Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:3.1.3.1 (alkaline phosphatase)
47,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The alarming increase in the number of clinical cases of carcinoma of the pancreas provides the stimulation to search for an experimental model that produces chronic progressive obstruction of the main pancreatic duct. Fifteen mongrel dogs were studied for 1 to 11 weeks. To induce chronic progressive obstruction of the pancreatic duct, a cellophane tape was placed around the main duct adjacent to its entrance into the duodenum and tied over a needle with a diameter identical to that of the duct; the needle was then withdrawn. All minor ducts were identified by pancreatography and then ligated with 2-0 silk. Each animal was followed up by repeated ductal pancreatography and measurements of serum amylase and alkaline phosphatase concentrations. Histologic, histochemical and ultrastructural studies were also performed. On both gross and microscopic examination each animal demonstrated chronic pancreatitis with preservation of the islands of Langerhans. In the early period (4 to 7 days) complete ductal obstruction occurred as demonstrated by pancreatography and by elevated serum values for amylase (264% increase) and alkaline phosphatase (209% increase). In contrast to what is seen after acute ductal ligation, the ductal epithelial cells increased in number and height. At 4 weeks a new collateral ductal system had developed and serum amylase and alkaline phosphatase values had reverted to normal. This model is useful in studying the kinetics of pancreatic ductal regeneration and the pathophysiology associated with chronic pancreatic ductal obstruction.
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PMID:[Effects of chronic and progressive obstruction of the main pancreatic duct on the epithelium of the ducts and the exocrine pancreatic tissue]. 73 96

In patients with chronic pancreatitis, common bile duct obstruction is reported in 3.2-45.6% of patients; however, only 5-10% of all patients with chronic pancreatitis require operative decompression of the bile duct. The cause of the intrapancreatic stricture of the common bile duct may be either a fibrotic inflammatory restriction, or compression by a pseudocyst. Obstruction of the duodenum is much less common than common bile duct obstruction in chronic pancreatitis occurring in less than 1-2% of patients with chronic pancreatitis. Colonic obstruction secondary to pancreatitis is very infrequent. The intrapancreatic strictures of chronic pancreatitis are characteristically smooth and tapering on endoscopic retrograde cholangiopancreatography (ERCP), but in some patients, they may have a sharp cut-off and closely resemble the appearance of carcinoma of the pancreas invading the bile duct. The natural history of these intrapancreatic strictures is variable. They may progress and be associated with cholangitis, biliary cirrhosis, common duct stones, or may remain stable for years or regress. Prior pancreaticojejunostomy is not protective against the development of intrapancreatic biliary strictures which may follow in 5-30% of patients, with most authors reporting an incidence of less than 10%. Evaluation of alkaline phosphatase, bilirubin, the presence of jaundice, or the appearance of an intrapancreatic stricture on ERCP is not predictive of whether cholangitis or biliary cirrhosis may or may not develop. The incidence of cholangitis and biliary cirrhosis in patients with intrapancreatic stricture is 9.4% and 7.3%, respectively. Laennec's cirrhosis occurs in a similar number of patients. Operation is indicated in patients with intrapancreatic strictures of the common bile duct in association with chronic pancreatitis in patients developing cholangitis, biliary cirrhosis, common duct stones, progression of the stricture, persistent high elevations of alkaline phosphatase and/or bilirubin for over a month or inability to rule out cancer of the pancreas or periampullary region. The operation of choice is choledochoduodenostomy or Roux-en-Y choledochojejunostomy to bypass the obstructed intrapancreatic portion of the common bile duct. Persistent duodenal obstruction for over 3 or 4 weeks is an indication for gastrojejunostomy. Pain is not a feature of common bile duct obstruction in the absence of cholangitis. In the presence of pain associated with chronic pancreatitis, longitudinal pancreaticojejunostomy is the operation of choice combined with Roux-en-Y choledochojejunostomy. Some of the newer operations, e.g., the Beger and Frey procedures, may make the necessity of a separate operation for biliary decompression superfluous.
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PMID:Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. 240 39

174 patients with chronic pancreatic diseases, 30 patients with pancreatic carcinoma and 144 with chronic relapsing pancreatitis, 50 of them with calcifications, were observed in the Department of Internal Medicine of the University of Marburg/FRG between 1972 and 1982. In order to differentiate between carcinoma and relapsing pancreatitis the data of these patients were analysed retrospectively with regard to patient history, actual complaints, findings of laboratory, sonography, ERCP and X-ray investigations. The following results were obtained: Of discriminating value are steatorrhoe, local palpatory pain, alcohol ingestion, a history of earlier attacks and relapsing pain situations; however, general abdominal pain, nausea, vomiting and weight loss (if not exactly specified) are not. Within the laboratory findings bilirubin, GOT, alkaline phosphatase, gamma-GT, serum potassium, blood sugar and chymotrypsin content of the stool were significant while serum and urine amylase were similarly distributed within the groups of patients. Carcinoma and chronic relapsing pancreatitis can be identified by sonography in the majority of patients, but calcifications of the pancreas were rarely demonstrated during this observation period. The obstruction of the extrahepatic bile ducts--mostly due to a carcinoma of the pancreas head--was usually well documented by sonography. Intraabdominal air proofed to be the most disturbing factor. In carcinoma patients, the ERCP is important in demonstrating a complete obstruction of the pancreatic duct and stenosis and dilatation of the extrahepatic bile ducts. In patients with chronic relapsing pancreatitis the pancreatic duct alterations such as dilatations and partial stenosis are well documented by ERCP especially if calcifications occur. In patients without calcifications, dilatation of the branches of the main duct are less relevant in the diagnosis of pancreatic diseases. Radiological demonstration of calcification of the pancreatic area is important for the differential diagnosis. Longstanding characteristical complaints, symptoms and calcifications within the pancreatic area are the most relevant factors in discriminating carcinoma and chronic relapsing pancreatitis.
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PMID:[Differential diagnostic evaluation of chronic pancreatitis in relation to pancreatic cancer based on clinical, laboratory chemical and diagnostic parameters. Studies of 174 patients in 10 years]. 353 95

Analysis of 56 patients with obstructive jaundice due to carcinoma of the pancreas or extrahepatic biliary tree showed that unexpected features were present in 25%. Presentation with painless jaundice was uncommon, and the symptoms were more often non-specific, with malaise, anorexia, and vomiting. Abdominal pain was frequent, and the condition was found in young patients. One-fifth presented with serum alkaline phosphatase levels of less than 30 K.A. units. Some had high serum aspartate aminotransferase levels, more characteristic of hepatocellular jaundice. A mathematical model may be helpful in correctly weighting these various criteria.
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PMID:Pitfalls in the diagnosis of jaundice due to carcinoma of the pancreas or biliary tree. 451 75

This is a retrospective review of 233 patients who had surgical exploration for proven or suspected malignant lesions of the exocrine pancreas and periampullary structures. There were 24 patients with carcinoma of the ampulla or duodenum, 12 with carcinoma of the bile duct, and 197 with lesions of the pancreas. Among the latter group, 128 patients had carcinoma diagnosed at initial operation (31 by duodenopancreatectomy, 33 by liver, and 64 by other biopsies), and 69 patients had suspected carcinoma of the pancreas without histological proof. History of jaundice, pruritus, nausea/vomiting, total weight loss, duration of pain, and values of blood urea nitrogen, bilirubin, alkaline phosphatase, and albumin were significantly different among the various groups. Patients who had resection of carcinoma of the duodenum or ampulla had the best 5-year survival rate (39 +/- 12%). Among patients with resectable or nonresectable carcinoma of the pancreas, some of the symptoms and laboratory tests studied had prognostic significance.
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PMID:Clinical and laboratory findings of carcinoma of the pancreas and periampullary structures. 669 85

Patients with inflammatory bowel disease and serum alkaline phosphatase persistently raised to more than twice the normal level were investigated to assess the frequency of primary sclerosing cholangitis (PSC) in the Gastro-intestinal Clinic from 1975 to 1981. Twelve patients had a persistently raised alkaline phosphatase level of hepatic origin, 9 out of 250 with ulcerative colitis and 3 out of 164 with Crohn's disease. PSC was demonstrated in 8(3%) of the patients with ulcerative colitis, and carcinoma of the pancreas in the remaining 1. Three of the patients with PSC also had gallstones. The colitis antedated the biliary symptoms and signs in all but 1 patient. There was no correlation between the duration, extent and activity of the colitis and the development and outcome of the liver involvement. Investigations in the 3 patients with Crohn's disease revealed the presence of PSC in 2 (1,2%) and chronic active hepatitis in the 3rd. Of the 2 with PSC, one had cholelithiasis and has had recurrent episodes of cholangitis. The other has had only mild symptoms.
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PMID:Primary sclerosing cholangitis associated with inflammatory bowel disease in Cape Town, 1975 - 1981. 682 39

In order to determine whether obstructive pancreatobiliary lesions increase the risk of duodenal erosions and ulcers, the duodenal mucosa of patients with these lesions were prospectively examined before endoscopic retrograde cholangiopancreatography (ERCP). During the study period, 133 patients underwent ERCP for various reasons in the Department of Medicine, The Aga Khan University Hospital. One hundred and twenty-three patients were eligible for final analysis. Sixty-five patients with bilirubin > or = 35 mumol/L and alkaline phosphatase > or = 2.5 times normal levels along with radiological evidence of pancreatobiliary obstruction were included in the obstruction group. Fifty-eight patients who did not fulfil these criteria were used in the control group. Acid peptic lesions, which included erosions and ulcers, were seen in 16 patients of the obstruction group and four patients of the control group (P = 0.016, odds ratio (OR) = 4.41). Patients with carcinoma of the pancreas had a greater number of lesions than the rest of the obstruction group (P = 0.001, OR = 8.75). Individual variables like age, sex, serum bilirubin, alanine aminotransferase, alkaline phosphatase, amylase levels, and duration of jaundice did not increase the vulnerability to acid peptic injury. The degree of obstruction multiplied by duration of jaundice (alkaline phosphatase x days) increased the susceptibility for duodenal disease (P = 0.047). From this data it was concluded that patients with obstructive pancreatobiliary lesions are more prone to acid peptic duodenal lesions.
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PMID:Duodenal erosions and ulcers in patients with pancreatobiliary obstruction. 943 33

A 5-year review of 50 patients, 28 males, 22 females, with a mean age of 42 years, operated for obstructive jaundice at Ile-Ife, Nigeria was undertaken. Neoplasms of the pancreas, liver, and bile duct were the common causes. Percutaneous Transhepatic Cholangiography (PTC) with hypotonic duodenography was excellent in determining the underlying lesions. Pancreatic carcinoma accounted for 28% of cases, cholelithiasis 24%, hepatoma 22%, metastatic cancer 14%, bile duct carcinoma 10%, and traumatic pancreatic pseudocyst 2%. The patients with malignancies were older than those with biliary calculi. Biochemically, elevated alkaline phosphatase, and conjugated hyperbilirubinaemia, particularly in malignant obstructions, were diagnostic. Benigh bile ductal obstructions were surgically managed without any mortality. Malignant obstructions were surgically managed without any mortality. Malignant obstructions with their advanced presentations were less successfully managed. Biopsy alone or palliative bypass procedure could only be offered and the survival rate was dismal.
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PMID:Diagnosis, management and prognosis of obstructive jaundice in Ile-Ife, Nigeria. 992 Oct 92

A 66-year-old white male presented with jaundice, pruritus, and a 30-pound weight loss over two months. Physical examination revealed scleral icterus. Laboratory evaluation revealed ALT 161 U/L, AST 290 U/L, alkaline phosphatase 2004 U/L, GGT 2,552 U/L, total bilirubin 10.2 mg/dL, and a carbohydrate antigen 19-9 (CA 19-9) level of 4,374 U/mL. Initial endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful due to ulceration in the duodenum healed with esomeprazole therapy. Subsequent ERCP showed a possible filling defect in the common bile duct treated with sphincterotomy and balloon sweeping of the common bile duct. Symptoms and jaundice resolved five months after initial presentation with normal labs and studies. While elevated CA 19-9 levels occur in most patients with carcinoma of the pancreas, it can also be elevated in patients with extrapancreatic malignancies and acute cholangitis. This case illustrates the fact that a markedly elevated CA 19-9 can be secondary to causes other than carcinoma.
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PMID:Patient with markedly elevated CA 19-9 not associated with malignancy. 1655 91

Experience with serum leucine aminopeptidase determination in 61 patients led to the following conclusions. The test is no more sensitive than the alkaline phosphatase test in cases of carcinoma of the pancreas. It is elevated in all cases of obstructive and hepatogenous jaundice and serves no useful function in their differentiation. It was a valuable test in cases of calculous biliary tract disease, being more sensitive than either bilirubin or alkaline phosphatase determinations. In three instances of elevated leucine aminopeptidase in disorders apparently not related to the liver or pancreas, laparotomy and autopsy showed involvement of these organs in two.
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PMID:The Diagnostic Value of Serum Leucine Aminopeptidase. 2032 67


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