Re: mrcp results

[Guest guest]

Are your amylase and Lipase elevated? How did the diagnosis you? When you

are having an acute attack have they done a tryspin test?

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

Acute Pancreatitis

Johan Hedström, M.D*., Jari Leinonen, M.Sc., and Ulf-Håkan 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 µg/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 µ 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.

I hope this helps.

Mark

mrcp results

> The doctor called today and told nothing showed up on the MRCP. Why

> is it that I'm having so much pain and nausea, if they can't see

> anything on the MRCP or the CT scan. Don't you think something would

> look amiss? I'm really confused right now. Tammy

>

>

>

>

>

>

>

[Guest guest]

Tammy,

I know that it is frustrating but CTs and MRCPs are not really all

that sensitive for finding CP.

Some quotes from an article written in the journal

Gastroenterology may explain this better. This was an article that

addressed the many problems associated with accurately

detecting and diagnosing early CP. I know in my case, it wasn't

until I had my second ERCP that the problem was found. This

was after 3 CTs, 2 MRIs, 3 ultrasounds....so hang in there,

eventually one of the tests will tell you what is wrong!

• " ...because of the technical limitations of CT, the earliest

changes of CP may not be identified. Thus, CT remains the best

screening tool for detection of CP and exclusion of other

intraabdominal disoders that may cause symptoms

indistinguishable from CP on clinical grounds alone. "

• ERCP: " In mild or early disease, findings include dilation and

irregularity of the smaller ducts and branches or the pancreas. In

more moderate disease, these changes are found in the main

pancreatic duct as well. Tortutosity, stricture, calcifications and

cysts may also be seen as disease becomes more severe.

Although the ductography seen in severe disease is

pathognomonic, the more subtle changes seen in minimal

disease are subject to variability in interpretation and difficulty in

distinguish normal from abnormal. "

• " .....in addition to the recognition of patients with signs and

symptoms of CP with minimal to no changes on ductography

(minimal change pancreatitis), suggest that current ERP

methods may not be capable of detecting a potentially large

group of patients with early disease. "

• EUS: " Important issues, however, need to be addressed. First,

'normal' features need to be more clearly defined. " .... " Second,

interobserver variability in interpretation must be carefully

evaluated. " ... " Finally, efforts to standardize EUS training are

under way. "

• MRI / MRCP: " Although studies have begun to demonstrate the

important role MRI and MRCP can play in the diagnosis and

staging of pancreatic cancer, investigation into their role in CP

has only recently begun. Major lesions such as grossly dilated

ducts, communicating pseudocysts and even pancreas divisum

can be detected. But small duct changes and calcifications are

not readily detected and the modality does not have therapeutic

potential. "

[Guest guest]

Thanks for the information. My amylase and lipase are always normal.

I've had the enzymes checked four or five times. The GI doc said he

suspected CP in November when he got the results of the fecal-fat

test. I'm not sure what the number was, but he said it was extremely

elevated. This was after four years of the doctors throwing up their

hands in frustration. I need to get up with my GI doc tomorrow to see

what the next step is going to be. He said he wants to do an

ultrasound and an ERCP, but I'm not sure when. Tammy