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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient with systemic lupus erythematosus is reported whose initial clinical presentation was that of acute pancreatitis, confirmed by pancreatic isoamylase elevation and pancreatic enlargement on computerized tomography. A lack of a correlation with steroid therapy and a need to document pancreatitis in a multisystem disease like lupus with radiographic evidence as well as pancreatic isoamylase elevations is emphasized.
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PMID:Systemic lupus erythematosus presenting initially with acute pancreatitis and a review of the literature. 264 79

To determine the clinical utility of routine determination of serum isoamylase (pancreatic/salivary) and/or lipase activity, sera were tested from 109 consecutive patients with elevated total serum amylase. Without knowledge of the isoamylase and lipase results, an assessment was made of the confidence with which the attending medical staff had made or excluded a diagnosis of acute pancreatitis. The attending staff had considered acute pancreatitis to be probable in 78, possible in 12 and unlikely in 19 patients. The confidence of the clinical diagnosis of acute pancreatitis was directly related to the degree of elevation of the serum total amylase: (mean IU/l +/- s.e.m.) probable pancreatitis 1807 +/- 313, possible pancreatitis 680 +/- 74, pancreatitis unlikely 493 +/- 50. Pancreatic isoamylase was elevated in 97% of patients with probable pancreatitis, 92% with possible pancreatitis and 68% in whom pancreatitis had been considered unlikely. Lipase elevations generally parallelled these results. Although gall-stones were usually sought among patients with probable pancreatitis, they were rarely sought in patients in the other categories. In conclusion, amylase isoenzyme or lipase determinations add little information in cases of clinically suspected acute pancreatitis with marked hyperamylasemia. The tests may have a role in the evaluation of patients with clinically unexplained hyperamylasemia by defining more precisely the origin of the amylase.
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PMID:The role of serum isoamylase and lipase determinations in clinical practice. 345 30

To elucidate the assumed relationship between hyperparathyroidism and pancreatitis, the pancreatic function was studied in 20 patients with hyperparathyroidism. In all cases removal of a parathyroid adenoma was followed by normalization of preoperative hypercalcemia. A modified Lundh's test with duodenal aspiration was performed before and after the operation. The volume of the aspirate and its content of electrolytes and pancreatic isoamylase were compared with findings in an age-matched control group. Preoperatively the volume of secretion was significantly less in the patients than in the controls. Carbonate levels were also decreased, but changes in enzymatic activity were slight. Postoperatively there was significant increase in aspirate volume and fall in the level of duodenal calcium. The results suggested an influence of hyperparathyroidism on exocrine pancreatic function, even when no symptoms of pancreatic disease are present.
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PMID:Pancreatic function in patients with hyperparathyroidism. A study with the Lundh test. 403 86

Traditional concepts of managing pancreatic pseudocysts have changed with the advent of computerized tomography (CT) and ultrasound scanning, but new misconceptions related to spontaneous resolution have replaced some old ones. This report shows a difference in natural history and treatment requirements when pseudocysts are associated with acute versus chronic pancreatitis. There were 42 consecutive patients with pseudocysts treated over 5 years. Thirty-one were known alcoholics, two had gallstone pancreatitis, and nine had idiopathic pancreatitis. An attack of acute pancreatitis was identifiable within 2 months preceding in 22 patients, but there were only chronic symptoms in 20. Spontaneous resolution of the pseudocyst occurred in three patients (7%), all of whom had recent acute idiopathic pancreatitis, normal serum amylase levels, and pancreatograms showing normal pancreatic ducts freely communicating with the pseudocyst. Factors associated with failure to resolve included known chronic pancreatitis, pancreatic duct changes of chronic pancreatitis, persistence greater than 6 weeks, and thick walls (when seen) on scan. Nearly all (18/19) patients with known chronic pancreatitis had successful internal drainage of the pseudocysts immediately upon admission, whereas 6/20 patients with antecedent acute pancreatitis were found to require external drainage at the time surgery was eventually elected. Isoamylase analysis, performed on serum from 19 patients by means of polyacrylamide gel electrophoresis, detected the abnormal pancreatic isoamylase pattern described as "old amylase" in 15. When old amylase was present in the serum, internal drainage was always possible (14/14). In four of five patients whose serum contained no detectable old amylase, internal drainage was not possible regardless of the length of prior observation. There were four nonfatal complications arising from an acute pseudocyst during the wait for maturity. It is concluded that prolonged waiting is expensive and unnecessary for pseudocysts in chronic pancreatitis when there has been no recent acute attack. However, pseudocysts developing after identifiable acute pancreatitis should be observed in the safety of a hospital for up to 6 weeks to allow for either spontaneous resolution or maturation of the cyst wall. The appearance of old amylase in the serum suggests that the pseudocyst wall has achieved sufficient maturity to allow safe internal anastomosis.
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PMID:Timing of surgical drainage for pancreatic pseudocyst. Clinical and chemical criteria. 407 84

Total serum amylase activity was found to be significantly elevated postoperatively in 11 (10%) of 110 patients undergoing various surgical procedures. Isoamylase analysis revealed that the rise was chiefly in the pancreatic-type isoamylase in seven of the 11 patients showing postoperative serum amylase elevations; in the other four patients, the elevation occurred principally in the salivary-type isoamylase. These data demonstrate that postoperative hyperamylasemia occurs surprisingly often and that serum amylase activity may rise even when the surgical procedure is extra-abdominal. Moreover, elevation of serum amylase activity after surgery is not necessarily an indication of pancreatitis and may reflect instead a rise in salivary-type isoamylase.
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PMID:The nature and significance of hyperamylasemia follwing operation. 483 59

The purpose of this study was to determine if routine isoamylase assay would provide valuable diagnostic information in patients with hyperamylasemia. Isoamylase distribution was determined in sera of 37 consecutive hyperamylasemic patients. The attending physicians (without knowledge of the isoamylase level) had considered acute pancreatitis to be "probable" in 19, "possible" in 4, and "unlikely" in 14 of these 37 patients. Three of the patients considered probably to have pancreatitis and 3 thought possibly to have pancreatitis had normal serum pancreatic isoamylase levels. Knowledge of the normal pancreatic isoamylase level in these 6 patients probably would have changed the clinical diagnosis to some condition other than pancreatitis. Of the 14 hyperamylasemic patients thought "unlikely" to have pancreatitis, 7 had an elevation of just pancreatic isoamylase and 3 additional patients had elevation of both pancreatic and salivary isoamylases. It seems likely that knowledge of these elevated pancreatic isoamylase levels would have changed the clinical diagnosis to "probable" pancreatitis for many of these patients. We conclude that routine isoamylase assay provides diagnostic information that might change the clinical diagnosis in 20%--40% of hyperamylasemic patients.
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PMID:Diagnostic value of routine isoamylase assay of hyperamylasemic serum. 617 89

A simple, rapid screening procedure for determining the relative amounts of pancreatic (P)- and salivary (S)-type amylase in serum is presented, involving incorporation of a selective inhibitor (from wheat-germ) into commercially available BMD Single-Vial Amylase and Beckman Enzymatic Amylase-DS procedures for manual and automated isoamylase measurements. Optimal concentrations of inhibitor inhibit the S-type amylase fraction by 87-88%. In contrast, the pancreatic fraction is inhibited by only 19% in either the manual or automated methods. The degree of inhibition is constant for amylase activities up to at least 520 U/L. Use of the ratio (P-amylase/total amylase activity) X 100 helps differentiate between hyperamylasemia caused by S-type or P-type amylase. In preliminary studies, patients with pancreatitis showed a ratio greater than 70%.
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PMID:Determinations of amylase isoenzymes in serum by use of a selective inhibitor. 617 45

Since hyperamylasemia with or without abdominal pain is a frequently encountered problem, serum isoamylase analysis in 52 patients was done to see if the organ source of the amylase would be helpful in a clinical setting. Four patterns of hyperamylasemia were found: 1) AMY1 (salivary) hyperamylasemia; 2) AMY2 (pancreatic) hyperamylasemia; 3) Both AMY1 and AMY2 amylase elevated; and 4) macroamylasemia. A variety of conditions other than pancreatitis were associated with hyperamylasemia, and some patients who were thought on clinical grounds to have pancreatitis had raised levels of AMY1 (salivary) amylase. This study suggests that hyperamylasemia alone is a poor indicator of pancreatic disease, and that isoamylase analysis will improve the accuracy with which amylase determinations are used.
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PMID:Clinical application of organ specific isoamylases. 618 Jun 63

Amylase activity in serum and urine, and isoamylase, were measured in 300 patients with abdominal pain to detect cases of macroamylasemia. Of these patients, 9 had hyperamylasemia and 2 were diagnosed as cases of macroamylasemia on the basis of their amylase/creatinine clearance ratio, the gel filtration pattern of their amylase on a dextran column, and results of immunological analysis. Amylase activity in macroamylasemia is reported to show an anomalous response to increase in reaction-temperature. In this report, measurements of the temperature-activity relationships of serum amylase confirmed that the ratio of serum amylase activity at 50 degrees C to that at 25 degrees C (AMY-50 degrees C/AMY-25 degrees C ratio) in patients with macroamylasemia was higher than that in normal subjects or patients with pancreatitis. Moreover, when macromolecular amylase in the sera of patients with macroamylasemia was separated from amylase of normal molecular weight by dextran gel chromatography, it showed a significantly higher AMY-50 degrees C/AMY-25 degrees C ratio than the latter. Measurement of this AMY-50 degrees C/AMY-25 degrees C ratio seems to be a convenient and useful method for differential diagnosis of hyperamylasemia.
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PMID:A simplified method for detecting macroamylasemia by measuring serum amylase activity at different reaction temperatures. 619 35

We compared results of measurements of total serum amylase, pancreatic isoamylase, and lipase measurements in patients with hyperamylasemia. Serial measurements of these three enzyme levels in patients recovering from acute pancreatitis indicated that pancreatic isoamylase and lipase were elevated above normal to a greater extent and remained elevated much longer than did the total amylase. This finding indicates an appreciable sensitivity advantage of the pancreatic isoamylase and lipase over total amylase measurement during the recovery phase of pancreatitis. Comparison of pancreatic isoamylase and lipase levels in selected sera indicated a good correlation (r = 0.84) between these two measurements in patients who did not have macroamylasemia. Lipase was normal in sera with amylase elevations due solely to salivary isoamylase. Thus, in nonmacroamylsemic sera, pancreatic isoamylase and lipase appear to be roughly interchangeable markers of the level of pancreatic enzymes in the blood. An advantage of the lipase assay is that this enzyme is normal in hyperamylasemia caused by macroamylasemia, whereas the inhibitor assay indicates that the pancreatic isoamylase is elevated. Development of automated assays for either pancreatic isoamylase or lipase should lead to the routine use of one of these assays in place of the present reliance on total amylase measurements in the diagnosis of pancreatitis.
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PMID:Comparison of serum amylase pancreatic isoamylase and lipase in patients with hyperamylasemia. 620 Feb 76


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