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Notes: Abstract We have studied the volume, protein concentration, total protein, and chymotrypsin and trypsin outputs in pure pancreatic juice (PPJ) following endoscopic cannulation of the pancreatic duct in 11 male and 2 female patients with advanced alcoholic cirrhosis (AC). Results were compared to those obtained from 21 nonalcoholic volunteers (NAV) and 26 chronic alcoholic (CA) patients without cirrhosis. Intravenous stimulation with secretin followed 10 min later by intravenous cholecystokinin-pancreozymin (CCK-PZ) resulted in highly significant increases in volumes during both phases of pancreatic stimulation in AC compared to NAV and CA. Protein concentration and total output during secretin stimulation was not different among the three groups. During CCK-PZ stimulation, CA exhibited a significant elevation in protein concentration and total output compared to NAV and AC. Although total chymotrypsin output was lower in secretin-stimulated CA than other groups, no other differences between the groups were observed in either of the hormone-stimulation phases. Marked elevations in trypsin output were observed in secretin-stimulated AC and in CCK-PZ-stimulated AC and CA. The high PPJ volume and the relatively low protein concentration observed in AC may effect a washout phenomenon resulting in a decreased tendency for ductal protein precipitation in these patients.

Notes: Abstract Increases in the activities of human circulatory ribonucleases have been associated with malignancies and other pathological conditions. To elucidate the relationship between circulatory ribonuclease and pancreatic malignancy, we have determined the activities in serum of ribonucleases selective for polycytidylic acid (ribonuclease C) and of α-amylase before and after surgery for pancreatic cancer and for several malignant and nonmalignant disorders unrelated to the pancreas. Prior to pancreatectomy, the activity of ribonuclease C in the serum of three pancreatic cancer patients was within the range of values obtained for healthy subjects. Unexpectedly, ribonuclease C began to increase within 2 hr after surgery, and amounts of ribonuclease C more than threefold higher than preoperative levels were found for at least 3 weeks after pancreatectomy. Variations in the serum concentrations of urea nitrogen and creatinine followed time courses which differed from those of ribonuclease C; thus the increases in the activity of ribonuclease C could not be attributed to renal impairment. The concentrations of α-amylase and trypsinogen in the blood of two of the pancreatic cancer patients were considerably higher than those of healthy subjects and declined rapidly to subnormal levels after pancreatectomy. Only a small amount of α-amylase and no trypsinogen were found in the blood of the third patient both before and after surgery, and samples of pure pancreatic juice obtained preoperatively after sequential intravenous administration of secretin and cholecystokinin-pancreozymin were negative for α-amylase and three proteolytic zymogens; nevertheless, the presurgical level of ribonuclease C in his serum was within the normal range. For all of the patients treated for nonpancreatic disorders, the concentrations of ribonuclease C and α-amylase in serum were not significantly altered by surgery. The rate and ultimate extent of the decrease in circulatory α-amylase following pancreatectomy indicate that ≈-80% of the α-amylase in blood is pancreatic in origin and that the half-life of pancreatic α-amylase in the peripheral circulation ≈-15 hr. From the highly significant increases in circulatory ribonuclease C which followed pancreatectomy for pancreatic cancer, we conclude that the exocrine pancreas is neither the sole nor the principal source of ribonuclease C in the peripheral circulation.

Notes: Abstract Total protein,α 1-antitrypsin,α 2-macroglobulin, amylase, methemalbumin, tryptic amidase activity, radioimmunoassayable elastase 2, and three lysosomal hydrolases were determined in the ascites fluid from patients with acute pancreatitis. In eight patients methemalbumin was detected in ascites and serum, supporting the diagnosis of hemorrhagic pancreatitis. Significant levels (4–45 μg/ml) of tryptic amidase activity were detected in ascites samples from all patients. Evidence is presented which demonstrates that the tryptic amidase activity is due toα 2-macroglobulin-bound trypsin. Pancreatic elastase 2, determined with a new sensitive and specific radioimmunoassay, ranged from 400 to 2100 ng/ml in serum and from 650 to 4460 ng/ml in ascites fluid. Substantial amounts ofα 2-macroglobulin trypsin and elastase 2, entering the circulation from the peritoneal cavity, might be responsible for certain serious complications seen in acute pancreatitis. However, with the exception of serum calcium and methemalbumin and the ascites fluid methemalbumin and total protein, none of the biochemical parameters studied showed a distinct correlation with the patient's outcome.