typically more than 1 year, suggests that health surveillance on appointment and then at annual intervals thereafter should be adequate to identify affected individuals in a bakery environment.     

An embryonic chick pancreas organ culture model: characterization and neural control of exocrine release

An embryonic chick (Gallus domesticus) whole-organ pancreas culture system was developed for use as an in vitro model to study cholinergic regulation of exocrine pancreatic function. The culture system was examined for characteristic exocrine function and viability by measuring enzyme release, and noting histological, morphological, and anti-amylase immuno-fluorescence staining changes over a series of incubation times. This embryonic culture system exhibits loss of viability and morphological degeneration after 12 h of incubation time. Characterization and development of this exocrine model system was an important aspect of this study. Assessment of the 18-day-old embryonic chick pancreas model clearly indicated biochemical and cholinergic functionality, and morphological integrity, of the tissue after 4-h incubation. This embryonic age and incubation period were utilized for all subsequent cholinergic studies. The in vitro model was used to study parasympathetic regulation of exocrine function via the muscarinc receptors present in the embryonic chick pancreas. The effects of synthetic muscarinic agonists (bethanechol and carbachol) and subtype-specific antagonists affected amylase release to varying degrees suggesting heterogeneity of receptors. The effects of the muscarinic receptor antagonists atropine (non-specific), pirenzepine (M(1)-selective) and 4-DAMP [4-diphenylacetoxy-N-methyl-piperidine methiodide] (M(3)-selective) on bethanechol-stimulated amylase release were examined. Atropine and 4-DAMP at concentrations of 2 microM and higher significantly inhibited (p<0.05) agonist-stimulated amylase release, while pirenzipine did not at 2 microM, but did at 200 microM. The M(3) subtype selective antagonist 4-DAMP (2 pM-2 mM) significantly inhibited (p<0.05) 5 mM bethanechol-stimulated amylase release at concentrations of 2 microM and greater (amylase activity decreased from 100.61 to 49.41 U/l/mg). The data suggest the existence of a muscarinic receptor subtype for the embryonic chick pancreas exocrine cells characteristic to the mammalian M(3) glandular subtype.     

Lipase/amylase ratio distinguishes mild acute biliary pancreatitis from nonpancreatitis

The report by Gumaste et al. [Gastroenterology 1991;101:1361–1366] that the lipase/amylase ratio (Lip/Amy) could be a new index distinguishing acute episodes of alcoholic (Lip/Amy >2) from nonalcoholic pancreatitis (Lip/Amy <2), with the critical value being Lip/Amy =2, has been followed by some debate between supporters and opponents. By comparing the Lip/Amy in a group of 16 carefully selected patients with mild acute gallstone-related (biliary) pancreatitis with that in a reference group of 44 controls, this study examines whether or not this ratio could be a useful index for diagnosing biliary pancreatitis. Considering that both pancreatic and hepatobiliary systems are blocked by stones, hepatic biochemical parameters such as serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB) were also included in fitting the regression equation. The average value of Lip/Amy in the biliary pancreatitis group was 2.29 ± 0.93, while that in the control group was 1.30 ± 0.99. Thus, Lip/Amy was found to be a significant index for distinguishing mild acute biliary pancreatitis from nonpancreatitis. However, the critical value of Lip/Amy seemed to depend on the diet pattern and cultural background.     

重症急性胰腺炎合并胰性脑病30例分析

目的 探讨重症急性胰腺炎合并胰性脑病的临床特点、出现时间与血尿淀粉酶、脑脊液、脑电图以及颅脑CT变化的关系.方法 根据1992年亚特兰大国际胰腺病会议制定"急性重症胰腺炎"的定义和中华消化学会胰腺病学组2003年上海会议制定的"急性胰腺炎诊治指南"作为诊断标准,并排除Wernicke脑病后进行回顾分析.结果 30例胰性脑病中,合并消化道出血16例,胸腹水14例,ARDS 3例,感染性休克2例,低钙血症10例,胰周脓肿2例,中毒性心肌炎9例,并发症发生率占86.3%;始发病因以胆源性疾患居多,出现精神神经症状的中位时间为8 d;PE组72 h BA、PEBA水平和各种并发症的发生率与对照组差异有显著性(P＜0.05).结论 胰性脑病发病高峰期多为病发后1周内,常与其他并发症并存;病人症状为反应迟钝、定向力障碍、意识模糊、幻觉及昏迷等;但脑脊液、脑电图及颅脑CT均正常;血中淀粉酶增高是PE发生的关键环节,其它并发症是促发因素;及时采用药物控制PLA2的释放及胰腺实质的广泛坏死,对于提高重症急性胰腺炎的抢救成功率,减轻胰性脑病发生,降低死亡率很有意义.     

急性有机磷中毒血清淀粉酶与疾病预后相关性探讨

目的 探讨急性有机磷中毒血清淀粉酶变化的临床意义。方法 患者入院当日采取血通过血清淀粉酶速率法检测血清淀粉酶。结果 61例中有机磷中毒患者中20例有淀粉酶增高，其中8例中间综合症及8例呼吸心跳骤停患者有均4例淀粉酶升高，且升高程度与病情严重程度呈正相关。结论 急性有机磷中毒可出现淀粉酶增高，且其增高程度对评估患者预后有重要意义。     

法莫替丁预防内镜逆行胰胆管造影术后胰腺炎的临床研究--附46例报告

目的 :探讨法莫替丁预防内镜逆行胰胆管造影 (endoscopicretrogradecholangiopan creatography ,ERCP)术后急性胰腺炎的作用。方法 :86例胆胰疾病患者分为法莫替丁组 4 6例和安慰剂组4 0例 ,分别在ERCP术前 1日和当日静脉滴注生理氯化钠 5 0 0mL加法莫替丁 2 0mg和单纯生理氯化钠 5 0 0mL ,每日 2次。术前、术后 4小时及 2 4小时分别测定血清淀粉酶并观察有无急性胰腺炎的临床表现如腹痛、呕吐、发热等。结果 :ERCP术后法莫替丁组及安慰剂组急性胰腺炎的发生率分别为 7% (3/ 4 6 )、13% (5 / 4 0 ) ,P <0 0 1;术后 4小时高淀粉酶血症的发生率分别为 30 % (14 / 4 6 )、 4 8% (19/ 4 0 ) ,P <0 0 5。术后 2 4小时两组血清淀粉酶水平差异无统计学意义。结论 :法莫替丁可减少ERCP术后急性胰腺炎的发生率     

泪液淀粉酶测定在自体颌下腺移植治疗角、结膜干燥症中的应用

目的：探讨自体颌下腺移植治疗角结膜干燥症术后泪液（S－T）中淀粉酶（AMY）含量的变化及意义。方法：采用国际临床化学联合会（IFCC）推荐的亚乙基封闭G7－PNP作底物的酶连续监测法（EPS法）测定移植术后S－T液及30例正常人泪液，颌下腺液AMY含量。结果：移植术后S－T液中AMY呈高分泌状态；术后随时间推移，S－T液中AMY呈现递减趋势，正常人泪液中亦含有高活性的AMY。结论：正常人泪液中含有高活性AMY这一事实证实颌下腺移植术是可行的，S－T液中高分泌水平的AMY提示移植腺体成活并有良好的分泌功能；S－T液中AMY递减趋势可能与眼部微环境变化，适应性变化有关。     

Acute pancreatitis and amiodarone： A case report

Amiodarone, a class Ⅲ antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary toxicity, hepatotoxicity, aggravation of arrhythmia, and thyroid diseases are well understood. A 66-year old woman with acute pancreatitis was admitted to our hospital with the complaint of epigastralgia radiating to both flanks for two months. Her symptoms and elevation of pancreatic enzymes did not respond to conventional medical treatment of pancreatitis for 18 d. No known causal factors for pancreatitis such as biliary tract stone, hypertriglyceridemia and alcohol consumption could be identified. Under the suspicion of amiodarone-induced acute pancreatitis, amiodarone was substituted by propafenone. Her symptoms soon alleviated and serum lipase level declined. Three months after hospital discharge, the abdominal pain did not recur. Amiodarone was approved to treat recurrent ventricular fibrillation or sustained ventricular tachyarrhythmia that has been resistant to other medications since 1986. Pancreatitis is a very rare adverse effect associated with the use of amiodarone, and only four cases of amiodarone-induced pancreatitis have been reported in literature. We report a patient who developed acute pancreatitis during amiodarone therapy.     

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

A 54-year old man with a family history of hyperlipidemia was admitted with a 12 h history of severe generalized abdominal pain associated with nausea, vomiting and abdominal distension. Examination of the abdomen revealed tenderness in the periumblical area with shifting dullness. Serum pancreatic amylase was 29 IU/L and lipase 44 IU/L, triglyceride 36.28 mmol/L. Ultrasound showed ascites. CT of the abdomen with contrast showed inflammatory changes surrounding the pancreas consistent with acute pancreatitis. Ultrasound （US） guided abdomen paracentesis yielded a milky fluid with high triglyceride content consistent with chylous ascites. The patient was kept fasting and intravenous fluid hydration was provided. Meperidine was administered for pain relief. On the following days the patient＇s condition improved and he was gradually restarted on a low-fat diet, and fat lowering agent （gemfibrozil） was begun, 600 mg twice a day. On d 14, abdomen US was repeated and showed fluid free peritoneal cavity. The patient was discharged after 18 d of hospitalization with 600 mg gemfibrozil twice a day. At the time of discharge, the fasting triglyceride was 4.2 mmol/L. After four weeks the patient was seen in the clinic, he was well.