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Query: UMLS:C0740577 (acute abdominal pain)
 1,982 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We assessed the diagnostic value of four commercially available methods for determining pancreatic lipase (LPS) in serum (the turbidimetric procedure from Boehringer, two enzymatic approaches from Kodak and Poli, and an immunochemical assay) in a population of 46 hospitalized patients with acute abdominal pain. In 31 cases (67.4%), the final diagnosis was acute pancreatitis. When evaluated by means of receiver-operating characteristic (ROC) curves, no significant differences were found among the procedures. Concerning clinical efficiency, all the assays had values equal to or greater than 90%. Using the calculation of the overlap index (OI) as a statistical approach to quantify the clinical utility of various LPS assays, the test having the greatest potential for differentiating between patients with and without acute pancreatitis was the turbidimetric assay (OI = 0.14).
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PMID:Diagnostic value of four assays for lipase determination in serum: a comparative reevaluation. 177 90

In 417 patients (213 men, 204 women) consecutively hospitalized with acute abdominal pain we evaluated the clinical usefulness of a latex-agglutination test at admission to screen for concentrations of pancreatic lipase (EC 3.1.1.3) in serum greater than 300 micrograms/L. The diagnoses of acute pancreatitis (in 25 patients, 6%) and other diseases were made without knowledge of the results of the latex test or of quantification of pancreatic lipase in the serum by enzyme immunoassay. In the latex assay, when agglutination was taken as a positive test for acute pancreatitis, we found a diagnostic efficiency of 0.986 (95% confidence limits: 0.971-0.997) for acute pancreatitis. The predictive value of a positive latex test result with respect to acute pancreatitis was 0.807 (0.625-0.926); the predictive value of a negative test was 1.000 (0.991-1.000). Six patients had false-positive test results. No false-negative test results were found by enzyme immunoassay. We conclude that the latex agglutination test is useful as an emergency test for diagnosis of acute pancreatitis in patients with acute abdominal pain; negative results virtually exclude acute pancreatitis.
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PMID:Immunochemical qualitative latex agglutination test for pancreatic lipase in serum evaluated for use in diagnosis of acute pancreatitis. 240 89

In 60 controls and 108 patients admitted with acute abdominal pain, Rapignost urinary amylase correctly identified (++) 18 of the 23 patients with acute pancreatitis (AP), with 8 results being equivocal (+), and 1 false negative. This is a suitable screening test for AP, but an equivocal result requires further investigation. In 14 patients with AP the serum amylase was over 1000 U/l with no false-positive results, whereas when 316 U/l was used as the diagnostic threshold, 22 cases were identified (but with 2 false positives). Serum lipase was 100% sensitive in the diagnosis of AP, but there were three false-positive results.
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PMID:Diagnosis of acute pancreatitis: a proposed sequence of biochemical investigations. 244 62

We evaluated the diagnostic value of serum amylase, isoamylase, and lipase for the diagnosis of acute pancreatitis from sera of patients with acute abdominal pain. Comparison was first made in condition A between 32 patients with image-proven pancreatitis and 414 patients with nonpancreatic acute abdomen (the control group), then in condition B, between 62 pancreatitis patients with or without image proof and the control group. We found (a) that patients with image-proven pancreatitis suffer a more severe clinical course than those without; (b) that the sensitivity, positive predictive value, and accuracy in condition B are higher than in condition A at any cutoff level; (c) that none of the enzyme assays is specific at the upper reference limit, but their diagnostic yields are much improved by raising cutoff levels to about three or four times the upper limit; and (d) that at these selected cutoff levels, amylase had a diagnostic value similar to p-isoamylase or lipase in both conditions (sensitivity 84% and 92% for amylase in conditions A and B, respectively; specificity 98% and 98%; positive predictive value 75% and 90%; negative predictive value 99% and 99%; accuracy 91% and 97%). In conclusion, at an appropriately selected cutoff level, amylase can be effectively used as the first-line test and isoamylase or lipase as adjunct tests for acute abdominal conditions.
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PMID:Serum amylase, isoamylase, and lipase in the acute abdomen. Their diagnostic value for acute pancreatitis. 168 29

In 134 consecutive patients with acute abdominal pain, we evaluated the clinical role of a new rapid test for serum lipase based on latex agglutination. The results were compared with those obtained with a widely used lipase immunoassay as well as with serum amylase and pancreatic isoamylase measurements. Fifty-five healthy subjects were studied as controls. In 174 cases (121 patients and 53 controls) the results of the two lipase assays were in agreement. A positive lipase latex test was found in 10 of 12 patients with acute pancreatitis, in eight of 24 patients with other pancreatic diseases, and in 14 of 98 with nonpancreatic diseases. The sensitivity and specificity of this test were similar to those of the other pancreatic enzyme assays performed. The results indicate that the lipase latex agglutination test is useful for emergency screening for acute pancreatitis in patients with acute abdominal pain.
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PMID:A rapid assay for serum immunoreactive lipase as a screening test for acute pancreatitis. 356 30

To determine the utility of serum amylase (AMY), lipase (Lp), pancreatic isoamylase (isoA), phospholipase A (PLA), and urine AMY in the diagnosis of acute pancreatitis, samples of serum and urine were obtained on admission and every day thereafter for 5 days from 384 patients with acute abdominal pain. Diagnostic accuracy, determined as the area under the receiver operating characteristic curve, was > 0.975 for serum AMY, Lp, isoA, and urine AMY. For each of these enzymes, a threshold value (twice to sixfold the upper limit of the reference values) offering diagnostic efficiency > 95% could be determined. In contrast, accuracy and efficiency of serum PLA were low. The profiles of these enzymes in acute pancreatitis decreased in a parallel fashion over 5 days except for PLA. We conclude that diagnostic utilities are similar for serum AMY, Lp, isoA, and urine AMY for acute pancreatitis, provided that an appropriate threshold is established.
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PMID:Amylase, lipase, pancreatic isoamylase, and phospholipase A in diagnosis of acute pancreatitis. 754 34

The diagnostic accuracy of a biochemical quantity is inversely related to the overlapping zone between the values of the population suffering from a disease and the population which does not. The ROC curves are an indirect measure of the overlapping zone between both populations. Specimens (plasma and urine) taken from 928 patients with symptoms of acute abdominal pain were used and the catalytic concentration of alpha-amylase, pancreatic alpha-amylase and triacylglycerol lipase (determined by two methods) were measured. Definitive diagnosis was obtained by following the directives of expert groups on the evaluation of diagnostic tests. Diagnostic accuracy was characterized by calculating the diagnostic sensitivity and specificity, by representing the ROC curves and by quantifying the areas under the ROC curves. The catalytic concentration of pancreatic alpha-amylase in plasma was the quantity with a greater area under the ROC curve (A = 0.9740) and then the one which had greatest diagnostic accuracy. If we considered the upper limit of the reference interval to be the cut-off value, the catalytic concentration of pancreatic alpha-amylase in plasma had a diagnostic sensitivity and specificity values of 0.96 and 0.88 respectively for the acute pancreatitis.
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PMID:Diagnostic accuracy evaluation using ROC curve analysis. 827 57

The purpose of this study was to determine 1) the incidence and magnitude of elevation in admission serum amylase and lipase levels in extrapancreatic etiologies of acute abdominal pain, and 2) the test most closely associated with the diagnosis of acute pancreatitis. Serum amylase and lipase levels were obtained in 306 patients admitted for evaluation of acute abdominal pain. Patients were categorized by anatomic location of identified pathology. Logistic regression analysis was used to compare the enzyme levels between patient groups and to determine the correlation between elevation in serum amylase and lipase. Twenty-seven (13%) of 208 patients with an extrapancreatic etiology of acute abdominal pain demonstrated an elevated admission serum amylase level with a maximum value of 385 units (U)/L (normal range 30-110 U/L). Twenty-six (12.5%) of these 208 patients had an elevated admission serum lipase value with a maximum of 3685 U/L (normal range 5-208 U/L). Of 48 patients with abdominal pain resulting from acute pancreatitis, admission serum amylase ranged from 30 to 7680 U/L and lipase ranged from 5 to 90,654 U/L. Both serum amylase and lipase elevations were positively associated with a correct diagnosis of acute pancreatitis (P < 0.001) with diagnostic efficiencies of 91 and 94 per cent, respectively. A close correlation between elevation of admission serum amylase and lipase was observed (r = 0.87) in both extrapancreatic and pancreatic disease processes. Serum amylase and lipase levels may be elevated in nonpancreatic disease processes of the abdomen. Significant elevations (greater than three times upper limit of normal) in either enzyme are uncommon in these disorders. The strong correlation between elevations in the two serum enzymes in both pancreatic and extrapancreatic etiologies of abdominal pain makes them redundant measures. Serum lipase is a better test than serum amylase either to exclude or to support a diagnosis of acute pancreatitis.
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PMID:Serum amylase and lipase in the evaluation of acute abdominal pain. 895 42

An accurate history and thorough physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient presenting with acute abdominal pain. An accurate diagnosis is needed to eliminate etiologies of acute abdominal pain and to appropriately direct therapy. Confirmation of the diagnosis is most often made by evaluation of serum amylase and lipase levels. Although hyperamylasemia is found in the majority of patients with acute pancreatitis, other nonpancreatic acute abdominal conditions may be present with hyperamylasemia. CT scanning provides an accurate confirmation of clinical and laboratory findings and offers excellent anatomic and morphologic representation of the pancreas and peripancreatic tissue. The following article, written by the late John H.C. Ranson, presents a discussion of the modalities available for diagnosing acute pancreatitis.
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PMID:Diagnostic standards for acute pancreatitis. 899 68

The acute pancreatitis is still serious diagnostic and therapeutic problem. In spite of many experiments there are no satisfactory methods of the treatment of this disease. Usually, it is diagnosed clinically by acute abdominal pain and increased pancreatic enzymes in blood and urine. The main disorder of this disease is the necrosis of the pancreatic gland. The aim of our investigations was the evaluation of effect of necrolytic enzymes on the course of acute experimental pancreatitis. Fibrolan was used. Fibrolan (Parke-Davis) is a preparation, which has necrolytic properties. It consists of two bovine enzymes: fibrinolysin and deoxyribonuclease. The examinations were carried out on 380 Wistar rats. The acute pancreatitis was induced by retrograde injection of 0.1 ml/0.1 kg body weight of 3% sodium taurocholate solution into the pancreatic duct as previously described by other authors. The experimental animals were divided into four groups: K0-control group (healthy animals), KP-animals with acute experimental pancreatitis without medication, S-rats with acute experimental pancreatitis, which were treated with 0.9% NaCl solution, and F-animals with acute experimental pancreatitis treated with Fibrolan. Fibrolan and 0.9% NaCl were injected into the peritoneal cavity three times a day with eight hours intervals from the 24th experimental hour. The serum amylase and lipase activities and the amylase activity in the urine were determined in each animal group in the 24th, 48th, 72nd, 96th, 120th, 144th experimental hour. For histopathological analysis pancreatic tissue samples were taken from the pancreatic gland. The intensification of the histological changes of these tissue samples was judged using a point score as described by Spormann et al. The results were statistically analysed. The animals of the KP group showed significant histological changes of the pancreas during the whole examination time. Point score: 75-100. Microscopically, tissue samples taken from the animals treated with Fibrolan showed less changes from the 72nd examination hour. There were observed regenerative processes and the improvement of the histological state was evident (point score: 0-50). Changes were less in rats treated with 0.9% NaCl solution than in KP group but the regenerative processes were slower than in F group (point score: 50-75). Enzymes levels were significant lower in F group than in others from the 48th experimental hour.
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PMID:[The effect of intraperitoneally administered necrolytic enzymes on the course of experimental acute pancreatitis]. 942 54


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