P.G. Lankisch

Exocrine Pancreatic Function in Insulin-Dependent Diabetes mellitus

Exocrine pancreatic function was studied in patients with long-standing insulin-dependent diabetes mellitus using the secretin-pancreozymin test (n = 53), and estimation of immunoreactive trypsin (n = 43) and pancreatic isoamylase (n = 43). The secretin-pancreozymin test was abnormal in 23 patients (43%). The abnormalities found were a decreased output of lipase (37%), amylase (36%) or trypsin (26%) and bicarbonate (15%). Serum immunoreactive trypsin was below normal in only 6 (14%) and pancreatic isoamylase in 29 (67%) patients. There was no correlation between impairment of the secretin-pancreozymin test and decreased serum enzyme levels. It is concluded that an impairment of exocrine pancreatic function is frequent in insulin-dependent diabetics but that a decrease in serum enzymes, especially in pancreatic isoamylase, does not reflect an impairment of pancreatic function in these patients.

Pancreolauryl test. Evaluation of a tubeless pancreatic function test in comparison with other indirect and direct tests for exocrine pancreatic function.

The sensitivity and specificity of the pancreolauryl test was evaluated in comparison with the NBT-PABA test, the estimation of fecal chymotrypsin and fat, and the secretinpancreozymin test in 168 patients with and without pancreatic disease. The overall sensitivity rate was as follows: pancreolauryl test 90%, NBT-PABA test 86%, fecal chymotrypsin 66%. In patients with pancreatic steatorrhea the sensitivity of the pancreolauryl test was 100%, the NBT-PABA test 97%, and the fecal chymotrypsin estimation 92%. The specificity of these tests was: pancreolauryl test 97.6%, fecal chymotrypsin 87%, and NBT-PABA test 81.8%. The pancreolauryl test may be recommended as a noninvasive easy-to-perform tubeless pancreatic function test with a sufficiently high sensitivity and specificity.

Functional Reserve Capacity of the Exocrine Pancreas

The functional reserve capacity of the pancreas, as reflected by the absence of steatorrhea, was correlated with the results of a secretin-pancreozymin test (SPT) in 47 patients with exocrine pancreatic insufficiency due to chronic pancreatitis. The results indicate that a severe reduction in enzyme output (but not in bicarbonate concentration and output) is usually associated with steatorrhea. However, there were a number of patients with steatorrhea despite only moderate enzyme output impairment, while others had normal fat excretion but severely reduced enzyme secretion. Thus, the degree of impaired pancreatic function, as measured by the SPT, cannot be predicted by the presence of steatorrhea; vice versa, a moderately abnormal SPT does not exclude the presence of pancreatic steatorrhea. Therefore, for a sophisticated evaluation of the functional reserve capacity of the exocrine pancreas, both the SPT and fecal fat analysis are considered necessary. The correlation between impaired glucose tolerance and exocrine pancreatic function was poor.

Pulmonary complications in fatal acute hemorrhagic pancreatitis

Morphological changes of the lung occur frequently in fatal acute hemorrhagic pancreatitis. The pulmonary alterations are independent of mechanical ventilation and therefore not due to iatrogenic damage caused by high inspired oxygen concentrations. The histological findings are similar to those seen in the so-called shock lung syndrome. The pulmonary lesion develops progressively and three stages can be separated: early, late, and final phase. The pulmonary complications in acute hemorrhagic pancreatitis may be explained by the release of mediators such as pancreatic enzymes or free fatty acids into the blood stream. In acute hemorrhagic pancreatitis a close monitoring for shock parameters is necessary. A fall in arterial Po2 is an early indication for mechanical ventilation, including positive end-expiratory pressure.

Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat

Continuous peritoneal dialysis significantly prolonged mean length of survival and reduced lethality rate of taurocholate-induced pancreatitis in the rat. The effect was improved by compensating protein loss due to pancreatitis and dialysis treatment. The beneficial effect of intravenous albumin treatment was enhanced when combined with dialysis treatment. Using hypothermic dialysate or adding aprotinin intraperitoneally had no additional effect.

Effect of a Specific Serine Protease Inhibitor on the Rat Pancreas: Systemic Administration of Camostate and Exocrine Pancreatic Secretion

Camostate, a synthetic serine protease inhibitor, specifically inhibits the trypsin activity in vitro. Immediately after intravenous administration of camostate (5, 2.5, 0.5, and 0.1 mg/kg body weight/h) the trypsin activity in the biliary-pancreatic juice was diminished dose-dependently in anaesthetized rats. The amylase release was not influenced. Camostate and its metabolites were detected by high-pressure liquid chromatography in the pancreatic juice and tissue; in plasma, only the metabolites were found. Therefore, the inhibitory action of camostate on the trypsin activity in the biliary-pancreatic juice may be due to penetration of camostate into the juice.

Trypsin Radioimmunoassay in the Diagnosis of Chronic Pancreatitis

Serum immunoreactive trypsin (IRT) determination has been recommended as a screening test in chronic pancreatitis. Using a commercial radioimmunoassay kit (RIA--gnost Trypsin; Behring-Werke, Marburg/Lahn, FRG) the interassay coefficient of variation was 26--44% for three different test sera. Gel filtration chromatography profiles revealed immunoreactivity in the position of 125I-trypsin and (less than 50%) in the void volume. The test was evaluated in controls (n = 90), chronic relapsing pancreatitis (CRP;n = 60) and after total pancreatectomy (n = 5). In 65% of the CRP cases decreased IRT values were found, whereas during acute attacks of CRP supranormal and normal values were found. After total pancreatectomy IRT levels were undetectable. It is concluded that the sensitivity of this IRT test is limited and that the available test system needs improvement.

When should treatment of acute experimental pancreatitis be started? The early phase of bile-induced acute pancreatitis.

SummarySodium taurocholate pancreatitis in the rat is a frequently used experimental model for evaluating therapeutical regimes in this disease. It is, however, uncertain when treatment should be started, as the early phase of this experimental model and thus the time when the pancreatitis really develops is unknown. Serum and pancreatic enzymes, as well as pancreatic morphology, were therefore studied 5, 30, and 60min after induction of sodium taurocholate pancreatitis. It was found that increase in serum enzymes and decrease in pancreatic enzymes and morphological changes characteristic for acute pancreatitis develop as early as 5 and 30 min after induction of pancreatitis. Thus, therapy in this model may be started shortly after induction of acute pancreatitis.

Continuous peritoneal dialysis as treatment of acute experimental pancreatitis in the rat. II. Analysis of its beneficial effect.

In acute sodium-taurocholate-induced pancreatitis in the rat, peritoneal dialysis reduced serum amylase levels and the amount of fat necrosis, but did not influence the damage to the pancreas itself. Pancreatic ascites obtained in the early course of the disease was found to have a hypotensive effect when given intraperitoneally to healthy rats. This effect vanished in the later course of acute experimental pancreatitis and was reduced by acidification of the ascites or by administration of an antihistaminic drug. Thus the beneficial effect of continuous peritoneal dialysis on survival time and mortality rate seems to be of systemic origin.

Antinuclear and Pancreatic Acinar Cell Antibodies in Pancreatic Diseases

Recently, the presence of acinar cell antibodies (ACA) and antinuclear antibodies (ANA) in acute and/or chronic pancreatitis have been discussed in the light of an immunological pathogenesis of pancreatitis. In the present study sera of 109 patients with pancreatic diseases were scanned for ACA and ANA which were found in 5 of 16 patients, respectively. The frequency of ACA and ANA was similar in patients with pancreatitis of known and unknown aetiology. In conclusion, the presence of ACA and ANA seems to be rather an epiphenomenon than an index for a certain immunological aetiology of pancreatitis.