ABSTRACT
BACKGROUND: Determinations of fecal fat and nitrogen reveal evidence of malabsorption and assist in estimating the efficacy of pancreatic enzyme treatment. Seventy-two-hour stool collection, with chemical analysis of fecal fat, and Kjeldahl's method for measurement of fecal nitrogen are generally accepted as standard methods for making these determinations. However, these traditional methods are expensive, time-consuming, and cumbersome. This study evaluated the efficiency and validity of an alternative method, using near-infrared reflectance spectroscopy (NIRS) and compared results with those of the standard methods. METHODS: Near-infrared reflectance spectroscopy is a secondary method: The instrument first has to be calibrated with samples analyzed by the standard method. Sixty-three stool samples with known fat content (range 4.79-292.5 mg/g), 24 samples with known nitrogen content (range 5.36-19.38 mg/g), and 24 samples with known water concentration (range 60.1-82.22%) served for calibration. A further 69 samples were analyzed to validate the procedure. RESULTS: There was a satisfactory correlation between the measurements produced by near-infrared reflectance spectroscopy and those produced by standard methods: fat r = 0.97; nitrogen r = 0.94; water r = 0.96. CONCLUSIONS: Near-infrared reflectance spectroscopy appears to be a reliable, simple, and rapid method of measuring different fecal components-as precise and accurate as the standard methods. Stool samples should be analyzed immediately after collecting or stored only a few days before analyzing.
Subject(s)
Feces/chemistry , Lipids/analysis , Nitrogen/analysis , Spectroscopy, Near-Infrared/methods , Water/analysis , Adolescent , Child , Child, Preschool , Humans , Linear Models , Reproducibility of ResultsABSTRACT
BACKGROUND: The secretin-pancreozymin test has been accepted as the gold standard for testing exocrine pancreatic function. However, this test is invasive, time-consuming, and expensive. Therefore, in daily practice, more simple, indirect methods are proposed. METHODS: The fecal concentration of human pancreatic elastase (E1) has been assessed for diagnostic sensitivity and specificity. For sensitivity, fecal E1 determination in 23 healthy children were studied. RESULTS: Sensitivity to detect pancreatic insufficiency was 100% and specificity 96%. CONCLUSIONS: Fecal E1 concentration appears to be a more sensitive and specific test of pancreatic function than other tests.
Subject(s)
Exocrine Pancreatic Insufficiency/diagnosis , Feces/enzymology , Pancreas/enzymology , Pancreatic Elastase/analysis , Adolescent , Adult , Child , Exocrine Pancreatic Insufficiency/enzymology , Female , Humans , Male , Pilot Projects , Reference Values , Sensitivity and SpecificityABSTRACT
Two methods for the determination of sodium in the sweat after stimulation by pilocarpine-iontophoresis were compared in 227 patients, among them 27 with a known cystic fibrosis. These two methods were 1. the standardized method by flame fotometry (State Pharmacopoeia of the German Democratic Republic) and 2. the determination of the sweat conductance by the new apparatus "CF-Conductognost". Both methods showed a good correlation. We recommend the conductometry for the decentralized screening because it saves time and gives results immediately. But in all patients with a questionable or pathologic value of conductance the sweat test should be repeated with the standardized method. This concerns only about 10 per cent of all patients.
Subject(s)
Cystic Fibrosis/diagnosis , Galvanic Skin Response , Pilocarpine , Sodium/analysis , Sweat/analysis , Adolescent , Child , Child, Preschool , Flame Ionization , Galvanic Skin Response/drug effects , Humans , InfantABSTRACT
The determination of fecal chymotrypsin is a suitable noninvasive screening test for the evaluation of exocrine pancreatic function. Using a photometric assay we found a specificity of 87.5% and a sensitivity of 80%. Beyond the first year of life the lowest limit of normal values is 72 micrograms chymotrypsin/g stool. The method is reproducible, and a 72-hour stool collection is unnecessary when several fecal chymotrypsin determinations in spot stool samples are performed.
Subject(s)
Chymotrypsin/analysis , Exocrine Pancreatic Insufficiency/diagnosis , Feces/analysis , Infant, Premature, Diseases/diagnosis , Pancreatic Function Tests , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Reference ValuesABSTRACT
Specificity and sensitivity of ALTAB test have been estimated in 40 healthy children and 13 cystic fibrosis patients. The test has been carried out in the modification as 2-hour-serum PABA-test. The found specificity was 90%, the sensitivity 100% respectively. Therefore this test is suitable for evaluation of exocrine pancreas function.
Subject(s)
4-Aminobenzoic Acid/blood , Aminobenzoates/blood , Cystic Fibrosis/diagnosis , Pancreatic Function Tests , Child , Cystic Fibrosis/blood , Humans , para-AminobenzoatesABSTRACT
In children (mean age 12.1 +/- 2.9 years) with cystic fibrosis, 44 bronchoscopic examinations were done under general anaesthesia with muscle relaxation using a Friedel type ventilation bronchoscope. The endoscopic picture of the mucous membranes was compared with the state of the bronchial secretions, its bacteriologic findings and content of acid mucopolysaccharides and DNA fibres (semiquantitative estimations). In all patients biopsy of the mucous membrane (central part of the bronchial tree) was performed for light and electron microscopy. The degree of reddening, swelling of the mucous membrane and hypersecretion was in some agreement with the intensity of the cellular infiltration and the production of pus (microscopic investigation). Secondary ultrastructural changes were detected in nearly all children, consisting of cellular oedema, swelling of mitochondria, dilatation of the endoplasmatic reticulum, protrusion of cells and fusion of cilia, enlarged intercellular spaces, thickening of the epithelial basal membrane, increased number of goblet cells, microtubular abnormalities of the cilia, lesions of the apical cell membrane with loss of cilia and microvilli. These ultrastructural changes were not correlated with the above-mentioned signs of inflammation.
Subject(s)
Bronchi/metabolism , Cystic Fibrosis/pathology , Adolescent , Bacteria/isolation & purification , Bronchi/microbiology , Bronchi/ultrastructure , Bronchoscopy , Child , Cystic Fibrosis/metabolism , Cystic Fibrosis/microbiology , DNA/analysis , Epithelium/pathology , Epithelium/ultrastructure , Female , Glycosaminoglycans/analysis , Humans , Male , Staphylococcus aureus/isolation & purificationABSTRACT
Twenty two patients with cystic fibrosis, 7 to 17 years of age, underwent each two bronchoscopic investigations, the second six months later than the first, in general anaesthesia with muscle relaxation using a ventilation bronchoscope and taking small biopsies of the mucous membrane. The degree of reddening, swelling of the mucous membranes and hypersecretion was in some agreement with the intensity of the cellular infiltration and the production of pus (microscopic investigation). Secondary ultrastructural changes were detected in nearly all children: e.g. cellular oedema, protrusion of cells and fusion of cilia, microtubular abnormalities of the cilia, lesions of the apical cell membranes and increased number of goblet cells. These changes of ultrastructure were not correlated to the mentioned signs of inflammation.
