[Value of mass dosage of the MB isoenzyme of creatinine phosphokinase in the diagnosis of recent myocardial infarction]. / Intérêt du dosage pondéral de l'iso-enzyme MB de la créatine phosphokinase pour le diagnostic de l'infarctus du myocarde récent.

In 391 patients admitted 3.7 hours (h) (median) after experiencing infarct-like pain, kinetic monitoring of CK-MB "mass" (threshold: 7 micrograms/l), myoglobin (threshold: 90 micrograms/l) and total CK (threshold: 290 micrograms/l) was carried out at the time of admission and after 1.5, 3, 6, 9, 12, 24 and 48 h. When myocardial infarction (MI) was treated conventionally (102 patients). CK-MB peaked 11 h (median) after the onset of pain, later than myoglobin (9 h), but before total CK (12 h). The peak of the markers was higher in Q+ than in Q-MI (p < 0.05). When MI was treated by thrombolytic medications (44 patients), the increases in CK-MB, myoglobin and total CK were larger, and occurred sooner (peaks 9, 6 and 6 h, after the onset of pain respectively), but did not last as long. In 245 patients who had not had MI (including 123 with spontaneous angina), the levels of the three markers remained stable and well below the decision thresholds. The sensitivities of CK-MB, myoglobin and total CK were respectively 47.1, 51.8 and 34.8% at the time of admission, 67.3, 82.7 and 57.1% after 3 h and 83.1, 76.9 and 88.9% after 6 h. The combined determination of CK-MB and of myoglobin had a higher sensitivity (67.7% at the time of admission, 84.9% after 1.5% and 88.2% after 3 h: but most of this gain was due to myoglobin. The specificity of the three markers and their diagnostic accuracy are comparable. In the course of recent MI, the kinetics of CK-MB mass are thus slower than those of myoglobin, but a little faster than those of total CK. The choice of the most effective biochemical marker depends upon the interval between onset of chest pain and hospitalization of the patient. Repetition of the determinations improves the diagnostic situation.

[Study of an optimal biological profile for demonstrating pancreatic involvement in acute abdominal syndrome]. / Recherche d'un profil biologique optimal pour la mise en évidence d'une atteinte pancréatique devant un syndrome abdominal aigu.

The authors have studied several seric, plasmatic and urinary constituents in patients hospitalized for an acute abdominal syndrome to be able to characterize an eventual pancreatic lesion; mainly seric and urinary amylase as well as its isoenzymes, lipase, liver profile and trypsin. In acute pancreatitis, the means of the maximal increases of seric amylase, lipase and trypsin are respectively: 10.7; 21.6 and 19.2 X N (upper normal limit) whereas in chronic pancreatitis, these elevations are 6.5 X N for amylase and 9.5 XN for lipase. The authors observed at J1 (first day of hospitalisation) and at J2 an increase in seric amylase, lipase and/or liver profile respectively in 95, 90 and 25 p. cent of acute pancreatitis; in 86, 86 and 14 p. cent of chronic pancreatitis and 43, 39 and 86 p. cent of bili duct diseases. In conclusion, it appears compulsory to run a liver profile with the pancreatic enzymes (amylase and lipase) to diagnose a pancreatitis in presence of an acute abdominal syndrome.

[Detection of hyperamylasuria. Value of a quick test]. / Dépistage d'une hyperamylasurie. Intérêt d'un test rapide.

A new reactive strip was used in a hospital admission unit, to detect amylasuria in the urine of 76 patients consulting for abdominal pain (population A) and of 68 unselected patients (population B). Detection on admission by this method was concordant with subsequent laboratory detection in 93% of the cases. The fast test was positive for amylasuria in 17 patients: 13 (17.1%) in population A and 4 (5.9%) in population B. The 8 patients recorded as "+" had moderate amylasuria with multiple but ill-defined symptoms mostly abdominal. The 9 patients recorded as "++" had marked amylasuria highly suggestive of an abdominal disease, including 4 cases of chronic pancreatitis.