Fecal pancreatic elastase in infants under 2 years of age.

OBJECTIVES AND METHODS: Fecal pancreatic elastase determination is of routine use in infant population presenting with a neonatal diagnosis of cystic fibrosis and in those with poor weight gain and growth, in order to precociously detect pancreatic insufficiency. However, there are few data regarding the value of one spot measure of elastase to assess pancreatic status in this population. This retrospective study reports the follow-up of fecal elastase measurement in 236 infants during the 2 first years of life. RESULTS: Fecal elastase was over 200 microg/g (i.e. normal cut-off) in a first sample in 122 patients (51.7% of patients) and below 200 microg/g in the remaining 114 patients. An alteration of elastase concentration was then observed in 18/122 infants (14.8%), leading to the diagnosis of pancreatic insufficiency at the end of the follow-up. In contrast, a normalization of fecal elastase was observed in 52 (45.6%) infants presenting with a first measurement below normal cut-off. CONCLUSION: This study shows that special attention should be given to the analysis of fecal elastase concentrations in infants as a precocious diagnosis of pancreatic insufficiency is crucial for the early introduction of a pancreatic enzyme replacement therapy which will prevent further consequence of malabsorption. One spot measure does not totally exclude pancreatic insufficiency in this population and a further control measurement of fecal elastase may be necessary.

Fecal calprotectin and α1-antitrypsin dynamics in gastrointestinal GvHD.

In a previous study, the fecal biomarkers calprotectin and α1-antitrypsin (α1-AT) at symptom onset were reported to be significantly associated with the response to steroids in gastrointestinal GvHD (GI-GvHD). The purpose of this trial was to evaluate the dynamics of the fecal biomarkers calprotectin and α1-AT throughout the course of GvHD. Patients who were refractory to steroids had initially higher biomarker levels and in the course of GvHD demonstrated a continuous increase in fecal biomarkers. In contrast, the dynamics of calprotectin and α1-AT demonstrated low and decreasing levels in cortico-sensitive GvHD. In steroid-refractory patients who received a second line of treatment, the biomarker levels at the beginning of second-line treatment did not predict the subsequent response. Nevertheless, calprotectin levels progressively decreased in subsequent responders, whereas non-responders demonstrated continuously high levels of calprotectin. α1-AT values correlated to a lesser extent with the response to second-line treatment and remained elevated in both non-responders and responders. In conclusion, calprotectin monitoring can be of use in the management of immunosuppressive treatment in GI-GvHD.

[Pertinence of simultaneous measurements of pO2 and sO2 on ABL 510]. / Pertinence des mesures simultanées de pO2 et sO2 sur l'ABL 510.

Blood tonometry is the only method to assess the accuracy of the pO2 determination on blood gas analyzers. ABL instruments by Radiometer were tested by two types of tonometry (film and bubble tonometry) and the validity of the algorithm for pO2 correction was analysed with these results. The role of the presentation of the specimen is also discussed. For the precision study on the ABL 510 analyzer, coefficients of variation for pO2 were < 0.37% and < 1.7% for within-run and day-to-day series respectively. pO2 accuracy was excellent. Linearity was verified between 0-620 mmHg (82.5 kPa), and interinstrument comparisons demonstrated a strict correlation with the Ciba-Corning 178 instrument. ABL 510 measures simultaneously oxygen saturation by spectrophotometry. Analytical results showed an acceptable level of imprecision, but the definition and the clinical significance of this parameter are ambiguous.