A controlled study on the use of intravenous fat in patients suffering from acute attacks of pancreatitis.

Thirty-one acute attacks of pancreatitis in 27 patients were studied. 15 attacks were treated with standard therapeutic measurements alone, and 16 attacks were, in addition, treated with intravenous infusions of a commercial fat emulsion (Intralipid). Fat infusions were started on the 2nd day after admission in a dose of 1,5 g fat/kg B.W./24 h. There was a tendency of quicker alleviation of pain in the controls, but the amounts of analgesics and antispasmodics required by these patients were higher. With regard to all other variables, which are commonly used to characterize the course of acute attacks of pancreatitis, we did not observe significant differences between the controls and the patients treated with fat. We conclude that intravenous infusions of fat in the dosage used in this study does not influence the course of acute attacks of pancreatitis.

[Diagnostic value of lipase and isoamylase determination. Monitoring studies in patients with proven and suspected pancreatitis]. / Diagnostischer Stellenwert der Lipase- und Isoamylasebestimmung. Verlaufsstudien an Patienten mit gesicherter und vermuteter Pankreatitis.

Changes of lipase (turbidimetric evaluation), total amylase and isoamylases (inhibition test) were determined in 93 patients with proven or suspect pancreatitis. In 35 patients with established acute pancreatitis 143 sera were investigated in the course of disease. Lipase and pancreatic amylase were increased in these samples significantly more often (thus longer in the course of disease) than total amylase. Eight patients with chronic pancreatitis and exocrine insufficiency showed very low lipase and pancreatic amylase activities whereas total amylase was normal. Observations in the course of two groups of patients with suspect (but not established) pancreatitis showed superior organ specificity of lipase and pancreatic amylase when compared to total amylase. However, no relevant difference of the diagnostic validity of both enzymes could be demonstrated.

Salivary secretion in chronic pancreatitis with special reference to albumin and lactoferrin.

Saliva from one parotid gland was collected under citric acid stimulation in three groups consisting of 69 control subjects and two groups consisting of 25 patients with chronic and relapsing chronic pancreatitis. Mixed saliva was collected under mechanical stimulation from 10 patients and 6 control subjects. Flow rates and the contents of bicarbonate, amylase and protein were determined. In a subgroup of patients and controls albumin and lactoferrin were measured. Wide inter- and intraindividual variations of secretory values were observed and normal values (which are reported in detail) were highly dependent from conditions of stimulation. Secretory patterns were not significantly different between patients and control subjects. It is concluded that the alterations leading to an elevation of albumin and lactoferrin and a fall in other secretory values are restricted to the exocrine pancreas and do not affect salivary glands in chronic pancreatitis.

Macroamylasemia induced by hydroxyethyl starch--confirmation by gel filtration analysis of serum and urine.

The concentration of alpha-amylase in blood rose significantly (Student's t-test) in seven normovolemic healthy subjects after they were given 30 g/m2 body surface area of hydroxyethyl starch 350/0.60 (HES 350/0.60, a new volemic colloid). Concomitant with elevated activity in blood, amylase clearance (Cam) was markedly reduced, even though clearance of creatinine (Ccr) was within normal limits. Similar findings were observed for one male subject given 500 ml (30 g) of HES 450/0.70. Sephadex G-100 gel elution profiles of serum recovered from one male subject after the infusion of HES 350/0.60 revealed the presence of a macroamylase complex eluted with the void volume. Small macroamylase complexes were also detected in urine voided from the same subject. By 24 to 48 hours postinjection, the high activity of alpha-amylase in blood was returning to basal levels, and this was observed to parallel the reduction of macroamylase complexes both serum and urine. The macroamylasemia induced by HES 350/0.60 represents the nonpathologic formation of large colloid-enzyme complexes not easily filtered at the renal glomerulus, and should be differentiated clinically from disease- or drug-induced hyperamylasemia.