Value of pancreatic-type isoamylase assay as an index of pancreatic insufficiency.

The study here reported was undertaken to assess the value of assay of the specific isoamylase form arising from the pancreas (P-type) as an index of pancreatic exocrine insufficiency. Measurements were made of serum total amylase activity, serum P-type isoamylase activity, and the amount of P-type isoamylase relative to creatinine (Upam/Ucr) in the urine in a series of patients with clinically suspected chronic pancreatitis and pancreatic insufficiency as determined from the pancreatic secretory response to secretin stimulation. Abnormally low values for P-type isoamylase in the serum and urine of these patients were infrequent. Conversely, values within the normal ranges for serum P-type isoamylase and Upam/Ucr were common. It is concluded that while subnormal values for P-type isoamylase in the serum and urine may be viewed as supportive evidence for pancreatic insufficiency, failure to find such values does not exclude this condition.

The diagnostic value of serum lysozyme activity in inflammatory bowel disease.

Serum lysozyme (muramidase) activity was determined by the Lyso-Plate diffusion technic in 419 subjects consisting of normal persons and patients with Crohn's disease, ulcerative colitis, nonspecific diarrhea and various other disorders. Lysozyme activity in the normal subjects did not exceed 37.8 microgram/ml. The values in the several groups of patients overlapped markedly with each other and with the normal range. Approximately two-thirds (62.1%) of the 37 patients with Crohn's disease had values that were within the normal range. In about half (51.8%) of the patients with this disease in whom the process was clinically active, serum lysozyme activity was increased. Of 10 patients with Crohn's disease who had undergone resection, heightened serum lysozyme activity was found only in the three patients in whom there was clinical evidence of recurrence of the disease. It is concluded that serum lysozyme activity is not a dependable means of distinguishing Crohn's disease from ulcerative colitis or nonspecific diarrheas. The determination would appear to be of value, however, in helping to identify activity, recurrence, or extension of the disease in patients with Crohn's disease.

B-glucuronidase in duodenal secretions.

Determination of B-glucuronidase activity was carried out in 203 subjects including 60 controls. A modified technic for assaying B-glucuronidase activity was used that employs glass column chromatography and Sephadex. Although the lowest mean value was in the group of patients with cancer of the pancreas, there was wide range of activity of B-glucuronidase in all groups and subgroups and considerable overlap in values between them. It was concluded, therefore, that B-glucuronidase activity assay of the duodenal contents was of no value as a diagnostic test for cancer of the pancreas or for distinguishing between the several diseases affecting the pancreas.