- Pankaj Sharma,
- Sharon Lim,
- David James,
- Robin T Orchard,
- Morag Horne,
- Carl A Seymour
- Medical registrar Senior house officer Senior house officer Consultant physician Department of Medicine, St Helier's NHS Trust, Carshalton, Surrey SM5 1AA
- Senior registrar Professor Department of Clinical Biochemistry, St George's Hospital Medical School, London SW17 0RE
EDITOR,—Johan Hedstrom and colleagues report that the trypsin 2-(alpha)1 antitrypsin complex is a diagnostic marker of pancreatitis.1 This reminds us of a diagnostic problem that arose when only the serum amylase concentration was considered in a patient with severe abdominal pain.
A 39 year old Muslim man presented with severe generalised abdominal pain. The surgical team concluded that his amylase concentration (57 IU/l; normal 0–90 IU/l) excluded acute pancreatitis. He had non-insulin dependent diabetes, smoked 20 cigarettes a day, and rarely drank alcohol. He had bilateral supraorbital xanthelasmas …
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