Chronic asymptomatic hyperamylasemia unrelated to pancreatic diseases

Case Report: Durable complete response of metastatic hepatocellular carcinoma with asymptomatic hyperamylasemia to combined immunotherapy of anti-cytotoxic T lymphocyte-associated antigen 4 plus anti-programmed cell death-1 antibodies

Background

Combined immunotherapy has shown promising results in the treatment of advanced HCC, whereas the priority population that would respond to the combined immunotherapy is still elusive. In addition, HCC with asymptomatic hyperamylasemia was not reported previously.

Case presentation

An aged patient was diagnosed as HCC with BCLC stage C (bone metastasis). Notably, this patient showed asymptomatic hyperamylasemia. The patient was then enrolled in a trial evaluating combined immunotherapy of anti-PD-1 antibody sintilimab (IBI308) plus anti-CTLA-4 antibody (IBI310) in advanced HCC. After being treated with combined immunotherapy, this patient rapidly achieved complete response (CR) according to mRECIST criteria or immune partial response (iPR) according to iRECIST criteria and maintain the CR state for more than 12 months. Interestingly, serum levels of amylase and lipase in this patient were reduced after treatment.

Conclusion

We reported, for the first time, a case of metastatic HCC with asymptomatic hyperamylasemia, and suggested that HCC patients with asymptomatic hyperamylasemia may benefit from combined immunotherapy of anti-CTLA-4 and PD-1 antibodies.

Hyperamylasemia and pancreatitis following posterior spinal surgery

BACKGROUND

Postoperative pancreatitis has primarily been reported as a complication of abdominal surgery, but there are some case reports of postoperative pancreatitis after spinal surgery. The objective of this study was to investigate a case series of hyperamylasemia and pancreatitis following posterior spinal surgery.

METHODS

The serum amylase level was measured following posterior spinal surgery in the prone position. Patients were divided into groups with a normal serum amylase level (0-125 IU/L) and with hyperamylasemia (>125 IU/L), based on the upper limit of normal of 125 IU/L in our institution. Relationships among preoperative factors, perioperative factors, and the serum amylase level were investigated.

RESULTS

Hyperamylasemia (serum amylase >125 IU/L) following posterior spinal surgery was found in 92 cases (35 %). Among perioperative factors, intraoperative estimated blood loss (EBL) and operating time were significantly higher in patients with high serum amylase than in patients with normal serum amylase (P < 0.01). In a multivariate regression model, intraoperative EBL (OR 1.001, 95 % CI 1.000-1.002; P = 0.001) and operation time (OR 1.006, 95 % CI 1.003-1.009; P = 0.006) were significantly associated with postoperative pancreatitis. Serum amylase levels of ≥ 5 times the upper limit of normal were found in six cases. Five of these cases were asymptomatic and one was caused by severe pancreatitis.

CONCLUSIONS

In our case series, intraoperative blood loss caused a rise in the serum amylase level following posterior spinal surgery. Thus, this level should be carefully monitored after spinal surgery with significant blood loss. Clinical symptoms of pancreatitis, such as abdominal pain and vomiting, should also be monitored following spinal surgery.

Establishment of biochemistry reference values for healthy Tanzanian infants, children and adolescents in Kilimanjaro Region

OBJECTIVE

To establish common biochemistry reference intervals for Tanzanian infants, children and adolescents living in the Kilimanjaro Region.

METHODS

We recruited healthy, HIV-uninfected Tanzanian infants, children and youth between the ages of 1 month and 17 years from local schools and clinics to participate in this study. Only afebrile children without signs of physical or chronic illness were enrolled. Nonparametric methods were used to determine 95% reference limits and their 90% confidence intervals, with outliers removed by the Tukey method.

RESULTS

A total of 619 healthy infants, children and adolescents were enrolled into the study. Twenty-three biochemistry parameters were measured. Compared to US reference intervals, several of the biochemistry parameters showed notable differences, namely alkaline phosphatase, phosphorus, amylase and lipase. Comparing our data to the US National Institutes of Health (NIH) Division of AIDS (DAIDS) grading criteria for classification of adverse events, we found that for selected parameters, up to 15% of infants or children in certain age groups would have been categorised as having an adverse event as defined by DAIDS.

CONCLUSIONS

Our study further confirms the need to use locally established reference intervals to define reference laboratory parameters among children in Africa, rather than relying on those derived from US or European populations. To our knowledge, this study provides the first set of locally validated biochemistry reference ranges for a paediatric population in Tanzania.