The presence of diastase1in human blood was first noted in 18462and subsequently the enzyme was found to be a normal constituent of mammalian blood in general. In 1863 the enzyme was shown to be present also in urine, and its origin was traced to the blood.3Eventually diastase was detected in lymph,4in pericardial fluid4band in feces.5Hepatic bile is almost completely devoid of diastase,6but the enzyme can be detected in the bile when the diastase content of blood is greatly increased by ligation of the pancreatic ducts.7Bile from the common bile duct and the gallbladder may contain appreciable amounts of diastase as the result of pancreatic reflux.8Assertions that measurable amounts of diastase are present in the cerebrospinal fluid,9the liver and the kidneys10are open to doubt. In this laboratory it was not possible to detect diastase in the

Ueber den Ursprung des diastatischen Fermentes im Blute und über seine Beziehungen zum Diabetes melitus

Diastatic activity of human blood

Die verborgene Lage des Pankreas brachte es mit sich, das seine Erkrankungen wenig beachtet wurden. Die Unauffalligkeit mancher Symptome trug hierzu bei und ferner die Tatsache, das Pankreaserkrankungen oft Zweitschaden sind und der auf die primare Krankheit gerichteten Aufmerksamkeit entgehen. Noch bis vor wenigen Jahren beachtete man fast nur den Krebs des Pankreas und die seltenen Cysten, weil sie als Geschwulste deutlich tastbar waren. Daneben entstand eine langsam zunehmende Kenntnis der akuten Pankreasnekrose, oder, wie man sich damals ausdruckte, der Pankreasapoplexie. Die grose Zahl der leichten Pankreasstorungen blieb unbeachtet. Vor 17 Jahren sagte mir Prof. Goldschmidt, der am Institut von Askanazy lange Zeit bei allen Sektionen das Pankreas systematisch untersucht hatte: histologische Veranderungen am Pankreas sind ungeheuer haufig. Sie sind ohne Interesse, die Klinik merkt nichts davon Einige klinische Erlebnisse, von guten Arzten und Klinikern lange verkannte Falle, die spater zu schweren Pankreasschaden und selbst zu Tod und Autopsie fuhrten, brachten mich zu der Uberzeugung, das eine klinische Pathologie dieses hochwertigen vielseitigen Organs zwar nur ganz ungenugend vorhanden sei, das sie aber entwickelt werden musse. Durch Bemuhungen um klinisch leicht erfasbare Zeichen wurden immerhin fuhlbare Fortschritte erzielt. Schon vorhandene Laboratoriumsmethoden wurden so erst fruchtbar. Es bestand ja die Tatsache, das die Physiologie des Pankreas sehr viel weiter entwickelt war als die Pathologie. Deshalb suchte man ohne rechte Fuhrung durch klinische Zeichen nach einer sog. funktionellen Pankreasdiagnostik. „Die Diagnostik des Pankreas wurde zu sehr ins Laboratorium verlegt“ (Katsch 1924).

Die Krankheiten der Bauchspeicheldrüse

The diagnosis of diseases of the pancreas is difficult because the organ is obscurely located; is rarely viewed by roentgen rays; its secretions are difficult to obtain, and frequently the symptoms are so similar to those associated with other diseases that differentiation is impossible. Both history and physical examination are important in diagnosis, but they rarely permit one to draw definite conclusions even though a pancreatic lesion is suspected. The determination of blood sugar levels, the trypsin content and the amount of fat and protein digestion in the stool, the serum amylase level and the secretin test are additional diagnostic aids. An increase in the blood sugar level and a decrease in fat and protein digestion in the stool are usually found only in long-standing and far advanced diseases of the pancreas and are therefore of limited value. The search for more specific pancreatic function tests led investigators to study

Evaluation of pancreatic function tests.

The diastatic ferments of the blood

1.

The permanent separation of the pancreas from the duodenum with the resulting permanent occlusion of all the pancreatic ducts in the dog resulted in a persistent increase of the activity of the diastase in the blood in three out of four animals. In one dog there was twice the maximum normal activity on the 551st day and in another dog there was four times, or 256 units, on the 895th day.




2.

In spite of the increased value of diastase in the blood of these dogs the pancreas at autopsy was found reduced to a small mass in which few acinar cells could be demonstrated.




3.

The source of the increased blood diastase in these dogs is unknown.




4.

There was no relation between the activity of diastase in the blood and in the urine. There was a small number of diastase units regularly present in the urine during the first week after the occlusion of the pancreatic ducts but after the second week the urine was usually free from diastase although the blood continued to yield a large number of units.

Diastase activity of blood and urine when the pancreatic ducts are permanently closed

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Ueber den Ursprung des diastatischen Fermentes im Blute und über seine Beziehungen zum Diabetes melitus

Citations

Diastatic activity of human blood

Die Krankheiten der Bauchspeicheldrüse

Evaluation of pancreatic function tests.

The diastatic ferments of the blood

Diastase activity of blood and urine when the pancreatic ducts are permanently closed

Related Papers (1)

Studies on blood and urinary amylase