P3 amylase isoenzyme in the diagnosis of pancreatitis.

P3 amylase isoenzyme was found to be present in the plasma of 43 out of 140 patients with suspected pancreatitis. Of 43 patients with the P3 isoenzyme, pancreatitis was definitely confirmed in 21 by laparotomy. Of the remainder, 19 had probable pancreatitis based on a combination of clinical, biochemical, endoscopic (ERCP), ultrasonic and computerised tomographic evidence, while 3 had possible pancreatitis based on clinical evidence alone. Of 97 patients without the P3 isoenzyme 1 patient had evidence of probable pancreatitis and 1 had evidence of possible pancreatitis. Statistical analysis (excluding the 4 cases of possible pancreatitis) showed that the P3 amylase isoenzyme had a sensitivity of 98%, a specificity of 100% and an efficiency of 99%. The predictive values of a positive and negative test were 100% and 99% respectively. Hyperamylasemia was not a pre-requisite to the presence of the P3 isoenzyme, since 11 out of 13 patients, with normal total amylase levels, were found to have the P3 band and confirmation of their pancreatitis. It is concluded that the P3 amylase isoenzyme is a specific and sensitive test for pancreatitis, and appears also to be superior to the total plasma amylase.

Hypersensitivity reactions to heparin: delayed onset thrombocytopenia and necrotizing skin lesions.

Significant hypersensitivity reactions to heparin may manifest as either delayed onset thrombocytopenia or as necrotizing skin lesions. Such hypersensitivity reactions are uncommonly recognized, partly because of their rarity and partly because their existence is not widely appreciated. Both adverse reactions may be readily diagnosed. In the presence of these reactions, continuing heparin therapy may lead to serious thrombo-embolic complications and death of the patient. In this study, two patients who highlight the clinical settings of these reactions are discussed with reference to their pathogenesis and clinical significance.

Rectal foreign bodies.

We review the histories of 26 patients who were treated at the Royal Perth Hospital for retained rectal foreign bodies. The foreign bodies that were retrieved and the age, sex and marital status of each patient are recorded and a number of the histories is presented. The complications that arose from either the insertion or removal of the foreign body are discussed, as are the methods of treatment that were employed. The various methods that the practitioner has at his disposal for dealing with this increasing problem are reviewed, and a plan of management of patients with non-perforating rectal foreign bodies is suggested.

Is colorectal carcinoma in the young a more deadly disease?

Of the 2923 cases of colorectal carcinoma treated from 1970 to 1981, only 12 (0.4%) were under the age of 30 years. Analysis of this group confirmed the higher incidence of more advanced tumours, as well as a higher frequency of predominantly mucin-secreting adenocarcinoma. Regardless of the mode of treatment, survival is particularly poor in the young patients, and, in our opinion, this is a reflection of the more aggressive behaviour of the type of carcinoma afflicting young patients.

Factors in the prognosis of gastric lymphoma.

The tumor-nodes-metastases (TNM) staging classification for gastric carcinoma was applied to 50 consecutive cases of primary gastric lymphoma. Survival statistics were obtained for each respective stage category and were remarkably similar to survival statistics for gastric carcinoma. Overall, patients with primary gastric lymphoma have a much better prognosis for survival than patients with gastric carcinoma since the latter present with far more frequent serosal penetration and nodal and distant metastases. Penetration of gastric lymphoma beyond the serosa is associated with a significantly decreased 5-year survival rate from 88 to 24%, and the presence of perigastric nodal involvement decreased the survival rate from 88 to 32%.

Bilateral liposarcoma of the breast.

A rare case of bilateral liposarcoma of the breast is described. This is the third such case ever to be presented. Factors influencing management and prognosis are discussed.

P3 amylase isoenzyme in patients with cholelithiasis.

The plasma P3 amylase isoenzyme was determined in 25 patients with proven cholelithiasis. In six patients who had a single gallstone and normal pancreas at operation, the total plasma amylase was within normal limits and the P3 amylase isoenzyme was absent. In the remaining 19 patients who had multiple gallstones, pancreatitis was found at surgery in 10. In this group of 10 patients, the total plasma amylase was above the reference range for healthy individuals in only five (50%), while the P3 amylase isoenzyme band was detected in all 10 (100%). It is concluded that P3 amylase isoenzyme is superior to the total plasma amylase in the diagnosis of pancreatitis in patients with gallstone.