SU1236375A1 - Method of diagnostic checking of childrenъs chronic pancreatitis - Google Patents

Abstract

This invention relates to gastroenterology. The purpose of the invention is to improve the accuracy of the method by examining a portion of duodenal contents taken on an empty stomach. In this portion, the concentration of histamine is determined by a known method. When the content of histamine is less than 2.0 µmol / l, chronic pancreatitis is diagnosed.

Description

112

The invention relates to medicine, in particular to pediatrics and gastroenterology, and can be used to diagnose chronic pancreatitis in children,

The purpose of the invention is to improve the accuracy of the method by examining a portion of the duodenal contents taken on an empty stomach.

The method is carried out as follows.

Patient with suspected patolo-GIK) pancreas p. The purpose of diagnosis is a comprehensive clinical, laboratory and instrumental study. To clarify the diagnosis, duodenal contents are examined, which are obtained by duodenal intubation. The assay uses a portion of duodenal juice, in which the concentration of histamine is determined. Juice is purified by the method of M.Roberts. For this purpose, an equal amount of acetone is added to 2.5 ml. The mixture is distilled to half volume under vacuum in a water bath at, then cooled in a refrigerator and then centrifuged for 15–20 min at 3000.

In the treated juice, histamine is determined by a known method. Method-based: on the ability of histamine to form with orthophthalic aldehyde in an acidic medium a highly fluorescent compound.

In the treated juice, Histamine is determined by a known method. The method is based on the ability of histamine to form a highly fluorescent compound with orthophthalic aldehyde in an acidic medium.

In test tubes with ground stoppers, 1 ml of purified juice is taken and 1 ml of 1N chloroacid is added to it. Then the samples are alkalinized with 0.2 ml of 5N. NaOH and add 1 g / / NaCE. and 4 ml of butanol-chloroform mixture. The tubes are stoppered, vigorously shaken for 3 minutes, and then centrifuged for 10 minutes at 1500 RPM.

Organic:) That phase is sucked into a clean tube and 2 ml of 0.1 N is poured. NaOH saturated with NaC is shaken for 2 minutes and centrifuged for 10 minutes at 1500 rpm. Then 3.5 ml of the organic phase are transferred to test tubes.

52

containing 2.5 .sh 0.01 n. FfCE, shake for 3 minutes and centrifuge for 10 minutes with 1 ml of the acid phase containing histamine, aspirated into a conventional Priligiot 0.2 t-in 1 n tube. NaOH, mix and add 0.1 ml of a solution of orthophthalic aldehyde in methanol, mix again. After 4 min, 0.1 ml of a 1.5 M phosphoric acid solution is poured to stabilize (a syurophore. The volume of the samples is adjusted to 5 MJT with water and fluorometric. The fluorescence is measured at a wavelength of 470 mm, using a light filter with a maximum of 365 for excitation of fluorescence. nm. A standard solution and a control sample are analyzed in parallel.

Standard. 0.1 µg / mp histamine is adjusted to 1.5 ml, 0.4 ml of 1N is poured. him and conducted through all stages of the experiment.

Control. To t, 5 ml HoQ: 0.5 ml 1N is added. NUC and also conducted through all stages of the experiment.

The concentration of histamine, calculated by the formula

212l1 U: §х22-.

from 1 ml

where O is the intensity of fluorescence

samples minus control; With fluorescence intensity

standard sample minus

control; 8.99 - conversion factor from µg /

/ ml to μmol / l.

For example, the fluorescence of experimentally-1 troughs of 3.5 "standard 1.0 control 0.7.

„(3j5-0,, 7) .. 8.99 .-. X -, 39 µmol / l

If the value of X is less than 2.0 mCMOLB / L, chronic pancreatitis is diagnosed.

Example 1. Svetlana P., 12 years old. Heredity of the patient is not from goshena. Has suffered measles, wind pox, and mumps. Sick 4 years. In the last year, abdominal pain is paroxysmal, occurs after eating and is localized in the E: upper abdomen. An objective examination of the patient determined morbidity in the epigastrium and left hypochondrium.

In the biochemical study of the activity of amylase in the blood (16.8 g /

/ h-l) and urine (12.5 g / h "l) was normal. The level of blood lipase increased to 6.5 units. (at a rate of 1.2 units). In the duodenal contents, a study of the activity of amylase and trypsin with pan-5 creozymin showed a moderate decrease in their concentrations. During relaxation duodenography, the sphincter of Oddi and papillitis was diagnosed. TO

Histamine was studied in the portion of the duodenal secretion of the donut, the concentration of which was sharply reduced: 0.37 µmol / l, which, according to the proposed method, corresponds to chronic pancreatitis. Teach the whole complex of research and the level of histamine in the portion, taken on an empty stomach, lower duodenal juice. .2.0 µmol / l, the patient was diagnosed 20: chronic p (gididiruyuschy pancreatitis, pain form.

Thus, the level of histamine in the patient's portions taken on an empty stomach, duodenal secretion, equal to 0.37 µmol / 5 / l, made it possible to specify the diagnosis of chronic pancreatitis.

Example 2. Ol L, 12 years old, was admitted to the hospital with complaints of abdominal pain, nausea, reduced appetite. Sick 3 years, increasing pain syndrome notes in the last year. The pains sometimes radiate to the back, are of a descending nature, localized in the upper half of the abdomen. On examination, the patient developed morbidity in the area of projection of the pancreas and epibastric.

In the laboratory study of Laz Croyi 13.4 g / hl and blood lipase 0.5 units. not changed. The level of pancreatic enzymes is reduced before and after the administration of pancreozymin. No changes were revealed on the relaxation probe duodenogram. The level of histamine in duodenal secretion was investigated; it turned out to be 1.8 µmol / L, which, according to the proposed method, is characteristic of a chronic inflammatory jg process in the pancreas.

Taking into account these clinics, the functional state of the pancreas and the histamine content in the tochaca portion of the duodenal juice, which turned out to be less than 2.0 µmol / l,

VNISHI Order 3083/46

35

Shuffle-half pr-tie, Uzhgorod, st. Project, 4

5 tO

f5 20

five

zo

- j g

j

6

five

the patient has a clinical diagnosis: chronic recurrent pancreatitis, painful form.

Thus, the proposed clinical examples show that the fasting histamine content in duodenal secretion is below 2.0 µmol / L according to the proposed method allows to diagnose chronic pancreatitis.

 Example 3. Larisa S.7 years. In the history of a patient with sepsis, dysentery, allergic diathesis. She was admitted to the hospital with complaints of moderate intensity of abdominal pain, reduced appetite, unstable stool. Sick more than three years. Palpation of the abdominal organs revealed tenderness in the upper abdomen.

In the study of blood amylase. on an empty stomach, its concentration was elevated (38.5 g / hl at a rate of 21.0 g / hl). The level of amylase in the duodenal juice on an empty stomach is lowered; an adequate response was obtained for pancreozymin. Gastritis was diagnosed with gastroduodenofibroscopy. The acid-forming function of the stomach was reduced. A study of the rhythm of bile excretion revealed biliary dyskinesia. When carrying out the glycemic curve with fruit, a decrease in fructose tolerance was diagnosed. The level of histamine in the patient's duodenal secret was investigated, it turned out to be 2.1 μmol / l, which, according to the proposed diagnostic method, made it possible to exclude the patient with chronic pancreatitis and, taking into account the whole complex of research, diagnose fructose intolerance, chronic gastritis with secretory insufficiency, biliary tract dyskinesia.

Claims (1)

Claims. A method for diagnosing chronic pancreatitis in children by determining the content of histamine in a biological fluid, characterized in that, in order to improve the accuracy of the method, the determination is carried out in a portion of the duodenal contents taken on an empty stomach, and when the content is less than 2.0 µmol / l diagnosed with chronic pancreatitis. Circulation 778 Subscription