Stool chymotrypsin activity measured by a spectrophotometric procedure to identify pancreatic disease in infants

The aim of this study was to assess the analytical performance of the BMC stool chymotrypsin test and its accuracy in diagnosing pancreatic disease in infants. The test utilizes a detergent which solubilizes chymotrypsin bound to stool residues, and a tetrapeptide coupled to p-nitroaniline which is specifically cleaved by chymotrypsin. We employed the IL Multistat at 30 degrees C to monitor enzyme activity as an increase in absorbance at 405 nm. The reaction was linear to 600 U/g stool. Recovery of exogenous chymotrypsin with a single detergent extraction was 98-105%, and of endogenous chymotrypsin (as determined by multiple extractions) 80-97%. Imprecision (CV) was 2.2% within-day and 2.4% between-day for the BMC control, and 2.4-5.2% for stool chymotrypsin in the range 8.3-14.4 U/g. Since the test utilises only 100 mg of stool, inhomogeneity of enzyme distribution was assessed by multiple assays on a single stool, which revealed a range of activity from 4.2-150%. We therefore recommend sampling of each stool in triplicate. With this procedure, chymotrypsin was measured in 220 consecutive stool samples submitted for fat determination from children. Applying the manufacturer's lower reference limit of 4.1 U/g, the following results were obtained (number abnormal/total number): suspected intestinal disease with normal stool fat (5/127); proven intestinal disease and increased stool fat (1/26); untreated cystic fibrosis (CF) with (19/22), and without (0/3) steatorrhea; CF with pancreatic insufficiency on replacement therapy (4/42).(ABSTRACT TRUNCATED AT 250 WORDS)     

Gastrointestinal Tract in Hyperthyroidism before and after Treatment

The state of the upper gastro-intestinal tract in hyperthyroidism was studied in 42 patients before and after treatment. Gastritis was found in 30 patients out of 39. The incidence of gastritis in the control series was 52 per cent. Numerous plasma cells and aggregates of lymphocytes were commonly observed in both gastric and intestinal biopsy specimens. Before treatment the basal secretion of hydrochloric acid was 1.2 mEq/h and after histalog stimulation 4.6 mEq/h. There was usually a fairly good correlation between the secretion values and the gastric morphology, but in 5 patients the maximal stimulation values remained below 1 mEq/h, in spite of a normal or only slightly altered gastric mucosa. The re-examination, performed 4 months after treatment, revealed improvement of gastritis in 7 and progress in 2 of 21 patients. In the 16 patients examined, the average number of eosinophils in gastric mucosa increased from 33 to 47 per 0.1 mm² of tissue. The hydrochloric acid secretion revealed a decreasing trend, in particular in patients who initially had values above 5 mEq/h. In 3 patients with initial values below 5 mEq/h a distinct increase was observed. Faecal fat excretion was definitely increased in 7 out of 30 hyperthyroid patients, in spite of a normal villous structure. Five patients were re-examined after adequate treatment and the fat excretion had returned to normal in all instances.     

临床药师参与1例继发性糖尿病患者治疗过程的总结与体会

目的 探讨临床药师在合理用药中的作用.方法 临床药师深入临床,参与1例继发性糖尿病患者的治疗过程、药学服务与监护.结果 临床药师对患者治疗方案进行药学监护,提供药学服务,提高了患者的治疗依从性和临床治疗效果,减少了药物的不良反应.结论 临床药师深入临床,开展药学监护和指导,作为医师的助手,有助于形成“医药护”的整体治疗团队,在临床合理用药中发挥举足轻重的作用.     

Gastritis Classified in Accordance with the Sydney System in Patients with Primary Sjögren's Syndrome

The aim of the present study was to determine colipase activity in various pancreatic enzyme tablets to ascertain whether these contained sufficient amounts of colipase to activate lipase during fat digestion. Colipase activity in all preparations tested exceeded that of lipase activity by a factor of 1.4–1.9 on a molar activity basis. Since optimal activity of lipase is obtained with colipase being present in a colipase to lipase molar activity ratio of 1.0, it is concluded that these preparations contain a sufficient amount of colipase to activate lipase.     

Ultrastructural Aspects of Enterocyte Defects in Infancy and Childhood

Although there has been substantial progress in the identification of diarrheal diseases in infancy and childhood, electron microscopy may be still required for establishing diagnosis, staging, and response to therapy. This review describes severe conditions in which histopathologic examination alone cannot provide a firm diagnosis needed for therapeutic decisions. Microvillus inclusion disease, in its several variants, typifies this category. In certain forms of congenital disorders of glycosylation with gastrointestinal involvement, electron microscopic diagnosis is helpful. Among disorders due to abnormal immune-mediated reactions, celiac disease and cow's milk protein intolerance show fine structural changes of both diagnostic and staging value. Likewise, protein-losing enteropathies, including lymphangectasia, reveal information on the nature and extent of intestinal involvement.     

BILE ACID EXCRETION AND MALABSORPTION IN INTRAHEPATIC CHOLESTASIS OF INFANCY ("NEONATAL HEPATITIS")

Bile acid excretion has been studied in four patients with intrahepatic cholestasis of infancy neonatal hepatitis) after intramuscular administration of cholic acid-24-¹⁴.C Bile acid secretion to the intestines was found to be highly impaired and the main route of excretion was via the urine. Practically all of the administered labeled cholic acid was conjugated prior to excretion. The main conjugates were glycocholic and taurocholic acid. At least three additional conjugates of cholic acid were isolated from the urine. Analysis of bile obtained from three of the patients in connection with operative cholangiography showed a very low concentration of bile acids, phospholipids and cholesterol. The bile was of normal colour owing to the presence of bilirubin. Severe steatorrhea and markedly impaired absorption of vitamin A was demonstrated when the patients were jaundiced. The impairment of bile acid excretion to the gut and the degree of steatorrhea were well correlated. In some of the patients steatorrhea persisted after the disappearance of jaundice. In those instances, the impairment of bile acid excretion to the gut was found to persist.     

Fecal Fat Measurement in the Presence of Long- and Medium-Chain Triglycerides and Fatty Acids Comparison of Three Methods

Background: It has been suggested that some of the limitations of the Van de Kamer method for fecal fat measurement could be overcome with the Jeejeebhoy method or the near-infrared reflectance assay. Methods: To test this hypothesis, a fecal fat test was carried out with the three methods, adding butter or MCT oil to the diet of four steatorrhoic patients. An in vitro recovery study of long- and medium-chain triglycerides was also performed. Results: The Jeejeebhoy method measured long- and medium-chain fats more accurately than the Van de Kamer method. It found consistently higher steatorrhea values. Mean results of the near-infrared reflectance analysis resembled those of the Van de Kamer method, but with wide discordance of individual data. Conclusion: The Jeejeebhoy method is more accurate than the Van de Kamer method for fecal fat measurement. The difference may be clinically relevant when most fecal fatty acids derive from medium-chain triglycerides. Near-infrared reflectance may be a viable proposition only when a greater degree of approximation is acceptable.     

Comparative effects of adjuvant cimetidine and omeprazole during pancreatic enzyme replacement therapy

In a double-blind, randomized crossover study, the hypotheses were tested that more powerful inhibition of gastric acid secretion by adjuvant omeprazole further improves the efficacy of pancreatic enzyme replacement therapy compared to adjuvant cimetidine and that excluding the influence of pH-related factors, by virtually complete inhibition of gastric acid secretion with 60 mg omeprazole daily, does not lead to total elimination of steatorrhea. During both adjuvant cimetidine and omeprazole treatment, fecal fat excretion was significantly lower compared to pancreatin monotherapy (P<0.01). Omeprazole showed a trend towards a more favorable decrease of fecal fat excretion compared to cimetidine but no statistically significant difference. Steatorrhea was almost never abolished, even during 60 mg omeprazole daily. Generally, pH-related factors are considered to explain an inadequate therapeutic response during pancreatic enzyme replacement therapy. However, this study indicates thatin vivo other factors also play a significant role.     

玉女煎加减治疗面部脂溢性皮炎

脂溢性皮炎（SD），系发生于头面及胸背等皮脂溢出部位的一种慢性炎症性皮肤病，多发生于青壮年。本病运用玉女煎治疗临床报道较少，笔者跟从黄蜀教授学习过程中，常予以玉女煎加减治疗该病取得较好的疗效。     

Diagnostic Accuracy of Fecal Elastase 1 Assay in Patients with Pancreatic Maldigestion or Intestinal Malabsorption

Several reports have indicated that fecal elastase-1 (EL-1) determination is a new, sensitive, and specific noninvasive pancreatic function test; however, very few patients with malabsorption due to small intestine diseases have been included in the previous studies. The aim of the study was to compare the diagnostic accuracy of fecal EL-1 and fecal chymotrypsin (FCT) in distinguishing between pancreatic maldigestion and intestinal malabsorption. Three groups of subjects were studied: group A included 49 patients with known cystic fibrosis (25 males, median age 5 years); group B included 43 subjects with various small intestine diseases (17 males, median age 6 years); and group C included 45 children without any history of gastrointestinal disease (22 males, median age 5 years). In all patients, stools were collected for 72 h on a standard diet and fecal EL-1, FCT, and steatocrit tests were performed. Both EL-1 and FCT were below normal limits in all CF patients with pancreatic maldigestion not treated with pancreatic enzyme (100% sensitivity for both assays); El-1, but not FCT, was also below normal in all the CF patients with pancreatic maldigestion treated with pancreatic extracts. Both EL-1 and FCT values in the CF group were significantly lower than in subjects with various small intestinal diseases and in children without any history of gastrointestinal disease (P < 0.0001). FCT, but not EL-1, values showed an inverse statistically significant correlation with steatocrit values in the whole CF group (P < 0.001); FCT was below normal in three of four CF patients with steatorrhea on pancreatic enzyme therapy. Both EL-1 and FCT had 100% specificity when calculated in children without any history of gastrointestinal disease; in contrast, specificity was 86% for EL-1 and 76% for FCT if we considered the control group with small intestinal diseases: low EL-1 was observed in two cases of intestinal giardiasis, two cases of short bowel syndrome, one case of celiac disease, and one case of intestinal pseudobstruction; FCT was abnormal in four cases of intestinal giardiasis, three cases of celiac disease, one case of short bowel syndrome, one case of Crohn's disease, and one case of intestinal pseudobstruction. Diagnostic accuracy was 92% for fecal EL-1 and 82% for FCT. Steatocrit values were over the normal limit in 11 patients with small intestine diseases; in 7/11 of these patients at least one of the pancreatic test results was below the normal limit. In conclusions, in patients with CF, fecal EL-1 determination is not more sensitive than FCT in identifying pancreatic maldigestion; however, fecal EL-1 assay is more specific than FCT determination in distinguishing pancreatic maldigestion from intestinal malabsorption.