Higher Serum Amylase Levels Research Articles

Enhanced susceptibility to pancreatitis in severe hypertriglyceridaemic lipoprotein lipase-deficient mice and agonist-like function of pancreatic lipase in pancreatic cells

Background and aims: Recurrent pancreatitis is a common complication of severe hypertriglyceridaemia in patients with various gene mutations in lipoprotein lipase (LPL) or apolipoprotein CII. However, the exact pathogenetic mechanism...

MORE ACCURATE PREDICTION OF POST‐ERCP PANCREATITIS BY 4‐H SERUM LIPASE LEVELS THAN AMYLASE LEVELS

Background: The aim of the present study was to evaluate and compare 4‐h post‐endoscopic retrograde cholangiopancreatography (ERCP) hyperamylasemia and hyperlipasemia as predictors of post‐ERCP pancreatitis.Methods: We reviewed 1631 consecutive cases consisting of 910 cases of diagnostic ERCP and 721 cases of therapeutic ERCP. Pancreatitis was diagnosed when abdominal pain persisted for 24 h after ERCP and the pain was associated with high serum amylase level and/or lipase level.Results: Pancreatitis developed in 69 (4.2%) of the 1631 cases. The receiver‐operator characteristic (ROC) curve of both the 4‐h amylase level and the 4‐h lipase level after diagnostic ERCP showed good test performance, with area under the curve of 0.88 (95% CI: 0.85–0.91) and 0.94 (95% CI: 0.92–0.96), respectively. The ROC of both the 4‐h amylase level and the 4‐h lipase level after therapeutic ERCP also showed good test performance, with an area under the curve of 0.92 (95% CI: 0.90–0.93) and 0.96 (95% CI: 0.94–0.97), respectively. The optimal cut‐off value for lipase after both diagnostic and therapeutic ERCP was 10‐fold the upper limit of the normal range. The serum lipase value after both diagnostic ERCP (P = 0.025) and therapeutic ERCP (P = 0.035) was a more effective predictor of post‐ERCP pancreatitis based on the areas under the ROC curve than was the serum amylase value.Conclusions: The 4‐h post‐ERCP lipase value is more useful for predicting pancreatitis after both diagnostic and therapeutic ERCP.

Lessons to be learned: a case study approach — acute appendicitis masquerading as macroamylasaemia

Macroamylasaemia is a condition in which serum amylase is elevated in the presence of a low to normal urinary amylase and normal renal function. It is rare but can masquerade as other clinical disorders. Discussed here is a case report of a patient who presented initially with abdominal pain (later recognized as being due to gangrenous appendicitis) and in whom there was a very high serum amylase level, leading to an erroneous initial diagnosis and management as acute pancreatitis. The CT scan of the abdomen was normal without any evidence of pancreatitis. Subsequently, the renal amylase:creatinine clearance ratio (C(am)/C(cr)) was found to be low, being characteristic and diagnostic of macroamylasaemia; the latter was, in turn, the cause for the elevated serum amylase level. The underlying macroamylasaemia had thus masqueraded as pancreatitis. The patient underwent appendicectomy and hence made an excellent recovery. It is vitally important to recognize this condition in order to avoid both an incorrect diagnosis and inappropriate treatment/management.

Does preoperative pancreatic duct stenting prevent pancreatic fistula after surgery? A cohort study

Background/objective Postoperative pancreatic fistula remains a major complication after pancreatic surgeries. To prevent pancreatic fistula, one of the employed management strategies is pancreatic duct stenting. The purpose of this study was to evaluate the efficacy and safety of preoperative pancreatic stenting to prevent pancreatic fistula after surgery. Methods Subjects comprised 18 consecutive patients who underwent pancreatic surgeries. Patients were divided into 2 groups: stenting group ( n = 7); and non-stenting group ( n = 11). Complications after stent placement were analyzed. Compared parameters between groups included background, incidence and grading of pancreatic fistula as judged by international study group of pancreatic fistula (ISGPF) criteria, duration until drain removal, and mean maximum level of drain amylase. Results Two patients displayed mild pancreatitis with high serum amylase levels after stenting. No significant differences in background or any other compared parameters to assess drainage effect were identified between stenting and non-stenting groups. Complications related to placement of the stent tube occurred in 4 patients with tube occlusion or cholestasis. Conclusions Although drainage effect in the stenting group was compared with that in the non-stenting group, no obvious effect was obtained. This procedure seems to require further investigation on indications for postoperative drainage to decrease the incidence of pancreatic fistula.

Cystic lesion of the parotid following drug‐induced toxic epidermal necrolysis (Lyell's syndrome)

A 32-year-old woman developed a unilateral cyst of the duct of parotid gland 4 months after severe oral involvement of drug-induced toxic epidermal necrolysis (TEN). The pathomechanism leading to the TEN epidermal destruction had presumably involved the salivary epithelium as well, leading to the development of the cystic lesion. The patient had low serum lipase levels, but high serum amylase levels at the time of TEN. These serological markers could represent a clue for the risk of developing cystic lesions of the large salivary glands following TEN.

Sex-related differences in effect of ethanol administration and folic acid supplementation on pancreatic amylase in rats.

The present study was designed to determine whether folic acid supplement is sufficient to reverse the negative effects of ethanol consumption on amylase activity during gestation, lactation, and growth. Moreover, this study investigated the sex-related differences in amylase content in the pancreatic tissue, serum, and urine. The animals were randomized into three groups: Control group (CG) received water and a basic rat diet during pregnancy, lactation, and growth; Ethanol-rats (EG) were fed an ethanol diet during pregnancy, the suckling period, and growth until death; and Ethanol + folic acid group (E + FG) were handled the same way as those of EG, except they received a folic acid supplement from reproduction until the end of experimental period. Our results showed that ethanol consumption decreased the pancreatic amylase level in offspring rats at 2 months postpartum. Folic acid supplementation did not alter pancreatic amylase activities. In offspring males, ethanol administration decreased serum amylase activity at 2 months postpartum. Folic acid supplementation in males resulted in higher serum amylase levels than those corresponding to the ethanol-fed group. In females, no significant differences between groups in serum amylase levels were found. Ethanol consumption decreased urinary amylase excretion (at 30 days and 2 months postpartum), but the folic acid-supplemented group showed a more pronounced decrease in urine amylase activity than in the ethanol-fed group. At 30 days postpartum, no sex difference in urinary amylase was identified. However, in general, males showed higher values for urine amylase than females at 2 months postpartum. A folic acid-supplemented diet exerts an advantageous effect on amylase in serum in offspring males at 2 months postpartum of mothers fed ethanol during gestation and lactation periods, because amylase renal absorption is increased. In offspring females, amylase renal absorption is also increased, but we did not observed an advantageous effect on amylase in serum. It may be that sexual differentiation in females at 2 months postpartum exerts a definitive effect on amylase in serum. We found a sex-related difference in amylase activities; therefore, we suggest that in future all results of the exocrine pancreas function, in male and female animals, be analyzed separately.

Association between CTLA-4 +49 A/G Polymorphism and Type 1B Diabetes in Japanese Population

+49 A/G polymorphism of CTLA-4 gene has been suggested to be associated with type 1 diabetes in some populations. However, a functional significance of the +49 A/G polymorphism is unknown, because it is believed the polymorphism does not affect the function of the CTLA-4 molecule. In this study, we examined the +49 A/G polymorphism of the CTLA-4 gene in 30 Japanese type 1 diabetic patients (14 type 1B and 16 type 1A) and 40 non-diabetic subjects in a case-control study, and stratified patients according to genotype of the polymorphism. The distribution of genotype frequencies differed between type 1 diabetic patients and controls (p<0.01). When the subjects were subdivided into type 1A and type 1B subgroups, a significant difference in G allele frequency was found only between type 1B patients and controls, whereas G allele frequency tended to be higher in type 1A diabetic patients than controls. Type 1B patients displayed more severe metabolic decompensation (higher plasma glucose concentration, lower urinary C-peptide levels, higher insulin requirement, and higher serum amylase levels), and were found to be more prone to diabetic ketoacidosis than type 1A patients. After stratification by genotype, differences in urinary C-peptide and serum amylase levels between type 1A and type 1B patients were found to be due to differences in the GG genotype subgroup, whereas in the AG subgroup those differences disappeared. In conclusion, the +49 A/G polymorphism of CTLA-4 gene was associated with the occurrence of type 1B diabetes in a Japanese population, and type 1B diabetics with a GG genotype were associated with more severe cell dysfunction than their type 1A counterparts.

Metallothionein Protects Against Cerulein-Induced Acute Pancreatitis

Oxidative stress has been proposed to play a role in the early events of acute pancreatitis, and metallothionein (MT) can provide protection against oxidative stress. Using transgenic mice, we characterized the effects of depletion of MT-I and -II, or overexpression of MT-I, on pancreatic responses during cerulein-induced acute pancreatitis. In MT-I/-II knockout mice, repeated injections of cerulein caused (a) higher serum amylase levels at 3 and 7 h after the initiation of acute pancreatitis; (b) earlier and stronger upregulation of oxidative stress-responsive genes, including heme oxygenase (HO)-1 and c-fos; and (c) exacerbated tissue damage (edema and polymorphonuclear neutrophil infiltration) compared with nontransgenic 129/SvCPJ mice. Total pancreatic glutathione (GSH + GSSG) content was similar between the knockout and nontransgenic 129/SvCPJ mice. Interestingly, during acute pancreatitis, CD-1 mice pretreated with L-buthionine-[S,R]-sulfoximine (BSO), which dramatically depleted pancreatic GSH, also had more severe pancreatitis, based on the same three criteria listed above, relative to untreated controls. No effects were observed with BSO treatment alone. Finally, during cerulein-induced acute pancreatitis, MT-I overexpressing transgenic mice (>20-fold increase in pancreatic MT-I content) had lower serum alpha-amylase levels between 7 and 24 h and delayed upregulation of HO-1 mRNA levels, but no difference in c-fos mRNA induction relative to the appropriate strain of nontransgenic mice. Diminished tissue damage (particularly cellular necrosis) was noted in these MT-I overexpressing transgenic mice. Total pancreatic GSH content was similar in these transgenic and nontransgenic mice during cerulein-induced acute pancreatitis. These studies suggest that pancreatic MT can function as an intracellular antioxidant as does GSH and that these intracellular antioxidants play a protective role during cerulein-induced acute pancreatitis.

Pancreatitis and primary hyperparathyroidism: forty cases.

Pancreatitis is associated with primary hyperparathyroidism (PHPT) in 1.5-7% of cases. The relationship of cause and effect between the two diseases has been debated. To evaluate this relationship, the clinical, biochemical and pathological data on 1435 patients operated on for hyperparathyroidism (HPT) over the past 30 years were retrospectively reviewed. A total of 1224 of these patients had biologically proven and cured PHPT and 211 patients had renal HPT (RHPT). The diagnosis of pancreatitis (PTS) was based on a high serum amylase level and/or abnormalities on ultrasound or computed tomography (CT) scan explorations. Only patients without biliary stones were included in the PTS group associated with HPT. A total of 3.2% (n = 40) of patients with PHPT had PTS, which was acute in 18 cases, subacute in 8 cases and chronic in 14 cases. This rate of PTS is higher than in a random hospital population. Surgical cure of HPT was followed by the spontaneous healing of 17/18 acute PTS, whereas six of the 22 patients with subacute or chronic PTS developed complications due to the evolution of their disease (diabetes, pancreatic duct stenosis treated by surgery). A single diseased gland was found in 27 patients with PTS, which is in favour of primary parathyroid disease, being responsible for, and not a consequence of, PTS. Only the serum calcium (13.0 vs 12.1 g/dL) level was significantly increased in PHPT patients with PTS, when compared to those without PTS. The calcium level is probably of major importance in the development of PTS, which was never encountered in 211 patients with RHPT, who had low calcium and high PTH levels. The data suggest that (i) the PTS-PHPT association is not incidental; (ii) PTS is the consequence and not the cause of PHPT; (iii) hypercalcaemia seems to be a major factor in the development of PTS in PHPT patients; and (iv) cure of PHPT leads to the healing of acute PTS, whereas it does not affect the evolution of subacute and chronic PTS.

The clinical challenge of multiple pancreatic pseudocysts

To evaluate the frequency of multiple pancreatic cysts, the likelihood of preoperative diagnosis, and therapeutic outcome, we retrospectively reviewed the records of 157 patients who underwent operation for pancreatic pseudocysts at 2 institutions between 1970 and 1992. Multiple pseudocysts were found in 29 (18.5%). The 8 women and 21 men ranged in age from 21 to 79 years. The etiology was alcohol abuse in 15 (52%), biliary tract disease in 6 (21%), alcohol abuse and biliary tract disease in 3 (10%), and a variety of other causes in the remaining 5 (17%). There was no difference in age, sex, race, etiology, or presenting signs and symptoms between patients with single pseudocysts and those with multiple cysts. Serum amylase levels were significantly higher in patients with multiple cysts compared to those with single cysts (P < 0.05). Computed tomography accurately demonstrated the extent of disease in 20 of 25 patients (80%), while 1 or more cysts were missed in 5 (20%). The mean number of cysts per patient was 2.7, with a range of 2 to 5. Average pseudocyst diameter was 7.8 cm, with a range from 3 to 20 cm. Multiple internal drainage procedures were performed in 19 patients, a combination of internal and external drainage in 6, external drainage in 1, and resection of multiple cysts in the tail in 2. There was no operative mortality. With a mean follow up of 38.5 months, only 1 recurrent pseudocyst has been found. There were six attempts at percutaneous drainage in six patients. Two of these patients were referred to our institution following failure of percutaneous drainage at other hospitals. Three other patients had residual symptomatic pseudocysts following percutaneous drainage at our hospitals and then underwent multiple internal drainage. The sixth patient refused operative drainage despite the persistence of residual symptomatic pseudocysts after attempted percutaneous drainage. The incidence of multiple pseudocysts (18.5%) is higher than previously reported. There is no difference in the clinical features of patients with single versus multiple pseudocysts. Patients with multiple cysts have higher serum amylase levels. Preoperative computed tomography underestimated the number of cysts in 20% of patients. Careful intraoperative exploration is still needed to avoid missing multiple pseudocysts. Internal drainage is the preferred therapy. A thorough search for multiple cysts at the initial operation should eliminate one potential cause for pseudocyst recurrence.

Lipase/amylase ratio: A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis

Because of observations that patients with acute episodes of alcoholic pancreatitis had high serum lipase levels whereas patients with gall stone pancreatitis had high serum amylase levels, a prospective study was undertaken to determine whether the ratio of serum lipase to serum amylase, a newly computed ratio, would discriminate between acute episodes of alcoholic and nonalcoholic pancreatitis. In phase one, 30 consecutive patients with acute pancreatitis were entered into the study and divided into groups A and B. Patients with renal failure were excluded from the study. Group A consisted of 20 patients in whom the etiology of pancreatitis was alcohol. Group B consisted of 10 patients whose pancreatitis was nonalcoholic in etiology (predominantly gallstones). Serum lipase values in group A ranged 492 to 25,706 U/L (median, 3433 U/L) and in group B from 711 to 31,153 U/L (median, 1260 U/L). These differences were not significant statistically. Serum amylase values in group A ranged from 104 to 2985 U/L (median, 331 U/L) and in group B from 423 to 13,000 (median, 1187 U/L). Although these figures were statistically different (P < 0.005), there was a considerable degree of overlap in the values between the two groups. The lipase/amylase ratio calculated from the blood sample obtained at presentation appeared to be a promising discriminatory index. The lipase/amylase ratio was calculated by using the amylase and lipase levels expressed as multiples of the upper limit of normal in each case. The lipase/amylase ratios in the alcoholic group ranged from 2.2 to 14.8, whereas the lipase/amylase ratio in nonalcoholic pancreatitis ranged from 0.31 to 1.93. These differences were statistically significant (P < 0.005). A lipase/amylase ratio of > 2 was indicative of an alcoholic etiology, and a ratio of < 2 suggested that the pancreatitis was nonalcoholic in nature. In phase two, this lipase/amylase ratio of 2 was applied prospectively to an unselected population of 21 consecutive patients with acute pancreatitis. Thirteen patients had a lipase/amylase ratio of > 2; in 11 of them, the etiology of the pancreatitis was alcohol. Eight patients had a lipase/amylase ratio of < 2; of them, only 1 patient had an alcoholic etiology for the pancreatitis. These differences were statistically significant (P < 0.05). The sensitivity of a lipase/amylase ratio of > 2 in detecting acute alcoholic pancreatitis was 91%, the specificity was 78%, and the positive predictive value was 85%.

Oral and dental characteristics in bulimic and anorectic patients

This article presents the oral situation of 11 anorectic and 41 bulimic patients and compares it with 50 healthy control persons. Although patients with an eating disorder showed less signs of gingival inflammation (sulcus-bleeding index (SBI): anorexia = 14.6%; bulimia = 12.5%; controls = 44.7%), they had clearly more enamel erosions than did healthy control persons. In 27 of 41 bulimic patients, a bilateral swelling of the parotid gland was found. A significant correlation between the parotid enlargement and enamel erosion exists in bulimic patients with a history of anorexia nervosa. Patients with an eating disorder had higher levels of serum amylase than did healthy control persons. A significant correlation between serum amylase activity and dental characteristics was found in bulimic patients.

A case of Gilbert’s syndrome combined with macroamylasemia

A 30-year-old Japanese male, who had no remarkable family history, visited our hospital with a complaint of abdominal pain, and unconjugated hyperbilirubinemia and hyperamylasemia were observed. He showed negative hemolysis tests, positive nicotinic acid test, low hepatic bilirubin UDP-glucuronyltransferase activity, decreased bilirubin diglucuronide and increased bilirubin monoglucuronide in bile, and a decrease in serum bilirubin after phenobarbital administration. He also showed high serum amylase level, low urine amylase level, and low amylase-creatinine clearance ratio. Gel filtration of serum with Sephadex G-200 revealed the existence of macroamylase. Countercurrent immunoelectrophoresis proved binding of serum amylase to lambda type IgA. From these results, the case was diagnosed as Gilbert's syndrome combined with macroamylasemia.

Use of UW Solution in Pancreas Transplantation

We have recently reported successful 72-h preservation of the canine pancreas with a new cold-storage solution developed at the University of Wisconsin (UW solution). Over 10 mo, we performed 11 combined pancreas-kidney and 4 isolated-pancreas transplants with this solution. In situ cooling of the donor pancreas was performed with 1000 ml of UW solution followed by ex vivo perfusion with an additional 250-500 ml. Graft preservation times ranged from 3 to 19 h (mean 10.2 h). Pancreas transplants were vascularized whole-organ grafts with pancreaticoduodenocystostomy. Early graft function was excellent as assessed by immediate insulin independence, high urinary amylase and low serum amylase levels, and a technetium perfusion index indicating good pancreatic blood flow. There were no episodes of primary nonfunction, graft pancreatitis, or vascular thrombosis. Actuarial patient and graft survival at 1 mo was 92.9%. We conclude that UW solution provides excellent early graft function for up to 19 h of cold storage. Based on previously reported data on its efficacy in liver and kidney preservation, UW solution seems ideally suited as a universal intra-aortic flush and cold-storage solution.

Clinical and histopathological profile of sarcoidosis of the heart and acute idiopathic myocarditis. Concepts through a study employing endomyocardial biopsy. II. Myocarditis.

Through an approach employing endomyocardial biopsy, early diagnosis of acute idiopathic myocarditis is possible. The histopathological findings consisted of fragmentation of muscle bundles, degenerative changes with lysis of myocytes and interstitial mononuclear cell infiltration. The cells were irregular in size and shape and contained slightly basophilic cytoplasm or were mixed with small round cells. Early clinical symptoms consisted of flu-like symptoms, i. e., higher fever, myalgia, malaise and arthralgia. Initial ECG changes consisted of complete A-V block in 9, bifascicular block in 3, and intraventricular conduction disturbance in 4 cases. Serial biopsies were performed at the early (0--2 weeks), middle (2--4 weeks), and late stages (more than 4 weeks) in 6 cases. Two of these biopsies were performed in 6 cases and all 3 were performed in one case. The numerous interstitial cell infiltration had almost disappeared by the early stage. At the late stage, either a slight or moderate degree of interstitial fibrosis was observed. These observations coincided well with the improvement of the ECG findings. Characteristic laboratory findings consisted of high LDH, GOT, and serum amylase levels. Varieties of treatments such as temporary cardiac pacing, peritoneal or hemo-dialysis, vasodilator therapy effectively to relieve the grave clinical condition. It is concluded that acute myocarditis may heal with remarkable improvement when the appropriate treatment is applied at the early stage of the disease.

Increased serum amylase levels in prostatic diseases

Serum amylase levels were found to be increased in 95 per cent of patients with benign prostatic hypertrophy and in 70 per cent of patients with prostatic cancer. No known causes for high serum amylase levels were present in these patients. Investigation of a possible relationship between amylase activity and prostatic diseases suggested that benign prostatic hypertrophy and prostatic cancer should be considered in the differential diagnosis of disorders associated with increased serum amylase levels.

Severe acute pancreatitis.

Introduction This paper is a review of our experience with severe acute pancreatitis at the University Hospitals of the State University of Iowa over a 20-year period, 1940-1960. The cases were selected upon the basis of history and physical findings indicating a severe illness and, in addition, by either high serum amylase levels or surgical or autopsy demonstration of severe acute pancreatitis. A total of 60 cases is in this series with a mortality of 29 (48.3%). Forth-two had their diagnosis substantiated either by operation during the acute illness or at autopsy. Of the remaining 18, the average amylase level was 1,419 Somogyi units, with the lowest level at 409 and the highest 5,330 units. Patients were not accepted for this series if the diagnosis was questionable, if the amylase level was below 400, or if their clinical findings were not those of a severe illness.* The entrance diagnosis in

The effect of serum albumin on enzyme activity in experimental hemorrhagic pancreatitis in dogs

This study was undertaken to determine the mechanism of action and the effect of the intravenous use of serum albumin upon the course of hemorrhagic pancreatitis in dogs. Experimental hemorrhagic pancreatitis was produced in eighty animals, and laboratory studies were done both pre- and postoperatively. Laboratory findings included a high serum amylase level and a reversal of serum proteolytic and antiproteolytic activity in the untreated animal. During the most severe stage of toxemia and shock, three groups of animals were treated with albumin, dextran and saline solutions, respectively. Animals receiving albumin responded much more quickly and recovered rapidly, while all animals which had received either dextran or saline died. Reversal of proteolytic and antiproteolytic activity was observed three to six hours following the induction of hemorrhagic pancreatitis. Levels returned to normal in six hours following treatment with human serum albumin.

Elevated serum amylase level associated with ruptured ectopic pregnancy.

Serum amylase level determinations provide one of the most specific means of making the diagnosis of inflammatory disease of the pancreas. However, it has been well established that increased concentrations of serum amylase may be produced, perhaps indirectly, by a variety of other conditions not associated with intrinsic pancreatic pathology. The list of such conditions is long and includes perforated peptic ulcer, peritonitis, acute gallbladder disease, choledocholithiasis, biliary dyskinesia, dissecting aneurysm of the aorta, pneumonia, bronchogenic carcinoma, intestinal obstruction, uremia, and mumps (whether or not pancreatitis is present).1They may also occur after the injection of morphine or codeine. In these conditions, however, the levels of serum amylase are rarely of the same magnitude as those attained in the early phases of acute pancreatitis, and they usually do not exceed 4001bto 6002Somogyi units. In the case to be described, much higher levels of serum amylase

Eight-year study of pancreatitis and sphincterotomy.

• The sphincter of Oddi was cut in 319 patients whose repeated attacks of abdominal pain and other symptoms had led to the diagnosis of recurrent pancreatitis. The diagnostic criteria included high serum amylase level and diminished production of pancreatic juice in the secretin test. It was believed that spasm in the sphincter would cause bile to enter the pancreatic duct system and provoke recurrent pancreatitis because the bile and pancreatic juice shared a common passageway before entering the duodenum. This passageway was demonstrated at operation in 316 patients, either by direct observation during transduodenal sphincterotomy, or by other means such as cholangiography. Sphincterotomy must be accompanied by cholecystectomy, whether the gallbladder is normal or not. The operation abolished the pain caused by distention of biliary and pancreatic ducts and ended the attacks of severe pain of recurrent pancreatitis. It did not prevent attacks of acute pancreatitis that resulted from ingestion of alcohol or fats in 16 patients. It did, in most cases, stop the progressive destruction of the pancreas and make regeneration possible.