Diagnostic Significance of the Pancreatic Juice, Serume and Urinary Amylase Determinations
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概要
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In 500 cases with various diseases and 50 normal control cases, standard secretin test was done and amylase activity was measured in the pancreatic juice obtained as well as in serum and in urine before and after the secretin stimulation. Amylase activity in pancreatic juice of the control group showed enough variance to that no clear cut normal range can be established statistically. However, if the lowest activity found in the control group is taken as the lowest normal threshold, then, amylase activities of the pancreatic juice of the cases with pancreatic diseases were found to be significantly lower than normal control group, and no significant difference was found between normal control group and cases with non-pancreatic diseases.In cases with established diagnosis of chronic pancreatitis, incidence of abnormal maximal bicarbonate concentration is higher than the abnormality of other two factors (volume and amylase output). In cases with pancreatic carcinoma, incidence of abnormal results were about the same in each of the 3 factors (volume, maximal bicarbonate concentration and amylase output) and there were cases which showed only the abnormal amylase activity in pancreatic juice. Furthermore, in the cases where chronic pancreatitis was suspected or in cases with moderate to slight chronic pancreatitis associated with the diseases of intraabdominal organs ajacent to the pancreas, the determination of the amylase activity of the pancreatic juice was found to be promising. It was therefore concluded that the measurement of the amylase activity in the pancreatic juice should be included in the standard secretin test.The simultaneous measurement of the serum and urinary amylase activity does not significantly increase the diagnostic ability of the secretin test in the cases with advanced chronic pancretitis or carcinoma of the pancreas, however it is useful in the diagnosis of mild pancreatic diseases where no abnormality can be found in the factors of pancreatic juice analysis or in the early detection of the chronic cases following acute pancreatitis. In the latter situation, the determination of urinary amylase need not be performed.Determinations of serum and urinary amylase activities before and after pancreozymin-secretin stimulation alone can not be used as a screening test of the chronic pancreatic diseases for there were enough false negative cases.
- 財団法人 日本消化器病学会の論文