The isoenzyme characteristics of alkaline phosphatase in human bile obtained from patients with gallstones have been determined by means of electrophoresis on polyacrylamide gel, both before and after preincubation with neuraminidase, and also by means of inhibition tests with heat, urea, and L-phenylalanine. Bile alkaline phosphatase is shown to be partly secreted by the liver cell, but partly derived from the small intestine. The presence of small-intestinal alkaline phosphatase in bile implies an enterohepatic circulation of this high molecular weight glycoprotein. The significance of this finding is discussed in relation to the mechanism whereby large protein molecules may pass across the plasma membrane of the liver cell.

Alkaline Phosphatase↗

PubMed1980

Indian childhood cirrhosis in the United Kingdom.

Two young brothers with cirrhosis are reported. They are the issue of a first-cousin marriage between Bangladeshi parents. The older boy was born in Bangladesh, the younger in England. A diagnosis of Indian childhood cirrhosis (ICC) was made on the basis of the clinical features and the liver histology. The younger brother represents the first example of this disease in a patient born in the United Kingdom.

Bangladesh↗

PubMed1979

Small-bowel volvulus in association with progressive systemic sclerosis.

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Aged↗

PubMed1979

Studies on the frequency and pathogenesis of liver involvement in rheumatoid arthritis.

A systematic prospective survey of 100 outpatients with rheumatoid arthritis revealed that 45 had biochemical evidence of liver disease. In most cases this was due to increases in total serum alkaline phosphatase (ALP) and/or gammaglutamyl transpeptidase (GGT). Examination of serum ALP isoenzyme profiles in 50 of the patients showed that the liver isoenzyme was the sole or major component in 44 patients, including many with normal total ALP levels. 18% had raised serum liver ALP together with raised GGT, suggestive of an underlying hepatobiliary lesion. No correlation could be detected between raised serum levels of liver enzymes and the age or sex of the patient, duration or severity of arthritis, and drug or alcohol history. However, there was a significant correlation between raised serum ALP and lacrimal or salivary gland dysfunction. It is suggested that immunological mechanisms may be involved in the development of hepatic abnormalities in rheumatoid arthritis.

Adult↗

PubMed1978

Pre-medication for endoscopy. A trial of atropine, pentazocine or pethidine as a supplement to diazepam.

The effects of giving atropine, pentazocine or pethidine, 30--45 minutes before intravenous diazepam have been assessed and compared with a control group given diazepam alone in a double-blind controlled trial of pre-medication for upper gastrointestinal endoscopy involving 143 patients and 6 endoscopists. Atropine or pentazocine increased the success rate of the procedure (p 0.007) but gave no other definite benefit. Pethidine improved the degree of sedation (p 0.01) and the success rate (p 0.007); the combination of pethidine given before diazepam ranked first of all the four treatment regimes. The patients' opinion of the procedure correlated with the duration of endoscopy and the experience of the endoscopist.

Adult↗

PubMed1977

Intestinal alkaline phosphatase in the diagnosis of liver disease.

Alkaline phosphatase isoenzymes have been studied by acrylamide gel disc electrophoresis in 76 patients with liver disorders comprising 15 with an extrahepatic lesion, 53 with an intrahepatic lesion, and eight patients who had features of both intra- and extrahepatic disease. No intestinal band was found in the 15 cases of extrahepatic liver disease, in marked contrast to the patients with intrahepatic lesions in whom an intestinal band was found in 45% of cases. The intrahepatic group was heterogeneous, a high incidence of intestinal bands being found in patients with cirrhosis of the liver. It is concluded that where a raised serum alkaline phosphatase is found in a patient with jaundice, and a gut band is present on electrophoresis, the lesion is likely to be intrahepatic.

Alkaline Phosphatase↗

PubMed1976

Polyacrylamide gel disc electrophoresis of alkaline phosphatase isoenzymes in bone and liver disease.

Acrylamide gel disc electrophoresis provides a reliable and reasonably rapid method of differentiating the raised serum alkaline phosphatase (AP) of bone origin from that of liver origin. The technique has been placed for the first time on a semiquantitative basis. Measurement of both band width and band position effectively distinguishes the bone from the liver isoenzyme, but band width provides superior discrimination. An origin band was seen in none of the normal subjects and in only 7% of patients with bone disease but was present in 78% of patients with liver disease, a highly significant increase. Fifty percent of normal individuals had a small-intestinal band in serum taken two hours after a meal, as did 35% of patients with liver disease, but the incidence of intestinal bands in bone disease was only 11%, significantly less than in the other two groups. The genetic control of small-intestinal AP in serum has been confirmed, but it has been demonstrated that the decrease of intestinal AP in bone disorders is not genetically determined.

Alkaline Phosphatase↗

PubMed1974

The action of secretin and pancreozymin on small-intestinal alkaline phosphatase.

The hormones secretin and cholecystokinin-pancreozymin (CCK) have been shown to release brush-border alkaline phosphatase into the small-intestinal lumen in the human subject. In contrast to the disaccharidases, large amounts of alkaline phosphatase are present in human duodenal juice. The range has been established in normal subjects. Following the intravenous administration of both secretin and CCK-pancreozymin there is a large rise in the output of alkaline phosphatase in human duodenal juice. These rises are also present in patients with complete obstruction of the common bile and pancreatic ducts, and since the pancreatic juice of man contains negligible amounts of alkaline phosphatase, it is clear that both hormones must cause small-intestinal alkaline phosphatase to be released into duodenal juice. The isoenzyme characteristics of bile, small-intestinal, and pancreatic alkaline phosphatase have been established, and isoenzyme studies used to confirm this new action of secretin and CCK-pancreozymin.

Alkaline Phosphatase↗

PubMed1972

Alkaline phosphatase.

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Alkaline Phosphatase↗

PubMed1972

Pancreatic alkaline phosphatase and a tumour variant.

Alkaline phosphatase has been extracted from human pancreas with n-butanol and has been shown to have distinctive isoenzyme characteristics when compared with the enzymes of small intestine and of normal serum. The enzyme has been demonstrated histochemically in a carcinoma of the pancreas and also in an islet cell tumour and the tumour enzyme has been shown to be unique, not only electrophoretically, but in being remarkably heat sensitive and in being activated by low molarities of urea.

Adenocarcinoma↗

PubMed1972