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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intestinal perfusion methods with a nonabsorbable marker allow an exact quantitative determination of intestinal absorption and secretion provided that methodological pitfalls are avoided. A modified technique is applied to the simultaneous measurement of biliary and pancreatic secretion during and depending on emptying of a mixed test meal. A duodenal segment was perfused with an isotonic polyethyleneglycol solution (PEG). Reinjection of duodenal aspirates maintained a normal enterohepatic circulation of bile acids (interruption less than 10%). The perfusion was performed in healthy volonteers over a period of 12 to 24 hours, with three mixed formula meals containing 51CrCl3 as a marker ingested at conventional feeding hours. Influence of meal size was studied by means of a high caloric (40 Kcal/b. wt. per day) test meal. Patients with cholesterol gallstones and cirrhosis of the liver only received one formula test meal of 300 Kcal. Instead of concentrations output of trypsin, lipase, bile acids and cholesterol (the latter corrected for duodenal absorption) was calculated from the dilution of PEG in the duodenal juice and gastric emptying was determined by following quantitatively the flow of 51CrCl3. Gastric emptying can be expressed by a single exponential function over most of the time. Only the last 60-100 Kcals were expelled by the stomach at a faster rate. The daily biliary and pancreatic secretion depend indirectly on the amount of food ingested. But during the day light hours (with continuous meal flow), secretion was similar in high and low caloric subjects, while a significant difference became obvious during night hours corresponding to differences in gastric emptying time. Mean hourly output of bile acid, biliary cholesterol, trypsin and lipase is independent from meal size and secretion of pancreatic enzymes reaches the values close to those after maximal stimulation by i.v. CCK-PZ. Output of pancreatic enzymes does not differ in health and gallstone disease or cirrhosis of the liver respectively. Since during digestion in normals approximately one forth of the bile acid pool is secreted hourly into the gut, the number of daily enterohepatic cycles of bile acids can be calculated by 4-6. Patients with cholesterol gallstones maintain normal bile acid output by enhanced cycling of the small pool: An average of 50% of the pool passed the duodenum per hour. A decreased bile acid pool is also present in cases of advanced cirrhosis of the liver. However, hourly output of bile acids in these patients is significantly less than in mild cirrhosis (with normal bile acid pool) or normal controls. Therefore the hourly fraction of the pool secreted is similar to healthy subjects. These findings provide an important information to explain abnormalities in bile acid metabolism in cirrhosis.
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PMID:[Simultaneous determination of gastric emptying and bile and pancreatic enzyme secretion]. 106 80

We have made a prospective study in alcoholic patients, with and without hepatic cirrhosis, in order to evaluate the presence of modifications in the composition of pancreatic juice (JPP) and in the pancreatogram that allows us to diagnose the existence of chronic pancreatitis associated with alcoholic cirrhosis (CE). The patients where 23 chronic alcoholics, 13 of them with CE and the other 10 with no hepatic injury (AC). In all, an endoscopic retrograde cholangiopancreatography (CPRE) was made and after having obtained a pancreatogram a intravenous infusion of secretin and cholecystokinin was performed. The total volume, the concentrations and the out-puts of bicarbonate, amylase, lipase and total proteins were measured in the pancreatic juice collected during 12 minutes. The pancreatogram was normal in the 92.3% of CE and in all the AC. Patients with CE had similar values of all the evaluated parameters to AC patients. In conclusion, there seems to be a good correlation between the pancreatogram and the analytic study of JPP, because the JPP has no qualitative and quantitative anomalies when the Wirsung duct is normal. In our opinion the study of JPP is not useful in the diagnostic of chronic pancreatitis associated with alcoholic hepatic cirrhosis.
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PMID:[Pancreatic function and morphology in chronic alcoholism with and without cirrhosis]. 141 27

Wolman's disease is a fatal disorder characterized by absence of acid lipase and accumulation of cholesterol esters. Inanition due to malabsorption and intractable diarrhea has been the most prominent cause of early demise within the first year. Further complications have included cirrhosis and pulmonary failure due to cholesterol ester storage in respective cells. Although sustained caloric balance can be maintained by total parenteral nutrition, this has not altered the eventual course of disease. The acid lipase deficiency in leucocytes in Wolman's disease can be corrected subsequent to bone marrow transplantation. This has proven to be the case in two patients so transplanted. In two other patients, engraftment was not obtained following bone marrow transplantation. The concept of treatment of Wolman's disease by providing normalization of the acid lipase activity by allogeneic bone marrow transplantation remains valid. However, improvement of bone marrow transplant procedure needs to be implemented since pre-existing morbid pathology enhances toxicity and may prevent engraftment. Alternative modifications for accomplishing sustained engraftment without toxicity need to be examined. Other potential therapies need to be inspected in treatment of patients with Wolman's disease. The capability of reducing cellular cholesterol synthesis by use of lovastatin, an inhibitor of 3-hydroxy-3-methylglutaryl-CoA reductase, is now available. In the future, isolation and purification of acid lipase will allow for direct infusion of missing enzyme. The molecular biology now known concerning acid lipase gene holds promise for the future for recombinant manufacturing of acid lipase. And, gene therapy with its use of autologous bone marrow transplantation will be tried in future.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Wolman's disease: a review of treatment with bone marrow transplantation and considerations for the future. 152 Oct 99

In order to assess the experimental level of enzymatic content in exocrine pancreas of cirrhotic rats, cirrhosis was induced with administration of thioacetamide (50 mg/kg) during ten weeks to male Wistar rats with an initial average weight of 350 g. Contents of amylase, lipase and trypsinogen were determined in pancreatic tissues and amylase, lipase and biliary salts in duodenal juice obtained by cannulation and perfusion with physiologic serum. A higher presence of trypsinogen and amylase was detected in pancreatic tissues, and of lipase in the duodenal juice, with a trend, although insignificant, towards a decrease in biliary salts among the cirrhotic group. No changes were observed in the morphologic study. The hypothesis that a deficit of biliary salts in experimental cirrhosis could be responsible of the enzymatic increase in the pancreatic tissue and, in particular, of the selective excretion of lipase, is discussed.
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PMID:[Modifications of the enzymatic content and morphology of the exocrine pancreas of rats with experimental hepatic cirrhosis induced by thioacetamide]. 172 29

This report describes a variant form of lipase found in a patient with cryptogenic liver cirrhosis. Serum lipase in this patient showed persistently increased activity with simultaneously normal activity of amylase. Results of exclusion chromatography demonstrate that the lipase activity in the serum of this patient eluted as a macromolecule. Since macromolecular complexes were not fixed by protein A, it seems unlikely that lipase is attached to IgG. Tests of the sera from 20 patients with raised serum lipase activity in acute pancreatitis or an acute episode of chronic pancreatitis revealed, in two patients, that a small but reproducible proportion of the total lipase activity eluted in the region of the macrolipase. In addition, 10% and 18% of the total lipase activity was found in the elution region of the macrolipase in two commercial pooled sera used for quality control. The results show that, in rare cases, macrolipasemia must be considered a possible cause of raised serum lipase activity.
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PMID:Macrolipasemia: a rare cause of persistently elevated serum lipase. 232 84

The pancreatic functions (PFD test and 75g GTT), pancreatic enzymes (serum-amylase, urine-amylase, serum-elastase I and serum-lipase), alcohol consumption histories, clinical symptoms, histological findings in the liver and ERP findings have been examined in 66 alcoholic patients. Fourty two out of 66 cases (64%) showed abnormal ERP findings which were compatible with chronic pancreatitis. But among these 42 cases, only 9 cases (21%) showed clinical symptoms such as epigastralgia, back pain, diarrhea and emaciation which suggest the existence of chronic pancreatitis. The degree of liver damage, alcohol consumption have no significant correlation with ERP findings. Furthermore, the severe alcoholic pancreatitis occurred in patients having mild liver injury more than those having severe liver injury such as cirrhosis. And the data of pancreatic functions and enzymes could not confirm ERP findings especially in patients with mild and moderate pancreatic injury when compared to normal ERP findings. We concluded that asymptomatic alcoholic pancreatitis occurred more frequently in painless alcoholic. It may be not suitable for only using the normal pancreatic functions test to diagnose the alcohol induced chronic pancreatitis.
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PMID:[Clinical study on alcoholic pancreatitis in alcoholics (especially in ERP findings)]. 275 67

To estimate the diagnostic value of elastase output in the duodenal aspirates during a pancreozymin secretin test, elastase as well as amylase, chymotrypsin, trypsin, and lipase was determined in 46 controls and 61 patients with various disease. The elastase output decreased significantly in chronic pancreatitis (mild exocrine insufficiency 13 and advanced eight), pancreatic cancer (n = 10), and liver cirrhosis (n = 14) when compared with the controls. The outputs of the four other enzymes also decreased in chronic pancreatitis and pancreatic cancer, not in liver cirrhosis. Low elastase output was found in four of 13 chronic pancreatitis patients with mild exocrine insufficiency, whereas low outputs of the other enzymes were observed in only one or less of the 13. The ratio of elastase to amylase alone was significantly lower in the pancreatic diseases. The results suggest that elastase is the most susceptible enzyme to pancreatic dysfunction and that its output and its ratio to amylase output provide a valuable index to assess the enzyme secretory capacity in the pancreatic diseases.
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PMID:Elastase secretion in pancreatic disease. 384 84

The purpose of this work was: a) the prospective study of the prevalence of hyperamylasemia in 100 patients with chronic alcoholism; b) the determination of the serum isoamylase distribution in patients with hyperamylasemia by an inhibitor assay; c) the search of the origin of elevated serum isoamylase S. Moderate hyperamylasemia was found in 15 patients. The importance of alcohol abuse, the prevalences of cirrhosis and smokers were not statistically different from those observed in normoamylasemic patients. After one week of hospitalization, serum amylase was still elevated in 11 of 14 alcoholic patients. Hyperamylasemia was due to an increase in the isoamylase P in 5 cases, in the isoamylase S in 7 cases, and in both forms in 3 cases. Activities of serum lipase and isoamylase P were roughly parallel. Only two out of 8 patients with elevated isoamylase P had chronic pancreatitis. The salivary origin of elevated isoamylase S was suspected in only one out of 10 patients. This work shows that the origin of moderate hyperamylasemia, observed in alcoholic patients, is often extrapancreatic. It is suggested that the dosage of serum lipase simpler than that of isoamylases, may be routinely used in chronic alcoholic patients for diagnostic purposes.
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PMID:[Occurrence and nature of hyperamylasemia in chronic alcoholics]. 608 28

Storage of cholesterol, cholesterol esters, and triglycerides with distribution in different organs is characteristical in 5 distinguishable familiary thesaurismoses. Cholesterol storage disease is due to relatively benign storage of cholesterol esters predominantly in the liver with gross enlargment of this organ. Acid lipase is lysosomes is also nearly inactive in the maligne Wolman's disease with calcification of the adrenals, hepatosplenomegalia and death during infancy by gastrointestinal complications. Very similar are other diseases without renal calcification but partly with pulmonal storage of cholesterol. In only one family another type of cholesterol lipidosis and cirrhosis together with aplasia of gall bladder, renal cysts, and hydronephrosis has been observed. Two types of pure triglyceride storage disease are described, but each of them in only few cases. Tendinous xanthomatosis by storage of cholestanol predominantly in brain with mental retardation, and xanthomatosis with beta-sitosterol but normal mental development are two rare steatoses with abnormal cholesterol-like lipids, in which xanthomatas are visible.
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PMID:[Disease with storage of neutral lipids (author's transl)]. 703 73

The diagnostic value of bile salt-dependent lipase for pancreatic diseases was tested in sera of 187 patients. Of these patients, 76 suffered from pancreatic carcinoma, 43 from nonmalignant liver diseases (cirrhosis and chronic hepatitis), 18 from acute pancreatitis, and 20 from chronic pancreatitis. The remaining subjects were controls without pancreatic pathology. Bile salt-dependent lipase was determined by a sandwich enzyme-linked immunosorbent assay using polyclonal antibodies. Amylase and CA 19-9 antigen were also determined. In sera from control patients, the mean level of bile salt-dependent lipase was 1.5 micrograms/L. This level is quite similar to that of patients with benign liver diseases (1.1 micrograms/L) and with chronic pancreatitis (1.4 micrograms/L), but it was raised to 3.5 micrograms/L in patients with acute pancreatitis and decreased to 0.5 microgram/L in subjects with pancreatic adenocarcinoma. Thirty percent of control subjects and 73% of cancer patients had a bile salt-dependent lipase serum level below the cutoff value of 0.5 microgram/L. In acute pancreatitis, 11 of 16 subjects had levels above 1.5 micrograms/L. Amylase level largely increased in acute pancreatitis but was normal in all other groups. Concerning CA 19-9 antigen, 65% of control patients and > 80% of patients with nonmalignant pancreatic or liver diseases had normal levels. In sera from cancer patients, 80% presented with high levels. Accordingly, 36 of 38 patients with pancreatic cancer had either low serum levels of bile salt-dependent lipase (< 0.5 microgram/L) or high values of CA 19-9 antigen (> 37 U/ml; sensitivity 95%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Is bile salt-dependent lipase concentration in serum of any help in pancreatic cancer diagnosis? 750 10


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