Time-course of changes in pancreatic size and enzyme composition in rats during starvation

The effect of starvation for 3, 5, or 7 d on body weight, fat stores, pancreatic weight, and enzyme composition was studied in 300 g rats and was compared with a. 3-d fast in 200 g rats. In the 300 g animals, fasting led to a gradual hypotrophy of the pancreas with a marked, continuous decrease in amylase content. Pancreatic lipase, trypsinogen, chymotrypsinogen, proelastase, and secretory trypsin inhibitor contents increased temporarily, but by d 7, they declined to about the initial values. This decline in enzyme levels coincided with the exhaustion of fat stores. The decrease in amylase content could be related to decreases in circulating insulin levels, whereas the temporary increase in lipase content may be owing to changes in plasma free fatty acid concentrations. In 200 g rats, starvation for 3 d led to exhaustion of fat stores that was accompanied by greater losses of pancreatic weight, protein, and amylase contents. In addition, the levels of trypsinogen and chymotrypsinogen decreased and lipase was unchanged. These findings indicate that during starvation, changes in pancreatic secretory enzymes are time-dependent and vary with the age, body weight, and/or adipose tissue mass of the rats.     

High-calorie, rice-derived, short-chain, glucose polymer-based oral rehydration solution in acute watery diarrhea

In this study, we have compared the effects of the World Health Organization oral rehydration solution (WHO ORS) and an ORS containing short polymers of glucose (Amylyte ORS) at a high caloric density (five times) and comparable osmolality, on stool output, duration of diarrhea, weight gain and fluid and electrolyte balance, in randomized, open-labeled, controlled clinical trials in five centers. A total of 198 male children (4 months to 10 years) with acute diarrhea (<72 h after onset) were assigned by random allocation to either WHO ORS or Amylyte ORS at five centers in Asia. Children were stratified according to grade of dehydration (mild, moderate or severe) and the initial purging rates during the first 6h (low (<2ml/kg/h), moderate (2–5ml/kg/h) and high (>5ml/kg/h) purgers). The clinical characteristics of the children in the two treatment groups were comparable. Amylyte ORS reduced stool volumes significantly in children with severe dehydration (285.4 ± 74.2 versus 75.5 ±20.0 ml/kg; p < 0.05) and in children with a high initial purging rate (200.3 ±42.8 versus 130.5 ± 9.1 ml/kg; p < 0.05). This was accompanied by a significant (276.4 ±14.6 versus 227.6 ± 11.8 ml/kg; p < 0.01) reduction in ORS requirements in the Amylyte ORS treated group, the effect being greatest in children with severe dehydration (491.5 ± 108.5 versus 155.7 ± 27.3 ml/kg; p < 0.01) or high initial purging rates (394.2 ± 66.2 versus 316.8 ± 34.8 ml/kg; p < 0.05). In mild or moderate dehydration and low or moderate purgers, duration of diarrhea in children treated with Amylyte ORS was not reduced. A significant (p < 0.05) reduction in duration of diarrhea was found in children with severe dehydration (56.4 ± 1.8 versus 34.0 ± 5.6h) or high purging rates (51.5 ± 7.1 versus 38.2 ± 4.8 h). Significantly (p < 0.0001) greater weight gain (520.3 ± 48.5 g versus 228.5 ± 42.1 g) and percent gain in weight (4.8 ± 0.4% versus 2.3 ± 0.4%) were found in children given Amylyte ORS compared with those given WHO ORS. Amylyte ORS rehydrated children with acute diarrhea, reduced stool volume, duration of diarrhea and ORS requirements in children with severe dehydration or high initial purging rates, and improved weight gain. Amylyte ORS has the advantage of containing short polymers of glucose that provide over five times the calories per liter than the glucose-based WHO ORS.     

Amylase and lipase measurements in paediatric patients with traumatic pancreatic injuries

Introduction

Pancreatic injuries occur in up to 10% of paediatric patients who suffer blunt trauma. Initial amylase and lipase measurements have not been helpful as a screening tool to detect pancreatic injuries. However, one primarily adult study suggests that a delayed measurement may be useful.

Materials and methods

A retrospective chart review was conducted of patients admitted to a Level I paediatric trauma centre from April 1996 to November 2006 with traumatic pancreatic injuries.

Results

The trauma database identified 51 patients with traumatic pancreatic injuries. Inclusion and exclusion criteria were met by 26 patients.Patients with initial amylase and lipase levels measured greater than 2 h post-injury were more consistently elevated compared to those patients who had levels measured at 2 h or less post-injury. There was a significant association between time of measurement and an increased amylase level (p = 0.012). No significant association was found for lipase measurements (p = 0.178).

Discussion and conclusions

In children with blunt pancreatic injury, elevated serum amylase levels were seen in a significantly higher percentage of patients with initial measurements at greater than 2 h post-injury compared to those measured at 2 h or less. Lipase measurements demonstrated a similar trend. Delayed amylase and lipase measurements may be helpful to detect pancreatic injuries, but further study is needed.     

急性胰腺炎的实验诊断研究进展

急性胰腺炎是临床上常见的急腹症之一，适时治疗的成功依赖于早期快速的确诊，实验室检查对早期诊断急性胰腺炎有重要作用。本文对实验室常规检测的淀粉酶、脂肪酶、胰蛋白酶原、羧肽酶等，从方法学发展到临床应用作一综述。     

乌司他丁联合奥曲肽治疗急性胰腺炎的疗效观察及对患者血清LPS、AMY和CRP水平的影响

目的探讨乌司他丁联合奥曲肽治疗急性胰腺炎的临床效果及对患者血清脂肪酶(LPS)、淀粉酶(AMY)及C反应蛋白(CRP)的影响。方法将2012年8月至2017年7月医院收治的100例急性胰腺炎患者随机分为对照组与观察组每组50例,对照组单用奥曲肽治疗,观察组在对照组基础上加用乌司他丁联合治疗,比较两组治疗效果,记录患者各症状改善时间,测定两组治疗前后血清LPS、AMY、CRP、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)等细胞、炎症因子水平的变化,统计治疗不良反应发生率。结果观察组临床治疗总有效率高于对照组(P<0.05);观察组腹痛消失时间、体温恢复时间、首次排便时间、恢复进食时间、AMY恢复时间、总住院时间均短于对照组(P <0.05);治疗前,两组血LPS、AMY、CRP、IL-6、IL-8、TNF-α水平比较差异无统计学意义(P>0. 05),治疗10 d,两组上述指标均降低(P <0. 05),观察组降低幅度高于对照组(P <0.05);两组治疗不良反应发生率比较差异无统计学意义(P> 0.05)。结论在急性胰腺炎患者的临床治疗中采用乌司他丁联合奥曲肽治疗方案,临床价值肯定,可明显下调患者血LPS、AMY及炎症因子水平,促进其恢复,且安全性高。     

肾综合征出血热患者胰腺功能变化的临床研究

将６５例确诊为肾综合征出血热（ＨＦＲＳ）的住院患者列为观察组,选１０例正常者为对照组,监测ＨＦＲＳ患者各期的空腹血糖、血淀粉酶,脂肪酶及胰岛素含量并随机选出３０例ＨＦＲＳ患者,于发热末期或少尿期行口服葡萄糖耐量试验及胰岛素释放试验（口服７５ｇ糖）。发现ＨＦＲＳ患者在发热期即出现血糖、血淀粉酶,脂肪酶及胰岛素水平升高,服糖后胰岛素释放减少,糖耐量减低。此变化在少尿期最显著,多尿期次灾,恢复期渐正常,     

肿瘤坏死因子α及淀粉酶对重症急性胰腺炎外科重症监护的临床干预及其效果评价

目的评价肿瘤坏死因子α（TNF-α）以及血、尿淀粉酶在外科ICU对重症急性胰腺炎患者临床干预的效果。方法回顾性分析我院外科ICU收治的32例急性重症胰腺炎患者,经我院外科ICU监护及治疗,比较治疗前后各组的TNF-α以及淀粉酶的结果。结果32例患者在临床干预后,TNF-α的曲线下面积为0．94,灵敏度为97％,特异度为90％;血淀粉酶的曲线下面积为0．89,灵敏度为93％,特异度为85％;尿淀粉酶的曲线下面积为0．87,灵敏度为75％,特异度为96％。结论TNF—α比淀粉酶能更好地用于评价急性重症胰腺炎患者的临床干预效果。     

The significance of plasma CCK and secretin in the oleate-stimulated pancreatico-biliary secretion in man

Summary In eight normal persons the plasma levels of secretin and cholecystokinin (CCK) measured after intraduodenal oleate were reproduced by intravenous (i.v.) infusion of synthethic secretin (3.4 pmol · kg^-1 · h^-1) and CCK-8 (17.5 pmol · kg^-1 · h^-1), either alone or in combination. Using an indicator dilution technique, the combined infusions of the two hormones were found to account for all the pancreatico-biliary secretion of amylase, bicarbonate, bile salts and volumen elicited in response to intraduodenal oleate, pH 6. Furthermore, the bicarbonate secretion and the flow rate elicited by secretin were augmented by CCK, whereas no augmentation was found with regard to the CCK-stimulated enzyme and bile salts output.     

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.     

The Clinical Significance of Salivary Amylase in Duodenal Aspirates in Evaluation of Exocrine Pancreas Function

Salivary and pancreatic amylases in duodenal aspirates were quantitated in 419 consecutive tests performed on 378 patients suspected of having insufficiency of the exocrine pancreatic function. Salivary amylase was detected in samples from 31% of the tests. However, the amount of salivary amylase was sufficient to cause a misinterpretation in 13 tests only. Five of these tests originated from patients with a history of surgery for peptic ulcer disease. This group of patients tended to have large amounts of salivary amylase in the duodenal aspirates. In the unoperated patients (n = 336) 200 tests yielded values for the total amylase concentration above the lower level of the reference interval, and only in 8 of these tests (4%) did correction for salivary amylase change the results to values below the reference interval. It it concluded that quantitation of isoamylase activity in duodenal samples is unlikely to be of significant value in patients without a history of surgery for peptic ulcer disease.