Inhibitor test for amylase isoenzymes: comparison with a simplified chromatographic method.

The percentage of pancreatic-type isoamylase activity and the ratio of pancreatic to salivary-type isoamylase activity were determined in five control and 35 hyperamylasemic serum samples by means of an established simplified chromatographic method and a recently described inhibitor test. There was good correlation in the results, except at very high and at very low levels of P-type isoamylase activity. At these extremes, the inhibitor method yields imprecise quantitative results. The inhibitor test findings may also prompt misleading conclusions when elevated serum amylase activity is due to undetected macroamylasemia.

PIPIDA excretory scintigraphy in the diagnosis of hepatobiliary disorders.

The diagnostic accuracy of hepatobiliary radionuclide imaging using 99mTC-labeled para-isopropyl acetanilido-iminodiacetic acid (99mTc-PIPIDA) in patients with hepatobiliary disorders was assessed in 50 patients. Thirty of the study group were jaundiced; the remaining 20 had other clinical features suggestive of some hepatobiliary disorder. The findings using PIPIDA proved to be correct in 22 (73%) of the 30 jaundiced patients and in 18 (90%) of 20 patients without jaundice. There appears to be a close relationship between the diagnostic accuracy of the test and the level of serum bilirubin. Thus, the diagnosis indicated by the PIPIDA test was correct in 30 (88%) of 34 patients in whom the serum bilirubin was less than 5 mg./dl. but only in 10 (62%) of 16 patients whose serum bilirubin exceeded 5 mg./dl. It is concluded from these observations that: 1. PIPIDA is diagnostically useful in the evaluation of hepatobiliary disorders, especially when the serum bilirubin is less than 5 mg./dl. and 2. the accuracy of this test is not absolute and the findings are not always definitive.

Simplified chromatographic method for isoamylase analysis.

A simplified and relatively rapidly performed chromatographic method for measuring the principal isoamylases in serum and urine has been developed. It is hoped that this method may help make isoamylase analysis more readily applicable in the ordinary clinical setting.

Cimetidine in the treatment of acute alcoholic pancreatitis. A randomized, double-blind study.

A double-blind study was made of the comparative effectiveness of cimetidine in the treatment of acute alcoholic pancreatitis. The study group was composed of 27 patients with acute episodes of alcoholic pancreatitis of mild to moderate severity. The patients were randomized into 2 groups, either receiving cimetidine, 300 mg four times daily or a placebo. Both groups were given intravenous fluids and meperidine hydrochloride (Demerol) as needed. There were no significant differences between the 2 groups as measured by a variety of clinical and laboratory parameters. The mean value of the daily serum amylase in the placebo group declined steadily to normal; hyperamylasemia in this group persisted for 52 +/- 11 hr (mean +/- SE). By contrast, serum amylase in the cimetidine group peaked at 24 hr after the start of treatment and remained abnormal slightly longer; the duration of hyperamylasemia in the group was 69 +/- 10 hr. It is concluded that: (1) cimetidine is not superior to a placebo in the management of mild to moderately severe acute alcoholic pancreatitis and (2) serum amylase activity in patients with acute alcoholic pancreatitis given cimetidine tends to be greater and hyperamylasemia is of somewhat longer duration than in those treated with a placebo.