The concentration of alpha-amylase in blood rose significantly (Student's t-test) in seven normovolemic healthy subjects after they were given 30 g/m2 body surface area of hydroxyethyl starch 350/0.60 (HES 350/0.60, a new volemic colloid). Concomitant with elevated activity in blood, amylase clearance (Cam) was markedly reduced, even though clearance of creatinine (Ccr) was within normal limits. Similar findings were observed for one male subject given 500 ml (30 g) of HES 450/0.70. Sephadex G-100 gel elution profiles of serum recovered from one male subject after the infusion of HES 350/0.60 revealed the presence of a macroamylase complex eluted with the void volume. Small macroamylase complexes were also detected in urine voided from the same subject. By 24 to 48 hours postinjection, the high activity of alpha-amylase in blood was returning to basal levels, and this was observed to parallel the reduction of macroamylase complexes both serum and urine. The macroamylasemia induced by HES 350/0.60 represents the nonpathologic formation of large colloid-enzyme complexes not easily filtered at the renal glomerulus, and should be differentiated clinically from disease- or drug-induced hyperamylasemia.

Originalia 141 Hintergrund ! Der plötzliche Herztod ist eine der führenden Todesursachen in Deutschland. In der Populärlitera-tur und dem Internet finden sich für Deutschland Zahlen zwischen 80 000 und 200 000 Tote jähr-lich, meist ohne Angaben von Quellen. Seriöse Schätzungen gehen von einer Inzidenz von 1:1000 aus [1, 2], woraus sich ableiten lässt, dass in Deutschland pro Jahr ca. 87 000 Patienten am plötzlichen Herztod versterben. Die Bedeutung einer Laien-Reanimation für ein positives Outcome steht außer Frage [3]. Jedoch ist die Hilfsbereitschaft von Laien in Deutschland zur Durchführung einer Laienreanimation bei einem Herz-Kreislauf-Stillstand bereits vor Eintreffen des Rettungsdienstes mit lediglich 15 % sehr gering [4]. In anderen europäischen Regionen (z. B. Nord-Holland oder Schweden) ist sie mit 60 % deutlich höher [5]. Beginnen Laien mit den Wiederbelebungsmaßnahmen, so steigt die Wahrscheinlichkeit für die Wiederherstellung eines Spontankreislaufs (ROSC) von 37 auf 50 % und die Wahrscheinlichkeit für eine Krankenhausaufnahme von 33 auf 37 % [4]. Im Deutschen Reanimationsregister wurde lediglich in 17,3 % der Fälle eine Laien-HLW registriert (n = 665), in 1,2 % der Fälle mit einer AED-Nutzung durch Laien (PAD-Public Access Defibrillation) [6]. Die ROSC-Wahrscheinlichkeit steigt deutlich an, wenn eine Herzdruckmassage ("Compression only") durchgeführt wird (40 % für das GesamtkolMeyer O et al. T-CPR Bayern … Notarzt 2013; 29: 141-147

Saliva from one parotid gland was collected under citric acid stimulation in three groups consisting of 69 control subjects and two groups consisting of 25 patients with chronic and relapsing chronic pancreatitis. Mixed saliva was collected under mechanical stimulation from 10 patients and 6 control subjects. Flow rates and the contents of bicarbonate, amylase and protein were determined. In a subgroup of patients and controls albumin and lactoferrin were measured. Wide inter- and intraindividual variations of secretory values were observed and normal values (which are reported in detail) were highly dependent from conditions of stimulation. Secretory patterns were not significantly different between patients and control subjects. It is concluded that the alterations leading to an elevation of albumin and lactoferrin and a fall in other secretory values are restricted to the exocrine pancreas and do not affect salivary glands in chronic pancreatitis.

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Changes of lipase (turbidimetric evaluation), total amylase and isoamylases (inhibition test) were determined in 93 patients with proven or suspect pancreatitis. In 35 patients with established acute pancreatitis 143 sera were investigated in the course of disease. Lipase and pancreatic amylase were increased in these samples significantly more often (thus longer in the course of disease) than total amylase. Eight patients with chronic pancreatitis and exocrine insufficiency showed very low lipase and pancreatic amylase activities whereas total amylase was normal. Observations in the course of two groups of patients with suspect (but not established) pancreatitis showed superior organ specificity of lipase and pancreatic amylase when compared to total amylase. However, no relevant difference of the diagnostic validity of both enzymes could be demonstrated.