Effect of secretin upon the levels of pancreatic enzymes in blood serum.

We have evaluated the serum changes of trypsin, pancreatic isoamylase and lipase, after rapid infusion of secretin, in 45 patients with chronic pancreatitis compared with 35 healthy control subjects. On the basis of duodenal intubation results, chronic pancreatitis patients were divided into two subgroups at different levels of functional impairment. Using the peak activities of the enzymes we have been able to separate the two chronic pancreatitis subgroups by statistical difference; only trypsin distinguishes healthy control subjects from mild to moderate chronic pancreatitis. Therefore, we propose to put into clinical practice this serum provocative test to evaluate the functional damage of an established chronic pancreatitis.

Clinical significance of serum pancreatic enzymes in the quiescent phase of chronic pancreatitis.

The most commonly used serum enzymes in pancreatic diseases are total amylase, pancreatic isoamylase, lipase and trypsin. To determine which of these enzymes is the most useful in the diagnosis of clinically quiescent chronic pancreatitis and which enzyme best reflects exocrine functional reserve, we studied 22 healthy control subjects, 44 patients with gastrointestinal, liver and biliary tract diseases, and 25 patients with chronic pancreatitis. On the basis of duodenal intubation, the latter were divided into two subgroups: one group of 13 patients with slight to moderate secretion deficiency and another of 12 patients with severe exocrine insufficiency. Of the enzymes studied, lipase, trypsin and pancreatic isoamylase are equally suitable for the evaluation of function in severe chronic pancreatitis, but not for the early diagnosis of the disease. Results for total amylase are not reliable so that its use in the study of chronic pancreatitis is not advisable.

Changes in serum pancreatic enzymes after hormonal stimulation in chronic pancreatitis.

Eighteen patients with chronic pancreatitis and 12 healthy controls were subjected to hormonal stimulation by continuous secretin plus cerulein intravenous infusion or a rapid injection of secretin. In both tests total serum amylase, lipase, and TLI (trypsin-like immunoreactive substances) levels were measured. Continuous intravenous infusion does not bring about changes in the serum levels of the enzymes studied; rapid injection of secretin, however, induces changes in the serum levels of TLI and lipase (but not amylase) which makes it possible to distinguish patients with chronic pancreatitis in its early stages from advanced chronic pancreatitis but is of doubtful value in distinguishing healthy subjects from those suffering with chronic pancreatitis.

[Behavior of the functional reserve of the exocrine pancreas compared to its morphologico-echographic aspect in subjects recently recovered from acute pancreatitis]. / Comportement de la réserve fonctionnelle du pancréas exocrine comparé à son aspect morphologico-échographique, chez des sujets récemment gueris d'une pancréatite aiguë.

Fifteen patients, who recovered from acute pancreatitis approximately one month earlier, were subjected to rapid intravenous injection of secretin. Serum trypsin (or rather trypsin-like immunoreactive substances: TLI) and lipase levels were measured serially both before and after stimulation. At the time of the test, the patients' pancreatic ultrasonograms were normal. Results were compared to those in 13 healthy controls. Our findings show that restoration of a normal ultrasonographic image coincides with almost complete recovery of the exocrine function of the pancreas. In fact, though a very slight exocrine pancreatic deficiency persists, this has neither statistical significance nor clinical and/or ultrasonographical significance.

[Agnogenic myeloid metaplasia (author's transl)]. / Metaplasia mieloide agnogenica

The AA., present a case of "agnogenic myeloid metaplasia" (MMA). They describe the principal findings that have led to this diagnosis: Fe59-erythrocynesis, radiologic study of skeleton and cytogenetic study. Fe59-erythrocynesis have shown an hypergetting of spleen and liver and an hypogetting of skeleton. The radiography of skeleton and particularly of humerus, femur and pelvis have shown a diffuse osteosclerosis with rare osteolytic areas. The cytogenetic study have shown an alteration with C-group trisomy.