Serum phospholipase A2 in diet-induced pancreatitis

Serum activities of amylase, lipase, phospholipase A2 and transaminases were measured in mice with diet-induced acute pancreatitis. To study the role of choline deficiency, one control group received only a choline-deficient diet (CD diet), another group received the choline-deficient diet with 0.5% DL-ethionine (CDE), and a third group received the choline-deficient diet and was given ethionine intraperitoneally. Serum amylase activities increased after 1 day of treatment in all experimental groups. In contrast, lipase activity rose later in the groups receiving ethionine either in the diet or intraperitoneally. In the CDE group there were significant changes in phospholipase A2 on the fourth day after test feeding was started, but no rise was seen in the other groups. Correspondingly, in the group receiving the CD diet alone and the group receiving intraperitoneal ethionine the mortality was significantly lower than in the group receiving ethionine in the diet. In all experimental groups there was a significant rise in serum transaminases (ASAT, ALAT). The rise in ALAT on day 4 was significantly higher in the CDE group than in the other two groups. The mortality rate in the CDE diet group on day 4 was 91%. In the animals to which ethionine was given intraperitoneally the corresponding mortality was 21%. In the CD diet group all animals survived for more than 4 days. The present results suggest that serum lipase and phospholipase A2 activities correlate better with the severity of diet-induced pancreatitis than do serum amylase levels. The most severe cases of the disease seemed to be associated with a rise in serum phospholipase A2 activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Early detection of acute fulminant pancreatitis by contrast-enhanced computed tomography

Twenty-eight consecutive patients with a first attack of acute alcohol-induced pancreatitis were examined by computed tomography (CT). After a survey scan of the abdomen a rapid contrast bolus (400 mg I/kg) was given intravenously, and the contrast enhancement of the pancreatic parenchyma was measured from a consecutive series of pancreatic scans. Nine patients with a fulminant course of the disease were operated on, and haemorrhagic necrotizing pancreatitis was found in eight. In all of these the contrast enhancement was decreased or absent. Patients recovering by conservative treatment showed normal or increased enhancement. The contrast enhancement seems to constitute a useful criterion for the early differentiation of acute fulminant pancreatitis from less severe forms of the disease.

[Animal experiment studies on the mechanism of action of flunitrazepam (Rohypnol) on the circulation and respiration]

In 29 experiments performed on relaxed cats with artificial respiration, the effects of 0.015; 0.03; 0.06 mg flunitrazepam per kg body weight i.v. with N2O basal anaesthesia and of 0.06 mg flunitrazepam per kg without basal anaesthesia were examined in respect to mean arterial blood pressure, heart rate and the efferent action potentials of the N. sympathicus and the N. phrenicus. In all experiments, a mild and short-term reduction in blood pressure, a slight tachycardia and a very brief inhibition of the sympathetic nerve were observed. Definite actions exercised by flunitrazepam consisted of an inhibition of the respiratory centre which was due to a reduction of the extent and intensity of the inspiratory discharges of the phrenic nerve, although the breathing rate was increased. A comparison of the tests with flunitrazepam alone and in combination with N2O yielded definite differences only in the case of the asphyxia tests. The combination produced a significant inhibition of the vagus centre which was absent when flunitrazepam was used alone.

Serum phospholipase A2 and pulmonary changes in acute fulminant pancreatitis

Twenty-three patients with acute fulminant pancreatitis were studied. The diagnosis was confirmed at laparotomy in every case. Blood samples for the assay of phospholipase A2 were collected for 14 days, and the pulmonary status of the patients was followed by monitoring the blood gases and the inspired oxygen fraction and studying a derived variable, the alveolar to arterial oxygen tension difference--the arterial oxygen tension ratio (A--aDo2/PaO2). The serum phospholipase A2 activities correlated with the changes in pulmonary function and with the outcome of the disease. Eight patients succumbed and they showed higher phospholipase A2 activities and A--aDo2/PaO2 ratios than the five patients who survived after major complications and the ten patients who survived without major complications. The results suggest that in acute fulminant pancreatitis serum phospholipase A2 activity correlates with the severity of the pulmonary changes. Furthermore, it seems to reflect the prognosis.

Serum phospholipase A2, immunoreactive trypsin, and trypsin inhibitors during human acute pancreatitis

Serum immunoreactive trypsin and phospholipase A2 were analyzed at regular intervals in seven patients hospitalized as a result of acute hemorrhage pancreatitis. alpha 1-Antitrypsin and alpha 2-macroglobulin levels and trypsin-inhibitor capacity of serum were determined simultaneously. Serum trypsin concentrations were markedly raised in all patients. The levels of immunoreactive trypsin remained elevated for longer periods than those of urinary amylase. alpha 1-Antitrypsin and trypsin-inhibitor capacity were also significantly increased as compared with the post-illness values, but alpha 2-macroglobulin decreased considerably, reaching the lowest levels on the 5th day after admission. Consequently, phospholipase and trypsin are released to the circulation during hemorrhagic pancreatitis, but the increase in trypsin is compensated for by an increase in trypsin-inhibitor capacity of serum due to elevated alpha 1-antitrypsin levels. The decrease of alpha 2-macroglobulin in hemorrhagic pancreatitis was one of the most interesting findings, and it is proposed that this inhibitor may be consumed in the elimination of proteases through the reticuloendothelial system. The two patients who died had higher phospholipase values than those who recovered, but the prognosis could not be predicted from the values of the other measured variables.

The effect of early pancreatectomy and peritoneal lavage on the development of experimental haemorrhagic pancreatitis in pigs

Forty-seven piglets were operated on; haemorrhagic pancreatitis was induced in 42 of them. The effects of pancreatic resection and peritoneal lavage on the development of the disease were compared. Since the pancreatic phospholipase A2 value has been shown to be important in the pathophysiology of the disease, the effect of pancreatic resection on the enzyme serum activities was studied. Early pancreatic resection and early peritoneal lavage were equally effective in reducing the mortality of the animals. When the pancreatic resection was performed later, most of the animals died. The difference in mortality between the groups was statistically significant (p less than 0.01). In the animals with late pancreatectomy the high serum phospholipase A2 activities fell to normal levels within a few hours after the operation. This strongly suggests that the enzyme is of pancreatic origin.

Chlorpromazine treatment of experimental acute fulminant pancreatitis in pigs

Acute pancreatitis was induced in 20 piglets. In the controls (10 piglets) no specific treatment was given, while in the experimental group the animals were treated with chlorpromazine, a potent phospholipase A2 inhibitor in vitro. Blood samples were taken from all animals for the assay of amylase, lipase, phospholipase A2, calcium, blood glucose and arterial blood gases both before the experiment and at various time intervals after its commencement. At autopsy, tissue specimens were taken from the pancreas, liver, lungs, heart and kidneys for histological studies. In the untreated animals there was a continuous rise in the phospholipase A2 levels, while the level decreased to zero on the second day in the treated animals (p less than 0.01, Student's t test). Moreover, in the untreated animals there was a sharp drop in the arterial pO2, while this remained unchanged in the treated animals (p less than 0.1, Student's t test). The mortality was significantly less (p less than 0.01, chi-square test) in the chlorpromazine-treated animals than in the controls. Serum phospholipase A2 levels correlated with the changes in pulmonary function and mortality. The results support the view that phospholipase A2 is of importance in the pathophysiology of acute pancreatitis.

Serum phospholipase A2 in human acute pancreatitis

The main problem in the diagnosis of acute pancreatitis is the early detection of the fulminant forms. So far, there is no single laboratory test that affords an unequivocal measure of the severity of the disease. We have studied the serum phospholipase A2 concentrations of 66 consecutive patients with acute or chronic relapsing pancreatitis. Fifty-two patients had a mild spontaneously healing form of the disease, whereas eight patients developed a pseudocyst or an abscess. Six patients had operatively established haemorrhagic pancreatitis. The serum phospholipase A2 concentrations were significantly higher in the patients with haemorrhagic pancreatitis than in those with a spontaneously healing disease. Moreover, in the patients with a milder form of the disease the serum phospholipase A2 concentrations correlated with prognostic signs suggested by others. The results suggest that the assaying of serum phospholipase A2 might be a valuable tool in the diagnosis and follow-up study of patients with acute pancreatitis.

Selective measurement of triacylglycerol lipase activities in pig post-heparin plasma

Immunochemical methods for the selective measurement of pig post-heparin plasma lipoprotein lipase and hepatic lipase are described and validated. A simple two step purification method for porcine hepatic lipase from hepatic perfusate based on affinity chromatography and gel filtration is reported. The activity of the post-heparin plasma lipoprotein lipase and hepatic lipase in swine is reported. It is demonstrated that fasting decreases the activity of post-heparin plasma lipoprotein lipase activity more than two-fold while it does not affect the hepatic lipase activity significantly.

Phospholipase A2 in serum and ascitic exudate in experimental acute haemorrhagic pancreatitis in pigs

We have developed a model of experimental haemorrhagic pancreatitis in pigs with a 100% mortality within 24 h without treatment. In this model we have studied the production of peritioneal exudate and compared the concentrations of amylase, lipase and phospholipase A2 in the ascitic exudate and serum. The results suggest that the determination of phospholipase A2 might be important in the diagnosis and follow-up of acute pancreatitis.

Xylocaine treatment in experimental pancreatitis in pigs

Experimental haemorrhagic pancreatitis was induced in 12 piglets by infusing Nataurocholate trypsin into the pancreatic duct with simultaneous intravenous secretin stimulation. Within some minutes after the infusion all animals developed severe pancreatitis accompanied by the production of bloody ascites. Unless given specific treatment the pigs died within 24 h. Of the animals treated with xylocaine infusion (50 microgram/kg/min for 24 h) one died within 24 h, one during the second day, and four lived for over a week, at which time they were killed. Although xylocaine treatment signficantly improved the survival of the animals, it did not seem to influence the local damage of the pancreatic tissue. Xylocaine has been shown to inhibit phospholipase-A in vitro. It is possible that xylocaine also acts in vivo by inhibiting phospholipase-A, thus preventing lethal tissue damages at an early stage of pancreatitis.