Disseminated fat necrosis mimicking gout

A case of disseminated fat necrosis in pancreatic disease which presented as an apparent arthritis is reported. The intravenous administration of aprotinin as a form is described.

[Clinical studies using a photometric method for determining serum lipase activity]

Results of measurement of serum lipase activity as determined by a UV-test described by Myrick and a titrimetric assay as described by Rick were compared as far as sensitivity and specificity in diagnosis of pancreatitis is concerned. Sensitivity of the UV assay is low (45% falsely normal values), and specificity as well (falsely pathological values in 55.5% of patients with liver disease and 9% of normal persons). In the UV assay lipoproteinlipases are measured as well as hepatic esterases: in 17 samples from persons having received heparin lipase activity was increased 3-8 fold. In a total of 99 samples no correlation was found between the results of the 2 assays. As a consequence it can be stated that the UV-test as described by Myrick has no relevance in diagnosis of pancreatitis; the commercially available assay kit is withdrawn in the meantime.

Time-resolved fluoroimmunoassay of human pancreatic phospholipase A2

We describe an immunofluorometric assay for human pancreatic phospholipase A2 based on time-resolved fluorescence. The labeled antibody technique in combination with the time-resolved 1-s fluorometric detection of the europium label, which essentially eliminates all background fluorescence, resulted in a high sensitivity (20 ng/L) and a wide (5000-fold) linear range. Nonspecific binding was minimized by treating the solid-phase antibody with NaSCN before coating, to remove endogenous antigen, and by immunosorbent purification of the antibody before labeling with europium. This is a one-incubation, multi-site, solid-phase assay on polystyrene microtiter strips, even though a polyclonal antibody was used. As measured by this assay, activity of immunoreactive phospholipase A2 was found to be above normal in sera of patients suffering from acute pancreatitis.

Radioimmunoassay for human pancreatic chymotrypsin and measurement of serum immunoreactive chymotrypsin contents in various diseases

A radioimmunoassay for human pancreatic chymotrypsin II has been developed. Serum immunoreactive chymotrypsin II content in healthy individuals ranged from 14.7 ng/ml to 77.5 ng/ml, the average being 37.5 ng/ml (SD = 19.6). Elevated values were observed in patients with acute pancreatitis and renal failure. After total pancreatectomy, serum immunoreactive chymotrypsin II was not detectable. A significant positive correlation was observed between serum immunoreactive chymotrypsin II and cationic trypsin contents.

Pancreatic ascites

A case of pancreatic ascites in an African is presented. It is a rare condition which is rapidly fatal. The diagnosis can be established if the clinician is aware of this condition; the significant finding is a grossly elevated ascitic fluid amylase.

[Value of blood lipase determination in pancreatic diseases. Comparison with blood amylase assay]

The comparative diagnostic value of plasma lipase and amylase levels was evaluated in 90 patients with various symptoms of pancreatic disease. Comparison with healthy subjects showed that the lipase assay was more sensitive than the amylase assay in patients with acute pancreatitis or post-traumatic pancreatic injury, but not in patients with chronic pancreatitis. On the other hand, acute pancreatitis can be detected earlier by measuring plasma amylase levels, owing to the rapid release of this enzyme. The relative importance of these two laboratory tests is discussed.

Radioimmunoassay of human pancreatic elastase 1. In vitro interaction of human pancreatic elastase 1 with serum protease inhibitors

A radioimmunoassay for determination of human pancreatic elastase 1 was developed and the interaction of pancreatic elastase 1 with serum protease inhibitors (alpha 2-macroglobulin and alpha 1-antitrypsin) was investigated. Gel filtration studies showed that immunoreactive elastase 1 was present in serum and intact plasma as a complex with alpha 1-antitrypsin. Proelastase 1 in human pancreatic juice did not bind to protease inhibitors. But, after incubation with human serum or after activation with bovine trypsin, it was present as a complex with alpha 1-antitrypsin. The pancreatic elastase 1 content of the serum, measured by radioimmunoassay, was found to be influenced by the contents of both serum alpha 2-macroglobulin and alpha 1-antitrypsin. A significant inverse correlation was observed between the serum immunoreactive elastase 1 and alpha 2-macroglobulin contents in various hepatic diseases. The concentration of serum immunoreactive pancreatic elastase 1 was 1.79 +/- 0.62 ng/ml (mean +/- SD) in 28 normal controls. Its concentration was significantly increased in patients with acute pancreatitis, and although its concentration varied widely in patients with pancreatic cancer, its average concentration in these patients was significantly elevated.

[Determination of the catalytic activity of lipase by the continuous titration method]

Development of a standardized procedure for the titrimetric assay of lipase has been suggested. Comparative studies with triolein und olive oil were therefore undertaken. Optimal conditions, such as pH, substrate and glycocholate concentrations, etc. were determined for the assay with triolein. The results agree with those obtained earlier with olive oil as substrate. Experience with the quality of various reagents used since 1966 is reported. Problems of methodology are then discussed, especially the incomplete characterization and purity of the bile acid preparations, and their effects on the test conditions. A critical analysis shows that two point tests with modifications of the continuous titration cannot give reliable results. Haemolysis and its effect on catalytic activity of lipase are used to illustrate the consequences of the uncritical acceptance of data from the literature. Furthermore, the required sensitivity of the analytical equipment, operational errors, and the uncritical evaluation and interpretation of analytical data are discussed. The first experiments to be performed with the addition of colipase are described, and the question of whether this cofactor should be used routinely for test purposes is considered. The problem of whether lipoproteinlipase can be quantitatively inhibited is discussed. In view of the outlay on apparatus and the time required for the assay, continuous titration is definitely not suitable for routine screening purposes. On the other hand, simpler methods that give reproducible quantitative results have not yet been developed.

Serum elastase I levels in pancreatic disease

The radioimmunoassay for human elastase I used in this study is accurate, sensitive, and specific, which we have confirmed. The assay can be done within 4 hours, which is important for clinical purposes. A total o 103 subjects were examined, and levels of 99 to 370 ng/dl (mean 200) in normal human sera were determined. The serum elastase levels in acute, acute relapsing, and chronic relapsing pancreatitis were significantly higher than normal. Although serial determinations returned to normal within 5 days after the onset of the attack, they decreased gradually and remained high on the 7th, 10th, and 11th days in patients who still had residual signs of pancreatitis. The values in patients with chronic pancreatitis and various other diseases were normal. The values in patients with acute pancreatitis were significantly higher than in those with hyperamylasemia of nonpancreatic origin. Twelve of 19 patients with pancreatic cancer had abnormal serum elastase levels; this was especially true in patients with cancer of the pancreatic head. We believe that the measurement of serum elastase levels by radioimmunoassay will become a useful diagnostic method for pancreatic disease in the future.

Clinical value of serum immunoreactive trypsin concentration

The clinical value of estimation of serum concentrations of immunoreactive trypsin was evaluated by studying 46 healthy controls, 23 controls in hospital, 44 patients with chronic pancreatic disease, and 184 patients with non-pancreatic conditions in which pancreatic disease commonly enters into the differential diagnosis. Serum trypsin concentration had a log normal distribution in the controls, and the calculated normal range was considerably wider than that previously reported. The concentration was abnormal in only 13 out of 27 patients with chronic pancreatitis and was extremely variable in patients with pancreatic cancer. Abnormal results occurred in 11% of the patients with non-pancreatic disease. Eighteen patients had a subnormal trypsin concentration, of whom six did not have pancreatic disease and 12 had either chronic pancreatitis or pancreatic cancer. There was no correlation between serum trypsin concentration and mean tryptic activity as measured by the Lundh test. Of 11 patients with pancreatic steatorrhoea, only seven had subnormal trypsin concentrations. There results suggest that the serum concentrations of immunoreactive trypsin has a low specificity and sensitivity for pancreatic disease and does no reflect the degree exocrine insufficiency in patients with proved chronic pancreatitis.

Relationship of selenium-dependent glutathione peroxidase activity and nutritional pancreatic atrophy in selenium-deficient chicks

Experiments were conducted to determine the relationship of selenium-dependent glutathione peroxidase (SeGSHpx) activity to the onset of nutritional pancreatic atrophy (NPA) in chicks. Chicks produced from hens fed a low Se, low vitamin E practical diet had low activities of SeGSHpx in plasma and pancreas at hatching. The SeGSHpx activity remained at a low level before and during all stages of the onset of NPA. Selenium supplementation of the diet prevented NPA and resulted in significant elevations in SeGSHpx activity. Although the early stages of NPA are believed to involve mitochondrial swelling, no significant differences were found in rate of oxygen uptake, respiratory control index or adenosine diphosphate to oxygen ratio between pancreatic mitochondria isolated from Se-deficient or Se-adequate chicks. Improvements in maternal Se status significantly increased chick pancreatic SeGSHpx activity at hatching and delayed the onset of NPA in chicks fed a Se-deficient diet. A significant proportion of the second-generation Se- and vitamin E-depleted chicks used in these studies was found to grow at nearly normal rates when fed the Se-deficient diet. These chicks, designated as refractory to the growth-depressing effect of severe Se-deficiency, were biochemically deficient (i.e., had very low SeGSHpx activities) and showed NPA. It is concluded that the Se-responsive lesion which results in NPA in the chick is different from that which results in depressed growth.