PANCREAS ALERTS
Clin Chem 2000; 46:2008-13
Taes YE, Louagie H, Yvergneaux JP, De Buyzere ML, De Puydt H, Delanghe JR, Lott JA.
University Hospital Ghent and General Hospital St.-Lucas. Ghent, Belgium. Department of Pathology, Ohio State University, Columbus, Ohio, USA.
The authors report the case of an 80-year-old woman who was admitted to the hospital with an intermittent volvulus of the right colon. A total colectomy was performed. Initially, both serum amylase and lipase increased concordantly, but, after a few weeks, the amylase normalized (85 U/L) whereas the lipase increased to 3,764 U/L. This discrepancy and persistence of hyperlipasemia suggested a macromolecular form of lipase.
The nature of the macromolecular complex was studied using high-pressure liquid gel-permeation chromatography, affinity chromatography, (immuno)electrophoresis and immunodiffusion. Gel-permeation chromatography revealed a macrolipase with a molecular mass >900 kDa which was responsible for up to 56% of the total serum lipase activity. Butanol extraction of the specimen did not alter the elution profile. The thermostabilities of both pancreatic lipase and the macroform were similar, whereas activation energy was lower in the macromolecular lipase. Agarose electrophoresis showed a broad band of lipase activity at the application site. Protein A-Sepharose affinity gel chromatography excluded IgG-linked lipase. Agarose electrophoresis and immunofixation excluded linkage to other immunoglobulins. Radial immunodiffusion did not show lipase activity in the immunoglobulin precipitation bands. Radial immunodiffusion with alpha2-macroglobulin (alpha2-MG) antibodies showed a diffuse spot of lipase activity within the precipitation band, suggesting a macromolecular association between lipase and alpha2-MG. Affinity gel chromatography for alpha2-MG showed lipase activity in the alpha2-MG-bound fractions.
Br J Surg 2000; 87:1494-9
Usatoff V, Brancatisano R, Williamson RC.
Department of Surgery, Hammersmith Hospital, Imperial College School of Medicine. London, UK.
Pseudocysts associated with chronic pancreatitis are generally intrapancreatic and associated with parenchymal disease. They tend to persist and cause complications. Minimally invasive methods of treatment challenge the traditional techniques of operative management. Surgery allows definitive treatment of the pseudocyst with the option of dealing appropriately with the diseased pancreas and excluding a neoplastic process. The aim of this study was to review the safety and efficacy of a surgical approach to the management of pseudocysts associated with chronic pancreatitis.
In this study the authors report a series of 112 consecutive patients operated for pseudocysts in the setting of chronic pancreatitis. Chronic pancreatitis was confirmed by imaging studies in association with exocrine and/or endocrine failure. Cysts were multiple in 31 patients and presented with complications other than pain in 47. Data were collected prospectively regarding the clinical presentation, the nature of the operation and its outcome. Forty-three per cent of the patients underwent drainage procedures, 50% had a resection and 7% had a combination of the two. Larger cysts and those located in the head and neck tended to be drained, while smaller and distal cysts were more often resected. The morbidity rate was 28% and the operative mortality rate was 1%. The cyst recurrence rate was 3% and pain was relieved in 74% of the patients.
The authors concluded that operative management of pseudocysts associated with chronic pancreatitis is effective with low morbidity and mortality rates and that the introduction of newer minimally invasive techniques will have to withstand comparison to this traditional approach.