Re: Diagnostic Test for CP

[Guest guest]

> I am scheduled to see our local GI doctor on Sept 25 and also have

an appt at

> U of Mich w/GI doctor there. Are there any specific tests that they

should be

> doing on me to test for CP or other problems with the pancreas,

such as

> pancreatic insufficiency? I have not been diagnosed w/CP only acute

> Pancreatitis in April-02 after I had already had 4 other attacks on

a monthly

> basis - but I did not know what they were and did not go to ER. But

since

> July I have been having some right upper quandrant pain that

radiates to my

> back and moves around to the left. Is there a list of tests they

should be

> doing? Any suggestions would be appreciated.

> Debbie in Mich

Hi Debbie:

CP is often near impossible to diagnose. That's why too many of us

have been through years of suffering, tests and procedures before

receiving the lousy news. Often, we have normal amylase and lipase

levels, fooling the doctors.

In my case, a simple blood test gave the answer. That was for

trypsinogen. The sample was drawn at the Cleveland Clinic and sent

to an outside lab in Utah. Result came back within two weeks.

I was trypsinogen deficient and the level was in the known CP range.

That was discovered THREE YEARSinto my illness and after seeing over

forty specialists at a dozen major hospitals.

To further confirm the diagnosis, I underwent a endoscopic ultrasound

(EUS) guided pancreatic biopsy with fine needle aspirations. The

tissue samples were consistent with a damaged organ.

-Ellen Grove

lin Square, NY

>

>

>

[Guest guest]

> I am scheduled to see our local GI doctor on Sept 25 and also have

an appt at

> U of Mich w/GI doctor there. Are there any specific tests that they

should be

> doing on me to test for CP or other problems with the pancreas,

such as

> pancreatic insufficiency? I have not been diagnosed w/CP only acute

> Pancreatitis in April-02 after I had already had 4 other attacks on

a monthly

> basis - but I did not know what they were and did not go to ER. But

since

> July I have been having some right upper quandrant pain that

radiates to my

> back and moves around to the left. Is there a list of tests they

should be

> doing? Any suggestions would be appreciated.

> Debbie in Mich

Hi Debbie:

CP is often near impossible to diagnose. That's why too many of us

have been through years of suffering, tests and procedures before

receiving the lousy news. Often, we have normal amylase and lipase

levels, fooling the doctors.

In my case, a simple blood test gave the answer. That was for

trypsinogen. The sample was drawn at the Cleveland Clinic and sent

to an outside lab in Utah. Result came back within two weeks.

I was trypsinogen deficient and the level was in the known CP range.

That was discovered THREE YEARSinto my illness and after seeing over

forty specialists at a dozen major hospitals.

To further confirm the diagnosis, I underwent a endoscopic ultrasound

(EUS) guided pancreatic biopsy with fine needle aspirations. The

tissue samples were consistent with a damaged organ.

-Ellen Grove

lin Square, NY

>

>

>

[Guest guest]

> I am scheduled to see our local GI doctor on Sept 25 and also have

an appt at

> U of Mich w/GI doctor there. Are there any specific tests that they

should be

> doing on me to test for CP or other problems with the pancreas,

such as

> pancreatic insufficiency? I have not been diagnosed w/CP only acute

> Pancreatitis in April-02 after I had already had 4 other attacks on

a monthly

> basis - but I did not know what they were and did not go to ER. But

since

> July I have been having some right upper quandrant pain that

radiates to my

> back and moves around to the left. Is there a list of tests they

should be

> doing? Any suggestions would be appreciated.

> Debbie in Mich

Hi Debbie:

CP is often near impossible to diagnose. That's why too many of us

have been through years of suffering, tests and procedures before

receiving the lousy news. Often, we have normal amylase and lipase

levels, fooling the doctors.

In my case, a simple blood test gave the answer. That was for

trypsinogen. The sample was drawn at the Cleveland Clinic and sent

to an outside lab in Utah. Result came back within two weeks.

I was trypsinogen deficient and the level was in the known CP range.

That was discovered THREE YEARSinto my illness and after seeing over

forty specialists at a dozen major hospitals.

To further confirm the diagnosis, I underwent a endoscopic ultrasound

(EUS) guided pancreatic biopsy with fine needle aspirations. The

tissue samples were consistent with a damaged organ.

-Ellen Grove

lin Square, NY

>

>

>

[Guest guest]

Serum Complex of Trypsin-2 and a 1-antitrypsin: A New Sensitive Marker of

Acute Pancreatitis

Johan Hedstr?m, M.D*., Jari Leinonen, M.Sc., and Ulf-H?kan Stenman, M.D.

Departmetnt of Clinical Chemistry, Helsinki University Central Hospital,

Helsinki, Finland

Introduction: Pathological intrapancreatic activation of trypsinogen to

trypsin occurs in acute pancreatitis (AP). When reaching blood, trypsin-2

forms a complex with a1-antitrypsin (AAT). The trypsin-2-AAT complex can be

specifically measured by a recently developed double antibody sandwich

assay.

Purpose: To estimate the diagnostic and prognostic accuracy of serum

determinations of trypsin-2-AAT in AP. Serum CRP, amylase and trypsinogen-2

were used as reference methods.

Design: A retrospective study on consecutive patients during March 1992 to

November 1993.

Setting: Patients treated for AP and other acute abdominal disorders at the

Second Department of Surgery at Helsinki University Central Hospital.

Methods: 110 patients with AP and 66 patients with acute abdominal diseases

of extrapancreatic origin were studied. The final diagnosis of AP was based

in findings of upper abdominal pain accompanied by the typical appearance of

AP in ultrasonography or computed tomography (CT). Based on the clinical

course, AP was classified as mild (n=82) or severe (n=28). Trypinogen-2 and

trypsin-2-AAT were determined by time- resolved immunofluorometric assays

(IFMA). The upper reference limit was 12 ?g/L. The ability of various tests

to differentiate between mild and severe AP and nonpnacreatic disease was

estimated on the basis of sensitivity and specificity at clinically relevant

cut-off levels and the validity of the test was further evaluated by

receiver-operating characteristic (ROC) curve analysis.

Results: At admission, all patients with AP had clearly elevated values of

trypsin-2-AAT (= 32 ? g/L), whereas only 5% of the controls had such values.

In AP, trypsinogen-2 and trypsin-2-AAT increased earlier than CRP and

remained elevated longer than amylase. There was also less overlapping

between patients with AP and controls for trypsin-2-AAT than for the other

markers. Time course profiles of trypsin-2-AAT showed that in severe cases

it mostly peaked in the initial sample and slowly decreased during the next

days. In patients with mild AP the peak was mostly observed in the second

day. Of the markers studied, trypsin-2-AAT showed the best accuracy (largest

area under the ROC curve) both in differentiating AP from controls and mild

from severe disease. At presentation, trypsin-2-AAT differentiated between

mild and severe AP much more accurately than CRP, AUC being 0.82 and 0.73,

respectively.

Conclusion: Of the markers studied, trypsin-2-AAT displayed the best

accuracy for differentiating between AP and extrapancreatic disease as well

as for predicting a severe course of the disease at presentation. If

available on automated instrumentation and on emergency basis, the assay

could markedly improve the diagnosis of this common and potentially lethal

disease.

Mark E. Armstrong

www.top5plus5.com

NW Chapter Rep

Pancreatitis Association, International

Diagnostic Test for CP

> I am scheduled to see our local GI doctor on Sept 25 and also have an appt

at

> U of Mich w/GI doctor there. Are there any specific tests that they should

be

> doing on me to test for CP or other problems with the pancreas, such as

> pancreatic insufficiency? I have not been diagnosed w/CP only acute

> Pancreatitis in April-02 after I had already had 4 other attacks on a

monthly

> basis - but I did not know what they were and did not go to ER. But since

> July I have been having some right upper quandrant pain that radiates to

my

> back and moves around to the left. Is there a list of tests they should be

> doing? Any suggestions would be appreciated.

> Debbie in Mich

>

>

>

[Guest guest]

Serum Complex of Trypsin-2 and a 1-antitrypsin: A New Sensitive Marker of

Acute Pancreatitis

Johan Hedstr?m, M.D*., Jari Leinonen, M.Sc., and Ulf-H?kan Stenman, M.D.

Departmetnt of Clinical Chemistry, Helsinki University Central Hospital,

Helsinki, Finland

Introduction: Pathological intrapancreatic activation of trypsinogen to

trypsin occurs in acute pancreatitis (AP). When reaching blood, trypsin-2

forms a complex with a1-antitrypsin (AAT). The trypsin-2-AAT complex can be

specifically measured by a recently developed double antibody sandwich

assay.

Purpose: To estimate the diagnostic and prognostic accuracy of serum

determinations of trypsin-2-AAT in AP. Serum CRP, amylase and trypsinogen-2

were used as reference methods.

Design: A retrospective study on consecutive patients during March 1992 to

November 1993.

Setting: Patients treated for AP and other acute abdominal disorders at the

Second Department of Surgery at Helsinki University Central Hospital.

Methods: 110 patients with AP and 66 patients with acute abdominal diseases

of extrapancreatic origin were studied. The final diagnosis of AP was based

in findings of upper abdominal pain accompanied by the typical appearance of

AP in ultrasonography or computed tomography (CT). Based on the clinical

course, AP was classified as mild (n=82) or severe (n=28). Trypinogen-2 and

trypsin-2-AAT were determined by time- resolved immunofluorometric assays

(IFMA). The upper reference limit was 12 ?g/L. The ability of various tests

to differentiate between mild and severe AP and nonpnacreatic disease was

estimated on the basis of sensitivity and specificity at clinically relevant

cut-off levels and the validity of the test was further evaluated by

receiver-operating characteristic (ROC) curve analysis.

Results: At admission, all patients with AP had clearly elevated values of

trypsin-2-AAT (= 32 ? g/L), whereas only 5% of the controls had such values.

In AP, trypsinogen-2 and trypsin-2-AAT increased earlier than CRP and

remained elevated longer than amylase. There was also less overlapping

between patients with AP and controls for trypsin-2-AAT than for the other

markers. Time course profiles of trypsin-2-AAT showed that in severe cases

it mostly peaked in the initial sample and slowly decreased during the next

days. In patients with mild AP the peak was mostly observed in the second

day. Of the markers studied, trypsin-2-AAT showed the best accuracy (largest

area under the ROC curve) both in differentiating AP from controls and mild

from severe disease. At presentation, trypsin-2-AAT differentiated between

mild and severe AP much more accurately than CRP, AUC being 0.82 and 0.73,

respectively.

Conclusion: Of the markers studied, trypsin-2-AAT displayed the best

accuracy for differentiating between AP and extrapancreatic disease as well

as for predicting a severe course of the disease at presentation. If

available on automated instrumentation and on emergency basis, the assay

could markedly improve the diagnosis of this common and potentially lethal

disease.

Mark E. Armstrong

www.top5plus5.com

NW Chapter Rep

Pancreatitis Association, International

Diagnostic Test for CP

> I am scheduled to see our local GI doctor on Sept 25 and also have an appt

at

> U of Mich w/GI doctor there. Are there any specific tests that they should

be

> doing on me to test for CP or other problems with the pancreas, such as

> pancreatic insufficiency? I have not been diagnosed w/CP only acute

> Pancreatitis in April-02 after I had already had 4 other attacks on a

monthly

> basis - but I did not know what they were and did not go to ER. But since

> July I have been having some right upper quandrant pain that radiates to

my

> back and moves around to the left. Is there a list of tests they should be

> doing? Any suggestions would be appreciated.

> Debbie in Mich

>

>

>

[Guest guest]

Serum Complex of Trypsin-2 and a 1-antitrypsin: A New Sensitive Marker of

Acute Pancreatitis

Johan Hedstr?m, M.D*., Jari Leinonen, M.Sc., and Ulf-H?kan Stenman, M.D.

Departmetnt of Clinical Chemistry, Helsinki University Central Hospital,

Helsinki, Finland

Introduction: Pathological intrapancreatic activation of trypsinogen to

trypsin occurs in acute pancreatitis (AP). When reaching blood, trypsin-2

forms a complex with a1-antitrypsin (AAT). The trypsin-2-AAT complex can be

specifically measured by a recently developed double antibody sandwich

assay.

Purpose: To estimate the diagnostic and prognostic accuracy of serum

determinations of trypsin-2-AAT in AP. Serum CRP, amylase and trypsinogen-2

were used as reference methods.

Design: A retrospective study on consecutive patients during March 1992 to

November 1993.

Setting: Patients treated for AP and other acute abdominal disorders at the

Second Department of Surgery at Helsinki University Central Hospital.

Methods: 110 patients with AP and 66 patients with acute abdominal diseases

of extrapancreatic origin were studied. The final diagnosis of AP was based

in findings of upper abdominal pain accompanied by the typical appearance of

AP in ultrasonography or computed tomography (CT). Based on the clinical

course, AP was classified as mild (n=82) or severe (n=28). Trypinogen-2 and

trypsin-2-AAT were determined by time- resolved immunofluorometric assays

(IFMA). The upper reference limit was 12 ?g/L. The ability of various tests

to differentiate between mild and severe AP and nonpnacreatic disease was

estimated on the basis of sensitivity and specificity at clinically relevant

cut-off levels and the validity of the test was further evaluated by

receiver-operating characteristic (ROC) curve analysis.

Results: At admission, all patients with AP had clearly elevated values of

trypsin-2-AAT (= 32 ? g/L), whereas only 5% of the controls had such values.

In AP, trypsinogen-2 and trypsin-2-AAT increased earlier than CRP and

remained elevated longer than amylase. There was also less overlapping

between patients with AP and controls for trypsin-2-AAT than for the other

markers. Time course profiles of trypsin-2-AAT showed that in severe cases

it mostly peaked in the initial sample and slowly decreased during the next

days. In patients with mild AP the peak was mostly observed in the second

day. Of the markers studied, trypsin-2-AAT showed the best accuracy (largest

area under the ROC curve) both in differentiating AP from controls and mild

from severe disease. At presentation, trypsin-2-AAT differentiated between

mild and severe AP much more accurately than CRP, AUC being 0.82 and 0.73,

respectively.

Conclusion: Of the markers studied, trypsin-2-AAT displayed the best

accuracy for differentiating between AP and extrapancreatic disease as well

as for predicting a severe course of the disease at presentation. If

available on automated instrumentation and on emergency basis, the assay

could markedly improve the diagnosis of this common and potentially lethal

disease.

Mark E. Armstrong

www.top5plus5.com

NW Chapter Rep

Pancreatitis Association, International

Diagnostic Test for CP

> I am scheduled to see our local GI doctor on Sept 25 and also have an appt

at

> U of Mich w/GI doctor there. Are there any specific tests that they should

be

> doing on me to test for CP or other problems with the pancreas, such as

> pancreatic insufficiency? I have not been diagnosed w/CP only acute

> Pancreatitis in April-02 after I had already had 4 other attacks on a

monthly

> basis - but I did not know what they were and did not go to ER. But since

> July I have been having some right upper quandrant pain that radiates to

my

> back and moves around to the left. Is there a list of tests they should be

> doing? Any suggestions would be appreciated.

> Debbie in Mich

>

>

>