1
|
Fusco A, Baorda F, Porta L, Lemos AA, Caccamo L, Tobaldini E, Costantino G. A woman with abdominal pain, jaundice and elevated CA 19.9. Intern Emerg Med 2019; 14:557-560. [PMID: 29777435 DOI: 10.1007/s11739-018-1879-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/14/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Alessandra Fusco
- Department of Internal Medicine, Ca' Granda IRCCS Foundation, Policlinico Hospital, Via F. Sforza 35, Milan, Italy.
| | - Francesca Baorda
- Department of Internal Medicine, Ca' Granda IRCCS Foundation, Policlinico Hospital, Via F. Sforza 35, Milan, Italy
| | - Lorenzo Porta
- Department of Biomedical and Clinical Sciences, "L. Sacco" University of Milan, Milan, Italy
| | - Alessandro A Lemos
- Department of Radiology, Ca' Granda IRCCS Foundation, Policlinico Hospital, Milan, Italy
| | - Lucio Caccamo
- General Surgery and Liver Transplant Unit, Ca' Granda IRCCS Foundation, Policlinico Hospital, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, Ca' Granda IRCCS Foundation, Policlinico Hospital, Via F. Sforza 35, Milan, Italy
| | - Giorgio Costantino
- Department of Internal Medicine, Ca' Granda IRCCS Foundation, Policlinico Hospital, Via F. Sforza 35, Milan, Italy
| |
Collapse
|
2
|
Rojas EM, Herrera VM, Miranda MC, Rojas DP, Gómez AM, Pallares C, Cobos SM, Pardo L, Gélvez M, Páez A, Mantilla JC, Bonelo A, Parra E, Villar LA. Clinical Indicators of Fatal Dengue in Two Endemic Areas of Colombia: A Hospital-Based Case-Control Study. Am J Trop Med Hyg 2019; 100:411-419. [PMID: 30652671 PMCID: PMC6367622 DOI: 10.4269/ajtmh.17-0323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/14/2018] [Indexed: 12/19/2022] Open
Abstract
According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case-control (1:2) study in two endemic areas of Colombia (2009-2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease's duration, and health-care provider) in the context of multiple imputation to estimate exposure to case-control associations. We evaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease's duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.
Collapse
Affiliation(s)
- Elsa M. Rojas
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
- Info Vida, Bucaramanga, Colombia
| | - Víctor M. Herrera
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - María C. Miranda
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - Diana Patricia Rojas
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Adriana M. Gómez
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | | | | | | | - Margarita Gélvez
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - Andrés Páez
- Instituto Nacional de Salud, Bogotá, Colombia
| | - Julio C. Mantilla
- Department of Pathology, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - Anilza Bonelo
- Emerging Viruses and Disease-VIREM, Universidad del Valle, Cali, Colombia
| | - Edgar Parra
- Instituto Nacional de Salud, Bogotá, Colombia
| | - Luis A. Villar
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| |
Collapse
|
3
|
Taylor T, Wheatley M, Gupta N, Nusbaum J. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment [digest]. Emerg Med Pract 2018; 20:1-2. [PMID: 29634896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature. [Points & Pearls is a digest of Emergency Medicine Practice.].
Collapse
Affiliation(s)
- Todd Taylor
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Matthew Wheatley
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Nachi Gupta
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey Nusbaum
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
4
|
Taylor T, Wheatley M. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment. Emerg Med Pract 2018; 20:1-24. [PMID: 29565526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/10/2017] [Indexed: 06/08/2023]
Abstract
There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature.
Collapse
Affiliation(s)
- Todd Taylor
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Matthew Wheatley
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| |
Collapse
|
5
|
Hariharan M, Sindhu R, Vijean V, Yazid H, Nadarajaw T, Yaacob S, Polat K. Improved binary dragonfly optimization algorithm and wavelet packet based non-linear features for infant cry classification. Comput Methods Programs Biomed 2018; 155:39-51. [PMID: 29512503 DOI: 10.1016/j.cmpb.2017.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/15/2017] [Accepted: 11/24/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Infant cry signal carries several levels of information about the reason for crying (hunger, pain, sleepiness and discomfort) or the pathological status (asphyxia, deaf, jaundice, premature condition and autism, etc.) of an infant and therefore suited for early diagnosis. In this work, combination of wavelet packet based features and Improved Binary Dragonfly Optimization based feature selection method was proposed to classify the different types of infant cry signals. METHODS Cry signals from 2 different databases were utilized. First database contains 507 cry samples of normal (N), 340 cry samples of asphyxia (A), 879 cry samples of deaf (D), 350 cry samples of hungry (H) and 192 cry samples of pain (P). Second database contains 513 cry samples of jaundice (J), 531 samples of premature (Prem) and 45 samples of normal (N). Wavelet packet transform based energy and non-linear entropies (496 features), Linear Predictive Coding (LPC) based cepstral features (56 features), Mel-frequency Cepstral Coefficients (MFCCs) were extracted (16 features). The combined feature set consists of 568 features. To overcome the curse of dimensionality issue, improved binary dragonfly optimization algorithm (IBDFO) was proposed to select the most salient attributes or features. Finally, Extreme Learning Machine (ELM) kernel classifier was used to classify the different types of infant cry signals using all the features and highly informative features as well. RESULTS Several experiments of two-class and multi-class classification of cry signals were conducted. In binary or two-class experiments, maximum accuracy of 90.18% for H Vs P, 100% for A Vs N, 100% for D Vs N and 97.61% J Vs Prem was achieved using the features selected (only 204 features out of 568) by IBDFO. For the classification of multiple cry signals (multi-class problem), the selected features could differentiate between three classes (N, A & D) with the accuracy of 100% and seven classes with the accuracy of 97.62%. CONCLUSION The experimental results indicated that the proposed combination of feature extraction and selection method offers suitable classification accuracy and may be employed to detect the subtle changes in the cry signals.
Collapse
Affiliation(s)
- M Hariharan
- Department of Biomedical Engineering, SRM Institute of Science and Technology, (Deemed to be University under section 3 of UGC Act 1956), Kattankulathur, 603203, Tamil Nadu, India.
| | - R Sindhu
- School of Computer and Communication Engineering, Universiti Malaysia Perlis (UniMAP), Campus Pauh Putra, Perlis 02600, Malaysia
| | - Vikneswaran Vijean
- School of Mechatronic Engineering, Universiti Malaysia Perlis (UniMAP), Campus Pauh Putra, Perlis 02600, Malaysia
| | - Haniza Yazid
- School of Mechatronic Engineering, Universiti Malaysia Perlis (UniMAP), Campus Pauh Putra, Perlis 02600, Malaysia
| | - Thiyagar Nadarajaw
- Consultant Pediatrician & Adolescent, Department of Pediatrics, Hospital Sultanah Bahiyah, Alor Setar, Kedah 05460, Malaysia
| | - Sazali Yaacob
- Universiti Kuala Lumpur Malaysian Spanish Institute, Kulim Hi-Tech Park, Kulim, Kedah, Malaysia
| | - Kemal Polat
- Department of Electrical and Electronics Engineering, Faculty of Engineering and Architecture, Abant Izzet Baysal University, Bolu 14280, Turkey
| |
Collapse
|
6
|
Peixoto JM, Mamede S, de Faria RMD, Moura AS, Santos SME, Schmidt HG. The effect of self-explanation of pathophysiological mechanisms of diseases on medical students' diagnostic performance. Adv Health Sci Educ Theory Pract 2017; 22:1183-1197. [PMID: 28144797 DOI: 10.1007/s10459-017-9757-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/15/2017] [Indexed: 06/06/2023]
Abstract
Self-explanation while diagnosing clinical cases fosters medical students' diagnostic performance. In previous studies on self-explanation, students were free to self-explain any aspect of the case, and mostly clinical knowledge was used. Elaboration on knowledge of pathophysiological mechanisms of diseases has been largely unexplored in studies of strategies for teaching clinical reasoning. The purpose of this two-phase experiment was to investigate the effect of self-explanation of pathophysiology during practice with clinical cases on students' diagnostic performance. In the training phase, 39 4th-year medical students were randomly assigned to solve 6 criterion cases (3 of jaundice; 3 of chest pain), either self-explaining the pathophysiological mechanisms of the findings (n = 20) or without self-explaining (n = 19). One-week later, in the assessment phase, all students solved 6 new cases of the same syndromes. A repeated-measures analysis of variance on the mean diagnostic accuracy scores showed no significant main effects of study phase (p = 0.34) and experimental condition (p = 0.10) and no interaction effect (p = 0.42). A post hoc analysis found a significant interaction (p = 0.022) between study phase and syndrome type. Despite equal familiarity with jaundice and chest pain, the performance of the self-explanation group (but not of the non-self-explanation group) on jaundice cases significantly improved between training and assessment phases (p = 0.035) whereas no differences between phases emerged on chest pain cases. Self-explanation of pathophysiology did not improve students' diagnostic performance for all diseases. Apparently, the positive effect of this form of self-explanation on performance depends on the studied diseases sharing similar pathophysiological mechanisms, such as in the jaundice cases.
Collapse
Affiliation(s)
- José Maria Peixoto
- Medical School, José do Rosário Vellano University, 66 Líbano Street, Itapoã, Belo Horizonte, MG, 31710030, Brazil.
| | - Sílvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Alexandre Sampaio Moura
- Medical School, José do Rosário Vellano University, 66 Líbano Street, Itapoã, Belo Horizonte, MG, 31710030, Brazil
| | - Silvana Maria Elói Santos
- Department of Propedeutics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Henk G Schmidt
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Badebarin D, Aslanabadi S, Teimouri-Dereshki A, Jamshidi M, Tarverdizadeh T, Shad K, Ghabili K, Khajir G. Different clinical presentations of choledochal cyst among infants and older children: A 10-year retrospective study. Medicine (Baltimore) 2017; 96:e6679. [PMID: 28445267 PMCID: PMC5413232 DOI: 10.1097/md.0000000000006679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Choledochal cyst is a rare and often benign congenital cystic dilation throughout the biliary tree. Due to the benign nature of choledochal cyst among early-diagnosed patients, the clinical assumption and diagnosis seem to be of utmost significance. Therefore, we sought to assess different clinical manifestations of choledochal cyst and relevant laboratory findings in infants and older children.Retrospectively, medical records of all patients with the diagnosis of choledochal cyst between 2005 and 2015 were reviewed. Demographic data, initial clinical presentation, positive findings on physical examination, history of any remarkable behavior such as persistent and unexplained crying and poor feeding, and diagnostic imaging modalities were listed. In addition, laboratory values for total and direct bilirubin, alkaline phosphatase, alanine transaminase, aspartate transaminase, prothrombin time, and partial thromboplastin time (PTT) were recorded for each patient. Patients were divided into 2 groups; younger than 1-year-old (infants), and 1 year to 18 years old (older children). Demographic data, clinical data, and laboratory values were compared between the infants and older children.Thirty-two patients with a diagnosis of choledochal cyst were included in the study: 9 patients (28.12%) were infants and 23 patients (71.87%) were older children. Abdominal pain was the most common presenting symptom (62.5%), followed by nausea/vomiting (59.4%) and jaundice (28.1%). None of the patients presented with the classic triad of abdominal pain, jaundice, and right upper quadrant mass. Seventeen older children (73.91%) presented with nausea and vomiting, while 2 subjects (22.22%) in the infantile group presented with this feature (P = .01). Similarly, abdominal pain was found in 20 older children (86.95%); however, none of the infants presented with abdominal pain at diagnosis (P < .001). By contrast, the abdominal mass was more detected in infants than the older children (33.33% vs. 0%, P = .01). In terms of laboratory values, the median PTT was 44 and 36 s in infants and older children, respectively (P = .04).Infants were more likely to present with abdominal mass and older children were more likely to have nausea, vomiting, and abdominal pain. Furthermore, infants had more prolonged PTT than older children, implying a potential bleeding tendency.
Collapse
Affiliation(s)
- Davoud Badebarin
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | - Saeid Aslanabadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | | | - Masoud Jamshidi
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | - Tuba Tarverdizadeh
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kaveh Shad
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamyar Ghabili
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ghazal Khajir
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
8
|
Revised surveillance case definitions. Commun Dis Intell (2018) 2015; 39:E599-601. [PMID: 26779734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
9
|
Bassari R, Koea JB. Jaundice associated pruritis: A review of pathophysiology and treatment. World J Gastroenterol 2015; 21:1404-1413. [PMID: 25663760 PMCID: PMC4316083 DOI: 10.3748/wjg.v21.i5.1404] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/19/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
To review the underlying pathophysiology and currently available treatments for pruritis associated with jaundice. English language literature was reviewed using MEDLINE, PubMed, EMBASE and clinicaltrials.gov for papers and trails addressing the pathophysiology and potential treatments for pruritis associated with jaundice. Recent advances in the understanding of the peripheral anatomy of itch transmission have defined a histamine stimulated pathway and a cowhage stimulated pathway with sensation conveyed centrally via the contralateral spinothalamic tract. Centrally, cowhage and histamine stimulated neurons terminate widely within the thalamus and sensorimotor cortex. The causative factors for itch in jaundice have not been clarified although endogenous opioids, serotonin, steroid and lysophosphatidic acid all play a role. Current guidelines for the treatment of itching in jaundice recommend initial management with biliary drainage where possible and medical management with ursodeoxycholic acid, followed by cholestyramine, rifampicin, naltrexone and sertraline. Other than biliary drainage no single treatment has proved universally effective. Pruritis associated with jaundice is a common but poorly understood condition for which biliary drainage is the most effective therapy. Pharmacological therapy has advanced but remains variably effective.
Collapse
|
10
|
Abstract
Newborns with ABO blood group incompatibility can have a spectrum of clinical presentations from remaining asymptomatic to severe hemolytic anemia with jaundice. This case presentation discusses dizygotic twins who demonstrated both ends of the clinical spectrum. Similar cases in which there is such extreme variation between twins were not attainable in the current literature, which prompted the authors to present it as a rare occurrence and one that was unexpected based on their past experience with ABO incompatibility both in singletons and in twins.
Collapse
|
11
|
Zhou J, Zhang Q, Li P, Shan Y, Zhao D, Cai J. Jaundice as a prognostic factor in patients undergoing radical treatment for carcinomas of the ampulla of Vater. Chin Med J (Engl) 2014; 127:860-864. [PMID: 24571877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Carcinomas of the ampulla of Vater (CAV) is a relatively rare malignant gastrointestinal tumor, and its postoperative prognostic factors have been well studied. However, as its first symptom, the impact of jaundice on the prognosis of CAV is not so clear. This study aims to explore the role of jaundice as a prognostic factor in patients undergoing radical treatment for CAV. METHODS The clinical data of 195 patients with CAV who were treated in the Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from January 1989 to January 2013 were retrospectively analyzed. Among them, 170 patients with pathologically confirmed CAV entered the statistical analysis. Jaundice was defined as a total bilirubin serum concentration of ≥ 3 mg/dl. Result Of these 170 patients, 99 (58.20%) had jaundice at presentation. Jaundice showed significant correlations with tumor differentiation (P = 0.002), lymph node metastasis (P = 0.016), pancreatic invasion (P = 0.000), elevated preoperative CA199 (P = 0.000), depth of invasion (P = 0.000), and tumor stage (P = 0.000). There were more patients with pancreatic invasion in the jaundice group than in the non-jaundice group. Also, lymph node metastasis was more common in the jaundice group (n = 26) than in the non-jaundice group (n = 8). The non-jaundice group had significant better overall 5-year disease-free survival (72.6%) than the jaundice group (41.2%, P = 0.013). Jaundice was not significantly correlated with the postoperative bleeding (P = 0.050). CONCLUSIONS Jaundice in patients with CAV often predicts more advanced stages and poorer prognoses. Pancreatic invasion and lymph node metastasis are more common in CAV patients with jaundice. Jaundice is not a risk factor for postoperative bleeding and preoperative biliary drainage cannot reduce the incidence of postoperative complications.
Collapse
Affiliation(s)
- Jianguo Zhou
- Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Qian Zhang
- Department of General Surgery, Aerospace Central Hospital, Beijing 100049, China
| | - Peng Li
- Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yi Shan
- Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Dongbing Zhao
- Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
| | - Jianqiang Cai
- Department of Abdominal Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
12
|
Norasyikin A, Rozita M, Mohd Johan M, Suehazlyn Z. Autoimmune polyglandular syndrome presenting with jaundice and thrombocytopenia. Med Princ Pract 2014; 23:387-9. [PMID: 24401542 PMCID: PMC5586888 DOI: 10.1159/000357645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 12/01/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report an uncommon presentation of a rare case of autoimmune polyglandular syndrome type IIIb in an elderly woman. CLINICAL PRESENTATION AND INTERVENTION A 62-year-old woman presented with anaemic symptoms and jaundice. Blood tests showed macrocytic anaemia due to vitamin B12 deficiency with Coombs negative haemolysis. A thyroid function test was consistent with hypothyroidism. Autoimmune antibody assays were positive for anti-parietal cell, anti-intrinsic factor and anti-thyroid peroxidase antibodies. A final diagnosis of autoimmune thyroiditis with pernicious anaemia, which constituted autoimmune polyglandular syndrome type IIIb, was made and the patient was treated with L-thyroxine, vitamin B12 injection and a blood transfusion. She was discharged uneventfully after a week of hospitalization. CONCLUSION This case showed that the presence of one autoimmune endocrine disease should prompt clinicians to look for other coexisting autoimmune diseases which may be asymptomatic despite positive autoantibodies.
Collapse
Affiliation(s)
- A.W. Norasyikin
- Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
- *Dr. Norasykin A. Wahab, Department of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000 (Malaysia), E-Mail
| | - M. Rozita
- Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
| | - M.J. Mohd Johan
- Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
| | - Z. Suehazlyn
- Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
| |
Collapse
|
13
|
Casey G. Jaundice: an excess of bilirubin. Nurs N Z 2013; 19:20-24. [PMID: 23539983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
14
|
Friis-Liby I, Wallerstedt S, Marschall HU. [Icterus and cholestasis]. Lakartidningen 2012; 109:2093-2096. [PMID: 23259215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
15
|
Metzner M, Wieland M, Rademacher G, Weber BK, Hafner-Marx A, Langenmayer MC, Ammer H, Klee W. [High incidence of jaundice in young calves in Southern Germany]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2012; 40:283-292. [PMID: 23076757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 06/25/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Between September, 2010, and August, 2011, a series of cases of jaundice of unknown origin in young calves was detected in a number of farms in Southern Germany. This paper describes the syndrome on the basis of 57 cases, and the approach taken to discover the cause. MATERIAL AND METHODS The clinical course of the disease is described in 19 patients. Using a case definition (calves aged 1-3 weeks, total serum bilirubin > 20 µmol/l and/or serum glutamate dehydrogenase [GLDH] activity >50U/l and/or autopsy findings with striking liver pathology [jaundice, liver dystrophy, cirrhosis]), 36 farms were included in an epidemiological survey. In a feeding trial, two batches of a dietary supplement feed, previously used in diseased calves on farms, were fed at the dosage recommendations of the manufacturer to four clinically healthy calves over 5days. Four other calves served as controls. The calves were clinically monitored daily, and blood samples were investigated using clinical chemistry and haematology. RESULTS Clinical examination revealed behavioural alterations (weakness, tonic-clonic seizures and bawling just before death), recumbency, jaundice and discolouration of faeces. In less severe cases without clinical signs, there was an increase in serum bilirubin concentration and/or GLDH activity. In the epidemiological survey of affected farms, the feeding of a diet supplement feed was registered in 54 of 57 cases. The feeding of two batches of that diet supplement feed to four clinically healthy calves resulted in a significant (p<0.05) increase in bilirubin and lactate concentrations, as well as the GLDH activity in serum, but without serious impairment of the general condition, whereas in control calves, no comparable changes were observed. CONCLUSION The results of the epidemiological survey and the feeding trial suggest a causal involvement of a dietary supplement feed. The toxic principle is unknown. CLINICAL RELEVANCE Knowledge of the clinical picture and the probable feed-related context is important to detect this disease early. The suspected dietary supplement feed has been taken off the market, but with other products similar problems may arise.
Collapse
Affiliation(s)
- M Metzner
- Klinik für Wiederkäuer mit Ambulanz und Bestandsbetreuung der Ludwig-Maximilians-Universität München, 85764 Oberschleißheim.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Wise SC, Tinsley SH, Cook LO. Paroxysmal cold hemoglobinuria: a case report. Immunohematology 2012; 28:118-123. [PMID: 23421540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 15-month-old white male child was admitted to the pediatric intensive care unit with symptoms of upper respiratory tract infection, increased somnolence, pallor, jaundice, fever, and decreased activity level. The purpose of this case study is to report the clinical findings associated with the patient's clinical symptoms and differential laboratory diagnosis.
Collapse
Affiliation(s)
- S C Wise
- Department of Medical Laboratory, Imaging and Radiologic Sciences, Georgia Health Sciences University, Augusta, GA 30909, USA
| | | | | |
Collapse
|
17
|
Lv J, Fu S, Guo J, Liu Y, Yuan H, Xiao X. [Primary research on daily administration times of rhubarb used to treat experimental jaundice in rats]. Zhongguo Zhong Yao Za Zhi 2011; 36:3506-3510. [PMID: 22368867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To study the rational daily administration times of rhubarb when it is used to treat experimental jaundice in rats, at the same time, validate the accuracy and feasibility of the method which was previously established to research the rational daily administration times of rhubarb (PD-PK method), and consummate it. METHOD After the rats were modeled by 4% ANIT (75 mg x kg(-1)) for two days, rhubarb extraction was drenched 3.6 g x kg(-1) once a day, 1.8 g x kg(-1) twice a day and 1.2 g x kg(-1) three times a day, respectively. Then the total bile and the flow rate of bile were observed. Blood was collected from the veins behind the eye sockets after different intervals and was used to investigate the biochemical indexes of the blood serum, such as TBIL, ALT, ALP, AST and GGT, and to determine the concentration of rheic acid in the blood plasma, then the time-effect curve and time-dose curve were obtained. The rational daily administration times of rhubarb was determined when it was used to treat experimental jaundice based on the comprehend analysis of time-effect and time-concentration relationships. RESULT Compared with the groups which were administered once a day and three times a day, the total bile within 8 h of the rats which were administered twice a day was 1.56 and 1.7 times higher, respectively, while the TBIL was 23%, 22%, and ALT was 86%, 65% of the other two, ALP was 50%, 71% of the other two, respectively. With administrated twice a day, the blood concentration of rheic acid could maintain a high level for a longer time, which maybe the main reason for its effect. CONCLUSION The method based on pharmacodynamics and pharmacokinetics is scientific and feasible to study the rational daily administration times of traditional Chinese medicine. Rhubarb is better to administrate two times a day to treat jaundice.
Collapse
Affiliation(s)
- Junlan Lv
- 302 Military Hospital of China, Beijing 100039, China
| | | | | | | | | | | |
Collapse
|
18
|
Silvain C. [Jaundice]. Rev Prat 2011; 61:687-696. [PMID: 21698908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Christine Silvain
- Service d'hépato-gastroentérologie et d'assistance nutritive, laboratoire inflammation tissus epithéliaux et cytokines EA 4331, CHU Poitiers, 86021 Poitiers Cedex, France.
| |
Collapse
|
19
|
Abstract
BACKGROUND Jaundice is one of the most common problems encountered in newborn infants, due to immaturity of hepatic conjugation and transport processes for bilirubin. Although the majority of neonatal jaundice is benign, some neonates with severe hyperbilirubinemia develop bilirubin encephalopathy or kernicterus. Accumulation of unconjugated bilirubin (UCB) in selected brain regions may result in temporary or permanent impairments of auditory, motor, or cognitive function; however, the molecular mechanisms by which UCB elicits such neurotoxicity are still poorly understood. The present study is undertaken to investigate whether prolonged exposure of rat organotypic hippocampal slice cultures to UCB alters the induction of long-term synaptic plasticity. METHODOLOGY/PRINCIPAL FINDINGS Using electrophysiological recording techniques, we find that exposure of hippocampal slice cultures to clinically relevant concentrations of UCB for 24 or 48 h results in an impairment of CA1 long-term potentiation (LTP) and long-term depression (LTD) induction in a time- and concentration-dependent manner. Hippocampal slice cultures stimulated with UCB show no changes in the secretion profiles of the pro-inflammatory cytokines, interleukin-1beta and tumor necrosis factor-alpha, or the propidium ioide uptake. UCB treatment produced a significant decrease in the levels of NR1, NR2A and NR2B subunits of N-methyl-D-aspartate (NMDA) receptors through a calpain-mediated proteolytic cleavage mechanism. Pretreatment of the hippocampal slice cultures with NMDA receptor antagonist or calpain inhibitors effectively prevented the UCB-induced impairment of LTP and LTD. CONCLUSION/SIGNIFICANCE Our results indicate that the proteolytic cleavage of NMDA receptor subunits by calpain may play a critical role in mediating the UCB-induced impairment of long-term synaptic plasticity in the hippocampus. These observations provide new insights into the molecular mechanisms underlying UCB-induced impairment of hippocampal synaptic plasticity which, in turn, might provide opportunities for the development of novel therapeutic strategies that targets these pathways for treatment.
Collapse
Affiliation(s)
- Fang-Yu Chang
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Che Lee
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Chun Huang
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuei-Sen Hsu
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Center for Gene Regulation and Signal Transduction Research, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
20
|
Wang HY, Xiu DR, Li ZF, Wang G. Coagulation function in patients with pancreatic carcinoma. Chin Med J (Engl) 2009; 122:697-700. [PMID: 19323937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The coagulation function in patients with pancreatic carcinoma is abnormal and the reason is not very clear. In this study, we retrospectively analyzed the coagulation function in patients with pancreatic carcinoma. METHODS From June 2004 to December 2007, 132 patients received diagnosis and treatment in our hospital. The coagulative parameters including the prothrombin time, activated partial thromboplastin time, and fibrinogen levels were collected and studied retrospectively. RESULTS The average fibrinogen levels in patients with pancreatic carcinoma, (476.21 +/- 142.05) mg/dl, were significantly higher than in patients with cholangiolithiasis, (403.28 +/- 126.41) mg/dl (P < 0.05). In patients with pancreatic carcinoma, the levels of fibrinogen in the group with jaundice were significantly higher than in patients without jaundice (P < 0.05). In patients who received Pancreaticoduodenectomy, Whipple's operation, the level of fibrinogen in the group with local invasiveness was significantly higher than in the group without invasiveness. The group with lymphatic metastasis had higher levels than the group without lymphatic metastasis (P < 0.05). There was no significant difference of intraoperative blood loss between patients with vitamin K, (748.27 +/- 448.51) ml, and those without vitamin K, (767.31 +/- 547.89) ml (P > 0.05). CONCLUSIONS The level of fibrinogen in patients with pancreatic carcinoma was elevated. The elevated fibrinogen level may be associated with invasiveness and lymphatic metastasis. Using vitamin K in perioperation management did not reduce intraoperative blood loss.
Collapse
Affiliation(s)
- Hang-Yan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | | | | | | |
Collapse
|
21
|
Kochar DK, Das A, Kochar SK, Saxena V, Sirohi P, Garg S, Kochar A, Khatri MP, Gupta V. Severe Plasmodium vivax malaria: a report on serial cases from Bikaner in northwestern India. Am J Trop Med Hyg 2009; 80:194-198. [PMID: 19190212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Epidemiologic studies and clinical description of severe Plasmodium vivax malaria in adults living in malaria-endemic areas are rare and more attention is needed to understand the dynamics and its interaction with the immune system. This observational study included 1,091 adult patients admitted to medical wards of S. P. Medical College and associated group of hospitals in Bikaner, India from September 2003 through December 2005. The diagnosis of P. vivax malaria was established by peripheral blood film (PBF), rapid diagnostic test (RDT), and polymerase chain reaction (PCR), and severe malaria was categorized as per World Health Organization guidelines. Of 1,091 patients with malaria, 635 had P. falciparum malaria and 456 had P. vivax malaria. Among patients with severe manifestations, 40 had evidence of monoinfection of P. vivax malaria diagnosed by PBF, RDT, and PCR. Complications observed were hepatic dysfunction and jaundice in 23 (57.5%) patients, renal failure in 18 (45%) patients, severe anemia in 13 (32.5%) patients, cerebral malaria in 5 patients (12.5%), acute respiratory distress syndrome in 4 patients (10%), shock in 3 patients (7.5%), and hypoglycemia in 1 (2.5%) patient. Thrombocytopenia was observed in 5 (12.5%) patients, and multi-organ dysfunction was detected in 19 (47.5%) patients. Further large-scale multicentric epidemiologic studies are needed to define the basic pathology of this less known entity.
Collapse
Affiliation(s)
- Dhanpat K Kochar
- Department of Medicine, S. P. Medical College, Bikaner, Rajasthan, India.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Singh V, Bhalla A, Sharma N, Mahi SK, Lal A, Singh P. Pathophysiology of jaundice in amoebic liver abscess. Am J Trop Med Hyg 2008; 78:556-559. [PMID: 18385348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Jaundice in patients with amoebic liver abscess is a frequent occurrence. However, the pathophysiology of jaundice in these patients is not fully understood. Hepatic necrosis leads to damage to bile ducts as well as various vascular structures, which in turn leads to biliovascular fistula and jaundice. We studied the mechanism of jaundice in patients with amoebic liver abscess. We prospectively evaluated 12 patients with amoebic liver abscess and jaundice from February 2002 to August 2007. All patients underwent various investigations, including imaging studies. There were 11 males and 1 female patient with a mean age of 41.3 years. Mean duration of illness before presentation was 13.8 days. All patients had fever and jaundice. We detected damaged hepatic veins and bile ducts in all patients with amoebic liver abscess causing biliovascular fistula and hyperbilirubinemia, which reverted to normal after biliary diversion with nasobiliary drainage. Jaundice in patients with amoebic liver abscess is caused by biliovascular fistula resulting from hepatic necrosis leading to damage to bile ducts and hepatic veins.
Collapse
Affiliation(s)
- Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 022 India.
| | | | | | | | | | | |
Collapse
|
23
|
Sanpavat S, Nuchprayoon I. Transcutaneous bilirubin in the pre-term infants. J Med Assoc Thai 2007; 90:1803-1808. [PMID: 17957922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE 1) To evaluate the accuracy of transcutaneous bilirubin (T(C)B) measurement compared to total serum bilirubin level (TSB) in the pre-term infants and 2) To establish cut-off values of T(C)B that indicated need for TSB. MATERIAL AND METHOD Premature infants whose birth weight was more than 1,000 grams and gestational age less than 36 weeks had paired T(C)B-TSB assessment when jaundice was observed. T(C)B was done using JM 103 (Minolta AirShields Jaundice Meter) on the forehead. T(C)B, which corresponded to TSB level that required phototherapy, was chosen as the cut-off point that indicated blood sampling for TSB. RESULTS Two hundred and forty-nine paired T(CB)-TSB measurements from 196 premature neonates were obtained. Birth weight was 1,887 +/- 344.4 grams. TSB ranged from 4.5-17.6 mg/dL (mean 9.4, SD 2.2 mg/dL), T(C)B 4.1-17.7 mg/dL (mean 9.7, SD 2.4 mg/dL). The correlation coefficient between T(C)B and TSB was significant (r 0.79, p < 0.0001). T(C)B had a tendency to overestimate TSB with the mean difference of TSB- T(C)B = -0.3 +/- 1.5 mg/dL and 95% confidence interval of the mean -0.1 to -0.5 mg/dL. Of all the variables of birth weight, gestational age, and postnatal age, only postnatal age significantly influenced the correlation of T(C)B-TSB. In the early postnatal age of 1-4 days, the number of T(C)B reading overestimated TSB more than underestimated. However, at > or = 5 days of age, the number of underestimation was more than those of overestimation. The cut-off points of T(C)B that indicated the need for blood sampling for TSB were chosen as the same level of TSB of 6, 8, 10, 11, and 12 mg/dL when phototherapy was recommended. Screening with T(C)B would eliminate painful procedure of blood taking by 40%. CONCLUSION Noninvasive T(C)B assessment demonstrated significant accuracy when compared to TSB. T(C)B can be adopted as a screening test to identify the need for blood sampling of serum bilirubin in premature infants.
Collapse
Affiliation(s)
- Suwimol Sanpavat
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
| | | |
Collapse
|
24
|
Listernick R. A 10-month-old boy with jaundice and abdominal pain. Pediatr Ann 2007; 36:306, 308-10. [PMID: 17727135 DOI: 10.3928/0090-4481-20070601-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
25
|
Deepak N A, Patel ND. Differential diagnosis of acute liver failure in India. Ann Hepatol 2007; 5:150-6. [PMID: 17060870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Complicated forms of certain infectious diseases like falciparum malaria, leptospirosis, dengue fever, ricketsial fever, typhoid fever, haemophagocytosis, herpes simplex virus, cytomegalovirus, tuberculosis or amoebic liver abscess can present with altered mentation and/or bleeding manifestations in presence of jaundice and mimic ALF due to acute viral hepatitis (AVH). METHODS We describe our experience in last 2 years with 28 patients of ALF due to above mentioned conditions (ALF-ID) and compared them with 28 patients with ALF due to AVH (ALF-AVH). RESULTS In ALF-ID, typhoid fever was present in 1, haemophagocytosis in 1, ricketsial infection in 4 (scrub typhus = 2, endemic typhus = 2), amoebic liver abscess in 4, leptospirosis in 5, dengue fever in 5 and falciparum malaria in 8 patients. In ALF-AVH, hepatitis E and B co-infection was responsible in 1, hepatitis A and E co-infection in 1 and hepatitis E, B and C co-infection in 1, hepatitis E in 18, hepatitis A in 2 and hepatitis B in 5 patients. Differentiation of various forms of ALF-ID from ALF-AVH depends on various clinical, haematological and biochemical parameters, in addition to specific diagnostic tests. Patients with ALF-AVH had mortality rate of 50% (14/28) and ALF-ID had mortality rate of 25% (7/28). CONCLUSIONS In developing countries, ALF-mimicking infections should be looked for in differential diagnosis of ALF. Early identification and treatment of these infections is important in reducing mortality.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Child
- Communicable Diseases/complications
- Communicable Diseases/diagnosis
- Communicable Diseases/drug therapy
- Communicable Diseases/physiopathology
- Diagnosis, Differential
- Female
- Hepatitis, Viral, Human/complications
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/drug therapy
- Hepatitis, Viral, Human/physiopathology
- Humans
- India
- Jaundice/physiopathology
- Liver Failure, Acute/diagnosis
- Liver Failure, Acute/drug therapy
- Liver Failure, Acute/etiology
- Liver Failure, Acute/physiopathology
- Male
- Middle Aged
- Prospective Studies
- Treatment Outcome
Collapse
Affiliation(s)
- Amarapurkar Deepak N
- Department Of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, India.
| | | |
Collapse
|
26
|
Abstract
Hyperbilirubinemia, or jaundice, is common in the ICU, with incidence up to 40% among critically ill patients. Unfortunately, it is poorly understood in the critically ill, and too often presents a diagnostic dilemma to the ICU physician. Causes of jaundice in the ICU are multiple; the etiology in any given patient, multifactorial. Acute jaundice can be a harbinger or marker of sepsis, multisystem organ failure (MSOF), or a reflection of transient hypotension (shock liver), right-sided heart failure, the metabolic breakdown of red blood cells, or pharmacologic toxicity. Acute ICU jaundice is best divided into obstructive and nonobstructive. This stratification directs subsequent management and therapeutic decisions.
Collapse
Affiliation(s)
- Vishal Bansal
- Department of Surgery, University of California at San Diego, San Diego, CA, USA
| | | |
Collapse
|
27
|
Langeloh L, Hinrichsen H. [Main symptom jaundice--differential diagnosis at the bedside]. Med Klin (Munich) 2007; 102:37-47; quiz 48-9. [PMID: 17221351 DOI: 10.1007/s00063-007-1007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In jaundice, tissues are yellow in color because of an excessive deposition of bilirubin secondary to hyperbilirubinemia. Bilirubin is the physiological end-product of heme metabolism. Jaundice is one of the main symptoms of hepatobiliary disease. Besides that, it might occur in the setting of cardiac, hematologic or pancreatic disorders. The onset of jaundice varies from acute with severe impairment of general condition to chronic and not being noticed by the patient at all. In the first part of this review, the physiological and pathophysiological molecular mechanisms of heme and bile metabolism are described in detail on a scientific basis. The knowledge of the main principles of heme degradation, canalicular bile secretion and enterohepatic cycling of bile salts helps to understand, why clinicians differentiate between prehepatic (hemolytic), hepatocellular and obstructive jaundice. A detailed patient's history and a careful physical examination are essential for the clinical differential diagnosis of jaundice. In combination with routinely obtained lab results, it is often possible to find the right diagnosis already at the bedside. To demonstrate this, the second part of this review sets the focus on the analysis of three case reports from the clinical point of view. The differential diagnosis of jaundice is summarized in a table.
Collapse
Affiliation(s)
- Lars Langeloh
- Klinik für Allgemeine Innere Medizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 12, 24105 Kiel
| | | |
Collapse
|
28
|
Shapiro SM, Sombati S, Geiger A, Rice AC. NMDA channel antagonist MK-801 does not protect against bilirubin neurotoxicity. Neonatology 2007; 92:248-57. [PMID: 17556843 DOI: 10.1159/000103743] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/05/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bilirubin encephalopathy or kernicterus is a potentially serious complication of neonatal hyperbilirubinemia. The mechanism of bilirubin-induced neurotoxicity is not known. Many neurological insults are mediated through NMDA receptor activation. OBJECTIVE We assessed the effect of the NMDA channel antagonist, MK-801 on bilirubin neurotoxicity in vivo and in vitro. METHODS Bilirubin toxicity in vitro was assessed using trypan blue staining. Sulfadimethoxine injected (i.p.) jaundiced Gunn rat pups exhibit many neurological sequelae observed in human hyperbilirubinemia. Brainstem auditory-evoked potentials (BAEPs), a noninvasive sensitive tool to assess auditory dysfunction due to bilirubin neurotoxicity, were used to assess neuroprotection with MK-801 (i.p.) in vivo. RESULTS In primary cultures of hippocampal neurons, 20 min exposure to 64:32 microM bilirubin:human serum albumin reduced the cell viability by approximately 50% ten hours later. MK-801 treatment did not protect the cells. MK-801 pretreatment doses ranging from 0.1-4.0 mg/kg did not protect against BAEP abnormalities in Gunn rat pups 6 h after sulfadimethoxine injection. CONCLUSION Our findings suggest that bilirubin neurotoxicity is not mediated through NMDA receptor activation.
Collapse
MESH Headings
- Animals
- Animals, Newborn
- Anti-Infective Agents
- Bilirubin/adverse effects
- Cell Survival/drug effects
- Cell Survival/physiology
- Disease Models, Animal
- Dizocilpine Maleate/pharmacology
- Dose-Response Relationship, Drug
- Evoked Potentials, Auditory, Brain Stem/drug effects
- Evoked Potentials, Auditory, Brain Stem/physiology
- Hyperbilirubinemia/chemically induced
- Hyperbilirubinemia/complications
- Hyperbilirubinemia/physiopathology
- Jaundice/chemically induced
- Jaundice/complications
- Jaundice/physiopathology
- Kernicterus/etiology
- Kernicterus/physiopathology
- Kernicterus/prevention & control
- Neurons/drug effects
- Neurons/physiology
- Neuroprotective Agents/pharmacology
- Rats
- Rats, Gunn
- Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors
- Receptors, N-Methyl-D-Aspartate/physiology
- Sulfadimethoxine
Collapse
Affiliation(s)
- Steven M Shapiro
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298-0599, USA
| | | | | | | |
Collapse
|
29
|
Kochar DK, Kaswan K, Kochar SK, Sirohi P, Pal M, Kochar A, Agrawal RP, Das A. A comparative study of regression of jaundice in patients of malaria and acute viral hepatitis. J Vector Borne Dis 2006; 43:123-9. [PMID: 17024861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND & OBJECTIVES Jaundice is one of the common manifestations of severe malaria in adults. The purpose of this study is to compare the pattern of clinical and biochemical parameters such as serum bilirubin and liver enzyme levels in patients of malaria with jaundice and acute viral hepatitis. METHODOLOGY The present study was conducted on 34 patients of malaria with jaundice and 15 patients of acute viral hepatitis. Estimation of serum bilirubin, aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase was done daily using standard procedures in malaria patients and weekly in acute viral hepatitis patients. RESULTS Mean level of serum bilirubin on first day in malaria and acute viral hepatitis patients was 7.07 +/- 3.94 and 10.38 +/- 7.87 mg%, whereas on Day 8 it was 1.19 +/- 1.43 and 7.88 +/- 7.02 mg% respectively. Mean level of AST on Day 1 in malaria and acute viral hepatitis patients was 158.47 +/- 120.35 and 1418.6 +/- 834.11 IU/L, whereas on Day 8 it was 41 +/- 28.33 and 775.3 +/- 399.01 IU/L respectively. Mean level of ALT on Day 1 in malaria and acute viral hepatitis patients was 220.14 +/- 145.61 and 1666.67 +/- 1112.77 IU/L, whereas on Day 8 it was 50.85 +/- 37.31 and 823.8 +/- 475.06 IU/L respectively. Mean level of serum alkaline phosphatase on Day 1 in malaria and acute viral hepatitis patients was 394.74 +/- 267.78 and 513.4 +/- 324.7 IU/L, whereas on Day 8 it was 84.76 +/- 68.50 and 369.27 +/- 207.75 IU/L respectively. INTERPRETATION & CONCLUSION We observed that resolution of jaundice in malaria took 1-2 weeks in contrast 6 to 8 weeks in viral hepatitis. This difference in duration was statistically significant. Thus, jaundice not resolving in 1-2 weeks time in a patient of malaria requires serious consideration for presence of other concomitant diseases including viral hepatitis.
Collapse
Affiliation(s)
- D K Kochar
- Department of Medicine, S.P Medical College, Bikaner, India.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Rice AC, Shapiro SM. Biliverdin-induced brainstem auditory evoked potential abnormalities in the jaundiced Gunn rat. Brain Res 2006; 1107:215-21. [PMID: 16828065 DOI: 10.1016/j.brainres.2006.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 06/01/2006] [Accepted: 06/02/2006] [Indexed: 11/19/2022]
Abstract
Brainstem auditory evoked potential (BAEP) abnormalities occur in jaundiced Gunn rats given sulfadimethoxine to displace bilirubin bound to serum albumin, releasing it into the tissues. One problem with the model is that after displacement, plasma bilirubin levels drop and do not correlate with neurological dysfunction. In this report, we administered biliverdin, the immediate precursor of bilirubin, in 15- to 17-day-old Gunn rat pups to create an improved model of bilirubin-induced neurological dysfunction. Total plasma bilirubin (TB) levels were measured with a Leica bilirubinometer. Biliverdin (40 mg/kg) or phosphate-buffered saline (PBS) was administered either once and BAEPs recorded 8 h later or twice, 12 h apart, and BAEPs recorded 24 h after the initial injection. A single biliverdin injection produced a significantly decreased amplitude of BAEP wave III, 1.21+/-0.25 vs. 0.49+/-0.27 microV (control vs. biliverdin). The two-injection paradigm resulted in a significantly elevated TB (9.9+/-1.2 vs. 14.9+/-3.1 mg/dl; control vs. biliverdin), significant increases in I-II (1.15+/-0.08 vs. 1.42+/-0.09 ms) and I-III (2.17+/-0.08 vs. 2.5+/-0.13 ms) interwave intervals and a decrease in the amplitude of wave III (1.36+/-0.30 vs. 0.38+/-0.26 microV). Additionally, there were significant correlations between TB and the amplitude of wave III (r2=0.74) and TB and the I-III interwave interval (r2=0.51). In summary, biliverdin administration in jaundiced Gunn rat pups produces BAEP abnormalities consistent with those observed in the sulfadimethoxine model and human newborn hyperbilirubinemia and resulted in increased plasma bilirubin levels that correlate with the degree of neurological dysfunction.
Collapse
Affiliation(s)
- Ann C Rice
- Department of Neurology, Box 980599, Virginia Commonwealth University, Richmond, VA 23298-0599, USA.
| | | |
Collapse
|
31
|
Brienza N, Dalfino L, Cinnella G, Diele C, Bruno F, Fiore T. Jaundice in critical illness: promoting factors of a concealed reality. Intensive Care Med 2006; 32:267-274. [PMID: 16450099 DOI: 10.1007/s00134-005-0023-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 11/28/2005] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In critical illness, liver dysfunction (LD) is associated with a poor outcome independently of other organ dysfunctions. Since strategies to support liver function are not available, a timely and accurate identification of factors promoting LD may lead to prevention or attenuation of its consequences. The aim of this study was to assess risk factors for LD in critically ill patients. DESIGN Prospective, observational study. SETTING A multidisciplinary intensive care unit (ICU) of a university hospital. PATIENTS All patients consecutively admitted over a 6-month period. INTERVENTION None. MEASUREMENTS AND RESULTS LD was defined as serum bilirubin levels >or=2 mg/dl and lasting for at least 48 h. Out of 283 patients, 141 matched inclusion criteria. Forty-four patients (31.2%) showed LD (LD group), while 97 (68.8%) were included in control group (C group). A binomial analysis showed that LD occurrence was associated with moderate (odds ratio [OR] 3.11; p=0.04) and severe shock (OR 3.46; p= 0.05), sepsis (OR 3.03; p=0.04), PEEP ventilation (OR 4.25; p=0.006), major surgery (OR 4.03; p=0.03), and gram-negative infections (OR 3.94; p=0.002). In stepwise multivariate analysis, the single independent predictive factors of LD resulted in severe shock (p=0.002), sepsis (p=0.03), PEEP ventilation (p=0.04), and major surgery (p=0.05). CONCLUSIONS In critically ill patients jaundice is common, and severe shock states, sepsis, mechanical ventilation with PEEP and major surgery are critical risk factors for its onset. Since there is no specific treatment, prompt resuscitation, treatment of sepsis and meticulous supportive care will likely reduce its incidence and severity.
Collapse
Affiliation(s)
- Nicola Brienza
- Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy.
| | - Lidia Dalfino
- Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Gilda Cinnella
- Anaesthesia and Intensive Care Unit, University of Foggia, Foggia, Italy
| | - Caterina Diele
- Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Bruno
- Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Tommaso Fiore
- Emergency and Organ Transplantation Department, Anaesthesia and Intensive Care Unit, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| |
Collapse
|
32
|
Muratori L, Ferrari R, Muratori P, Granito A, Bianchi FB. Acute icteric hepatitis induced by a short course of low-dose cyclophosphamide in a patient with lupus nephritis. Dig Dis Sci 2005; 50:2364-5. [PMID: 16416192 DOI: 10.1007/s10620-005-3065-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
33
|
Rodríguez Hernández H, Franco Valles IS, Alvarez Santana G. [Jaundice-affected patient]. Rev Gastroenterol Mex 2005; 70 Suppl 3:43-4. [PMID: 17471857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
34
|
Naveau S, Perlemuter G, Balian A. [Epidemiology and natural history of cirrhosis]. Rev Prat 2005; 55:1527-32. [PMID: 16255293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The cirrhosis prevalence in the whole French population can be estimated between 2000 and 3300 cases/million of individuals. Alcoholism, hepatitis C virus and non alcoholic fatty liver disease are the three most common causes of cirrhosis in France. About 40% of patients with cirrhosis have compensated cirrhosis and are asymptomatic over long period of 1 to 10 years. Decompensation of cirrhosis was considered when a patient first developed one of the mayor complications of the disease (ascites, jaundice, encephalopathy or gastrointestinal haemorrhage). After the first decompensation, the incidence of death is about 10% by year, in the absence of hepatic transplantation. The mortality of patients with cirrhosis and acute varicose bleeding has greatly decreased over the past 2 decades in concurrence with an early and combined use of pharmacological and endoscopic therapy, but hepatocellular carcinoma is the most frequent life threatening complication.
Collapse
Affiliation(s)
- Sylvie Naveau
- Service hépato-gastroentérologie, hôpital Antoine Béclère, 92141 Clamart Cedex.
| | | | | |
Collapse
|
35
|
Abstract
Jaundice is not an unusual accompaniment of malaria. It can occur due to intravascular hemolysis, disseminated intravascular coagulation, and, rarely, 'malarial hepatitis'. Although the primary schizogony of the malarial parasite always leads to the rupture of the infected hepatocyte, alteration of the hepatic functions is uncommonly recorded due to this event. Histologically, the hepatitis or the actual inflammation in the liver has never been demonstrated. Nonetheless, the term 'malarial hepatitis' (MH) has been used in the literature to describe the occurrence of hepatocellular jaundice in patients with Plasmodium falciparum infection. The authors' own data and review of the literature indicate that it is not an uncommon entity. In endemic areas, jaundice is seen in approximately 2.5% of patients with falciparum malaria. It also appears to be a heterogeneous syndrome and one can recognize two clinical subsets. In one group there was an acute, virulent presentation with coma, renal failure and in some cases even hemorrhagic manifestations. It is only in this setting that jaundice signified a 'severe' disease as noted by the World Health Organization action program. This presentation is often confused with acute viral hepatitis and acute hepatic failure in non-endemic areas, but can be clinically differentiated.
Collapse
Affiliation(s)
- Anil C Anand
- Department of Medicine, Armed Forces Medical College, Pune, India.
| | | |
Collapse
|
36
|
Rhoton WA, Fede R, Sterling M, Klein KM. A fifty-five-year old-male with chronic icterus. N J Med 2004; 101:37-46. [PMID: 15605799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
|
37
|
Lao XM, Zhang YQ, Guan YX, Guo RP, Lin XJ, Yuan YF, Li JQ, Li GH. [Evaluation of liver reserve function by ICGR15 detection before hepatectomy for hepatocellular carcinoma]. Ai Zheng 2004; 23:1213-7. [PMID: 15473939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND & OBJECTIVE Accurate estimation of liver reserve function before hepatectomy for liver cancer may avoid postoperative liver failure. Recently,it has been considered that indocyanine green retention rate at 15 minutes (ICG(R15))can assess liver reserve function with exactitude and high sensitivity. This study was to discuss the evaluation of liver cirrhosis severity and liver reverse function by ICG(R15), analyze the relationship between ICG(R15) and post-operative liver failure,and compare ICG(R15) with Child-Pugh grading. METHODS Records of 225 patients with resected hepatocellular carcinoma (HCC)have been collected. Pre-operative data, such as a variety of routine liver biochemistry tests, Child-Pugh grading, and ICG(R15) value, and intra-operative data, post-operative data were analyzed. RESULTS The mean value of ICG(R15) was (9.9+/-6.2)% in cirrhosis group,and (7.4+/-3.8)% in non-cirrhosis group (P< 0.01). The mean value of ICG(R15) was (8.5+/-5.0)% in mild cirrhosis subgroup, (10.7+/-5.7)% in moderate cirrhosis subgroup, and (15.8+/-9.6)% in severe cirrhosis subgroup; significant differences can be observed while multiple comparisons were performed (P< 0.05). The mean values of ICG(R15) in patients who suffered from post-operative ascites, and jaundice were (11.5+/-6.8)%,and (12.1+/-7.1)%; significantly higher than those without ascites, and jaundice [(8.5+/-4.9)%,and (9.0+/-5.3)%] (P< 0.05). Possible predictor variables indicating risk factors of post-operative complications were entered into a multiple logistic regression model, the results showed that ICG(R15) significantly affected the occurrence of both post-operative ascites and jaundice (P< 0.05). The mean value of ICG(R15) of patients of Child-Pugh B grade was (15.2+/-8.6)%, much higher than that of patients of Child-Pugh A grade [(8.8+/-5.1)%](P< 0.01). ICG(R15) values were above 10% in 67 of the 212 patients of Child-Pugh A grade, and 6 of these 67 patients have a value above 20%. CONCLUSIONS ICG(R15) value rises with the aggravation of liver cirrhosis,it affects the occurrence of post-operative liver failure significantly. Some correlation can be observed between ICG(R15) and Child-Pugh grading.
Collapse
Affiliation(s)
- Xiang-Ming Lao
- Department of Hepatobiliary, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P.R.China
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
Liver involvement is usually a minor manifestation of Kawasaki disease and includes hepatobiliary dysfunction or gallbladder hydrops. We describe here an unusual case of jaundice revealing an adult onset Kawasaki disease. An 18-year-old man presented with abdominal pain and jaundice associated with cholestasis as the initial manifestation of Kawasaki disease. Abdominal evaluation (ultrasonography and CT-scan) did not find abnormality. Other signs typical of the Kawasaki disease occurred a few days later and permitted diagnosis. With aspirin and intravenous immunoglobulins, outcome was favorable without any cardiovascular complication. Our case suggests that Kawasaki disease should be added to the etiological list of painful febrile icterus in young patients.
Collapse
|
39
|
Roche SP, Kobos R. Jaundice in the adult patient. Am Fam Physician 2004; 69:299-304. [PMID: 14765767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders. Organizing the differential diagnosis by prehepatic, intrahepatic, and posthepatic causes may help make the work-up more manageable. Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin. Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. The conjugated (direct) bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders. Posthepatic disorders also can cause conjugated hyperbilirubinemia. Gallstone formation is the most common and benign posthepatic process that causes jaundice; however, the differential diagnosis also includes serious conditions such as biliary tract infection, pancreatitis, and malignancies. The laboratory work-up should begin with a urine test for bilirubin, which indicates that conjugated hyperbilirubinemia is present. If the complete blood count and initial tests for liver function and infectious hepatitis are unrevealing, the work-up typically proceeds to abdominal imaging by ultrasonography or computed tomographic scanning. In a few instances, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis.
Collapse
Affiliation(s)
- Sean P Roche
- Department of Family and Community Medicine, Albany Medical College, Albany, New York 12208, USA
| | | |
Collapse
|
40
|
Jawaid Q, Saeed ZA, Di Bisceglie AM, Brunt EM, Ramrakhiani S, Varma CR, Solomon H. Biliary-venous fistula complicating transjugular intrahepatic portosystemic shunt presenting with recurrent bacteremia, jaundice, anemia and fever. Am J Transplant 2003; 3:1604-7. [PMID: 14629294 DOI: 10.1046/j.1600-6135.2003.00267.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 50-year-old White man with noncirrhotic portal hypertension presented with bleeding from gastric varices. Bleeding was initially managed with band ligation and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Over the next few months, the patient had recurrent episodes of anemia, jaundice, fever and polymicrobial bacteremia. Computed tomography (CT) of the abdomen and chest, upper and lower endoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and echocardiography failed to explain the bacteremia and anemia. Follow-up CT scan and Doppler sonography 9 months after placement showed TIPS was occluded. Repeat ERCP showed a bile leak with free run-off of contrast from the left hepatic duct into a vascular structure. The patient's status was upgraded for liver transplantation with Regional Review Board agreement and subsequently received a liver transplant. Gross examination of the native liver demonstrated a fistula between the left bile duct and the middle hepatic vein. Pathologic evaluation confirmed focal necrosis of the left hepatic duct communicating with an occluded TIPS and nodular regenerative hyperplasia consistent with noncirrhotic portal hypertension. Infection is rarely reported in a totally occluded TIPS. Biliary fistulas in patent TIPS have been treated by endoluminal stent graft and endoscopic sphincterotomy with biliary stent placement. Liver transplantation may be the preferred treatment if TIPS becomes infected following its complete occlusion.
Collapse
Affiliation(s)
- Qaiser Jawaid
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
The liver has a number of important functions. It metabolises drugs and endogenous substances and contributes to their excretion by the body. Plasma proteins are synthesised in the liver which also acts as a storage organ for glycogen and vitamin B12. The liver is also important in the production of clotting factors for normal haemostatic function.
Collapse
Affiliation(s)
- M Greenwood
- Lecturer, Department of Oral and Maxillofacial Surgery, The Dental School, Framlington Place, Newcastle upon Tyne NE2 4BW.
| | | |
Collapse
|
42
|
Pelletier G, Roulot D, Davion T, Masliah C, Causse X, Oberti F, Raabe JJ, Van Lemmens C, Labadie H, Serfaty L. A randomized controlled trial of ursodeoxycholic acid in patients with alcohol-induced cirrhosis and jaundice. Hepatology 2003; 37:887-92. [PMID: 12668982 DOI: 10.1053/jhep.2003.50118] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of our multicenter study was to assess the efficacy of ursodeoxycholic acid (UDCA) on the survival of patients with alcohol-induced cirrhosis and jaundice. We included patients with histologically proven alcohol-induced cirrhosis and serum bilirubin >50 micromol/L. After randomization, patients received either UDCA (13-15 mg/kg/d) or a placebo for 6 months. Two hundred twenty-six patients (113 in each group) were included in 24 centers. There were 139 men and 87 women, mean age of 50.3 years. Seventy-four percent had associated alcohol-induced hepatitis, and 24% received a corticosteroid therapy. At inclusion, the 2 groups were comparable for the main clinical and biologic parameters, but serum bilirubin was higher in the UDCA group than in the placebo group (163 micromol/L vs. 145 micromol/L, P <.03). The percentage of patients lost at follow-up or who resumed their alcoholism during the study was comparable in the 2 groups. During the study, 55 patients died, 35 in the UDCA group and 20 in the placebo group. In the intention to treat analysis, the probability of survival at 6 months (Kaplan-Meier method) was lower in the UDCA than in the P group (69% vs. 82%, respectively; P =.04, log-rank test). After adjustment on the bilirubin level at entry (Cox model), the independent predictive value of the treatment group did not reach the statistical level (RR = 1.64, CI 0.85-2.85; P =.077). In conclusion, UDCA administered at the dose recommended in primary biliary cirrhosis has no beneficial effect on the 6-month survival of patients with severe alcohol-induced cirrhosis. An inappropriate dosage of UDCA cannot be excluded as an explanation for the lack of therapeutic benefit.
Collapse
Affiliation(s)
- Gilles Pelletier
- Department of Gastroenterology of Hôpital Bicêtre, Assistance Publique-Hôopitaux de Paris, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Podymova SD. [Differential diagnosis in jaundice]. Klin Med (Mosk) 2003; 81:66-71. [PMID: 14971162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
|
44
|
Payen JL, Rongières M. [History of hepatitis. I. From jaundice to viruses]. Rev Prat 2002; 52:2097-100. [PMID: 12602229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Jean-Louis Payen
- Services d'hépato-gastro-entérologie et d'orthopédie Hôpital Purpan 31059 Toulouse.
| | | |
Collapse
|
45
|
Sileri P, Morini S, Sica GS, Schena S, Rastellini C, Gaspari AL, Benedetti E, Cicalese L. Bacterial translocation and intestinal morphological findings in jaundiced rats. Dig Dis Sci 2002; 47:929-34. [PMID: 11991630 DOI: 10.1023/a:1014733226337] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The susceptibility to sepsis in obstructive jaundice may be related to bacterial translocation (BT) from the gastrointestinal tract. We evaluated BT to visceral organs and morphological changes of the intestinal mucosa in a rat model of obstructive jaundice. Animals were randomly divided into two groups: in group A the common bile duct was tied and divided, while group B had the bile duct mobilized but not tied. After seven days, peritoneal swabs and liver, spleen, pancreas, lung, mesenteric lymph nodes (MLN), cecum, and terminal ileum biopsies were obtained for cultures. Light and electron microscopy were performed on intestinal samples. The TUNEL assay was performed to detect apoptosis. Data were analyzed using Fisher exact test and Student t test. Bile duct obliteration resulted in an increased incidence of BT. Seven days after duct obliteration, BT to the peritoneal cavity was evident in 37.5% of the animals in group A and 25% in group B. The respective BT rates for the two groups were: 42.8% vs 37.5% to MLN, 71.4% vs 25% to liver, 42.8% vs 12.5% to spleen, 28.6% vs 0% to pancreas and 14.3% vs 0% to lungs. Despite a trend, this was not statistically significant. Cecal counts did not differ statistically among the groups, while ileal counts were significantly higher in jaundiced rats (P < 0.05). Structural and ultrastructural abnormalities were evident only in the mucosa of the terminal ileum of jaundiced rats. Apoptosis was significantly increased in the terminal ileum of jaundiced rats (P < 0.002). This study suggests the possible association of biliary obstruction and BT. The nonspecific physical injury observed may contribute to breakdown of gastrointestinal barrier function thus promoting BT.
Collapse
Affiliation(s)
- Pierpaolo Sileri
- Division of Transplantation, University of Illinois at Chicago, 60612, USA
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Oursler KA, Saladino AJ. Case records of the VA Maryland Healthcare System/University of Maryland Medicine. A 75-year-old man with right upper quadrant pain and gallstones. Am J Med Sci 2002; 323:146-50. [PMID: 11908859 DOI: 10.1097/00000441-200203000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kris Ann Oursler
- Department of Medicine, University of Maryland School of Medicine, VA Maryland Health Care System, Baltimore, USA
| | | |
Collapse
|
47
|
Lü W, Sun G. [Clinical characteristics of primary biliary cirrhosis with Sjögren's syndrome of 20 cases]. Zhonghua Nei Ke Za Zhi 2001; 40:747-9. [PMID: 11930680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Primary biliary cirrhosis (PBC) is a chronic non-suppurative destructive cholangitis of unknown etiology. It has been reported that patients with PBC suffer from xerostomia and keratoconjunctivitis at high prevalence and PBC has been shown to be associated with Sjögren's syndrome. This study investigated the relationship between PBC and Sjögren's syndrome. METHOD 20 cases diagnosed as PBC consented to the evaluation for Sjögren's syndrome which included clinical and serological features, Schirmer's test, measurement of parotid flow rate and labial minor salivary gland biopsy. RESULTS The main manifestations of PBC are jaundice, pruritus, hepatosplenomegaly. M2 subtype of antimitochondrial antibody is of great specificity for PBC. Many PBC patients are suffering from xerostomia and keratoconjunctivitis sicca but do not have typical serological and pathological presentations of primary Sjögren's syndrome. Corticosteroids and immunosuppressive agents have disappointing effects in the treatment. Ursodeoxycholic acid is effective to certain extent. CONCLUSION It was indicated that Sjögren's syndrome associated with PBC appears to be a secondary form differing from primary Sjögren's syndrome.
Collapse
Affiliation(s)
- W Lü
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | | |
Collapse
|
48
|
Abstract
The role of plasma bilirubin-albumin binding in the pathogenesis of kernicterus in human newborns is controversial. Kernicterus in the jaundiced (jj) Gunn rat pup, an animal model for kernicterus, prolongs interwave intervals and decreases wave amplitude in the auditory brainstem response (ABR). Plasma total bilirubin concentration (TBC), albumin concentration, and unbound bilirubin concentration (UBC), a measure of bilirubin-albumin binding, were measured in 16-day-old jj Gunn rat pups (n = 21) and compared with ABR wave latencies, interwave intervals, and wave amplitudes by linear correlation. The UBC, but not the TBC or TBC/albumin ratio, correlated positively and significantly with ABR I-II and I-III interwave intervals (r = 0.55, p = 0.009, and r = 0.60, p = 0.004, respectively). The UBC, but not the TBC or TBC/albumin ratio, predicts bilirubin toxicity, as measured by bilirubin-induced ABR changes in jj Gunn rat pups.
Collapse
Affiliation(s)
- C E Ahlfors
- Division of Neonatology, California Pacific Medical Center, San Francisco, CA, USA.
| | | |
Collapse
|
49
|
Sauter BV, Parashar B, Chowdhury NR, Kadakol A, Ilan Y, Singh H, Milano J, Strayer DS, Chowdhury JR. A replication-deficient rSV40 mediates liver-directed gene transfer and a long-term amelioration of jaundice in gunn rats. Gastroenterology 2000; 119:1348-57. [PMID: 11054394 DOI: 10.1053/gast.2000.19577] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS In the quest for a recombinant viral vector for liver-directed gene therapy that would permit both prolonged and efficient transgene expression in quiescent hepatocytes in vivo and repeated administration, we evaluated a recombinant simian virus 40 (rSV40). METHODS The rSV40 was generated through replacement of the DNA encoding for the T antigens (Tag) by the coding region of human bilirubin-uridine 5'-diphosphate-glucuronosyl-transferase (BUGT) complementary DNA (SV-hBUGT). Helper-free rSV40 units were generated at infectious titers of 5 x 10(9) to 1 x 10(10) infectious units (IU)/mL in a Tag-producing packaging cell line (COS-7 cells). RESULTS After 1, 3, or 7 daily infusions of 3 x 10(9) IU of SV-hBUGT through an indwelling portal vein catheter in bilirubin-UGT-deficient jaundiced Gunn rats, mean serum bilirubin concentrations decreased by 40%, 60% and 70%, respectively, in 3 weeks and remained at those levels throughout the duration of the study (40 days). Results of liver biopsies from SV-hBUGT-treated Gunn rats, but not from controls, were positive for human BUGT DNA, messenger RNA, and protein. Bilirubin-UGT activity in liver homogenates was 8%-12% of normal, and bilirubin glucuronides were excreted in bile. Immunostaining showed that >50%-60% of hepatocytes stably expressed the transgene. Portal vein infusion of an rSV40 expressing hepatitis B surface antigen (HBsAg) in a naive Gunn rat and a Gunn rat that had received 7 injections of SV-BUGT resulted in approximately equal levels of hepatic expression of HBsAg, indicating that multiple inoculations of SV-BUGT did not elicit neutralizing antibodies. Plasma alanine aminotransferase levels and liver histology remained normal despite repeated injections of rSV40. CONCLUSIONS rSV40 vectors may represent a significant advance toward gene therapy for metabolic diseases.
Collapse
Affiliation(s)
- B V Sauter
- Department of Medicine, Seaver Institute of Human Genetics, Albert Einstein College of Medicine, New York, New York, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
|