alpha-chymotrypsin and Cholelithiasis

There have been various studies of exocrine pancreatic function after acute pancreatitis, but few have examined the relationship between this function and the etiology of the pancreatitis. The aim of this work was to study pancreatic function in patients who had had acute alcoholic or acute biliary pancreatitis.. Seventy-five patients who had had a single attack of acute pancreatitis were studied. The etiology was alcohol in 36 and cholelithiasis in 39. Pancreatic function was studied between 4 and 18 months after pancreatitis by duodenal intubation in 18 patients (8 alcohol, 10 lithiasis) and by the amino acid consumption test (AACT) in the remaining 57 (28 alcohol, 29 lithiasis). For those who underwent AACT, the test was repeated 1 year after the first examination.. Among the 36 patients with alcoholic pancreatitis, most had impaired pancreatic function at both duodenal intubation (8/8, 100%) and at AACT (22/28, 78.6%); at the second test, the AACT remained pathological (18/23, 82.1%). Of the 39 patients with biliary pancreatitis, only 4 of the 10 (40%) who underwent duodenal intubation and only 5 of the 29 (17.2%) who performed AACT had pancreatic insufficiency; at the second test, only 4 of the 26 (15.4%) who repeated the AACT were pathological. The differences in the frequency and degree of pancreatic insufficiency between patients with alcoholic and those with biliary pancreatitis were statistically significant.. The results show that after alcoholic acute pancreatitis, the pancreatic insufficiency was significantly more frequent and more severe than after biliary pancreatitis. These findings together with the fact that the insufficiency was also more persistent suggest that acute alcoholic pancreatitis may occur in a pancreas that already has chronic lesions.

Topics: Acute Disease; Adolescent; Adult; Aged; Amino Acids; Bicarbonates; Ceruletide; Cholelithiasis; Chymotrypsin; Exocrine Pancreatic Insufficiency; Female; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatitis; Pancreatitis, Alcoholic

The aim of the present study was to investigate in human subjects whether or not the ingestion of two liquid meals that differed only in their fatty acid composition (due to the addition of olive oil (group O) or sunflowerseed oil (group S) as the source of dietary fat) would lead to differences in the pancreatic enzyme activities secreted into the duodenum. The experiments were performed in eighteen cholecystectomized subjects who, during the 30 d period immediately before surgery, modified their habitual diets in such a way that their fat composition would reflect, as far as possible, that of the experimental meals. Lipase (EC 3.1.1.3), colipase, amylase (EC 3.2.1.1), chymotrypsin (EC 3.4.21.1) and trypsin (EC 3.4.21.4) activities were measured in duodenal contents aspirated before and after the ingestion of the test meals. The plasma levels of secretin and cholecystokinin (CCK) were also examined. Duodenal enzyme activities were similar in resting conditions. No significant differences were revealed in postprandial enzyme activities, except for lipase activity, which was higher in group O, probably in relation to the greater plasma CCK concentrations observed in this group. In the absence of enzyme output data, we should not exclude the possibility that the type of dietary fat will affect human pancreatic enzyme secretion to a greater extent than is evident from the present study, for instance through a flow-mediated effect, as we previously observed in dogs.

Topics: Amylases; Cholecystokinin; Cholelithiasis; Chymotrypsin; Colipases; Dietary Fats, Unsaturated; Humans; Lipase; Olive Oil; Pancreas; Peptide Hydrolases; Plant Oils; Secretin; Sunflower Oil; Trypsin

Antileukoprotease, an inhibitor of granulocyte elastase, was studied in paired sera from 19 patients with pneumonia and from 9 patients with cholecystolithiasis. The circulating level of antileukoprotease was significantly higher in patients with pneumonia compared with patients with cholecystolithiasis. In the latter group, surgery raised the level of general acute phase reactants, but did not affect the level of antileukoprotease. In sera from patients with pneumonia, antileukoprotease was recovered in a free and active form, as shown by gel-filtration of sera before and after the addition of leukocyte elastase. A local protective function of antileukoprotease is suggested by the finding that antileukoprotease was bound to granulocyte elastase in purulent bronchial secretions.

Topics: Acute-Phase Proteins; Adult; alpha 1-Antitrypsin; Blood Proteins; Bronchitis; Cholelithiasis; Chromatography, Gel; Chymotrypsin; Female; Humans; Male; Orosomucoid; Pancreatic Elastase; Pneumonia; Protease Inhibitors; Proteinase Inhibitory Proteins, Secretory; Proteins; Sputum

Assessment of the clinical value of the pancreolauryl test (PLT) in the literature range from "useless" to a specifity of 95% and a sensitivity of 98%. In this work, our own data are presented in relation to various reference methods. The results are derived from the largest collective investigated to data, comprising 40 controls and 391 patients (108 with chronic pancreatitis and 283 with other gastrointestinal disorders). The specifity of the the PLT varies between 81% and 95% according to the "quality" of the control collective. The PLT is particularly frequently pathological in patients with diseases in the region of the gallbladder/bile duct and the gastrointestinal tract. The sensitivity of the PLT for chronic pancreatitis varies between 68% and 100%, depending on 9 different reference methods employed. Based on the prevalence of chronic pancreatitis with exocrine insufficiency in various patient collectives, the predictive value of the PLT for the presence of this disorder can be calculated using our data.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Cholelithiasis; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Exocrine Pancreatic Insufficiency; Gastrointestinal Diseases; Humans; Liver Diseases; Pancreatic Diseases; Pancreatic Function Tests; Pancreatitis; Secretin; Tomography, X-Ray Computed

Antileukoprotease is an important inhibitor of leukocyte elastase and seems to be the primary defence factor against elastase in the respiratory tract. The circulating level of antileukoprotease increases in inflammatory diseases and seems to be related to the degree of inflammation of the lung parenchyma. Antileukoprotease cannot be included among the general acute phase reactants as it does not increase in connection with surgical trauma.

Topics: alpha 1-Antichymotrypsin; Cholecystectomy; Cholelithiasis; Chymotrypsin; Humans; Orosomucoid; Pneumonia; Protease Inhibitors; Proteinase Inhibitory Proteins, Secretory; Proteins; Radioimmunoassay

Topics: Adolescent; Child; Cholelithiasis; Chymotrypsin; Clinical Enzyme Tests; Cystic Fibrosis; Diagnosis; Exocrine Pancreatic Insufficiency; Feces; Gastrointestinal Diseases; Geriatrics; Humans; Infant; Intubation; Intubation, Gastrointestinal; Liver Diseases; Pancreatic Neoplasms; Pancreatitis; Trypsin

Topics: Amylases; Bradykinin; Carboxypeptidases; Cholecystitis; Cholelithiasis; Chymotrypsin; Enzyme Inhibitors; Humans; Kallikreins; Metabolism; Pancreatitis; Trypsin