WorldWideScience

Sample records for experimental obstructive jaundice

  1. Effect of propolis on oxidative stress and histomorphology of liver tissue in experimental obstructive jaundice.

    Science.gov (United States)

    Kismet, K; Sabuncuoglu, M Z; Kilicoglu, S S; Kilicoglu, B; Devrim, E; Erel, S; Sunay, A E; Erdemli, E; Durak, I; Akkus, M A

    2008-01-01

    Propolis is a natural product collected by honey bees from various plant sources. We aimed to determine the possible effects of propolis on oxidative stress and hepatocyte apoptosis in experimental obstructive jaundice. Thirty rats were divided into three groups: group I, sham-operated; group II, ligation and division of the common bile duct (BDL); group III, BDL followed by oral supplementation of propolis in a daily dose of 100 mg/kg. Liver samples were examined under the light microscope and transmission electron microscope. Hepatocyte apoptosis was quantitated using the transferase-mediated uridine nick end labeling (TUNEL) assay. Plasma and liver malondialdehyde (MDA) levels and glutathione peroxidase (GSH-Px) activities were measured. The plasma and liver levels of MDA were significantly lower in the propolis group than in the BDL group (p propolis group than in the BDL group (p 0.05). In the propolis group, the enlargement of hepatocytes, dilatation of canaliculi and the edema regressed. The regenerating and normal hepatocytes were demonstrated. In the TUNEL assay, propolis administration reduced hepatocyte apoptosis. Propolis showed a significant hepatoprotective effect in this experimental obstructive jaundice model. 2008 S. Karger AG, Basel

  2. The Effect of Montelukast on Liver Damage in an Experimental Obstructive Jaundice Model.

    Science.gov (United States)

    Kuru, Serdar; Kismet, Kemal; Barlas, Aziz M; Tuncal, Salih; Celepli, Pinar; Surer, Hatice; Ogus, Elmas; Ertas, Ertugrul

    2015-04-01

    Montelukast is a cysteinyl-leukotriene type 1 (CysLT1) selective receptor antagonist. In recent years, investigations have shown that montelukast possesses secondary anti-inflammatory activities and also antioxidant effects. For this reason, we aimed to determine the possible effects of montelukast on liver damage in experimental obstructive jaundice. 30 Wistar-Albino male rats were randomized and divided into three groups of 10 animals each: group I, sham-operated; group II, ligation and division of the common bile duct (BDL) followed by daily intraperitoneal injection of 1 ml of saline; group III, BDL followed by daily intraperitoneal injection of 10 mg/kg montelukast dissolved in saline. The animals were killed on postoperative day 7 by high-dose diethyl ether inhalation. Blood and liver samples were taken for examination. In this study, liver malondialdehyde (MDA) (p = 0.001), myeloperoxidase (p = 0.003), and total sulfhydryl (SH) (p = 0.009) were found to be significantly different between the BDL + montelukast and the BDL groups. Plasma total SH (p = 0.002) and MDA (p = 0.027) values were also statistically different between these groups. Statistical analyses of histological activity index scores showed that the histopathological damage in the BDL + montelukast group was significantly less than the damage in the control group (p montelukast showed a significant hepatoprotective effect in this experimental obstructive jaundice model, which might be due to its antioxidant and anti-inflammatory activities.

  3. The protective effects of pomegranate on liver and remote organs caused by experimental obstructive jaundice model.

    Science.gov (United States)

    Yilmaz, E E; Arikanoğlu, Z; Turkoğlu, A; Kiliç, E; Yüksel, H; Gümüş, M

    2016-01-01

    We aimed to investigate the protective potential of pomegranate extract on the liver and remote organs in rats with obstructive jaundice. The rats were split into 4 groups. In Group 1 (G1) (sham group) rats, the common bile duct was mobilized without any ligation. Group 2 (G2) received a combination of the sham operation and synchronous treatment with pomegranate. Group 3 (G3) received common bile duct ligation (CBDL). Group 4 (G4) were subjected to CBDL and treatment with pomegranate. After 8 days, we measured total oxidative status (TOS) and antioxidant capacity in the rats' liver tissue and remote organs, and evaluated blood levels of malondialdehyde and total antioxidant capacity (TAC). G3 rats showed significantly raised malondialdehyde level as compared to G1 rats (p pomegranate therapy, a decrease in malondialdehyde was observed (p = 0.015). TAC levels were significantly raised in the G3 rats compared to the G1 rats (p = 0.004). TAC levels dropped after pomegranate therapy (p = 0.011). CBDL caused elevated TOS levels in the liver and remote organs, with a statistically significant increase in the lung tissue (p = 0.002). TOS levels in the CBDL groups decreased after pomegranate treatment (p pomegranate on the liver and remote organs in obstructive jaundice.

  4. Evaluation of the phagocitary capacity of the mononuclear system in an experimental model of obstructive jaundice employing Tc-99m Escherichia coli

    Energy Technology Data Exchange (ETDEWEB)

    Diniz, Simone Odilia Fernandes; Nelson, David Lee; Cardoso, Valbert Nascimento [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Farmacia]. E-mail: simone@farmacia.ufmg.br; Barbosa, Alfredo Jose Afonso; Araujo, Ivana Durval; Machado, Leonardo Augusto da Silva [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Medicina

    2005-10-15

    Infections and endotoxemia continue to be the principal causes of morbidity and mortality of patients with obstructions of the bile duct. The objective of the present work was the investigation of the phagocitary capacity of the mononuclear system in an experimental model of obstructive jaundice utilizing Tc-99m E.coli. The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were significantly higher in jaundiced rats than in the control animals (p < 0.001). The liver of the jaundiced animals presented a significant reduction in Tc-99m E.coli uptake when compared to the controls (p < 0.001). The data also showed that there was a significant increase in the uptake of Tc-99m E.coli by the lungs of jaundiced rats (p < 0.01). The histological analyses of the liver of jaundiced rats showed an intense and diffuse proliferation of the bile ducts and an intensified polyploidy of the hepatocytes (mean volume = 843 {mu}m{sup 3}), but no significant alterations were observed in the lungs of either group. This dates could contribute to a better understanding of the mechanisms involved in cases of bacteraemia, renal failure and pulmonary dysfunction observed in clinical analyses of obstructive jaundice.(author)

  5. Progress in surgical palliative treatment for malignant obstructive jaundice

    Directory of Open Access Journals (Sweden)

    LIANG Zhang

    2013-06-01

    Full Text Available Obstructive jaundice, also known as surgical jaundice, is divided into benign and malignant types. Most of the patients newly diagnosed with malignant obstructive jaundice have lost the opportunity of receiving radical surgery due to its insidious onset, so surgical palliative treatment is very important for patients with advanced malignant obstructive jaundice. This paper elaborates on various current modalities of surgical palliative treatment for malignant obstructive jaundice. Appropriate modality of surgical palliative treatment is of great significance for patients with advanced malignant obstructive jaundice.

  6. Alteration of the renal regulatory hormonal pattern during experimental obstructive jaundice Alteración del patrón hormonal regulatorio renal durante la ictericia obstructiva experimental

    Directory of Open Access Journals (Sweden)

    F. J Padillo

    2009-06-01

    Full Text Available Objective: the alteration of hormones regulating sodium and water status is related to renal failure in obstructive jaundice (OJ. Experimental design: OJ was induced by common bile duct ligation. Samples were obtained from the control (SO and OJ groups at 24 and 72 hours, and at 7 days. Different parameters related to biliary obstruction, liver and renal injury, and vasoactive mediators such as renin, aldosterone, endothelin-1 (ET-1 and prostaglandin E2 (PGE2 were studied. Results: bile duct ligation caused an increase in total bilirubin (p < 0.001 and alkaline phosphatase (AP (p < 0.001. The SO and OJ groups had the same values for diuresis, renin, and creatinine clearance at 24 h. However, animals with OJ had a lower sodium concentration in urine than SO animals (p < 0.01, as well as an increase in aldosterone levels (p < 0.03. ANP levels were moderately increased during OJ but did not reach statistical significance when compared to the SO group. In contrast, OJ animals showed a rise in serum ET-1 concentration (p < 0.001 and increased PGE2 in urine (p < 0.001. Conclusions: biliary obstruction induced an increase in ET-1 release and PGE2 urine excretion. These hormones might play a role during the renal complications associated with renal disturbances that occur during OJ.

  7. Translocação bacteriana para o rim na icterícia obstrutiva experimental Bacterial translocation to kidney in obstructive experimental jaundice

    Directory of Open Access Journals (Sweden)

    Aldo da Cunha Medeiros

    1997-06-01

    Full Text Available Estudo com o objetivo de verificar a possibilidade de ocorrência de translocação bacteriana para os rins de ratos, após ligadura de colédoco. Foram utilizados 29 ratos Wistar com peso médio de 171 ± 12,6g. Os animais foram divididos aleatoriamente em grupo I (n=14 e grupo II (n=15. Com técnica asséptica, nos ratos no grupo I foi feita ligadura de colédoco com fio de seda nº 3 zeros e no grupo II foi simulada a ligadura com a simples manipulação do colédoco com pinça de Adson ("sham operation". No 7º dia pós-operatório os animais foram sacrificados e ressecados os rins para exame histopatológico (coloração H.E. e microbiológico (meios agar sangue e agar MacConkey. Houve crescimento bacteriano de Klebsiela sp em 28,5% dos casos no grupo I e foram observadas alterações histopatológicas significativas no mesmo grupo. As diferenças foram estatisticamente significantes quando foram comparados os 2 grupos (pExperimental study in order to determine if obstructive jaundice promotes basterial translocation from the gastrointestinal tract to the kidney in rats. We used 29 Wistar male rats weighing 171±12,6g. They were ramdomly separated in goup I (n=14 and group II (n=15 and operated with asseptic technic. The group I underwent common bile ducts ligature with number 000 silk suture, and in group II (control the common bile ducts were manipulated with Adson forceps, as a sham operation. On 7th postoperative day the rats were killed with an overdose of anesthesic and had their kidneys resected. Portions of each kidney were harvested for quantitation of bacterial translocation and histopatologic examination. The incidance of bacterial translocation was 28,5% (Klebsiella sp in group I and 0% in group II (p<0,05. Intersticial edema, nephrosis and tubular degeneration were observed in group I and the histology was normal in group II. The authors conclude that obstructive ajundice promotes bacterial translocation to the kidney

  8. Internal endoprosthesis as treatment of obstructive jaundice in pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Burcharth, F.; Holst Pedersen, J.

    1981-03-01

    In five patients with pancreatitis, obstructive jaundice was relieved by internal drainage of the biliary tract with an endoprosthesis inserted by percutaneous transhepatic technique. The average duration of treatment was 3.5 months. The endoprosthesis was removed by means of a duodenoscope, and jaundice did not recur.

  9. Murine model of long-term obstructive jaundice.

    Science.gov (United States)

    Aoki, Hiroaki; Aoki, Masayo; Yang, Jing; Katsuta, Eriko; Mukhopadhyay, Partha; Ramanathan, Rajesh; Woelfel, Ingrid A; Wang, Xuan; Spiegel, Sarah; Zhou, Huiping; Takabe, Kazuaki

    2016-11-01

    With the recent emergence of conjugated bile acids as signaling molecules in cancer, a murine model of obstructive jaundice by cholestasis with long-term survival is in need. Here, we investigated the characteristics of three murine models of obstructive jaundice. C57BL/6J mice were used for total ligation of the common bile duct (tCL), partial common bile duct ligation (pCL), and ligation of left and median hepatic bile duct with gallbladder removal (LMHL) models. Survival was assessed by Kaplan-Meier method. Fibrotic change was determined by Masson-Trichrome staining and Collagen expression. Overall, 70% (7 of 10) of tCL mice died by day 7, whereas majority 67% (10 of 15) of pCL mice survived with loss of jaundice. A total of 19% (3 of 16) of LMHL mice died; however, jaundice continued beyond day 14, with survival of more than a month. Compensatory enlargement of the right lobe was observed in both pCL and LMHL models. The pCL model demonstrated acute inflammation due to obstructive jaundice 3 d after ligation but jaundice rapidly decreased by day 7. The LHML group developed portal hypertension and severe fibrosis by day 14 in addition to prolonged jaundice. The standard tCL model is too unstable with high mortality for long-term studies. pCL may be an appropriate model for acute inflammation with obstructive jaundice, but long-term survivors are no longer jaundiced. The LHML model was identified to be the most feasible model to study the effect of long-term obstructive jaundice. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Effect of melatonin on myocardial oxidative stress induced by experimental obstructive jaundice Efecto de la melatonina en el estrés oxidativo del miocardio en un modelo experimental de obstrucción biliar

    Directory of Open Access Journals (Sweden)

    A. Cruz

    2009-07-01

    Full Text Available Objective: melatonin has been demonstrated to have active antioxidant properties in different tissues during experimental cholestasis. The aim of this research was to study myocardial oxidative stress on obstructive jaundice, and to analyze the effect of melatonin on myocardial oxidative lesions. Material and methods: we achieved cholestasis by ligature and sectioning of the main bile duct. Melatonin was administered intraperitoneally (500 µg/kg/day. We measured malondialdehyde (MDA, reduced glutathione (GSH, catalase (CAT, superoxide dismutase (SOD and glutathione peroxydase (GPx antioxidant enzyme levels in the heart tissue. Results: obstructive cholestasis increased MDA and decreased GSH as well as all antioxidant enzymes. Melatonin administration significantly decreased MDA values, and increased GSH and antioxidant enzymes on the icteric animal myocardium. Conclusions: melatonin treatment prevents oxidative stress in the cardiac tissue as induced by experimental cholestasis.

  11. [Portal hypertensive biliopathy--an unusual cause of obstructive jaundice].

    Science.gov (United States)

    Carlebach, Matthias

    2012-12-01

    Biliary symptoms may be an unusual presentation of portal hypertension, especiaLly in patients with portal vein thrombosis. This is a case report of a patient who developed acute and chronic portal vein thrombosis that presented as obstructive jaundice. The discussion will focus on diagnostic modalities and therapeutic options.

  12. Management of Patients with Obstructive Jaundice: Experience in a ...

    African Journals Online (AJOL)

    About 47% of the patients had cholecysto jejunostomy and operative mortality was 15.6%. Conclusion: Carcinoma head of pancreas is the commonest cause of obstructive jaundice in Nigeria with many of the patients in the 6th decade. Diagnosis and management continue to be a challenge especially as a result of late ...

  13. Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

    NARCIS (Netherlands)

    van der Gaag, N.A.; Kloek, J.J.; de Castro, S.M.M.; Busch, O.R.C.; van Gulik, T.M.; Gouma, D.J.

    2009-01-01

    Preoperative biliary drainage (PBD) has been introduced to improve outcome after surgery in patients suffering from obstructive jaundice due to a potentially resectable proximal or distal bile duct/pancreatic head lesion. In experimental models, PBD is almost exclusively associated with beneficial

  14. Identification of bile survivin and carbohydrate antigen 199 in distinguishing cholangiocarcinoma from benign obstructive jaundice.

    Science.gov (United States)

    Liu, Yanfeng; Sun, Jingxian; Zhang, Qiangbo; Jin, Bin; Zhu, Min; Zhang, Zongli

    2017-01-01

    To investigate whether bile survivin and carbohydrate antigen 199 (CA199) can be helpful in distinguishing cholangiocarcinoma (malignant obstructive jaundice) from benign obstructive jaundice. Receiver operating characteristic curve was used to evaluate the feasibility of bile survivin and CA199 in differentiating cholangiocarcinoma from benign obstructive jaundice. The area under the curve for survivin and CA199 in bile and serum were 0.780 (p jaundice.

  15. Biliary intervention for malignant obstructive jaundice; Treatment through PTCD fistula

    Energy Technology Data Exchange (ETDEWEB)

    Naoi, Yutaka (Juntendo Univ., Tokyo (Japan). School of Medicine); Suzuki, Fuminao

    1990-10-01

    Currently, diagnosis of obstructive jaundice has become easier with CT and USEG, and percutaneous transhepatic cholangialdrainage (PTCD) for obstructive jaundice has also become much safer using USEG control. We have performed PTCD in 277 cases, from December 1976 to May 1989 at Saitama Cancer Center with specially designed thin needle. And using a PTCD fistula, we have been attempted radiotherapy for 7 cases of the bile duct cancer using Remoto After Loading System (RALS), and hyperthermia for 5 cases of bile duct cancer using antenna of microwaves. From autopsy cases, we evaluated treated lesion pathologically, and we obtained the following results. Dosage of biliary RALS need up to 50 Gy at the point of 1 cm from {sup 60}Co sourse. Biliary hyperthermia using microwave seem to be unsuccessful, and further improvement to the antenna of microwave were necessary. Furthermore, we have attempted biliary endoprosthesis 27 cases, for better quality of life to the patients with malignant obstructive jaundice. These methods seem to be effective in prolonging patient's lives, comparing of cases in which PTCD of an external fistula has been performed. (author).

  16. Mortality-related Factors in Patients with Malignant Obstructive Jaundice.

    Science.gov (United States)

    Kurniawan, Juferdy; Hasan, Irsan; Gani, Rino Alvani; Simadibrata, Marcellus

    2016-10-01

    to obtain survival rate and mortality-related factors of malignant obstructive jaundice patients. all medical records of obstructive jaundice inpatient at Cipto Mangunkusumo Hospital, Jakarta from January 2010 to December 2013 were reviewed retrospectively. The following factors were analyzed in terms of mortality: age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid factors. total 181 out of 402 patients were enrolled in this study with male proportion was 58.6%, and patients aged 50 years or above was 57.5%. Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and Charlson comorbid score ≥4 were independent predictors of mortality. Patients with significant prognostic factors had median survival 14 days compared with overall median survival 26 days. Score ≥2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. sepsis, unsuccessful or no prior bilirary drainage, and Charlson comorbid score ≥4 are factors significantly associated with shortened survival in malignant obstructive jaundice patients. Prognostic score  ≥2 was determined to classify patients into high risk mortality group. Mortality of patients with those significant prognostic factors can be predicted in 76.9%.

  17.  Papillary Cystadenocarcinoma of Ovary Presenting as Obstructive Jaundice: A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Sunil Kumar

    2012-03-01

    Full Text Available  Obstructive jaundice resulting from malignancy of gastrointestinal tract and hepatobiliary tract has been reported in various studies. Ovarian malignancy leading to obstructive jaundice due to portal lymphadenopathy is of rare occurrence. We report a case presented with obstructive jaundice and on further evaluation, found to have ovarian papillary cyst adenocarcinoma with secondaries at porta hepatis which was managed successfully by neoadjuvant chemotherapy followed by cytoreductive surgery.

  18. Pre-operative biliary drainage for obstructive jaundice

    Science.gov (United States)

    Fang, Yuan; Gurusamy, Kurinchi Selvan; Wang, Qin; Davidson, Brian R; Lin, He; Xie, Xiaodong; Wang, Chaohua

    2014-01-01

    Background Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient. Objectives To assess the benefits and harms of pre-operative biliary drainage versus no pre-operative biliary drainage (direct surgery) in patients with obstructive jaundice (irrespective of a benign or malignant cause). Search methods We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2012. Selection criteria We included all randomised clinical trials comparing biliary drainage followed by surgery versus direct surgery, performed for obstructive jaundice, irrespective of the sample size, language, and publication status. Data collection and analysis Two authors independently assessed trials for inclusion and extracted data. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on the available patient analyses. We assessed the risk of bias (systematic overestimation of benefit or systematic underestimation of harm) with components of the Cochrane risk of bias tool. We assessed the risk of play of chance (random errors) with trial sequential analysis. Main results We included six trials with 520 patients comparing pre-operative biliary drainage (265 patients) versus no pre-operative biliary drainage (255 patients). Four trials used percutaneous transhepatic biliary drainage and two trials used endoscopic sphincterotomy and stenting as the method of pre-operative biliary drainage. The risk of bias was high in all trials. The proportion of patients with malignant obstruction varied between 60

  19. Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis.

    Science.gov (United States)

    Manterola, Carlos; Otzen, Tamara

    One of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. A total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.

  20. Assessment of bacterial translocation in obstructive jaundice using Tc-99m Escherichia coli

    Energy Technology Data Exchange (ETDEWEB)

    Diniz, Simone Odilia Fernandes; Nelson, David Lee [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Farmacia]. E-mail: simone@farmacia.ufmg.br; Barbosa, Alfredo Jose Afonso; Araujo, Ivana Durval; Machado, Leonardo Augusto da Silva [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Medicina; Bernardo Filho, Mario [Universidade do Estado, Rio de Janeiro, RJ (Brazil). Dept. de Biofisica e Biometria

    2005-10-15

    In obstructive jaundice, the passage of bacteria and endotoxins through the intestine wall to reach the systemic circulation is associated with septicemia, renal failure and pulmonary dysfunction. The aim of this work was to investigate bacterial translocation utilizing {sup 99m} Tc-E.coli in an experimental model of obstructive jaundice. The levels of bilirubin in rats that were subjected to ligature of the bile duct were significantly increased when compared to control animals (p < 0.001). The biodistribution results did not show any translocation of {sup 99m} Tc-E.coli to the mesenteric lymphatic nodules, liver, spleen or lungs of the rats that suffered ligature of the bile duct (p > 0.05). The evaluation of the intestinal permeability using 'per os' administration of {sup 99m} Tc-DTPA showed 1.61 {+-} 0.57% and 1.39 {+-} 0.72% of radioactivity in the urine of the control and jaundice animals, respectively. The histological analysis of the distal wall of the ileum showed that the covering epithelium and the crypt were morphologically preserved in both groups. The seven-day period after the ligature of the bile duct may not have been long enough to promote modifications in intestinal wall to occur so as to permit the passage of Tc-99m E.coli. (author)

  1. Objectification of facial color inspection to differentiate obstructive/nonobstructive jaundice in neonates by spectrophotometer.

    Science.gov (United States)

    Shen, Zhen; Zheng, Shan; Dong, Rui; Chen, Gong

    2017-12-01

    The purpose of this study was to study whether color difference in facial color truly exists between neonates with obstructive and nonobstructive jaundice, and whether the color difference could be objectified by spectrophotometer. Twelve biliary atresia patients were enrolled in an obstructive jaundice group and 15 neonates admitted for non-conjugated hyperbilirubinemia in a nonobstructive group. Nine patients with syphilis (n=6) and sacrococcygeal teratoma (n=3) were studied as control. Transcutaneous total bilirubin (TB) and hemoglobin were recorded. Face color was measured by spectrophotometer. Spectral reflection curve and L*a*b* model parameters were studied. Facial color of jaundiced neonates were characteristic in waveform that reflectivity at wavelength of 550nm was significantly decreased compared with control by 16.4±3.4%, while not significantly different between obstructive and nonobstructive jaundice (p=0.124). At 650nm, reflection in nonobstructive jaundice was decreased by 8.4±2.3% (pL*a*b* model, mean color difference between obstructive and nonobstructive jaundice was 9.60. L* was significantly different: control (71.84±3.75%)>obstructive jaundice (58.09±1.25%)>nonobstructive jaundice (54.25±7.27%). Value b* was higher in jaundiced patients compared to normal control (11.88±2.16, p<0.001), but not significantly different in obstructive and nonobstructive jaundice (20.12±2.17vs18.25±4.58). Value a* was not significantly different between normal control (5.57±2.38) and obstructive jaundice (5.25±1.19), but was lower than nonobstructive jaundice (14.03±3.29, p<0.001). TB was significantly correlated with b* (R=0.526, p=0.014), while hemoglobin was correlated with a* (R=0.791, p<.001) and L* (R=-0.707, p<.001). Obstructive and nonobstructive jaundice could be objectively differentiated through facial color inspection by spectrophotometer. Study of Diagnostic Test. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Endoscopic internal biliary drainage in a child with malignant obstructive jaundice caused by neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tadao; Yoshida, Hideo; Matsunaga, Tadashi; Kouchi, Katunori; Ohtsuka, Yasuhiro; Ohnuma, Naomi [Department of Paediatric Surgery, Chiba University, School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677 (Japan); Tsuyuguchi, Toshio; Yamaguchi, Taketo; Saisho, Hiromitsu [First Department of Internal Medicine, Chiba University School of Medicine, Chiba (Japan)

    2003-02-01

    We describe a 13-year-old girl who underwent insertion of a Flexima biliary stent for obstructive jaundice due to compression of the extrahepatic bile duct by an enlarged lymph node secondary to neuroblastoma. This novel endoscopic internal biliary drainage procedure was safe and effective even for a child, and improved her quality of life. We further review other treatment options available for malignant obstructive jaundice in children. (orig.)

  3. Metastatic Breast Cancer to the Common Bile Duct Presenting as Obstructive Jaundice

    Directory of Open Access Journals (Sweden)

    Justin Cochrane

    2015-07-01

    Full Text Available Metastatic breast cancer is typically identified in the bones, lymph nodes, lungs and liver. Rarely does metastatic breast cancer involve the common bile duct (CBD without direct extension from liver metastasis into the CBD. We present a woman diagnosed with metastatic breast cancer in the CBD after presenting with obstructive jaundice. Patients with a history of primary breast cancer who present with obstructive jaundice secondary to CBD mass need identification of the mass in order to provide appropriate treatment.

  4. Jaundice

    Science.gov (United States)

    ... causes jaundice. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. As red blood cells break down, your body builds new cells to replace them. The old ones are processed by the liver. If the liver cannot handle the blood cells ...

  5. Tactics and Surgical Treatment of Obstructive Jaundice of Different Etiology

    Directory of Open Access Journals (Sweden)

    V.M. Ratchik

    2014-12-01

    Full Text Available In the department of surgery of the digestive organs of State institution «Institute of gastroenterology of National aca-demy of medical sciences of Ukraine» for the period from 2003 to 2013, 567 patients with pathology of the hepatopancreatobiliary zone of different etiology, complicated with obstructive jaundice, underwent surgery. 197 (34.7 % patients with bilirubinemia more than 200 µmol/l and III degree of liver failure underwent two-stage treatment. Endoscopic (two-step techniques were applied for the treatment of 143 (25.2 % patients with choledocholithiasis. One-step minimally invasive interventions — laparoscopic cholecystectomy, external drainage of the common bile duct, lithoextraction, balloon dilatation of the sphincter of Oddi — implemented in 41 (10.4 % patients. In complications chronic pancreatitis, draining surgeries were performed in 20 (25.6 % patients and resection-draining — in 39 (50.0 %, with the correction of bile outflow, as well as endoscopic, laparoscopic and minimally invasive puncture-draining operations were carried out. 2 (2.6 % patients underwent pancreatoduodenectomy by Whipple. Two-stage surgeries were performed in 26 (33.3 % patients. At tumors of cholangiopancreatoduodenal zone, 18 (30.5 % patients underwent percutaneous endobiliary reducing interventions followed by radical surgery in 10 (16.9 % patients.

  6. Outcomes in Patients with Obstructive Jaundice from Metastatic Colorectal Cancer and Implications for Management

    Science.gov (United States)

    Nichols, Shawnn D.; Albert, Scott; Shirley, Lawrence; Schmidt, Carl; Abdel-Misih, Sherif; El-Dika, Samer; Groce, J. Royce; Wu, Christina; Goldberg, Richard M.; Bekaii-Saab, Tanios; Bloomston, Mark

    2016-01-01

    Introduction Patients with metastatic colorectal cancer can develop jaundice from intrahepatic or extrahepatic causes. Currently, there is little data on the underlying causes and overall survival after onset of jaundice. The purpose of this study was to characterize the causes of jaundice and determine outcomes. Methods Six hundred twenty-nine patients treated for metastatic colorectal cancer between 2004 and 2010 were retrospectively reviewed. Those developing jaundice were grouped as having intrahepatic or extrahepatic obstruction. Demographics, clinicopathologic, and outcome data were analyzed. Results Sixty-two patients with metastatic colorectal cancer developed jaundice. Intrahepatic biliary obstruction was most common, occurring in younger patients. Time from metastatic diagnosis to presentation of jaundice was similar between groups, as was the mean number of prior lines of chemotherapy. Biliary decompression was successful 41.7 % of the time and was attempted more commonly for extrahepatic causes. Median overall survival after onset of jaundice was 1.5 months and it was similar between groups, but improved to 9.6 months in patients who were able to receive further chemotherapy. Conclusions Jaundice due to metastatic colorectal cancer is an ominous finding, representing aggressive tumor biology or exhaustion of therapies. Biliary decompression is often difficult and should only be pursued when additional treatment options are available. PMID:25300799

  7. [Effect of artenisiae scopariae and poriae powder on calpain-2 expression in liver tissue from rats with obstructive jaundice].

    Science.gov (United States)

    Cui, Yubao

    2015-05-01

    To explore the eff ect of artenisiae scopariae and poriae powder (ASPD) on calpain-2 expression in liver tissue from rats with obstructive jaundice. The rat model of obstructive jaundice was established. SD rats was divided into the control group, the obstructive jaundice group, the obstructive jaundice model plus ASPD group, the obstructive jaundice model plus saline group. Th e serum levels of TBIL, ALT, AST and other biochemical indexes were detected. The pathological changes of liver tissue were evaluated by HE staining. The calpain-2 mRNA and protein expression in liver was measured by Real-time PCR and immunohistochemistry or Western blot, respectively. The calpain-2 mRNA and protein expression levels were significantly up-regulated in live tissues from the rats with obstructive jaundice in a time-dependent manner. The ASPD could inhibit the calpain-2 expression in rats with obstructive jaundice concomitant with the decreased liver damage and the improved liver function, suggesting that calpain-2 was involved in endoplasmic reticulum stress-mediated cellular apoptosis and the occurrence of obstructive jaundice. ASPD could be used for patients with obstructive jaundice to promote the recovery of liver function after operation and to reduce the incidence of complications, which provide a theoretical basis for the reasonable application of traditional Chinese medicine in the peroperative period.

  8. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice

    DEFF Research Database (Denmark)

    Andersen, J R; Sørensen, S M; Kruse, A

    1989-01-01

    In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic cholangi......In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic...... cholangiography 50 patients were randomised to the two treatment alternatives. All 25 patients randomised to endoprosthesis were treated by this procedure, whereas only 19 of 25 patients randomised to bypass surgery underwent operative biliary-digestive anastomosis. Life table analysis revealed no difference...... in survival between treatment groups or randomisation groups. No differences were found when other variables were compared. We conclude, that palliation of obstructive jaundice in malignant bile duct obstruction with endoscopically introduced endoprosthesis is as effective as operative bypass....

  9. The efficacy of endoscopic palliation of obstructive jaundice in hepatocellular carcinoma.

    Science.gov (United States)

    Park, Semi; Park, Jeong Youp; Chung, Moon Jae; Chung, Jae Bock; Park, Seung Woo; Han, Kwang-Hyub; Song, Si Young; Bang, Seungmin

    2014-09-01

    Obstructive jaundice in patients with hepatocellular carcinoma (HCC) is uncommon (0.5-13%). Unlike other causes of obstructive jaundice, the role of endoscopic intervention in obstructive jaundice complicated by HCC has not been clearly defined. The aim of this study was to evaluate the clinical characteristics of obstructive jaundice caused by HCC and predictive factors for successful endoscopic intervention. From 1999 to 2009, 54 patients with HCC who underwent endoscopic intervention to relieve obstructive jaundice were included. We defined endoscopic intervention as a clinical success when the obstructive jaundice was relieved within 4 weeks. Clinical success was achieved in 23 patients (42.6%). Patients in the clinical success group showed better Child-Pugh liver function (C-P grade A or B/C; 17/6 vs. 8/20), lower total bilirubin levels (8.1±5.3 mg/dL vs. 23.1±10.4 mg/dL) prior to the treatment, and no history of alcohol consumption. The only factor predictive of clinical success by multivariate analysis was low total bilirubin level at the time of endoscopic intervention, regardless of history of alcohol consumption [odds ratio 1.223 (95% confidence interval, 1.071-1.396), p=0.003]. The cut-off value of pre-endoscopic treatment total bilirubin level was 12.8 mg/dL for predicting the clinical prognosis. Median survival after endoscopic intervention in the clinical success group was notably longer than that in the clinical failure group (5.6 months vs. 1.5 months, p≤0.001). Before endoscopic intervention, liver function, especially total bilirubin level, should be checked to achieve the best clinical outcome. Endoscopic intervention can be helpful to relieve jaundice in well selected patients with HCC.

  10. Small simple hepatic cysts causing obstructive jaundice: a case report of sclerotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Ji; Song, Soon Young; Koh, Byung Hee; Cho, On Koo [Hanyang University College of Medicine, Hanyang University Hospital, Seoul (Korea, Republic of); Kim, Yong Soo [Hanyang University Guri Hospital, Guri (Korea, Republic of)

    2007-10-15

    A 62-year-old man visited our hospital for a regular follow-up of a known liver cirrhosis. Laboratory tests revealed recently elevated total and direct bilirubin levels. Imaging studies showed two small hepatic cysts (2.7 and 2.9 cm in the largest diameter) compressing both central intrahepatic ducts, respectively. Obstructive jaundice caused by the cysts was diagnosed. Sclerotherapy of the cysts was performed with 100% ethanol after aspiration of the cyst contents. An follow-up CT obtained after 3 months showed decreased cyst size and improved bile duct dilatation. It is known that obstructive jaundice due to a hepatic cyst is rare, and the cysts were unusually large and centrally located. We report a case of obstructive jaundice caused by very small hepatic cysts that was successfully treated with sclerotherapy.

  11. Comparison Of Ultrasound Evaluation Of Patients Of Obstructive Jaundice With Endoscopic Retrograde Cholangio-Pancreatography Findings.

    Science.gov (United States)

    Farrukh, Syed Zea-Ul-Islam; Siddiqui, Arif Rasheed; Haqqi, Syed Afzal; Muhammad, Asif Jan; Dheddi, Abdul Samad; Khalid, Saad Khalid

    2016-01-01

    Ultrasonography has proven to be quite effective in differentiating hepatocellular from obstructive cause of jaundice in various studies. This study was conducted with the aim to determine the efficacy of ultrasonography and Endoscopic Retrograde Cholangio-Pancreatography (ERCP) in the diagnosis of obstructive reason of jaundice. In this descriptive case series, 200 patients with >15 years age of either gender with cholestatic liver enzymes were included, i.e., those patients who had an ultrasound prior to ERCP at the department of gastroenterology of Patel Hospital, Karachi. Patients known to have liver disease with cholestatic jaundice had imaging other than ultrasound were excluded. The results of ultrasonography and ERCPs were compared in particularly looking for the cause of obstruction. Out of total 200 patients, mean age was 41.22±12.46 years with 107 (53.5%) females. Ability of ultrasound in correctly diagnosing obstructive reason for stone CBD was found to be 72.5%, dilated CBD without reason 41.7%, proximal obstruction, 63.15%, distal CBD obstruction 60%, and sludge 66.7%. Overall ability of ultrasound in correctly diagnosing the cause of obstruction was 64.17%. Ultrasound is recommended as the initial examination, which provides a guide to choose patients for either a more advanced noninvasive imaging like MRCP or to an invasive procedure like ERCP.

  12. MALIGNANT OBSTRUCTIVE JAUNDICE: A STUDY OF INVESTIGATIVE PARAMETERS AND ITS OUTCOME

    Directory of Open Access Journals (Sweden)

    Tilakdas S. Shetty

    2016-08-01

    Full Text Available BACKGROUND Obstructive jaundice is a surgical condition that occurs when there is an obstruction to the passage of conjugated bilirubin from the liver cells to the intestine. This study has studied five clinical and nine laboratory parameters in patients presenting with malignant obstructive jaundice along with their radiological findings. By studying these parameters, the prognosis of patients with malignant obstructive jaundice and the best possible intervention could be predicted. AIM To study the various aetiopathological aspects associated with obstructive jaundice and investigative parameters of these patients thereby evaluating the prognosis. MATERIALS AND METHODS This observational study has been conducted in a tertiary institute by collecting data of 50 cases of malignant obstructive jaundice admitted to the surgical wards of BYL Nair Hospital from August 2011 to August 2014 with followup of 3 months to obtain mortality data. Male and female patients above 18 years and below 80 years of age with histologically proven malignant obstructive jaundice were included as part of this study. Data of retrospective cases were obtained from Medical Record section without disclosing the address or identification of the patient. RESULTS In this study, a total of 50 cases of histologically proven malignant obstructive jaundice were evaluated. 50 patients were studied out of which 33 were male and 17 were female. Majority of the patients were in the age group of 61-70 years i.e. 21 of them. 11 patients were between 41-50 years of age, 10 were less than 40 years of age and 8 were between 51-60 years. The most common presentation of the patients was with yellowish discolouration of sclera and urine (YDS/YDU seen in 44 patients followed by pruritus seen in 38 patients. Dilated Common Bile Duct with/without pancreatic duct dilatation was the most common finding on sonography followed by a mass seen in the head of the pancreas. Moderately differentiated

  13. Assessment of bacterial translocation in obstructive jaundice using Tc-99m Escherichia coli

    Directory of Open Access Journals (Sweden)

    Simone Odília Fernandes Diniz

    2005-10-01

    Full Text Available In obstructive jaundice, the passage of bacteria and endotoxins through the intestine wall to reach the systemic circulation is associated with septicemia, renal failure and pulmonary dysfunction. The aim of this work was to investigate bacterial translocation utilizing 99mTc-E.coli in an experimental model of obstructive jaundice. The levels of bilirubin in rats that were subjected to ligature of the bile duct were significantly increased when compared to control animals (p 0.05. The evaluation of the intestinal permeability using "per os" administration of 99mTc-DTPA showed 1.61 ± 0.57% and 1.39 ± 0.72% of radioactivity in the urine of the control and jaundice animals, respectively. The histological analysis of the distal wall of the ileum showed that the covering epithelium and the crypt were morphologically preserved in both groups. The seven-day period after the ligature of the bile duct may not have been long enough to promote modifications in intestinal wall to occur so as to permit the passage of Tc-99m E.coli.Na icterícia obstrutiva, a passagem de bactérias e endotoxinas através da parede intestinal alcançando a circulação sistêmica está associada com septicemia, falência renal e disfunção pulmonar. A proposta deste trabalho foi investigar a translocação bacteriana, empregando a Tc-99m E.coli, em um modelo experimental de icterícia obstrutiva. Os níveis de bilirrubina nos ratos que sofreram a ligadura do ducto biliar estavam significativamente aumentados quando comparados com os valores dos animais controles (p0,05. A avaliação da permeabilidade intestinal usando a administração "per os" de 99mTc-DTPA mostrou um percentual de eliminação deste radiofármaco na urina de 1,61±0,57 e 1,39±0,72 para os animais controles e ictéricos, respectivamente. A análise histológica da parede distal do íleo mostrou que tanto o epitélio de revestimento quanto as criptas apresentaram morfologicamente conservados em ambos os

  14. Obstructive jaundice as a long-term complication in a patient with liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Boll, D.; Thoeni, R.F.

    1981-07-15

    Obstructive jaundice related to stricture and stone in cystic duct was found in a patient 6 years after liver transplantation and cholecystojejunostomy. Complications with biliary drainage following liver transplantation are discussed. In the presence of dilated ducts seen by ultrasound, percutaneous transhepatic cholangiography performed immediately can lead to surgical correction, thus preventing failure of the liver transplant.

  15. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice

    DEFF Research Database (Denmark)

    Andersen, J R; Sørensen, S M; Kruse, A

    1989-01-01

    cholangiography 50 patients were randomised to the two treatment alternatives. All 25 patients randomised to endoprosthesis were treated by this procedure, whereas only 19 of 25 patients randomised to bypass surgery underwent operative biliary-digestive anastomosis. Life table analysis revealed no difference...... in survival between treatment groups or randomisation groups. No differences were found when other variables were compared. We conclude, that palliation of obstructive jaundice in malignant bile duct obstruction with endoscopically introduced endoprosthesis is as effective as operative bypass....

  16. Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography.

    Science.gov (United States)

    Chen, Chien-Hua; Yang, Chi-Chieh; Yeh, Yung-Hsiang; Yang, Tsang; Chung, Tieh-Chi

    2015-09-01

    Ultrasonography (US) cannot demonstrate all the etiologies of biliary tract dilatation in patients with jaundice. Thus, we evaluated the etiologic yield of endosonography (EUS) for suspected obstructive jaundice when no definite pathology was found on US. Additionally, we sought to identify the predictors of the most common etiologies. We performed a retrospective review of 123 consecutive patients who had undergone EUS for suspected obstructive jaundice when no definite pathology was identified on US. The most common diagnoses included no pathological obstruction (n = 43), pancreatobiliary malignancy (n = 41), and choledocholithiasis (n = 28). Pancreatobiliary malignancy was associated with common bile duct (CBD) dilatation, and fever and elevated alanine aminotransferase were predictors of choledocholithiasis (p jaundice, 100% (40/40) for no pathological finding, 100% (23/23) for ampullary cancer, 100% (13/13) for pancreatic cancer, 75% (3/4) for CBD cancer, and 92.9% (26/28) for choledocholithiasis, respectively. Besides the two patients with focal chronic pancreatitis misdiagnosed as with pancreatic cancer, EUS missed the lesions in one CBD cancer patient and two patients with choledocholithiasis. The overall accuracy of EUS in ascertaining pancreatobiliary malignancy and choledocholithiasis was comparable (97.6%, 40/41 vs. 92.9%, 26/28; p > 0.05). Marked CBD dilatation (≥12 mm) should remind us of the high risk of malignancy, and the presence of CBD dilatation and fever is suggestive of choledocholithiasis. Negative EUS findings cannot assure any pathological obstruction in patients with clinically suspected obstructive jaundice. Copyright © 2013. Published by Elsevier B.V.

  17. [Serum and bile cytokines dynamics in patients with non-tumoral obstructive jaundice and suppurative cholangitis].

    Science.gov (United States)

    Gadzhiyev, J N; Tagiyev, E G; Bagirov, G S; Gadzhiyev, N J

    To study serum and bile cytokines dynamics in patients with non-tumoral obstructive jaundice and suppurative cholangitis. Comparative study of serum and bile cytokines in 49 operated patients with biliary pathology was performed. Patients were divided into 3 groups. The first group included 24 patients with acute calculous cholecystitis (ACCh), the second group consisted of 12 patients with chronic calculous cholecystitis (CCCh) and the third group included 13 patients with choledocholithiasis complicated by obstructive jaundice and suppurative cholangitis. All patients had increased level of TNF-α, IL-4 и IL-6. There was augmentation of biliary cytokines in patients with obstructive jaundice compared with those with acute and chronic calculous cholecystitis. In patients with obstructive jaundice and suppurative cholangitis the highest levels of cytokines were observed. Patients with obstructive jaundice (OJ), suppurative cholangitis (SCh) and chronic calculous cholecystitis had higher levels of cytokines in both blood and bile than in those with OJ, SCh and acute calculous cholecystitis that is explained by development of purulent inflammation on background of previous cytokines imbalance and chronic inflammation. In general, patients with acute calculous cholecystitis had higher levels of TNF-α and IL-6 in blood serum and IL-4 in bile. Patients with chronic calculous cholecystitis had higher concentration of TNF-α and IL-4 in bile and IL-6 - in blood serum. Both forms of cholecystitis and their complications are associated with increased cytokines in serum and bile. The level of augmentation depends on the type of inflammation and complications. Comparative study of cytokines can be the most informative criterion to monitor the postoperative period.

  18. Glucagon-like peptide-2 protects impaired intestinal mucosal barriers in obstructive jaundice rats.

    Science.gov (United States)

    Chen, Jun; Dong, Jia-Tian; Li, Xiao-Jing; Gu, Ye; Cheng, Zhi-Jian; Cai, Yuan-Kun

    2015-01-14

    To observe the protective effect of glucagon-like peptide-2 (GLP-2) on the intestinal barrier of rats with obstructive jaundice and determine the possible mechanisms of action involved in the protective effect. Thirty-six Sprague-Dawley rats were randomly divided into a sham operation group, an obstructive jaundice group, and a GLP-2 group; each group consisted of 12 rats. The GLP-2 group was treated with GLP-2 after the day of surgery, whereas the other two groups were treated with the same concentration of normal saline. Alanine aminotransferase (ALT), total bilirubin, and endotoxin levels were recorded at 1, 3, 7, 10 and 14 d. Furthermore, on the 14(th) day, body weight, the wet weight of the small intestine, pathological changes of the small intestine and the immunoglobulin A (IgA) expressed by plasma cells located in the small intestinal lamina propria were recorded for each group. In the rat model, jaundice was obvious, and the rats' activity decreased 4-6 d post bile duct ligation. Compared with the sham operation group, the obstructive jaundice group displayed increased yellow staining of abdominal visceral serosa, decreased small intestine wet weight, thinning of the intestinal muscle layer and villi, villous atrophy, uneven height, fusion, partial villous epithelial cell shedding, substantial inflammatory cell infiltration and significantly reduced IgA expression. However, no significant gross changes were noted between the GLP-2 and sham groups. With time, the levels of ALT, endotoxin and bilirubin in the GLP-2 group were significantly increased compared with the sham group (P jaundice group than in the GLP-2 group (P jaundice rats, which might be attributed to increased intestinal IgA and reduced bilirubin and endotoxin.

  19. Effects of Different Palliative Jaundice Reducing Methods on Immunologic Functions in Patients with Advanced Malignant Obstructive Jaundice.

    Science.gov (United States)

    Tang, Kun; Sui, Lu-Lu; Xu, Gang; Zhang, Tong; Liu, Qiang; Liu, Xiao-Fang

    2017-08-01

    This study aimed to investigate the effects of three treatment methods on the immunological function of patients with advanced malignant obstructive jaundice (MOJ). Patients with advanced MOJ were randomly divided into three groups according to biliary drainage methods. Detection of levels of multi-indices were investigated in different time periods. After drainage, the levels of complement 3 (C3) and complement 4 (C4) were increased. Forteen days post-operation, the levels of immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM) in the group undergoing palliative surgery decreased significantly compared to those in both percutaneous transhepatic cholangio drainage (PTCD) and endoscopic retrograde biliary drainage (ERBD) groups. The level of serum endotoxin in the group undergoing palliative surgery decreased gradually. Palliative surgery for reducing jaundice is superior to PTCD and ERBD in improving immune function of patients with MOJ. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  20. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice.

    Science.gov (United States)

    Andersen, J R; Sørensen, S M; Kruse, A; Rokkjaer, M; Matzen, P

    1989-01-01

    In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic cholangiography 50 patients were randomised to the two treatment alternatives. All 25 patients randomised to endoprosthesis were treated by this procedure, whereas only 19 of 25 patients randomised to bypass surgery underwent operative biliary-digestive anastomosis. Life table analysis revealed no difference in survival between treatment groups or randomisation groups. No differences were found when other variables were compared. We conclude, that palliation of obstructive jaundice in malignant bile duct obstruction with endoscopically introduced endoprosthesis is as effective as operative bypass. PMID:2475392

  1. [Application of (125)I seeds combined with biliary stent implantation in the treatment of malignant obstructive jaundice].

    Science.gov (United States)

    Wang, T; Liu, S; Zheng, Y B; Song, X P; Jiang, W J; Sun, B L; Wang, L G

    2016-03-23

    To study the feasibility and therapeutic effect of the application of (125)I seeds combined with biliary stent implantation on the treatment of malignant obstructive jaundice. Fifty patients with malignant obstructive jaundice treated from September 2010 to February 2013 in Yantai Yuhuangding Hospital were included in this study. Among them, 24 patients received biliary stent implantation combined with (125)I seeds intraluminal brachytherapy as experimental group, and 26 were treated by biliary stent implantation as control group.The total bilirubin, direct bilirubin and tumor markers (CA-199, CA-242, CEA) before and after surgery, the biliary stent patency status was assessed, and the survival time was evaluated. The 24 patients in experimental group were implanted with 30 (125)I seeds successfully in a total of 450 seeds. Jaundice was improved greatly in both groups. The CA-199 and CA-242 after treatment in the experimental group were significantly decreased than that before treatment (P=0.003 and P=0.004). CEA was also decreased, but showed no statistical significance (P>0.05). There were no significant improvement comparing the CA-199, CA-242 and CEA before and 2 months after surgery in the control group (P>0.05). The rate of biliary stent patency was 83.3% (20/24) in the experimental group and 57.7% (15/26) in the control group (P=0.048). The mean biliary stent patency time in the experimental group was 9.84 months (range 1-15.5 months). The mean biliary stent patency time in the control group was 5.57 months (range 0.8-9 months). There was a significant difference between the two groups (P=0.018). The median survival time was 10.2 months in the experimental group and 5.4 months in the control group (Pjaundice, therefore, is a safe and effective treatment in this malignancy.

  2. Clinical Study on Using (125)I Seeds Articles Combined with Biliary Stent Implantation in the Treatment of Malignant Obstructive Jaundice.

    Science.gov (United States)

    Wang, Tao; Liu, Sheng; Zheng, Yan-Bo; Song, Xue-Peng; Sun, Bo-Lin; Jiang, Wen-Jin; Wang, Li-Gang

    2017-08-01

    Aim: To study the feasibility and curative effect of(125)I seeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice. Patients and Methods: Fifty patients with malignant obstructive jaundice were included. Twenty-four were treated by biliary stent implantation combined with intraluminal brachytherapy by (125)I seeds articles as the experimental group, while the remaining 26 were treated by biliary stent implantation only as the control group. The goal of this study was to evaluate total bilirubin, direct bilirubin and tumor markers (cancer antigen (CA)-199, CA-242 and carcinoembryonic antigen (CEA)), as well as biliary stent patency status and survival time before and after surgery. Results: Jaundice improved greatly in both groups. The decreases of CA-199 and CA-242 had statistical significance (p=0.003 and p=0.004) in the experimental group. The ratio of biliary stent patency was 83.3% (20/24) in the experimental group and 57.7% (15/26) in the control group (p=0.048). The biliary stent patency time in the experimental group was 1~15.5 (mean=9.84) months. The biliary stent patency time in the control group was 0.8~9 (mean=5.57) months, which was statistically significant (p=0.018). The median survival time was 10.2 months in the experimental group, while 5.4 months in control group (pjaundice possibly by inhibiting the proliferation of vascular endothelial cells and the growth of tumor. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  3. [Pilot study of a stent made of a shape memorizing alloy used for obstructive jaundice].

    Science.gov (United States)

    Hyodo, H; Fukui, M; Tamanawa, Y

    1990-05-01

    To learn about endoprosthetic stents used for obstructive jaundice, we examined the pathohistologic effects of stents on bile ducts using 35 adult mongrel dogs. Small histological changes of the epithelium were observed under a microscope for materials having a shape-memorizing alloy with gold plating. Our stent contain NiTi, which restored the memorized shape and size at 40-42 degrees C. The initial outer diameter of stent was 3 mm. After memory restoration, the diameter expanded 5 mm in diameter. An alloy was 0.3-0.5 mm phi in diameter. In this paper, we introduced our insertion devices and display those of cases where stents were used for endoprosthesis in obstructive jaundice.

  4. Pruritus and Jaundice

    Science.gov (United States)

    McPhedran, N. T.; Henderson, R. D.

    1965-01-01

    The records of 147 patients who had pruritus and jaundice (11% of a series of 1262 patients with jaundice) were reviewed in an effort to delineate more clearly the etiology of jaundice associated with pruritus. Fifty-two had obstructive jaundice caused by neoplasm, 51 had obstructive jaundice not caused by neoplasm, 42 had pruritus associated with hepatogenous jaundice, and two had jaundice and pruritus associated with a lymphoma. Pruritus occurred in 17% of all patients with non-neoplastic obstructive jaundice and in 45% of patients with neoplastic obstructive jaundice. Hepatogenous jaundice was the cause of pruritus in almost one-third of the patients in this series-occurring in 20% of patients with infectious hepatitis and in 7% of patients with cirrhosis. This large series confirms the clinical impression that pruritus occurs most often in association with extrahepatic biliary obstruction, and as well re-emphasizes the common association of pruritus with hepatogenous jaundice. PMID:14296007

  5. Obstructive jaundice due to tuberculosis of distal CBD and periampullary region mimickcholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Sumantra Ray

    2012-01-01

    Full Text Available Abdominal tuberculosis (TB commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis is extremely rare. Here we report a case of obstructive jaundice which was initially thought to be due to lower-end cholangiocarcinoma but postoperatively it was found to be tuberculosis.

  6. Tuberculous abscess of the pancreas presenting as obstructive jaundice: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Dong Kyun; Cho, June Sik; Shin, Kyung Sook; Kang, Dae Young [College of Medicine, Chungnam National Univ., Taejon (Korea, Republic of)

    2002-06-01

    Pancreatic tuberculosis is very rare, though dissemination to the gastrointestinal tract and mesenteric lymph nodes is common. We describe a case of pancreatic tuberculosis presenting as a cystic mass in the pancreatic head, with biliary obstruction, in a patient with miliary pulmonary tuberculosis. Surgery for the curative treatment of jaundice was performed, and the histopathologic findings indicated that a pancreatic abscess with caseous necrosis was present, consistent with tuberculosis.

  7. Operable severe obstructive jaundice: How should we use pre ...

    African Journals Online (AJOL)

    2013-11-04

    (5):655-662. [http://dx.doi.org/10.1097/00000658-199911000-00007]. 59. Gouma DJ, Coelho JC, Fisher JD, Schlegel JF, Li YF, Moody FG. Endotoxemia after relief of biliary obstruction by internal and external drainage in rats.

  8. Magnetic Resonance Cholangiopancreatography (MRCP) Evaluation of Obstructive Jaundice in Comparison with Endoscopic Retrograde Cholangiopancreatography (ERCP).

    Science.gov (United States)

    Imam, S; Islam, M N; Khan, N A; Mostafa, S N; Amin, M S; Rahman, S; Akhter, P

    2017-04-01

    This cross sectional study was carried out in the department of Radiology and Imaging in collaboration with Department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2014 to evaluate the efficacy of Magnetic resonance cholangiopancreatography (MRCP) and ERCP in the management of obstructive jaundice and also to determine diagnostic validity accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in evaluation of obstructive jaundice. For this purpose, a total of 60 patients with obstructive jaundice who underwent MRCP and Endoscopic retrograde cholangiopancreatography (ERCP) in the above mentioned hospital were enrolled. More than one third (35.0%) patients were in 5th decade and the mean age was 46.2±12.9 years. Male female ratio was 1.1:1. Most (45.0%) of the patients had filling defect, 28.3% had concentric stenosis and 26.7% eccentric stenosis. In MRCP findings more than one third (35.0%) patients had choledocholithiasis followed by 26.7% had cholangiocarcinoma, 10.0% benign CBD stricture and 8.3% had ascariasis. In ERCP findings 31.7% patients had choledocholithiasis followed by 16.7% had cholangiocarcinoma, 13.3% benign CBD stricture and 10.0% ascariasis. All patients had increased serum bilirubin.

  9. Obstructive Jaundice as a Complication of Macrocystic Serous Cystadenoma of the Pancreas.

    Science.gov (United States)

    Koncoro, Hendra; Putra, I Komang W D; Wibawa, I Dewa N

    2016-04-01

    Macrocystic serous cystadenoma is an unusual and essentially benign pancreatic tumor. Herein, we report on a 40-year-old woman diagnosed with macrocystic serous cystadenoma who presented with obstructive jaundice. A cystic lesion in the head and body of the pancreas was revealed by abdominal computed tomography. Intraoperative pancreatic cyst aspiration ruled out mucinous cystic neoplasm which has a malignant potential. The pancreatic cyst fluid cytology was basophilic amorph materials concluded as benign cystic lesion. Internal drainage was performed instead of pancreatic resection which showed good outcome. Biliary obstruction is a rare complication of serous cystadenoma. This case describes an unusual clinical presentation of macrocystic serous cystadenoma.

  10. Obstructive Jaundice as a Complication of Macrocystic Serous Cystadenoma of the Pancreas

    Directory of Open Access Journals (Sweden)

    Hendra Koncoro

    2016-09-01

    Full Text Available Macrocystic serous cystadenoma is an unusual and essentially benign pancreatic tumor. Herein, we report on a 40-year-old woman diagnosed with macrocystic serous cystadenoma who presented with obstructive jaundice. A cystic lesion in the head and body of the pancreas was revealed by abdominal computed tomography. Intraoperative pancreatic cyst aspiration ruled out mucinous cystic neoplasm which has a malignant potential. The pancreatic cyst fluid cytology was basophilic amorph materials concluded as benign cystic lesion. Internal drainage was performed instead of pancreatic resection which showed good outcome. Biliary obstruction is a rare complication of serous cystadenoma. This case describes an unusual clinical presentation of macrocystic serous cystadenoma.

  11. In vivo and ex vivo effects of propofol on myocardial performance in rats with obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Ren Hong-Mei

    2011-12-01

    Full Text Available Abstract Background Responsiveness of the "jaundiced heart" to propofol is not completely understood. The purpose of this study was to evaluate the effect of propofol on myocardial performance in rats with obstructive jaundice. Methods Male Sprague-Dawley rats (n = 40 were randomly allocated into two groups, twenty underwent bile duct ligation (BDL, and 20 underwent a sham operation. Seven days after the surgery, propofol was administered in vivo and ex vivo (Langendorff preparations. Heart rate, left ventricular end-systolic pressure (LVESP left ventricular end-diastolic pressure (LVEDP, and maximal rate for left ventricular pressure rise and decline (± dP/dtmax were measured to determine the influence of propofol on the cardiac function of rats. Results Impaired basal cardiac function was observed in the isolated BDL hearts, whereas in vivo indices of basal cardiac function (LVESP and ± dP/dt in vivo were significantly higher in rats that underwent BDL compared with controls. With low or intermediate concentrations of propofol, these indices of cardiac function were within the normal physiologic range in both groups, and responsiveness to propofol was unaffected by BDL. When the highest concentration of propofol was administrated, a significant decline in cardiac function was observed in the BDL group. Conclusions In rats that underwent BDL, basal cardiac performance was better in vivo and worse ex vivo compared with controls. Low and intermediate concentrations of propofol did not appear to impair cardiac function in rats with obstructive jaundice.

  12. Evaluation of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma.

    Science.gov (United States)

    Sugiyama, Gen; Okabe, Yoshinobu; Ishida, Yusuke; Saitou, Fumihiko; Kawahara, Ryuichi; Ishikawa, Hiroto; Horiuchi, Hiroyuki; Kinoshita, Hisafumi; Tsuruta, Osamu; Sata, Michio

    2014-06-14

    To review the usefulness of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma and identify problems that may need to be addressed. The study population consisted of 36 patients with obstructive jaundice caused by hepatocellular carcinoma (HCC) who underwent endoscopic biliary stenting (EBS) as the initial drainage procedure at our hospital. The EBS technical success rate and drainage success rate were assessed. Drainage was considered effective when the serum total bilirubin level decreased by 50% or more following the procedure compared to the pre-drainage value. Survival time after the procedure and patient background characteristics were assessed comparatively between the successful drainage group (group A) and the non-successful drainage group (group B). The EBS stent patency duration in the successful drainage group (group A) was also assessed. The technical success rate was 100% for both the initial endoscopic nasobiliary drainage and EBS in all patients. Single stenting was placed in 21 patients and multiple stenting in the remaining 15 patients. The drainage successful rate was 75% and the median interval to successful drainage was 40 d (2-295 d). The median survival time was 150 d in group A and 22 d in group B, with the difference between the two groups being statistically significant (P jaundice caused by HCC, as it appears to contribute to prolongation of survival time.

  13. Extramedullary plasmacytoma of the pancreas as an uncommon cause of obstructive jaundice: a case report

    Directory of Open Access Journals (Sweden)

    Leake Pierre-Anthony

    2009-08-01

    Full Text Available Abstract Introduction Though uncommon, extramedullary plasmacytoma of the pancreas should be considered in the differential diagnosis of obstructive jaundice and pancreatic neoplasms. This report highlights a case of obstructive jaundice in a 46-year-old West Indian man that resulted from an extramedullary plasmacytoma. Case presentation A 46-year-old West Indian man presented to our hospital with evidence of a significant upper gastrointestinal bleed. He gave a recent history of jaundice, constitutional symptoms and back pain. Ultrasonography revealed a mass in the head of the pancreas with resultant common bile duct dilatation. The patient required urgent surgical intervention for ongoing bleeding at which time a biopsy of the pancreas was taken. Histological analysis revealed a plasmacytoma of the pancreas. A blood film showing rouleaux formation and a skeletal survey demonstrating multiple lytic lesions confirmed multiple myeloma. Before further evaluation or treatment was carried out, the patient defaulted from follow-up and died from his illness seven months later. Conclusion This case represents an example of multiple myeloma with visceral involvement, brought to clinical attention through involvement of the pancreas. The report serves to reaffirm knowledge of the various presentations, the optimal diagnostic tools and the current proposed treatment strategies for extramedullary plasmacytomas of the pancreas.

  14. Precursor B-cell acute lymphoblastic leukemia presenting as obstructive jaundice: a case report

    Directory of Open Access Journals (Sweden)

    Awasum Michael

    2011-07-01

    Full Text Available Abstract Introduction Acute leukemias very rarely present with jaundice. Herein we report a case of precursor B-cell acute lymphoblastic leukemia that presented with jaundice in an adult. Case presentation A 44-year-old Hispanic man presented with right upper quadrant abdominal pain and jaundice. His initial blood work revealed pancytopenia and hyperbilirubinemia. Direct bilirubin was more than 50% of the total. His imaging studies were unremarkable except for hepatomegaly. All blood screening tests for various hepatocellular etiologies were normal. A diagnosis of precursor B-cell acute lymphoblastic leukemia was made upon liver biopsy. It also showed lymphocytic infiltration of the hepatic parenchyma leading to bile stasis. The diagnosis was subsequently confirmed upon bone marrow biopsy. The patient was treated with a hyperfractionated cyclophosphamide/vincristine/doxorubicin/dexamethasone regimen. Conclusion Acute lymphoblastic leukemia should be one of the differential diagnoses that should be considered when initial work-up for jaundice is inconclusive. Some cases of acute lymphoblastic leukemia have been reported in both adults and children to have presented with the initial manifestation of jaundice, but only a few had no radiographic evidence of biliary obstruction. Such presentation can pose a serious diagnostic dilemma for clinicians. This manuscript attempts to highlight it. Moreover, we believe that if acute lymphoblastic leukemia presentations similar to this case continue to be reported in adults or children, a specific immunophenotypic expression and cytogenetic abnormality may be found to be associated with hepatic infiltration by leukemia. This may substantially contribute to the further understanding of the pathophysiology of this hematologic disease.

  15. Diagnostic Accuracy of MRCP as Compared to Ultrasound/CT in Patients with Obstructive Jaundice.

    Science.gov (United States)

    Singh, Amandeep; Mann, Harkaran Singh; Thukral, Chuni Lal; Singh, Neeti Rajan

    2014-03-01

    The expanding spectrum of therapeutic options for patients with surgical jaundice makes it necessary for the radiologist to precisely assess the etiology, location, level and extent of disease. To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with obstructive jaundice taking direct cholangiographies (ERCP and PTC), hystologic tests and anatomo-pathological findings after surgical intervention as gold standard. This prospective study included 50 patients who were referred to the radiology department with clinical features of biliary obstructive disease. Initial ultrasonography (USG) evaluation was followed by Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP);however in cases of benign pathologies where USG findings were unequivocal Computed tomography (CT )was not done to avoid unnecessary radiation exposure. The results were read by radiologists blinded to other imaging findings. The characteristic Endoscopic Retrograde Cholangiopancreatography (ERCP) features/ histopathological diagnosis / surgical findings (as applicable) were considered as final. Diagnostic accuracy of MRCP (98%) in the diagnosis of benign and malignant diseases was relatively high (98% and 98%) as compared to CT (82.86% and 91.43% in benign and malignant respectively) and USG (88% and 88%). In the diagnosis of benign diseases MRCP was 100% sensitive compared to ultrasound (80.77%), which was more sensitive than CT scan (54.55%).In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to CT scan (91.67%), which was more sensitive than ultrasonography (79.17%). Ultrasound as a screening modality is useful to confirm or exclude biliary dilatation and to choose patients for MRCP examination. MRCP is an important non invasive imaging investigation in the pre operative evaluation of patients with obstructive jaundice.

  16. Obstructive jaundice caused by pancreaticoduodenal artery aneurysms associated with celiac axis stenosis: case report and review of the literature.

    Science.gov (United States)

    Yin, Tiansheng; Wan, Zhili; Chen, Hongwei; Mao, Xixian; Yi, Yayang; Li, Dewei

    2015-07-01

    Pancreaticoduodenal artery aneurysm (PDA) is quite rare, which accounts for only approximate 2% of all visceral aneurysms. Besides, PDA is usually related to celiac axis stenosis (CAS) and prone to rupture. Advanced imaging examination can facilitate the disclosure of such peripancreatic masses, but most of them were seldom diagnosed until they rupture because of the nonspecific symptoms. Secondary to PDA, obstructive jaundice is however an extremely rare manifestation. A case of an 84-year-old man is reported here, who suffered from severe jaundice caused by a ruptured PDA associated with CAS. In addition, this review collects and organizes PDAs with jaundice by applying a MEDLINE search and discusses the pathogenesis and therapeutic options of these aneurysms leading to external compression over the bile duct. Consequently, the formation of PDA with obstructive jaundice is based on the specific anatomy of pancreaticoduodenal arcades. When there is a retroperitoneal mass around the head of the pancreas associated with unexpected jaundice, PDA should be considered, for which early aggressive therapy is required. The case report and literature review suggest that PDA associated with obstructive jaundice may be treated successfully by single transcatheter arterial embolization (TAE) without auxiliary biliary drainage, whether it ruptures or not. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Obstructive jaundice in autoimmune pancreatitis can be safely treated with corticosteroids alone without biliary stenting.

    Science.gov (United States)

    Bi, Yan; Hart, Phil A; Law, Ryan; Clain, Jonathan E; Farnell, Michael B; Gleeson, Ferga C; Kendrick, Michael L; Levy, Mike J; Pearson, Randall K; Petersen, Bret T; Pisney, Lisa D; Smyrk, Thomas C; Takahashi, Naoki; Topazian, Mark D; Vege, Santhi Swaroop; Chari, Suresh T

    2016-01-01

    Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting. From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evaluated to determine the outcomes. Fifteen AIP subjects (87% male, mean age 68.4 years) were treated with corticosteroids at initial presentation (n = 8), first (n = 5) or subsequent (n = 2) relapse. Mean values (upper limit of normal, ULN) of liver tests prior to corticosteroids were aspartate aminotransferase (AST) 203.5u/l (4 × ULN), alanine aminotransferase (ALT) 325.8u/l (6 × ULN), alkaline phosphatase (ALP) 567.4u/l (5 × ULN), and total bilirubin (TB) 5.9 mg/dl (5.9 × ULN). At first follow-up (mean 4 days) the decrease was 54.9% for AST, 51.6% for ALT, 33% for ALP and 47.2% for TB (all p  1.5 × ULN, 1/15 had ALP > 1.5 × ULN, 1/15 had TB > 1.5 × ULN. No patient required biliary stent placement, or developed cholangitis or other infectious complications during steroid treatment. Under the supervision of an experienced pancreatologist and with close monitoring of patients, obstructive jaundice secondary to definitive AIP can be safely and effectively managed with corticosteroids alone, without the need for biliary stenting. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  18. Relationship between ways of nutritional support and immune function in patients with malignant obstructive jaundice after PTCD

    Directory of Open Access Journals (Sweden)

    YANG Shenghua

    2014-11-01

    Full Text Available ObjectiveTo investigate the clinical effect of different nutritional therapies on the immune function of patients with malignant obstructive jaundice after percutaneous transhepatic cholangiodrainage (PTCD. MethodsA total of 50 patients with malignant obstructive jaundice who were admitted to our hospital from January 2009 to March 2013 were randomly divided into two groups according to the admission order. The patients in group A (n=25 received enteral nutritional support after PTCD, and those in group B (n=25 received total parenteral nutritional support after PTCD. Intra-group and inter-group comparisons were made in terms of jaundice clearance, nutritional indices, and body’s immune function on preoperative day 1 and postoperative day 7; comparison between the two groups was made by t test. ResultsAmong the 50 patients who underwent PTCD, 39 (78% had good drainage, while 11 (22% did not reach the expectation, of which, 5 (10% were in group A and 6 (12% in group B. In both groups, the nutritional indices on postoperative day 7 were significantly higher than those on preoperative day 1(P<0.05, but no significant difference in these indices was observed between group A and group B on postoperative day 7 (P>0.05. The immune function of patients in both groups was significantly improved following PTCD and nutritional support (P<0.05, but there was no significant difference between the two groups (P>0.05. Although the same scheme of nutritional support was used, there were 11 patients who did not achieve the expected jaundice clearance after PTCD and had limited improvement in immune function compared with those who had complete jaundice clearance (all P<0.05. ConclusionJaundice clearance is closely related to PTCD in patients with malignant obstructive jaundice, but not markedly associated with the ways of nutritional support.

  19. Endoscopic palliation of malignant obstructive jaundice in extremely elderly patients: plastic stent is enough.

    Science.gov (United States)

    Grönroos, Juha M; Gullichsen, Risto; Laine, Simo; Salminen, Paulina

    2010-04-01

    Although the price of biliary metal stents is manyfold higher when compared to plastic stents, the lower frequency of recurrent obstructions makes metal stents superior to plastic stents for endoscopic palliation of malignant biliary stricture in most patients. Is this the case in extremely elderly patients as well? A retrospective data review comprising prospective data collection and double-entry bookkeeping of therapeutic endoscopic retrograde cholangiopancreatographies (ERCP) with biliary strictures referring to malignancy in 14 patients aged 90 years or older at our institution in 1997-2007. Plastic stents were successfully inserted in 11 out of 14 patients, yielding a technical success rate of 79 %. In the remaining three patients, high biliary obstruction was relieved percutaneously in two cases while the general condition of one patient was so poor that terminal care decision was made in that case. There was no recurrent biliary obstruction in any of the patients with plastic stents prior to death which occurred after a mean of 2.8 months, giving a clinical success rate of 100 %. To be concluded, in extremely elderly patients with malignant obstructive jaundice, palliation with plastic stent is effective enough.

  20. Bile acid receptor TGR5 overexpression is associated with decreased intestinal mucosal injury and epithelial cell proliferation in obstructive jaundice.

    Science.gov (United States)

    Ji, Chen-Guang; Xie, Xiao-Li; Yin, Jie; Qi, Wei; Chen, Lei; Bai, Yun; Wang, Na; Zhao, Dong-Qiang; Jiang, Xiao-Yu; Jiang, Hui-Qing

    2017-04-01

    Bile acids stimulate intestinal epithelial proliferation in vitro. We sought to investigate the role of the bile acid receptor TGR5 in the protection of intestinal epithelial proliferation in obstructive jaundice. Intestinal tissues and serum samples were obtained from patients with malignant obstructive jaundice and from bile duct ligation (BDL) rats. Intestinal permeability and morphological changes in the intestinal mucosa were observed. The functions of TGR5 in cell proliferation in intestinal epithelial injury were determined by overexpression or knockdown studies in Caco-2 and FHs 74 Int cells pretreated with lipopolysaccharide (LPS). Internal biliary drainage was superior to external biliary drainage in recovering intestinal permeability and mucosal histology in patients with obstructive jaundice. In BDL rats, feeding of chenodeoxycholic acid (CDCA) decreased intestinal mucosa injury. The levels of PCNA, a marker of proliferation, increased in response to CDCA feeding and were paralleled by elevated TGR5 expression. CDCA upregulated TGR5 expression and promoted proliferation in Caco-2 and FHs 74 Int cells pretreated with LPS. Overexpression of TGR5 resulted in increased PCNA, cell viability, EdU incorporation, and the proportion of cells in S phase, whereas knockdown of TGR5 had the opposite effect. Our data indicate that bile acids promote intestinal epithelial cell proliferation and decrease mucosal injury by upregulating TGR5 expression in obstructive jaundice. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Ultrasonography, computed tomography, and cholescintigraphy in suspected obstructive jaundice--a prospective comparative study

    DEFF Research Database (Denmark)

    Matzen, P; Malchow-Møller, A; Brun, B

    1983-01-01

    In order to compare their capacity to visualize the bile ducts, ultrasonography, computed tomography, and cholescintigraphy were performed in 56 consecutive jaundiced patients in whom extrahepatic cholestasis was clinically suspected. The predictions as to the patency of the large bill ducts were...... compared with the final diagnoses made on the basis of direct cholangiography together with autopsy, biopsy, operative findings, and the clinical course. Thirty-nine patients (70%) had obstructed bile ducts, and 17 (30%) had patent large bile ducts. Using a simple scoring scale with 112 points...... as the maximum, ultrasonography obtained 72 points, computed tomography received 56 points, and cholescintigraphy totalled 37 points. Nonsignificant trends were found in favor of ultrasonography as compared with computed tomography and of computed tomography as compared with cholescintigraphy (p greater than 0...

  2. Influence of the Gut Microflora and of Biliary Constituents on Morphological Changes in the Small Intestine in Obstructive Jaundice

    Directory of Open Access Journals (Sweden)

    M. Saeed Quraishy

    1996-01-01

    Full Text Available Increased amounts of intestinal endotoxin are absorbed in obstructive jaundice. The precise mechanism is not known but the increased absorption may arise from alterations in the luminal contents, in the intestinal flora, in the gut wall or in interactions between all three. To examine the effects of the intestinal flora we have compared the morphological changes in the small intestine in obstructive jaundice in germ free and conventional rats while the effects of bile constituents have been examined by addition of bile constituents to the diet of bile duct ligated rats. Changes in the intestine were examined, histologically, by enzyme histochemistry, and by transmission and scanning electron microscopy. The results showed no differences in response between germ free and conventional rats. Feeding of diets containing bile salts exacerbated the lesion. Feeding of diets containing cholesterol, however, reduced the degree of intestinal changes produced by cholestasis and completely antagonised the increase in damage caused by feeding of bile salts.

  3. Biliary drainage by teflon endoprosthesis in obstructive jaundice - experiences in 69 patients treated by PTCD or ERCD

    Energy Technology Data Exchange (ETDEWEB)

    Rupp, N.; Kramann, B.; Gullotta, U.; Reiser, M.

    1983-02-01

    In 69 patients with extrahepatic biliary obstruction a specially designed teflon tube, the endoprosthesis, was inserted across the ductal stenosis either by percutaneous or by endoscopic route to reduce jaundice. After gaining experience our success rate of stent placement was more than 90%. Compared with catheter drainage the endoprosthesis worked faster and more efficiently, while in palliative treatment the quality of life of the patient improved and secondary cholangitis was prevented. The rate of significant long-term stent obstruction can be tolerated in view of the expected life span of four months as an average in our material.

  4. OPPORTUNITIES OF ENDOSCOPIC RETROGRADE STENTING OF THE BILE DUCTS IN MALIGNANT TUMORS OF THE PANCREATOBILIARY ZONE, COMPLICATED BY OBSTRUCTIVE JAUNDICE

    Directory of Open Access Journals (Sweden)

    S. A. Budzinsky

    2013-01-01

    Full Text Available Purpose. In the last 10 years in the treatment of acute jaundice, developed on a background of malignant tumors of the pancreatobiliary zone (PBZ, more preferred method is endoscopic retrograde biliary drainage.Material and methods. From January 2007 to July 2012 in the clinic of hospital surgery N. 2 PRNMU endoscopic biliary stenting was performed in 441 patients. Of these, 324 (73.5% stenting fell to 234 patients with a tumor of the extrahepatic bile ducts. The diagnostic program included ultrasonography, computed tomography, endoscopic ultrasonography and endoscopic retrograde cholangiopancreaticography.Results. Installing of bilioduodenal stent in 223 patients (95.3% was generated after the pre-endoscopic papillosphincterotomy (EPST. The adequacy of the biliary drainage after produced in the required amount of biliary stent placement was achieved in all patients. In 46 cases, execute the biliary tract prosthesis failed. Complications of endoscopic interventions presented with acute pancreatitis, cholangitis, bleeding from the area of EPST, perforated duodenal wall and migration of the stent were in 19 cases (5?9%. Postoperative mortality was 3?8%. 7 patients (3% died after the endoscopic decompression of the biliary tract. After stenting in all patients with jaundice it was resolved or significantly reduced. In 185 of them (79% was the definitive guide endoscopic treatment because of severity of tumor process. In cases of jaundice reccurence endoscopic stent recanalizing or replacement were performed. In the remaining cases (21% patients after the resolution of jaundice decompressive surgical intervention were done.Conclusion. The method of endoscopic retrograde biliary drainage allows you to prepare patients with obstructive jaundice for surgical intervention, including the radical. The frequency of complications after endoscopic retrograde operations on the major duodenal papilla for acute jaundice blastomatous origin did not differ from

  5. The hepatic protective mechanism of Ginkgo biloba extract in rats with obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Ming-Zhe Weng

    2011-11-01

    Full Text Available The objective of our study was to examine the hepatic protective mechanism of Ginkgo biloba extract (GBE in rats with obstructive jaundice (OJ. Twenty rats underwent bile duct ligation and received daily intraperitoneal injections of either control saline or Ginkgo biloba extract for 14 days. Ten sham-operated rats had their bile duct exposed but not ligated or sectioned. Serum alanine transaminase (ALT was analyzed for liver function tests and liver damage was further assessed by histologic examination. The levels of endothelin 1 (ET-1 and nitric oxide (NO in blood and liver homogenate were measured. The serum alanine transaminase was elevated in the bile duct ligation rats (BDL rats; GBE could significantly lower serum transaminase level and ameliorate liver histological damage. ET-1 and NO levels in both plasma and liver tissue were also elevated in common bile duct (CBD-ligated rats, but this increase was significantly decreased by GBE treatment. Moreover, the degree of liver damage severity positively correlates with high levels of ET-1 and NO. GBE mediated the liver protective effect at least in part by suppressing overproduction of ET-1and NO and restoring a proper balance between ET-1and NO to some extent.

  6. Transjugular Insertion of Bare-Metal Biliary Stent for the Treatment of Distal Malignant Obstructive Jaundice Complicated by Coagulopathy

    Energy Technology Data Exchange (ETDEWEB)

    Tsauo Jiaywei, E-mail: 80732059@qq.com; Li Xiao, E-mail: simonlixiao@gmail.com; Li Hongcui, E-mail: lihongcui520@126.com; Wei Bo, E-mail: allyooking@tom.com; Luo Xuefeng, E-mail: luobo_913@126.com; Zhang Chunle, E-mail: sugar139000@163.com; Tang Chengwei, E-mail: 20378375@qq.com [West China Hospital of Sichuan University, Department of Gastroenterology and Hepatology (China); Wang Weiping, E-mail: irjournalclub@gmail.com [Section of Interventional Radiology, Cleveland Clinic, Imaging Institute (United States)

    2013-04-15

    This study was designed to investigate retrospectively the feasibility of transjugular insertion of biliary stent (TIBS) for the treatment of distal malignant obstructive jaundice complicated by coagulopathy. Between April 2005 and May 2010, six patients with distal malignant obstructive jaundice associated with coagulopathy that was unable to be corrected underwent TIBS at our institution for the palliation of jaundice. Patients' medical record and imaging results were reviewed to obtain information about demographics, procedure details, complications, and clinical outcomes. The intrahepatic biliary tract was successfully accessed in all six patients via transjugular approach. The procedure was technically successfully in five of six patients, with a bare-metal stent implanted after traversing the biliary strictures. One procedure failed, because the guidewire could not traverse the biliary occlusion. One week after TIBS, the mean serum bilirubin in the five successful cases had decreased from 313 {mu}mol/L (range 203.4-369.3) to 146.2 {mu}mol/L (range 95.8-223.3) and had further decreased to 103.6 {mu}mol/L (range 29.5-240.9) at 1 month after the procedure. No bleeding, sepsis, or other major complications were observed after the procedure. The mean survival of these five patients was 4.5 months (range 1.9-5.8). On imaging follow-up, there was no evidence of stent stenosis or migration, with 100 % primary patency. When the risks of hemorrhage from percutaneous transhepatic cholangiodrainage are high, TIBS may be an effective alternative for the treatment of distal malignant obstructive jaundice.

  7. A pilot study of intraluminal brachytherapy using (125)I seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice.

    Science.gov (United States)

    Yang, MinJie; Yan, ZhiPing; Luo, JianJun; Liu, QingXin; Zhang, Wen; Ma, JinQing; Zhang, ZiHan; Yu, TianZhu; Zhao, Qian; Liu, LingXiao

    To investigate the safety and feasibility of intraluminal brachytherapy using (125)I seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice. From January 2010 to February 2015, 18 consecutive patients diagnosed with locally advanced, nonmetastatic, inoperable pancreatic ductal adenocarcinoma with obstructive jaundice were enrolled and underwent intraluminal brachytherapy using (125)I seed strand. Dose calculation was performed using a software. The procedure-related and radiation complications were assessed. Obstruction-free survival and overall survival were calculated using the Kaplan-Meier method. The technique successful rate of (125)I seed strand implantation was 100%. Successful bile drainage was achieved in all patients. The estimated mean accumulating dose (R = 5 mm, z = 0, 240 days) was 167.2 Gy, from 164.19 to 170.05 Gy. Two patients had adverse event of Grade 3, one of Grade 4. Stent dysfunction occurred in 1/18 (5.6%) patients. The mean and median obstruction-free survival time were 10.61 months (95% confidence interval [CI]: 7.04, 14.18) and 7.26 months (95% CI: 2.14, 12.38). The mean and median overall survival time were 11.91 months (95% CI: 7.39, 16.43) and 7.26 months (95% CI: 2.14, 12.38). Intraluminal brachytherapy using (125)I seed strand may be consider as a safe treatment option for the therapy of locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice with acceptable complication rates. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  8. Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

    Science.gov (United States)

    2011-01-01

    Background Obstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality. Methods This was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5. Results A total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8%) patients underwent surgical treatment and the remaining 6 (5.2%) patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive

  9. Liver elasticity measurement before and after biliary drainage in patients with obstructive jaundice: a prospective cohort studya prospective cohort study.

    Science.gov (United States)

    Kubo, Kimitoshi; Kawakami, Hiroshi; Kuwatani, Masaki; Nishida, Mutsumi; Kawakubo, Kazumichi; Kawahata, Shuhei; Taya, Yoko; Kubota, Yoshimasa; Amano, Toraji; Shirato, Hiroki; Sakamoto, Naoya

    2016-07-08

    Obstructive jaundice has been reported to influence liver elasticity, independent of liver fibrosis. The aim of our prospective study was to evaluate the changes in liver elasticity, before and after biliary drainage, in patients with obstructive jaundice, and to evaluate the correlation between elasticity measures and serum markers of liver fibrosis. This is a prospective cohort study of 20 patients with obstructive jaundice. Liver elasticity was assessed by Transient Elastography (TE) and Virtual Touch™ Quantification (VTQ). Serum total bilirubin (T-Bil) level was measured before biliary drainage (Day 0), with measures repeated at 2 days (Day 2) and 7 days (Day 7) after biliary drainage. Serum levels of the following markers of liver fibrosis were also obtained on Day 0 and Day 7: hyaluronic acid (HA), procollagen-III-peptide (P-III-P). T-Bil, TE, and VTQ for the left (VTQ-L) and right (VTQ-R) lobes of the liver were all elevated before biliary drainage, with respective levels, measured at Day 0, of 11.9 ± 1.5 mg/dl, 12.1 ± 0.9 kPa, 2.23 ± 0.10 m/s, and 1.85 ± 0.10 m/s. All values decreased on Day 7 after drainage: T-Bil, 4.7 ± 1.0 mg/dl (P elasticity measures correlated with serum levels of T-Bil, P-III-P, and HA (r = 0.35-0.67, P elasticity, measured by TE and VTQ, after biliary drainage. Measures of liver elasticity correlated to levels of T-Bil and serum markers of liver fibrosis. (UMIN ID: UMIN00001284313). University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN ID: UMIN00001284313 ); Registration date: 2014-01-14.

  10. Hydatid cyst of the liver which demaged the confluence of the hepatic ducts causing deep obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.

    2003-01-01

    Full Text Available Complications of the hydatid cyst of the liver on bile ducts appear in 5-25% representing almost two third of all complications of the hydatid liver cysts. Fortunately a damage to the bile ducts causes only an infection of the cyst usually without major consequences. More serious complications such as cholangitis and deep obstructive jaundice are much rarer. The defect of the bile duct usually is a periferal one. Damage to the major ducts are rarer and those on the confluence of hepatic ducts itself are the rarity. In that case biliary reconstruction may be a serious chalenge. The authors present a 23 year-old man in whom a centrally localised hydatid cyst made a major damage of the confluence of all three hepatic ducts causing deep obstructive jaundice. After standard procedure for hydatid cyst an intracavital mucosa to mucosa hepaticoje-junostomy was carried out with excellent success. More then six years after surgery the patient stayed symptom-free with bilirubin and alkaline phosphatase within normal limits.

  11. A rare cause of obstructive jaundice and weight loss in Von Recklinghausen's disease

    NARCIS (Netherlands)

    Bukkems, S.F.; Stoot, J.H.M.B.; Driessen, A.L.C.; Beets Tan, R.G.; van Nieuwenhoven, M.A.; Masclee, A.

    2010-01-01

    We present the case of a patient with the rare triad of Von Recklinghausen's disease associated with a somatostatinoma and a gastrointestinal stromal tumour (GIST). The patient had recurrent jaundice, the typical somatostatinoma syndrome, positive MR imaging but negative Ga-DOTATOC PET scanning in a

  12. Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis.

    Science.gov (United States)

    Huibregtse, K; Tytgat, G N

    1982-01-01

    The endoscopic techniques for introducing a large calibre (3.2 mm) biliary endoprosthesis to relieve jaundice are described. In 45 patients such an endoprosthesis was successfully introduced. The median survival time in 18 patients was 41 days (range three to 187). Twenty-six patients are still alive after a median of 28 days (range seven to 244). One patient had a surgical bypass after 24 days. Short-term complications were cholangitis and fever in 11 patients. Late complications were recurrent jaundice in four, upward migration of the endoprosthesis in two, and clogging of the endoprosthesis in one patient. The risk of cholangitis, which used to be a major problem with transpapillary introduced prostheses of smaller calibre, seems definitely diminished by using one with a large calibre. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:7076014

  13. Adjusting CA19-9 values to predict malignancy in obstructive jaundice: Influence of bilirubin and C-reactive protein

    Science.gov (United States)

    La Greca, Gaetano; Sofia, Maria; Lombardo, Rosario; Latteri, Saverio; Ricotta, Agostino; Puleo, Stefano; Russello, Domenico

    2012-01-01

    AIM: To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice (BJ) and malignant jaundice (MJ). METHODS: All patients admitted for obstructive jaundice, in the period 2005-2009, were prospectively enrolled in the study, obtaining a total of 102 patients. On admission, all patients underwent complete standard blood test examinations including C-reactive protein (CRP), bilirubin, CA19-9. Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels (total bilirubin > 2.0 mg/dL). The standard cut-off level for CA19-9 was 32 U/mL, whereas for CRP this was 1.5 mg/L. The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value. The patients were divided into 2 groups, MJ and BJ, and after the adjustment a comparison between the 2 groups of patients was performed. Sensitivity, specificity and positive predictive values were calculated before and after the adjustment. RESULTS: Of the 102 patients, 51 were affected by BJ and 51 by MJ. Pathologic CA19-9 levels were found in 71.7% of the patients. In the group of 51 BJ patients there were 29 (56.9%) males and 22 (43.1%) females with a median age of 66 years (range 24-96 years), whereas in the MJ group there were 24 (47%) males and 27 (53%) females, with a mean age of 70 years (range 30-92 years). Pathologic CA19-9 serum level was found in 82.3% of MJ. CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ. Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ (P = 0.000 and P = 0.02), while the CRP level was significantly higher in BJ (P = 0.000). Considering a CA19-9 cut-off level of 32 U/mL, 82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9 (P = 0.002). A CA19-9 cut-off of 100 U/mL increases the difference between the two groups: 35.3% in

  14. Newborn Jaundice

    Science.gov (United States)

    ... factors increase a newborn’s chance of having jaundice: Premature birth East Asian or Mediterranean ethnicity Sibling who had jaundice Feeding difficulties Breast-feeding What are the symptoms of jaundice in ...

  15. Newborn jaundice

    Science.gov (United States)

    Jaundice of the newborn; Neonatal hyperbilirubinemia; Bili lights - jaundice; Infant - yellow skin; Newborn - yellow skin ... to be able to do this efficiently. Most newborns have some yellowing of the skin, or jaundice. ...

  16. [Managements for jaundice].

    Science.gov (United States)

    Furuse, Junji; Toki, Masao; Kitamura, Hiroshi; Hirokawa, Satoshi; Nagashima, Fumio

    2011-04-01

    Jaundice is a yellowish pigmentation of skin and mucous membranes caused by hyperbilirubinemia, which itself has various causes. Jaundice related to malignant tumors is classified as obstructive jaundice. This disease proceeds from biliary tract obstruction and liver failure by progression of intrahepatic tumors, including metastases from other malignancies. Biliary tract cancer, pancreatic head cancer, or lymph nodes metastases from other sites of cancer are mainly responsible for the obstruction of the bile duct. In patients with obstructive jaundice, biliary drainage is often required in order to give treatments such as chemotherapy. In patients with biliary drainage, various complications arise, such as cholangitis due to obstruction ofa biliary stent, and bleeding from the ulcer due to a dislodged stent to the duodenum. It is crucial to manage those complications as oncologic emergencies. Jaundice of liver failure due to hepatic metastases is often observed in patients with gastrointestinal malignancies such as gastric cancer or colorectal cancer. Although chemotherapy is the usual application for those patients, useful anti-cancer agents are limited. It is crucial to diagnose and decide the best treatments as soon as possible for patients with very advanced hepatic metastases.

  17. Melatonin exerts a more potent effect than S-adenosyl-l-methionine against iron metabolism disturbances, oxidative stress and tissue injury induced by obstructive jaundice in rats.

    Science.gov (United States)

    Muñoz-Castañeda, Juan R; Túnez, Isaac; Herencia, Carmen; Ranchal, Isidora; González, Raúl; Ramírez, Luz M; Arjona, Alvaro; Barcos, Montserrat; Espejo, Isabel; Cruz, Adolfo; Montilla, Pedro; Padillo, Francisco J; Muntané, Jordi

    2008-07-30

    Melatonin and S-adenosyl-l-methionine (SAMe) prevent oxidative stress and tissue dysfunction in obstructive jaundice (OJ). Lipid peroxidation is exacerbated in the presence of trace amounts of iron (Fe). The study investigated the regulation by melatonin and SAMe the induction of oxidative stress, iron metabolism disturbances and tissue injury in an experimental model of OJ. Different parameters of lipid peroxidation, antioxidant status, tissue injury and Fe metabolism were determined in liver and blood. OJ induced Fe accumulation in liver, and increased transferrin (Tf) saturation and loosely bound Fe content in blood. Melatonin, and SAMe at lesser extent, enhanced protein Tf content in liver and blood, that reduced loosely bound Fe content in blood. Melatonin and SAMe did not affect ferritin (FT) and Tf mRNA expression, but reduced Tf receptor (TfR) mRNA expression in liver. In conclusion, the effect of melatonin and SAMe on Fe metabolism may be included in the beneficial properties of these agents on lipid peroxidation and tissue injury induced by OJ.

  18. CHEMILUMINESCENT ACTIVITY OF NEUTROPHILIC GRANULOCYTES IN PROGRESSION OF OBSTRUCTIVE JAUNDICE DEPENDING ON ITS ORIGIN AND BILIRUBIN LEVELS

    Directory of Open Access Journals (Sweden)

    O. V. Smirnova

    2016-01-01

    Full Text Available Mechanical jaundice (MJ is a severe pathological condition, caused by obstruction of the bile ducts, requiring immediate surgical intervention. Etiologically, MJ can be of benign (60-80% of the cases, or malignant origin. MJ progression depends on the underlying pathology, and, moreover, on bilirubin levels. Focal inflammation in affected area represents a significant mechanism of the MJ progression. Neutrophilic granulocytes, are primarily involved into the immune response, i.e., pathogen elimination. Hence, the MJ progression may depend on their functional activity. In this context, the aim of our study was to investigate chemiluminescent activity of neutrophil granulocytes in progression of MJ, depending on the bilirubin levels and origin of the jaundice. All the MJ patients showed altered chemiluminescent activity of granulocytes. Both spontaneous and induced chemiluminescence (CL intensity was decreased in the patients with gallstoneassociated MJ. Meanwhile, the CL intensity did not change in MJ caused by benign tumors (BTP. An increased activation index reflected higher induced activity of phagocytes. In patients with MJ of malignant origin, the largest number of changes was found, i.e., an increase in the induced luminescence intensity and higher activation indexes were revealed. The MJ progression depends on blood bilirubin levels. All the patients with gallstone-related MJ exhibited a decrease in spontaneous and induced CL activity of the neutrophils. In cases of BTP-caused MJ, the indexes of spontaneous and induced CL decreased at the bilirubin levels of 60 to 200 mmol/L, with increased activation index suggesting elevated induced activity over its spontaneous levels. In patients with MJ and bilirubin levels >200 mmol/L, distinct unidirectional changes in the granulocyte activation were observed, with increased spontaneous and induced CL intensity. In patients with MJ caused by malignancies with bilirubin levels <60

  19. Protective effects of Salvia miltiorrhizae on the hearts of rats with severe acute pancreatits or obstructive jaundice*

    Science.gov (United States)

    Zhang, Xi-ping; Feng, Guang-hua; Zhang, Jie; Cai, Yang; Tian, Hua; Zhang, Xiao-feng; Zhou, Yi-feng; Wang, Zhi-wei; Wang, Ke-yi

    2009-01-01

    Objective: To investigate the therapeutic effects and mechanisms of Salvia miltiorrhizae (Danshen) in the treatment of severe acute pancreatitis (SAP)- or obstructive jaundice (OJ)-induced heart injury. Methods: A total of 288 rats were used for SAP- (n=108) and OJ-associated (n=180) experiments. The rats were randomly divided into sham-operated, model control, and Salvia miltiorrhizae-treated groups. According to the difference of time points after operation, SAP rats in each group were subdivided into 3, 6 and 12 h subgroups (n=12), whereas OJ rats were subdivided into 7, 14, 21, and 28 d subgroups (n=15). At the corresponding time points after operation, the mortality rates of the rats, the contents of endotoxin and phospholipase A2 (PLA2) in blood, and pathological changes of the hearts were investigated. Results: The numbers of dead SAP and OJ rats in the treated groups declined as compared with those in the model control group, but not significantly (P>0.05). The contents of endotoxin (at 6 and 12 h in SAP rats and on 7, 14, 21, and 28 d in OJ rats, respectively) and PLA2 (at 6 and 12 h in SAP rats and on 28 d in OJ rats, respectively) in the treated group were significantly lower than those in the model control group (PSalvia miltiorrhizae improved myocardial pathological changes, reduced the content of PLA2 in blood, and decreased the mortality rates of SAP and OJ rats, exerting protective effects on the hearts of the rats. PMID:19283874

  20. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice.

    Science.gov (United States)

    Gundry, S R; Strodel, W E; Knol, J A; Eckhauser, F E; Thompson, N W

    1984-06-01

    Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography ( PTHC ) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5 +/- 7.6 mg/dL and 14.9 +/- 7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5 +/- 6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 +/- 4.3 mg/dL and 9.0 +/- 5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period.

  1. Jaundice (image)

    Science.gov (United States)

    Jaundice is a condition produced when excess amounts of bilirubin circulating in the blood stream dissolve in ... the eyes. With the exception of normal newborn jaundice in the first week of life, all other ...

  2. ACR appropriateness criteria jaundice.

    Science.gov (United States)

    Lalani, Tasneem; Couto, Corey A; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Katz, Douglas S; Kaur, Harmeet; Miller, Frank H; Qayyum, Aliya; Small, William C; Sudakoff, Gary S; Yaghmai, Vahid; Yarmish, Gail M; Yee, Judy

    2013-06-01

    A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  3. Effect of obstructive jaundice on hepatic hemodynamics: use of Sonazoid-enhanced ultrasonography in a prospective study of the blood flow balance between the hepatic portal vein and hepatic artery.

    Science.gov (United States)

    Wakui, Noritaka; Takeda, Yuki; Nishinakagawa, Shuta; Ueki, Nobuo; Otsuka, Takafumi; Oba, Nobuyuki; Hashimoto, Hiroshi; Kamiyama, Naohisa; Sumino, Yasukiyo; Kojima, Tatsuya

    2015-10-01

    To prospectively clarify the effects of obstructive jaundice (OJ) on hepatic hemodynamics using contrast-enhanced ultrasonography (US). Subjects comprised 14 patients admitted to our hospital for OJ between April 2013 and March 2014. Contrast-enhanced US was performed using the LOGIQ E9 ultrasound device during the jaundice phase, before biliary drainage, and again after improvement of jaundice. After injecting the Sonazoid contrast agent, contrast dynamics were recorded in the right kidney and liver segments 5 or 6. Prototype software was used to calculate mean arrival time (AT) of the contrast agent in the liver parenchyma. Statistical analysis was performed to compare the mean AT in the jaundice and improved jaundice phases. We were unable to follow up three of the 14 patients after biliary drainage; thus, we included 11 patients for further analysis. The mean AT of the contrast agent was 2.0 ± 1.8 and 6.1 ± 2.3 s in the jaundice and improved jaundice phases, respectively, showing significantly shorter AT in the jaundice phase (p = 0.0033). Our findings indicate that OJ may influence the blood flow balance between the hepatic portal vein and hepatic artery.

  4. Effect of biliary drainage on inducible nitric oxide synthase, CD14 and TGR5 expression in obstructive jaundice rats

    Science.gov (United States)

    Wang, Zi-Kai; Xiao, Jian-Guo; Huang, Xue-Fei; Gong, Yi-Chun; Li, Wen

    2013-01-01

    AIM: To investigate the effect of biliary drainage on inducible nitric oxide synthase (iNOS), CD14 and TGR5 expression in rats with obstructive jaundice (OJ). METHODS: Male adult Sprague-Dawley rats were randomly assigned to four groups: OJ, sham operation (SH), internal biliary drainage (ID) and external biliary drainage (ED). Rat models were successfully established by two operations and succumbed for extraction of Kupffer cells (KCs) and liver tissue collection on the 8th and 15th day. KCs were isolated by in situ hepatic perfusion and digested with collagen IV, density gradient centrifuged by percoll reagent and purified by cell culture attachment. The isolated KCs were cultured with the endotoxin lipopolysaccharide (LPS) with and without the addition of ursodeoxycholic acid (UDCA). The expression of iNOS, CD14 and bile acid receptor-TGR5 protein in rat liver tissues was determined by immunohistochemistry. The expression of iNOS and CD14 messenger RNA (mRNA) on the isolated KCs was detected by reverse transcription polymerase chain reaction (PCR) and the TGR5 mRNA level in KCs was measured by real-time quantitative PCR. RESULTS: The iNOS protein was markedly expressed in the liver of OJ rats, but rare expressed in SH rats. After relief of OJ, the iNOS expression was decidedly suppressed in the ID group (ID vs OJ, P < 0.01), but obviously increased in rats of ED (ED vs OJ, P = 0.004). When interfered only with LPS, the expression of iNOS mRNA by KCs was increased in the OJ group compared with the SH group (P = 0.004). After relief of biliary obstruction, the iNOS mRNA expression showed slight changes in the ED group (ED vs OJ, P = 0.71), but dropped in the ID group (ID vs OJ, P = 0.001). Compared with the simple intervention with LPS, the expressions of iNOS mRNA were significantly inhibited in all four groups after interfered with both LPS and UDCA (P < 0.01, respectively). After bile duct ligation, the CD14 protein expression in rat liver was significantly

  5. Jaundice causes

    Science.gov (United States)

    ... is a yellow color in the skin, mucus membranes, or eyes. The yellow color comes from bilirubin, a byproduct of old red blood cells. Jaundice is a sign of other diseases. This article discusses the possible causes of jaundice in children ...

  6. Biliary obstruction and wound healing, infection, renal function and bloodcoagulation : an experimental study in rats

    NARCIS (Netherlands)

    J.P. Snellen

    1984-01-01

    textabstractThe purpose of the study reported in this thesis, was to investigate the effects of biliary obstruction on wound healing, resistance to infection, renal function and blood coagulation. Disturbances in these processes are often reported in patients with obstructive jaundice, and may lead

  7. ALGORITHM OF DIAGNOSTICS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH ACUTE CHOLECYSTITIS, CHOLEDOCHOLITHIASIS AND OBSTRUCTIVE JAUNDICE

    Directory of Open Access Journals (Sweden)

    M. D. Dibirov

    2017-01-01

    Full Text Available We performed a retrospective analysis of treatment in 4,197 patients with acute cholecystitis. Destructive complicated cholecystitis was diagnosed in 658 (25.3% patients . There were 431 (65.5% patients of elderly and senile age. All patients had comorbidities. Cardiovascular insufficiency — 73.9%, respiratory diseases — 29.2%, diabetes — 26%. For urgent indications, 12 (2.8% patients were operated, 2 (16.6% of them died. In 419 (97.2% patients, mini-invasive treatment was performed. Endoscopically, jaundice wasn’t managed in 86 (20.5% cases. In 62 (14.8% cases, percutaneous transhepatic microcholangiography was performed under ultrasound guidance. Laparoscopic cholecystectomy was performed in 183 (43.6 % cases, traditional cholecystectomy was performed in 149 (35.6% cases, and in 38 of them (23.9% it was combined with Kerr’s drainage of choledoch. Mini-invasive cholecystectomy was performed in 87 (20.7% cases. Postoperative complications were revealed in 21 (5.0% patients, in 7 (2.9% of elderly age and 14 (7.9% of senile age. Postoperative mortality rate was 2.0%. The use of minimally invasive interventions in the complex treatment of this group of patients was the main goal and it was reasoned by the severity of the initial condition of elderly and senile patients.

  8. MR features of a case of afferent loop syndrome presenting as obstructive jaundice; IRM d'un syndrome de l'anse afferente revele par un ictere obstructif

    Energy Technology Data Exchange (ETDEWEB)

    Chevallier, P.; Souci, J.; Oddo, F.; Diaine, B.; Padovani, B. [Centre Hospitalier Regional et Universitaire de Nice, Hopital Archet 2., Service d' Imagerie Medicale, 06 - Nice (France); Gueyffier, C. [Centre Hospitalier Regional de Cannes, Service d' Hepato-Gastro-enterologie, 06 - Cannes (France)

    2001-02-01

    The afferent loop syndrome corresponds to an acute or chronic obstruction of the afferent loop following a partial gastrectomy with Billroth II gastro-jejunal anastomosis. We describe the case of a 77-year-old man with history of partial gastrectomy for peptic ulcer disease performed 31 years ago and currently admitted for jaundice and poor general status. MR imaging showed dilatation of biliary and pancreatic ducts and showed a soft tissue mass between the afferent loop and the residual stomach. Endoscopy showed complete obstruction of the afferent loop by a biopsy-proven adenocarcinoma. The patient died of sepsis shortly after endoscopy of septicemia. (authors)

  9. Collagen levels are normalized after decompression of experimentally obstructed colon

    DEFF Research Database (Denmark)

    Rehn, Martin; Ågren, Sven Per Magnus; Syk, I

    2011-01-01

    Our aim was to define the dynamics in collagen concentrations in the large bowel wall following decompression of experimental obstruction.......Our aim was to define the dynamics in collagen concentrations in the large bowel wall following decompression of experimental obstruction....

  10. Evaluation of Jaundice in Adults.

    Science.gov (United States)

    Fargo, Matthew V; Grogan, Scott P; Saguil, Aaron

    2017-02-01

    Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. The evaluation of jaundice relies on the history and physical examination. The initial laboratory evaluation should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, alkaline phosphatase, ?-glutamyltransferase, prothrombin time and/or international normalized ratio, albumin, and protein. Imaging with ultrasonography or computed tomography can differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders. Ultrasonography is the least invasive and least expensive imaging method. A more extensive evaluation may include additional cancer screening, biliary imaging, autoimmune antibody assays, and liver biopsy. Unconjugated hyperbilirubinemia occurs with increased bilirubin production caused by red blood cell destruction, such as hemolytic disorders, and disorders of impaired bilirubin conjugation, such as Gilbert syndrome. Conjugated hyperbilirubinemia occurs in disorders of hepatocellular damage, such as viral and alcoholic hepatitis, and cholestatic disorders, such as choledocholithiasis and neoplastic obstruction of the biliary tree.

  11. Infant jaundice (image)

    Science.gov (United States)

    Jaundice is a yellow discoloring of the skin, mucous membranes, and eyes, caused by too much bilirubin ( ... hemoglobin made by the liver) in the blood. Jaundice is a condition produced when excess amounts of ...

  12. A case of jaundice of obscure origin.

    Science.gov (United States)

    Khan, Fahad M; Alcorn, Joseph; Hanson, Joshua

    2014-05-01

    Idiopathic painless jaundice with significant elevations in serum transaminases, occurring in a previously healthy patient, invokes a circumscribed set of possibilities including viral hepatitis, auto-immune hepatitis (AIH) and drug-induced liver injury (DILI). In this described case, common causes of cholestatic jaundice were considered including drug-induced liver injury, viral causes of hepatitis, and auto-immune antibodies. Biliary obstruction was excluded by appropriate imaging studies. Liver biopsy was obtained, though not definitive. After detailed investigation failed to reveal a cause of the jaundice, an empiric trial of steroids was initiated on the possibility that our patient had antibody-negative AIH and not DILI, with an associated grave prognosis. Empiric treatment with prednisone led to rapid resolution of jaundice and to the conclusion that the correct diagnosis was antibody-negative AIH.

  13. [The factors affecting the results of mechanical jaundice management].

    Science.gov (United States)

    Malkov, I S; Shaimardanov, R Sh; Korobkov, V N; Filippov, V A; Khisamiev, I G

    To improve the results of obstructive jaundice management by rational diagnostic and treatment strategies. Outcomes of 820 patients with obstructive jaundice syndrome were analyzed. Diagnostic and tactical mistakes were made at pre-hospital stage in 143 (17.4%) patients and in 105 (12.8%) at hospital stage. Herewith, in 53 (6.5%) cases the errors were observed at all stages. Retrospective analysis of severe postoperative complications and lethal outcomes in patients with obstructive jaundice showed that in 23.8% of cases they were explained by diagnostic and tactical mistakes at various stages of examination and treatment. We developed an algorithm for obstructive jaundice management to reduce the number of diagnostic and tactical errors, a reduction in the frequency of diagnostic and tactical errors. It reduced the number of postoperative complications up to 16.5% and mortality rate to 3.0%.

  14. Newborn jaundice - what to ask your doctor

    Science.gov (United States)

    ... your doctor; What to ask your doctor about newborn jaundice ... What causes jaundice in a newborn child? How common is newborn jaundice? Will the jaundice harm my child? What are the treatments for jaundice? How long does ...

  15. Management of neonatal jaundice.

    Science.gov (United States)

    Tan, K L

    1989-08-01

    Neonatal jaundice is the commonest complication among newborn infants in Singapore. Treatment is only required when the jaundice becomes severe. The trans-cutaneous bilirubinometer is useful in screening for neonatal jaundice; it is fairly reliable at levels less than or equal to 200 mumol/l in fullterm babies. Phototherapy is the commonest form of treatment and is effective in almost all cases if high intensity phototherapy is also used. Exchange transfusion is now only rarely used in view of its known complications and relatively high mortality rate.

  16. Problematic Issues of Differential Diagnosis of Jaundice in Children. Case Studies (Clinical Lecture

    Directory of Open Access Journals (Sweden)

    S.O. Kramariov

    2016-07-01

    Full Text Available Depending on the level, at which bilirubin metabolism disorders occur, the following types of jaundice are identified: hemolytic, hepatocellular, obstructive. Hemolytic jaundice is characterized by increased levels of indirect bilirubin in the blood at a normal activity of liver cell enzymes, in parallel there is a reduction in hemoglobin, red blood cells levels and high reticulocytosis in the blood. A typical laboratory sign of hepatocellular jaundice is elevated level of total bilirubin due to the direct one and increased activity of hepatocellular enzymes. Obstructive jaundice occurs in violation of the bile outflow from the gallbladder and bile ducts into the lumen of the small intestine.

  17. Breast milk jaundice

    Science.gov (United States)

    ... babies who show signs of hunger are given pacifiers. Breast milk jaundice may run in families. It ... look at blood cell shapes and sizes Blood type Complete blood count Reticulocyte count (number of slightly ...

  18. Erythromycin estolate and jaundice.

    Science.gov (United States)

    Inman, W H; Rawson, N S

    1983-01-01

    Using prescription-event monitoring to determine whether erythromycin estolate was a more frequent cause of jaundice than erythromycin stearate or tetracycline 12 208 patients, for whom 5343 doctors had prescribed one of the three drugs, were identified by the Prescription Pricing Authority. Of the questionnaires sent to general practitioners about the possible occurrence of jaundice, 76% were returned. There were 16 reports of jaundice, of which four were attributable to gall stones, three to cancer, six to viral hepatitis, and only three were possibly related to an antibiotic. All three patients, in whom the antibiotic was a possible cause, had been treated with erythromycin stearate. No case was attributable to the estolate which had previously been suspected of being a more frequent cause of jaundice. Although the incidence is unknown, it is very unlikely to be more than one in 100. PMID:6407653

  19. Breast milk jaundice

    Directory of Open Access Journals (Sweden)

    Katarzyna Szczepańska

    2017-06-01

    Full Text Available Jaundice is the most common clinical symptom in the neonatal period. Free serum bilirubin levels during the first days after birth are higher than at any point later in life. Breastfeeding is associated with both increased risk and severity of jaundice. Early-onset breastfeeding jaundice is primarily a result of insufficient caloric supply and resolves gradually with the normalisation of lactation. Late-onset type, i.e. breast milk jaundice, develops after 4–7 days of life in otherwise healthy neonates and is mainly associated with the presence of an unknown factor in breast milk, which increases the enterohepatic reabsorption of bilirubin. Breast milk (late-onset jaundice is the most common cause of persistent jaundice due to increased unconjugated bilirubin. Elevated conjugated bilirubin always indicates a pathological process and requires urgent diagnosis extension. It was believed until recently that breast milk jaundice is a mild condition, which never leads to central nervous system damage. This, however, is not entirely certain in the light of currently available scientific research; therefore it is necessary to monitor bilirubin levels. Since breast milk jaundice is a diagnosis of exclusion, it is usually preceded by differential diagnosis. In the case of breast milk jaundice, serum bilirubin levels will return to normal by 12–14 weeks of life. In the case of newborns/infants in good condition, who develop properly and gain weight systematically, supporting parents in effective breastfeeding, monitoring and regular check-ups of the child are recommended. Breast milk jaundice is not a contraindication to prophylactic vaccination.

  20. Neonatal jaundice and human milk.

    Science.gov (United States)

    Soldi, Antonella; Tonetto, Paola; Varalda, Alessia; Bertino, Enrico

    2011-10-01

    Breastfeeding is linked both to a greater jaundice frequency and intensity in the first postnatal days ("breastfeeding jaundice") and to visible jaundice persisting beyond the first two weeks of life ("breast milk jaundice"), but the appearance of skin jaundice is not a reason for interrupting breastfeeding which can and should continue without any interruption in most cases. There have been numerous contributions to the literature, which have rescaled the direct role of breast milk, both in early jaundice and in the more severe cases of late jaundice. In fact, the reviewed guidelines for detection and management of hyperbilirubinemia underline, how prevention of badly managed breastfeeding and early support for the couple mother-child are effective prevention measures against severe early-onset jaundice; furthermore, the breastfeeding interruption is no longer recommended as a diagnostic procedure to identify breast milk jaundice because of its low specificity and the risk to disregarding the detection of a potentially dangerous disease.

  1. CT vs. MRCP in choledocholithiasis jaundice.

    Science.gov (United States)

    Petrescu, I; Bratu, A M; Petrescu, S; Popa, B V; Cristian, D; Burcos, T

    2015-01-01

    Obstructive jaundice can raise problems to diagnostic imaging. The radiologist must choose the most appropriate examination that delivers the most important diagnostic information because the differences between a lithiasic obstruction and a tumoral one are vital. This information helps the surgeon speed up the process of decision-making, because the treatment may be very different in relation to the nature of the obstruction. This study tries to demonstrate the diagnostic accuracy of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in detecting the obstacle in the common bile duct (CBD) and the possibility of establishing the lithiasic nature of the obstruction. A retrospective analysis was analyzed during an interval of 18 months that included jaundice patients admitted in the General Surgery Department of "Coltea" Clinical Hospital. They were examined by CT scanning and by MRCP, being suspected of choledocholithiasis. 63 patients were included in the study, 34 females and 29 males. 33 CT scans and 30 MRCP exams were performed. CT scan is useful in detecting residual or iterative choledocholithiasis in patients after cholecystectomy, contrast enhanced CT (CECT), being able to differentiate between lithiasic and non-lithiasic obstruction. MRCP delivers important anatomic details of the biliary tree; it is superior to CT in diagnosing the hepatocholedochal lithiasis; MRCP tends to replace endoscopic retrograde cholangiopancreatography (ERCP)--the diagnostic "gold standard" reducing the number of unnecessary invasive diagnostic procedures.

  2. Peroxisome proliferators-activated alpha agonist treatment ameliorates hepatic damage in rats with obstructive jaundice: an experimental study

    Directory of Open Access Journals (Sweden)

    Alper Murat

    2007-11-01

    Full Text Available Abstract Background Peroxisome proliferators-activated receptor alpha (PPARα activation modulates cholesterol metabolism and suppresses bile acid synthesis. This study aims to evaluate the effect of short-term administration of fenofibrate, a PPARα agonist, on proinflammatory cytokines, apoptosis, and hepatocellular damage in cholestasis. Methods Forty male Wistar rats were randomly divided into four groups: I = sham operated, II = bile duct ligation (BDL, III = BDL + vehicle (gum Arabic, IV = BDL + fenofibrate (100 mg/kg/day. All rats were sacrificed on 7th day after obtaining blood samples and liver tissue. Total bilirubin, aminotransferase (AST, alanine aminotransferase (ALT and alkaline phosphatase (ALP, gamma-glutamyl transferase, (GGT, tumor necrosis factor alpha (TNF-α, interleukin 1 beta (IL-1 β, and total bile acid (TBA in serum, and liver damage scores; portal inflammation, necrosis, bile duct number, in liver tissue were evaluated. Apoptosis in liver was also assessed by immunohistochemical staining. Results Fenofibrate administration significantly reduced serum total bilirubin, AST, ALT, ALP, and GGT, TNF-α, IL-1 β levels, and TBA (P P P P Conclusion Short-term administration of fenofibrate to the BDL rats exerts beneficial effects on hepatocellular damage and apoptosis.

  3. Fluorescein-related extensive jaundice.

    Science.gov (United States)

    Kalkan, Asim; Turedi, Suleyman; Aydin, Ibrahim

    2015-03-01

    Fluorescein is a chemical dye frequently used in eye diseases to assess blood flow in the retina, choroid tissue, and iris. Although it has many known adverse effects, it has not previously been reported to lead to jaundice. The purpose of this case report was to emphasize that for patients presenting at the emergency department with jaundice symptoms, it should not be forgotten by emergency physicians that jaundice can develop after fluorescein angiography. Case: A 65-year-old woman presented at the emergency department with extensive jaundice that had developed on her entire body a few hours after fluorescein angiography applied because of vision impairment. The test results for all the diseases considered to cause jaundice were normal,and fluorescein-related jaundice was diagnosed. Conclusion: A detailed anamnesis should be taken when jaundice is seen in patients who have undergone fluorescein angiography, and it should not be forgotten that fluorescein dye is a rare cause of jaundice.

  4. Cephalexin Induced Cholestatic Jaundice

    Directory of Open Access Journals (Sweden)

    Abhinav Agrawal

    2014-01-01

    Full Text Available Cephalexin is a very commonly prescribed orally administered antibiotic which has many potential side effects. Amongst these cholestatic jaundice has been infrequently reported as an adverse reaction. We present a case of a 57-year-old male who exhibited features of cholestatic jaundice including elevated liver function tests (LFTs after taking cephalexin and showed improvement on removal of the offending agent. During this time he was symptomatically treated with cholestyramine. Complete resolution of LFTs was seen in four weeks. Cephalexin induced cholestasis is rare and hence requires a high degree of clinical suspicion for prompt diagnosis and treatment.

  5. Experimental evaluation of furosemide renography in unobstructed and partially obstructed upper urinary tracts in pigs

    Energy Technology Data Exchange (ETDEWEB)

    Harving, N.; Christiansen, P.; Taagehoj-Jensen, F.; Frokjaer, J.; Djurhuus, J.C.; Mortensen, J. (Institute of Experimental Clinical Research, University of Aarhus (Denmark))

    1991-06-01

    To evaluate the reliability and the constancy of the furosemide renography an experimental evaluation of the test has been performed. A standardized unilateral partial proximal ureteral obstruction was applied to 11 pigs. Preoperatively and again weekly in the three weeks following obstruction a furosemide renogram (FR) was done. The furosemide renography was a very constant parameter in the unobstructed kidney (85%) and in the partly obstructed kidney (85%). A type I FR pattern (O'Reilly classification) was an exact indicator of an unobstructed pelvis. After partial ureteral obstruction, an immediate change in the FR pattern was seen either into type II or type IIIa renography. In this experimental study furosemide renography was found to be a reliable tool in the differentiation between the unobstructed normal renal pelves and the partly obstructed dilated renal pelves.

  6. [Jaundice and pathological liver values].

    Science.gov (United States)

    Schwarzenbach, Hans-Rudolf

    2013-06-05

    Jaundice corresponds to elevated bilirubin- levels, whereat one has to distinguish between direct and indirect serum-bilirubin. In the present Mini Review causes and differential diagnosis of jaundice are outlined. Ultrasound-diagnostic plays a major role in identifying intrahepatic or extrahepatic jaundice. Attention is given to the differential diagnosis of elevated liver enzymes in presence of jaundice, pointing out the distinction between hepatocellular and cholestatic parameters as well as the differentiation in acute or chronic increase. Moreover, the consequences of liver enzyme elevations including further diagnostic procedures, are highlighted. Finally, possibilities and limitations of modern diagnostic tests for liver fibrosis are briefly overviewed.

  7. Hepatobiliary Cystadenoma Revealed by a Jaundice: A Case Report

    Directory of Open Access Journals (Sweden)

    Taoufiq Harmouch

    2011-01-01

    Full Text Available Introduction. Hepatobiliary cystadenomas are rare benign cystic tumors and have a potential for recurrence and malignant transformation. The diagnosis may be very difficult because of absence of typical imaging feature in some cases. Case Presentation. In this paper, the authors discuss a 57-year-old woman who presented a jaundice related to hepatobiliary cystadenoma. Biological and radiological examinations have led to surgery, and the diagnosis is made after a histological examination of surgical specimens. Conclusion. This observation illustrates a hepatobiliary cystadenoma revealed by jaundice. Histology examination contributed to diagnosis. The authors discussed the mechanisms of biliary obstruction and differential diagnoses through a review of the literature.

  8. Jaundice as a Rare Indication for Aortic Aneurysm Repair.

    Science.gov (United States)

    Rieß, Henrik C; Tsilimparis, Nikolaos; Behrendt, Christian A; Wipper, Sabine; Debus, Eike S; Larena-Avellaneda, Axel

    2015-10-01

    Compression of adjacent anatomic structures by an abdominal aortic aneurysm (AAA) can result in a variety of symptoms. We describe the case of an 88-year-old Caucasian woman with jaundice, elevated laboratory parameters for extrahepatic and intrahepatic cholestasis, and concomitant juxtarenal AAA compressing the liver hilum. Following exclusion of other common causes for cholestasis, the patient was considered to have a symptomatic AAA. Open abdominal aortic surgery revealed a contained rupture and was repaired. Obstructive jaundice secondary to a compromising AAA is a rare condition and to the best of our knowledge has not been reported to date. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Modern imaging in patients with obstructive jaundice

    African Journals Online (AJOL)

    2007-07-19

    Jul 19, 2007 ... Its main limitation is in patients with impaired renal function with high serum creatinine levels, as contrast may be nephrotoxic. Artefacts produced by patient movement, respiration and support devices also limit diagnostic value. Magnetic resonance imaging (MRI). MRI is the most recent advance in cross-.

  10. Establishment of peritoneal liquid electrophoretogram from healthy horses and horses submitted to experimentally induced intestinal obstruction

    Directory of Open Access Journals (Sweden)

    A.F.S. Nogueira

    2014-06-01

    Full Text Available The initial inflammatory stages of the colic syndrome include changes known as acute phase response. The aim of this study was to contribute with the establishment of reference values concerning the electrophoretogram of peritoneal liquid from healthy horses and horses submitted to experimentally induced intestinal obstruction. Twenty-one horses were allotted in four groups: duodenal obstruction (DG, ileum obstruction (IG, left-dorsal colon obstruction (MG, and control group (CG. Peritoneal liquid was sampled before obtruction (T0, with 3 hours of obstruction (T3 and 6, 30, 102 and 174 hours after desobstructing (T6, T30, T102 and T174, respectively. Total protein levels were determined by the biuret method and protein fractions were obtained by SDS-PAGE electrophoresis. The acute phase proteins (APP identified were Immunoglobulin-A, ceruloplasmin, transferrin, albumin, α1-antitrypsin, heavy and light chains of immunoglobulin-G, haptoglobin, α1-acid glycoprotein and a still unnamed protein, which was called P24. There was no difference (P>0.3 in protein levels among groups, although a significant difference (P>0.05 was observed between distinct experimental moments in each group evidencing a higher response of the APP in the obstructed groups. The APP fractioning of the peritoneal liquid was standardized to establish a standard curve for healthy equines and those submitted to induced intestinal obstruction. Moreover, it was verified that the SDS-PAGE electrophoresis was sensitive and effective to help diagnose abdominal inflammatory processes.

  11. [Experimental hypertony caused by obstruction of the anterior chamber angle ab interno (author's transl)].

    Science.gov (United States)

    Maguritsas, N; Vikas, C; Theodossiadis, G; Vergados, I; Velissaropoulos, P

    1976-07-01

    In 30 rabbits, separated into 3 groups (A, B and C), the entire area (A), three quarters (B) half of the anterior chamber angle (C) was experimentally obstructed by means of a homologous scleral graft. In groups A and B a statistically significant change of the intraocular pressure and of the cornea diameter was shown as compared with the control eye and group C. This change is due to the obstructed area of the angle. The increased intraocular pressure lasted for some months. The graft was well tolerated by the tissue of the angle and the obstruction of the angle was total, as was confirmed by means of the histological preparations.

  12. Estudo ultrassonográfico morfométrico do fígado e trato biliar de suínos submetidos a obstrução biliar experimental Sonographic morphometry of the liver and biliary tract in porcine models submitted to experimental biliary obstruction

    Directory of Open Access Journals (Sweden)

    Aline Gomes de Campos

    2013-04-01

    Full Text Available OBJETIVO: Comparar as alterações anatômicas decorrentes de um quadro de icterícia obstrutiva experimental induzida em suínos nos períodos pré e pós-operatório por meio de exame ultrassonográfico. MATERIAIS E MÉTODOS: Seis suínos da raça Landrace, com 36 dias de idade, foram submetidos a obstrução biliar completa mediante ligadura do ducto colédoco por cirurgia videolaparoscópica. RESULTADOS: Não ocorreram dificuldades na execução dos procedimentos obstrutivos e a recuperação cirúrgica foi eficiente. Decorridos sete dias, os animais apresentaram icterícia, bilirrubinúria e acolia fecal. O exame ultrassonográfico comparativo permitiu visualizar hepatomegalia, colecistomegalia e aumento no calibre do ducto colédoco em todos os animais, assim como alterações decorrentes da colestase. A avaliação morfométrica revelou aumento significativo nos diâmetros da vesícula biliar e do lobo hepático lateral esquerdo. CONCLUSÃO: Os suínos representam um modelo experimental adequado de icterícia obstrutiva, e o exame ultrassonográfico demonstrou-se sensível e relevante no diagnóstico das alterações decorrentes de obstrução biliar extra-hepática nesses animais.OBJECTIVE: To compare, by means of ultrasonography, pre- and postoperative anatomical changes arising from experimentally induced obstructive jaundice in porcine models. MATERIALS AND METHODS: Six 36-day-old Landrace pigs underwent laparoscopically induced complete biliary obstruction by common bile duct ligation. RESULTS: No difficulty was faced during the procedures and the surgical recovery was uneventful. After seven days, the animals showed jaundice, bilirubinuria and acholic stools. Comparative ultrasonography allowed visualization of hepatomegaly, cholecystomegaly and increased caliber of the common bile duct in all the animals, as well as changes resulting from cholestasis. The morphometric analysis revealed a significant increase in diameter of the

  13. Thyrotoxic crisis presenting with jaundice.

    Science.gov (United States)

    Wickramasinghe, R D S S; Luke, W A N V; Sebastiampillai, B S; Gunathilake, M P M L; Premaratna, R

    2016-06-23

    Thyrotoxic crisis is a medical emergency requiring early diagnosis and urgent management, which can be challenging due to its diverse clinical presentations. While common presentations include fever, sweating, palpitations, tremors and confusion, presence of jaundice is rare. We report a 35-year-old male who presented with jaundice due to cholestasis along with other features of thyrotoxic crisis due to Graves' disease. He had a good clinical recovery with resolution of cholestasis following treatment for thyrotoxic crisis. Jaundice can be a rare manifestation of thyrotoxic crisis, and should be considered in the differential diagnosis when other clinical features of thyrotoxic crisis are present. However secondary causes of jaundice should be looked into and excluded.

  14. Cholestatic jaundice by malignant lesions: pictorial essay;Ictericia colestatica por lesoes de natureza maligna: ensaio iconografico

    Energy Technology Data Exchange (ETDEWEB)

    Santa Anna, Tatiana Kelly Brasileiro de; Santana, Alex Menezes; Rizzuto, Mauricio Soares; Chagas, Alessandro Rosa Rodrigues; Zuppani, Aguinaldo Cunha, E-mail: tatianakelly@hotmail.co [Hospital Santa Marcelina, Sao Paulo, SP (Brazil). Setor de Radiologia e Diagnostico por Imagem; Rezende, Marcelo Bruno; Viveiros, Marcelo de Melo [Hospital Santa Marcelina, Sao Paulo, SP (Brazil). Servico de Cirurgia do Figado e Hipertensao Portal

    2009-12-15

    Malignant obstructive jaundice is most commonly caused by cancer of pancreatic head, papilla tumor, cholangiocarcinoma and biliary obstruction induced by secondary lesions of the liver or lymph nodes. Patients usually present with weight loss, abdominal pain, jaundice and progressive increase of direct bilirubin, being essential the evaluation by imaging methods for the proper diagnosis, staging and therapeutic planning. This essay illustrates the imaging aspects of ultrasound and computed tomography - and in specific situations magnetic resonance cholangiography - of the major malignancies that lead to cholestatic jaundice. (author)

  15. Obstructive jaundice induces early depression of mitochondrial respiration in rat hepatocytes A icterícia obstrutiva induz depressão precoce da respiração mitocondrial em hepatócitos de ratos

    Directory of Open Access Journals (Sweden)

    Riad Naim Younes

    2007-08-01

    Full Text Available INTRODUCTION: Oxidative phosphorylation dysfunction of hepatocyte mitochondria is involved in the pathophysiology of organ dysfunction following obstructive jaundice (OJ. However the time period from biliary occlusion to the occurrence of the dysfunction has not been determined decisively. PURPOSE: To evaluate the early effects (1 d and 7 d of OJ on liver mitochondria respiratory function in rats. METHODS: Male Wistar rats (200-250 g were randomly divided into the following 3 groups: laparotomy plus OJ for 24 h (1d group (n = 10; laparotomy plus OJ for 7 d (7d group (n = 10; sham control procedure (CTR group (n = 12. At the end of OJ periods, total serum bilirubin level, hepatic enzyme activity levels (GOT, GTP, Gama-GT, ALP, mitochondrial respiration phases S3 and S4, as well as the respiratory control ratio (RC = S3/S4, and ADP consumption/oxygen consumption (ADP/O ratio, were determined. RESULTS: Total serum bilirubin, activity of most hepatic enzymes, and O2 consumption during basal (S4 respiration were increased in the 1d and 7d groups (ANOVA, p = 0.05 vs. CTR. After ADP addition, the O2 consumption rate (S3 in the 1d group remained similar to the CTR rate (ANOVA p > .05, while the RC rate was reduced (ANOVA, p = 0.001 vs. CTR. The effects observed on mitochondrial respiration in the 1d group were exacerbated in the 7d group. CONCLUSION: These results indicate that OJ induces early (24 h depression of liver mitochondria respiration, and thus may lead to early reduction in the production of high energy bonds.INTRODUÇÃO: A disfunção da fosforilação oxidativa das mitocôndrias do hepatócito está envolvida na fisiopatologia da disfunção orgânica subseqüente à icterícia obstrutiva (IO. Entretanto, a precocidade da ocorrência desta disfunção permanece obscura. OBJETIVO: Avaliar o efeito precoce da IO na função respiratória mitocondrial em ratos. MÉTODOS: Ratos Wistar machos (200 a 250g foram randomizados em 3 grupos que foram

  16. Experimental validation of tonal noise control from subsonic axial fans using flow control obstructions

    Science.gov (United States)

    Gérard, Anthony; Berry, Alain; Masson, Patrice; Gervais, Yves

    2009-03-01

    This paper presents the acoustic performance of a novel approach for the passive adaptive control of tonal noise radiated from subsonic fans. Tonal noise originates from non-uniform flow that causes circumferentially varying blade forces and gives rise to a considerably larger radiated dipolar sound at the blade passage frequency (BPF) and its harmonics compared to the tonal noise generated by a uniform flow. The approach presented in this paper uses obstructions in the flow to destructively interfere with the primary tonal noise arising from various flow conditions. The acoustic radiation of the obstructions is first demonstrated experimentally. Indirect on-axis acoustic measurements are used to validate the analytical prediction of the circumferential spectrum of the blade unsteady lift and related indicators generated by the trapezoidal and sinusoidal obstructions presented in Ref. [A. Gérard, A. Berry, P. Masson, Y. Gervais, Modelling of tonal noise control from subsonic axial fans using flow control obstructions, Journal of Sound and Vibration (2008), this issue, doi: 10.1016/j.jsv.2008.09.027.] and also by cylindrical obstructions used in the literature. The directivity and sound power attenuation are then given in free field for the control of the BPF tone generated by rotor/outlet guide vane (OGV) interaction and the control of an amplified BPF tone generated by the rotor/OGV interaction with an added triangular obstruction between two outlet guide vanes to enhance the primary non-uniform flow. Global control was demonstrated in free field, attenuation up to 8.4 dB of the acoustic power at BPF has been measured. Finally, the aerodynamic performances of the automotive fan used in this study are almost not affected by the presence of the control obstruction.

  17. Effect of ipsilateral ureteric obstruction on contralateral kidney and role of renin angiotensin system blockade on renal recovery in experimentally induced unilateral ureteric obstruction

    Directory of Open Access Journals (Sweden)

    Shasanka S Panda

    2013-01-01

    Full Text Available Aims: To study, the effects of ipsilateral ureteric obstruction on contralateral kidney and the role of renin angiotensin system (RAS blockade on renal recovery in experimentally induced unilateral ureteric obstruction. Materials and Methods: Unilateral upper ureteric obstruction was created in 96 adult Wistar rats that were reversed after pre-determined intervals. Losartan and Enalapril were given to different subgroups of rats following relief of obstruction. Results: The severity of dilatation on the contralateral kidney varied with duration of ipsilateral obstruction longer the duration more severe the dilatation. There is direct correlation between renal parenchymal damage, pelvi-ureteric junction (PUJ fibrosis, inflammation and severity of pelvi-calyceal system dilatation of contralateral kidney with duration of ipsilateral PUJ obstruction. Conclusions: Considerable injury is also inflicted to the contralateral normal kidney while ipsilateral kidney remains obstructed. Use of RAS blocking drugs has been found to significantly improve renal recovery on the contralateral kidney. It can, thus, be postulated that contralateral renal parenchymal injury was mediated through activation of RAS.

  18. Evaluation of Jaundice meter in the assessment of jaundice among ...

    African Journals Online (AJOL)

    2015-02-24

    Feb 24, 2015 ... Objectives: To evaluate the corre- lation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) among Nigerian preterm neonates, and to deter- mine the parameters affecting the relationship. Method: Jaundiced preterm neo- nates delivered between 28 and 36 weeks of gestation admitted.

  19. Evaluation of Jaundice meter in the assessment of jaundice among ...

    African Journals Online (AJOL)

    2015-02-24

    Feb 24, 2015 ... Abstract: Background: The ob- jective assessment of the severity of neonatal jaundice is Total Se- rum Bilirubin (TSB) determina- tion, which requires multiple blood sampling. This has inherent problems, including risks of anae- mia and infection. Transcutaneous. Bilirubinometry (TcB) is a reli-.

  20. Branding to treat jaundice in India.

    Science.gov (United States)

    John, Selva Inita; Balekuduru, Ainash; Zachariah, Uday; Eapen, C E; Chandy, George

    2009-01-01

    Jaundice is regarded as a mysterious disease rather than a symptom of disease in several parts of India. We describe 8 cases that underwent branding to treat jaundice and subsequently presented to our centre. The causes for jaundice in these patients included a variety of benign and malignant disorders. Our report suggests that despite being literate, strong cultural beliefs lead people to seek potentially harmful procedures like branding to treat jaundice in parts of India.

  1. The “jaundice hotline” for the rapid assessment of patients with jaundice

    Science.gov (United States)

    Mitchell, Jonathan; Hussaini, Hyder; McGovern, Dermot; Farrow, Richard; Maskell, Giles; Dalton, Harry

    2002-01-01

    Problem Patients with jaundice require rapid diagnosis and treatment, yet such patients are often subject to delay. Design An open referral, rapid access jaundice clinic was established by reorganisation of existing services and without the need for significant extra resources. Background and setting A large general hospital in a largely rural and geographically isolated area. Key measures for improvement Waiting times for referral, consultation, diagnosis, and treatment, length of stay in hospital, and general practitioners' and patients' satisfaction with the service. Strategies for change Referrals were made through a 24 hour telephone answering machine and fax line. Initial assessment of patients was carried out by junior staff as part of their working week. Dedicated ultrasonography appointments were made available. Effects of change Of 107 patients seen in the first year of the service, 62 had biliary obstruction. The mean time between referral and consultation was 2.5 days. Patients who went on to endoscopic retrograde cholangiopancreatography waited 5.7 days on average. The mean length of stay in hospital in the 69 patients who were admitted was 6.1 days, compared with 11.5 days in 1996, as shown by audit data. Nearly all the 36 general practices (95%) and the 30 consecutive patients (97%) that were surveyed rated the service as above average or excellent. Lessons learnt An open referral, rapid access service for patients with jaundice can shorten time to diagnosis and treatment and length of stay in hospital. These improvements can occur through the reorganisation of existing services and with minimal extra cost. PMID:12142314

  2. Experimental study of the diagnostic potentialities of bioimpedance measurement in acute intestinal obstruction.

    Science.gov (United States)

    Rodin, A V; Pleshkov, V G; Leonov, S D; Bazhenov, S M

    2013-10-01

    The dynamics of impedance values of the small and large intestine, parietal peritoneum, and greater omentum was analyzed during different periods of experimental acute intestinal obstruction. The impedance was below the normal, which indicated progressive microcirculatory disorders and necrosis of the intestinal wall. The histomorphological picture of healing of anastomoses created after resection of the intestine with consideration for bioimpedance values and of anastomoses created after resection of the intestine in a priori viable tissues virtually did not differ.

  3. Comparison of different morphological parameters with duration of obstruction created experimentally in unilateral upper ureters: An animal model

    Directory of Open Access Journals (Sweden)

    Shasanka Shekhar Panda

    2014-01-01

    Full Text Available Background: The objective of the following study is to determine and to compare the different morphological parameters with duration of obstruction created experimentally in unilateral upper ureters of rats. Materials and Methods: Unilateral upper ureteric obstruction was created in 60 adult Wistar rats that were reversed after predetermined intervals. Rats were sacrificed and ipsilateral kidneys were subjected for analysis of morphological parameters such as renal height, cranio-caudal diameter, antero-posterior diameter, lateral diameter, volume of the pelvis and average cortical thickness: Renal height. Results: Renal height and cranio-caudal diameter of renal pelvis after ipsilateral upper ureteric obstruction started rising as early as 7 days of creating obstruction and were affected earlier than antero-posterior and lateral diameter and also were reversed earlier than other parameters after reversal of obstruction. Renal cortical thickness and volume of the pelvis were affected after prolonged obstruction (> 3 weeks and were the late parameters to be reversed after reversal of obstruction. Conclusions: Cranio-caudal diameter and renal height were the early morphological parameters to be affected and reversed after reversal of obstruction in experimentally created ipsilateral upper ureteric obstruction.

  4. Influência da icterícia colestática na variação ponderal em modelo experimental Influence of cholestatic jaundice on the weight variance in an experimental model

    Directory of Open Access Journals (Sweden)

    Leonardo de Souza Vasconcellos

    2012-12-01

    Full Text Available OBJETIVO: Avaliar a influência da icterícia colestática na variação ponderal. MÉTODOS: Foram utilizados 64 ratos adultos, distribuídos em seis grupos: F1 (n=6 - fêmeas normais, F2 (n=6 - fêmeas laparotomizadas, F3 (n=20 - fêmeas ictéricas, M1 (n=6 - machos normais, M2 (n=6 - machos laparotomizados, M3 (n=20 - machos ictéricos. A icterícia foi obtida com ligadura e secção do ducto biliopancreático. Os pesos dos animais foram registrados semanalmente, durante sete semanas. No 14º dia de experimento, dosaram-se as bilirrubinas séricas e os hormônios gonadais. Após a sétima semana, realizou-se estudo histológico do fígado. RESULTADOS: Os animais dos grupos F3 e M3 apresentaram bilirrubinas elevadas e diminuição da massa corpórea, quando comparados com os demais grupos. As diferenças ponderais foram significativas a partir da quarta semana entre as fêmeas e da quinta semana entre os machos. Nos animais ictéricos houve aumento do estradiol e diminuição da progesterona e da testosterona total. Septos de fibroses perivenular e periportal, colangite e hiperplasia de ductos biliares ocorreram no fígado dos animais ictéricos. Nenhum animal apresentou cirrose. CONCLUSÃO: Ocorreu redução do peso corpóreo murino em presença de icterícia colestática em ambos os sexos.OBJECTIVE: To evaluate the influence of cholestatic jaundice in weight variation. METHODS: We used 64 adult rats divided into six groups: F1 (n = 6: normal females; F2 (n = 6: laparotomy females; F3 (n = 20: jaundiced females; M1 (n = 6: normal males; M2 (n = 6: laparotomy males; M3 (n = 20: jaundiced males. Jaundice was obtained by ligation and section of the biliopancreatic duct. The animal weights were recorded weekly for seven weeks. On the 14th day of the experiment, bilirubin and gonadal hormones were assessed. After the seventh week a histological study of the liver was performed. RESULTS: The animals in groups F3 and M3 showed elevated bilirubin and

  5. Assessment of jaundice in the hospitalized patient.

    Science.gov (United States)

    Kathpalia, Priya; Ahn, Joseph

    2015-02-01

    Jaundice in the hospitalized patient is not an uncommon consultation for the general gastroenterologist. It is essential to explore the underlying cause of jaundice because management is largely aimed at addressing these causes rather than the jaundice itself. Although the diagnostic evaluation for jaundice can be broad, clinical judgment must be used to prioritize between various laboratory tests and imaging studies. Most importantly, clinicians must understand which conditions are emergent and/or require evaluation for liver transplantation. Further studies need to be performed to better understand the outcomes of hospitalized patients who develop jaundice. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. The study on clinical value of the detection about serum and Unconjugated Bilirubin in diagnosis of neonatal jaundice.

    Science.gov (United States)

    Wang, Guangzhou; Wang, Jiefei; Huang, Nannan; Yu, Fengqin

    2016-01-01

    In this paper, the clinical value of the detection about serum and unconjugated bilirubin (UCB) in neonatal jaundice was studied to found an effective and rapid method for diagnose of neonatal jaundice. ALB (Serum Albumin), total serum bilirubin (TSB) and UCB were detected by ELISA method among the 100 cases with neonatal jaundice selected for the study. The values of ALB, UCB and TSB in moderate jaundice patients were (42.83±3.87) g/L, (287.35±44.38) μm/L, (304.16±43.40) μm/L, respectively; as for the severe jaundice patients, the values were (38.41±4.82) g/L, (354.38±48.75) μm/L, (375.20±47.51) μm/L. The results showed significant differences with the pjaundice patients. The level of ALB, UCB, TSB in hemolytic jaundice, obstructive jaundice and jaundice caused by other infections also had significant differences, and the difference was statistically significant (pjaundice.

  7. Effect of Small Intestine Strangulation Obstruction on Clinical and Histopathological Parameters An Experimental Study in Donkeys

    Directory of Open Access Journals (Sweden)

    Heba Mohamed M. Kuraa

    2011-06-01

    Full Text Available To study clinical and histopathological changes occur within the first 12 hours of strangulating obstruction of the small intestine in equine, twenty five adult donkeys were used in an experimental study. Strangulation obstruction of the small intestine was performed for 3, 6, 9 and 12 hours, respectively. Clinical examination was done before surgery and at 3 hours intervals postoperatively. After euthanasia, histopathological examination was made 10 cm, 1, 2 and 3 meters proximal to the strangulated part. Three hours postoperatively, the animals began to show signs of abdominal pain, they were looking around, stamping the hind feet, falling down suddenly. Nine hours postoperatively, animals showed signs of depression with intermittent nervous movements in the form of circle movement. After 12 hours, the animals were lying down; There were a significant reduction in the body temperature, respiratory rate, pulse rate, heart rate with significant increase in capillary refill time. Macroscopic changes of the strangulated part were congestion, edema, and dark red discoloration of the intestinal wall and mesentery. Distension of the intestine proximal to the strangulation extended more with increase the period of strangulation. Microscopic examination showed showed severe congestion, dark brown to blackish discoloration with fibrous shreds on the strangulated segment. Peticheal hemorrhages were observed in the intestinal wall and its mesentery for a distance up to 3 meters. The severity of signs varies according to the duration of obstruction which could give a remarkable justification of the prognosis of the patient and the availability of treatment.

  8. THE RELATION OF THE SPLEEN TO BLOOD DESTRUCTION AND REGENERATION AND TO HEMOLYTIC JAUNDICE : II. THE RELATION OF HEMOGLOBINEMIA TO HEMOGLOBINURIA AND JAUNDICE IN NORMAL AND SPLENECTOMIZED ANIMALS.

    Science.gov (United States)

    Pearce, R M; Austin, J H; Eisenbrey, A B

    1912-09-01

    The results of this study may be stated as follows. 1. Rapid injection of more than 0.06 of a gram per kilo of hemoglobin intravenously into a normal animal is followed by the appearance of hemoglobin in the urine (pelvis of kidney) within eight to ten minutes. 2. After rapid injection of more than 0.012 of a gram per kilo per minute of hemoglobin, 16 to 36 per cent. of the total amount, if this equals 0.25 of a gram per kilo, is eliminated in the urine and is accompanied by choluria. 3. If the injection of not more than 0.35 of a gram per kilo is made slowly (less than 0.01 of a gram per kilo per minute), the amount eliminated in the urine is only 2.33 to 9.5 per cent. of the total amount injected, and choluria does not occur. 4. The concentration of free hemoglobin in the blood which constitutes the threshold value of the kidneys for hemoglobin is approximately 0.06 of a gram of hemoglobin per kilo of body weight. When about this concentration is reached, hemoglobin appears in the urine. 5. The amount of hemoglobin per kilo of body weight which, after rapid injection, may be retained without jaundice, is approximately 0.18 of a gram. When 0.22 or 0.23 of a gram is retained bile pigments appear in the urine. The threshold of the liver for jaundice in point of hemoglobin saturation lies, therefore, between 0.18 and 0.22 of a gram per kilo of body weight. With slow injections a greater amount may be retained without choluria. 6. The absence of the spleen does not alter greatly the percentage of hemoglobin eliminated by the kidney, nor does it raise the threshold of the liver for jaundice. 7. In the presence of jaundice, either hemolytic or obstructive, the amount of hemoglobin retained by splenectomized animals is slightly diminished and that eliminated by the kidneys is correspondingly increased. Upon these data may be based the following explanation of the mechanism by which free hemoglobin is removed from the blood serum. Hemoglobin is not removed by the kidney

  9. Detecting jaundice by using digital image processing

    Science.gov (United States)

    Castro-Ramos, J.; Toxqui-Quitl, C.; Villa Manriquez, F.; Orozco-Guillen, E.; Padilla-Vivanco, A.; Sánchez-Escobar, JJ.

    2014-03-01

    When strong Jaundice is presented, babies or adults should be subject to clinical exam like "serum bilirubin" which can cause traumas in patients. Often jaundice is presented in liver disease such as hepatitis or liver cancer. In order to avoid additional traumas we propose to detect jaundice (icterus) in newborns or adults by using a not pain method. By acquiring digital images in color, in palm, soles and forehead, we analyze RGB attributes and diffuse reflectance spectra as the parameter to characterize patients with either jaundice or not, and we correlate that parameters with the level of bilirubin. By applying support vector machine we distinguish between healthy and sick patients.

  10. Chronic intermittent hypoxia and obstructive sleep apnea: an experimental and clinical approach

    Directory of Open Access Journals (Sweden)

    Sforza E

    2016-04-01

    Full Text Available Emilia Sforza, Fréderic Roche Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA SNA-EPIS 4607, Faculté de Médecine J. Lisfranc, UJM Saint-Etienne, Université de Lyon, Saint-Etienne, France Abstract: Obstructive sleep apnea (OSA is a prevalent sleep disorder considered as an independent risk factor for cardiovascular consequences, such as systemic arterial hypertension, ischemic heart disease, cardiac arrhythmias, metabolic disorders, and cognitive dysfunction. The pathogenesis of OSA-related consequence is assumed to be chronic intermittent hypoxia (IH inducing alterations at the molecular level, oxidative stress, persistent systemic inflammation, oxygen sensor activation, and increase of sympathetic activity. Overall, these mechanisms have an effect on vessel permeability and are considered to be important factors for explaining vascular, metabolic, and cognitive OSA-related consequences. The present review attempts to examine together the research paradigms and clinical studies on the effect of acute and chronic IH and the potential link with OSA. We firstly describe the literature data on the mechanisms activated by acute and chronic IH at the experimental level, which are very helpful and beneficial to explaining OSA consequences. Then, we describe in detail the effect of IH in patients with OSA that we can consider "the human model" of chronic IH. In this way, we can better understand the specific pathophysiological mechanisms proposed to explain the consequences of IH in OSA. Keywords: hypoxia, intermittent hypoxia, experimental studies, obstructive sleep apnea

  11. Experimental and Theoretical Study of Air Flow with Obstruction Through Test Section of Wind Tunnel

    Directory of Open Access Journals (Sweden)

    Hayder Kraidy Rashid

    2016-03-01

    Full Text Available This paper estimates the sound and flow generated by a turbulent air flow in a duct from the knowledge of mean quantities (average velocity and sound pressure level.The sound excitation by fluid flow through duct can be used to predict fluid behavior. This behavior can be carried out by discovering the relation between sound excitation and fluid flow parameters like Reynolds number, Strouhal number and frequencies of turbulent fluid flow. However, the fluid flow container stability has to be taken in account simultaneously with fluid flow effect on sound generation and propagation. The experimental system used in this work is air flow through subsonic wind tunnel duct.The sound pressure levels of air flows through test section of subsonic wind tunnel (at three air flow velocities2.5, 7.3 and 12.5 m/s respectively were carried out experimentally. The sound excitation or generation by air flow throughout the test section of subsonic wind tunnel without any obstruction can't be used to imagine the fluid behavior. To predict fluid flow properties,an infinite cylinder was immersed in order to obstruct the air flow and generate a new source of sound.This case is relevant to a wide range of engineering applications including aircraft landing gear, rail pantographs and automotive side-mirrors. Sound measurements have been taken in an anechoic room at Babylon University. ANSYS program software is used to simulate all experimental results.The experimental and theoretical data that were presented in this paper will give further insight into the underlying sound generation mechanism.In the presented work, the linkage between sound generation and CFD results using thepresented work results and ANSYS simulation results was done.The results discuss the effects of fluid flow parameters such as Reynolds and Strouhal numbers on the sound generation, propagation features and vice-versa. The results are compared with other researchers which give good agreements.

  12. Paraneoplastic jaundice and prostate cancer.

    Science.gov (United States)

    Vieira, Ana Claudia; Alvarenga, Maria Joana; Santos, Jose Carlos; Silva, Alberto Mello

    2017-04-22

    Cholestasis has numerous causes. We present the case of a 78-year-old man with a common diagnosis in this age group and gender but with an unusual presentation. There are only 11 articles published of patients with jaundice due to a paraneoplastic syndrome associated with prostate cancer. Interleukin 6 and other proinflammatory cytokines appear to contribute to the pathophysiology of this syndrome. Our patient remains symptom free 4 months after treatment initiation. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. THE RELATION OF THE SPLEEN TO BLOOD DESTRUCTION AND REGENERATION AND TO HEMOLYTIC JAUNDICE

    Science.gov (United States)

    Pearce, R. M.; Austin, J. H.; Eisenbrey, A. B.

    1912-01-01

    The results of this study may be stated as follows. 1. Rapid injection of more than 0.06 of a gram per kilo of hemoglobin intravenously into a normal animal is followed by the appearance of hemoglobin in the urine (pelvis of kidney) within eight to ten minutes. 2. After rapid injection of more than 0.012 of a gram per kilo per minute of hemoglobin, 16 to 36 per cent. of the total amount, if this equals 0.25 of a gram per kilo, is eliminated in the urine and is accompanied by choluria. 3. If the injection of not more than 0.35 of a gram per kilo is made slowly (less than 0.01 of a gram per kilo per minute), the amount eliminated in the urine is only 2.33 to 9.5 per cent. of the total amount injected, and choluria does not occur. 4. The concentration of free hemoglobin in the blood which constitutes the threshold value of the kidneys for hemoglobin is approximately 0.06 of a gram of hemoglobin per kilo of body weight. When about this concentration is reached, hemoglobin appears in the urine. 5. The amount of hemoglobin per kilo of body weight which, after rapid injection, may be retained without jaundice, is approximately 0.18 of a gram. When 0.22 or 0.23 of a gram is retained bile pigments appear in the urine. The threshold of the liver for jaundice in point of hemoglobin saturation lies, therefore, between 0.18 and 0.22 of a gram per kilo of body weight. With slow injections a greater amount may be retained without choluria. 6. The absence of the spleen does not alter greatly the percentage of hemoglobin eliminated by the kidney, nor does it raise the threshold of the liver for jaundice. 7. In the presence of jaundice, either hemolytic or obstructive, the amount of hemoglobin retained by splenectomized animals is slightly diminished and that eliminated by the kidneys is correspondingly increased. Upon these data may be based the following explanation of the mechanism by which free hemoglobin is removed from the blood serum. Hemoglobin is not removed by the kidney

  14. Transjugular intrahepatic portosystemic shunt for severe jaundice in patients with acute Budd-Chiari syndrome.

    Science.gov (United States)

    He, Fu-Liang; Wang, Lei; Zhao, Hong-Wei; Fan, Zhen-Hua; Zhao, Meng-Fei; Dai, Shan; Yue, Zhen-Dong; Liu, Fu-Quan

    2015-02-28

    To evaluate the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) for severe jaundice secondary to acute Budd-Chiari syndrome (BCS). From February 2009 to March 2013, 37 patients with severe jaundice secondary to acute BCS were treated. Sixteen patients without hepatic venule, hepatic veins (HV) obstruction underwent percutaneous angioplasty of the inferior vena cava (IVC) and/or HVs. Twenty-one patients with HV occlusion underwent TIPS. Serum bilirubin, liver function, demographic data and operative data of the two groups of patients were analyzed. Twenty-one patients underwent TIPS and the technical success rate was 100%, with no technical complications. Sixteen patients underwent recanalization of the IVC and/or HVs and the technical success rate was 100%. The mean procedure time for TIPS was 84.0±12.11 min and angioplasty was 44.11±5.12 min (Pmean portosystemic pressure in the TIPS group decreased significantly from 40.50±4.32 to 16.05±3.50 mmHg (Pmean portosystemic pressure gradient decreased significantly from 33.60±2.62 to 7.30±2.21 mmHg (Pmean follow-up of 12.6 mo, there was no recurrence of jaundice in either group. Severe jaundice is not a contraindication for TIPS in patients with acute BCS and TIPS is appropriate for severe jaundice due to BCS.

  15. Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice

    Science.gov (United States)

    Gupta, Mamta; Pai, Radha R.; Dileep, Devi; Gopal, Sandeep; Shenoy, Suresh

    2013-01-01

    Background: Endoscopic evaluation is critical in assessing the cause of obstructive jaundice. Cytological techniques including bile aspiration and biliary brushings have become the initial diagnostic modality. Aim: The aim of this study is to evaluate the role of endoscopic biliary tract cytology as a diagnostic tool in the evaluation of extrahepatic cholestatic jaundice. Materials and Methods: A total of 56 biliary tract specimens including 34 bile aspirations and 22 biliary brushings from 41 consecutive patients who had presented with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) were assessed by cytological examination. The smears prepared were analyzed for standard cytological features. Results: Cytologic diagnosis was adenocarcinoma in 13 (31.7%) cases, atypical in 2 (4.9%), reactive in 3 (7.3%) and benign changes in 19 (46.3%) cases. 4 (9.8%) cases were non-diagnostic. Serum bilirubin was significantly elevated in the malignant group. Biliary stricture was the most common finding on ERCP (68.3%). On cytological examination, presence of solitary, intact atypical cells, enlarged nuclei, irregular nuclear membrane, coarse chromatin and nucleoli were important cytologic criteria for differentiating malignant from benign biliary specimens. Conclusions: Regular use of bile cytology and brushings during ERCP evaluation of extrahepatic cholestatic jaundice is invaluable in obtaining a morphologic diagnosis. A systematic approach, use of strict cytomorphologic criteria and inclusion of significant atypia as malignant diagnosis may improve the sensitivity. PMID:24130407

  16. [Long-Term Multidisciplinary Therapy for Multiple Liver Metastases from Colorectal Cancer with Biliary Drainage for Occlusive Jaundice--A Case Report].

    Science.gov (United States)

    Okamura, Shu; Mikami, Koji; Murata, Kohei; Nushijima, Yoichirou; Okada, Kazuyuki; Yanagisawa, Tetsu; Fukuchi, Nariaki; Ebisui, Chikara; Yokouchi, Hideoki; Kinuta, Masakatsu

    2015-11-01

    Here, we report the case of a 43-year-old man who was diagnosed with sigmoid colon cancer with synchronous multiple liver metastases following resection of a primary lesion. Subsequent mFOLFOX+BV therapy elicited a marked response in the liver metastases, which led to the patient undergoing hepatic (S7) radiofrequency ablation (RFA), hepatic resection (lateral segmentectomy and partial [S5] resection), and cholecystectomy. Six months later, transluminal RFA was repeated because liver (S7) metastasis recurred, and 8 courses of XELOX plus BV therapy were administered. As obstructive jaundice due to recurrence of the liver metastases developed after a 6 months hiatus in chemotherapy, we endoscopically inserted a biliary stent. Despite reducing IRIS plus BV therapy, obstructive jaundice developed again, and 3 intrahepatic biliary stents were inserted with percutaneous transhepatic biliary drainage. To date, the patient has been alive for 4 years since the initial resection of the primary lesion after undergoing consecutive systemic chemotherapy with different regimens. Some studies have shown that in cases of obstructive jaundice caused by advanced gastrointestinal cancer, longer survival could be expected by reducing the severity of jaundice, suggesting that resuming chemotherapy as well as improving the severity of jaundice could contribute to better outcomes. The patient in the present case was successfully treated twice with biliary drainage for occlusive jaundice and chemotherapy, suggesting that a combination of multidisciplinary therapy and adequate local therapy such as biliary drainage could be important for the treatment of metastatic liver cancer.

  17. [The 455th case: swollen leg, jaundice and mental disturbance].

    Science.gov (United States)

    Dong, R; Weng, L; Guo, T; Zhu, T N; Zhao, J L; Wu, Q J; Zeng, X F

    2017-04-01

    A 17-year-old young man with a history of swollen leg and intermittent jaundice was presented to Peking Union Medical College Hospital with acute fever and mental disturbance. He developed deep venous thrombosis, acute myocardial infarction and plantar skin necrosis during the past four years, and was presented with an acute episode of fever, thrombocytopenia, acute kidney injury, acute myocardial infarction, mental disturbance, and obstructive jaundice. Laboratory tests showed schistocytes on peripheral blood smear.High titer of antiphospholipid antibodies was detected.Strikingly, the activity of a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 (ADAMTS13)was significantly decreased without the production of inhibitors. Images indicated stenosis of the common bile duct, common hepatic duct, and cystic duct, which caused dilation of bile ducts and the gall bladder. Corticosteroids and anticoagulation therapy were effective at first, but the disease relapsedonce the corticosteroids tapered down. Plasma exchange was administrated for 17 times, which was effective temporarily during this episode. Methylprednisolone pulse therapy, intravenous immunoglobulin, rituximab, anticoagulation therapy, and bile drainage, were all tried but still could not control the disease. The patient's family agreed to withdraw treatment after he developed septic shock.

  18. Laser Photoradiation Therapy For Neonatal Jaundice

    Science.gov (United States)

    Hamza, Mostafa; Hamza, Mohammad

    1987-04-01

    This paper describes our leading experience in the clinical application of laser in the treatment of neonatal jaundice. Currently, the irradiation of jaundiced infants during neonatal life to fluorescent light is the most common treatment of neonatal hyperbilirubinemia. The authors have investigated the photodegradation of bilirubin by laser in vitro and in Gunn rats before embarking on its clinical application in the treatment of jaundice in the new born child. This work was done to study the theraputic effect of laser compared to the currently used phototherapy in the treatment of neonatal jaundice. We selected 16 full term neonates with jaundice to be the subject of this study. The neonates of the study were devided into two groups. The first group was treated with continuous phototherapy . The second group recieved photoradiation therapy with gas laser The laser used was a CW argon-ion laser tuned to oscillate at 488.0 nm wavelength. This wavelength selection was based on our previous studies on the effect of laser irradiation of Gunn rats at different wavelengths. Comparison of the results of both methods of treatment will be reported in detail. The advantages and limitations of laser photoradiation therapy for neonatal jaundice will be discussed.

  19. Clinical-morphological correlation of nasal obstruction with skull base development and otitis media. An experimental study.

    Science.gov (United States)

    Maurizi, M; Scarano, E; Frusoni, F; Deli, R; Paludetti, G

    1998-01-01

    Morphological changes of the middle ear were investigated by means of microotoscopy and scanning electron microscopy in 40 developing Albino rats. In 20 one nostril (group B) and in 20 both nostrils (group C) had been experimentally obstructed. 20 rats were used as controls (group A). Microotoscopy and scanning electron microscopy on the middle ear mucosa were performed when the animals were 2 months old, i.e. at 90% of their development. At microotoscopy the tympanic membranes, homolateral to the obstructed nostril, proved to be abnormal in 81% of group B rats and in almost all rats belonging to group C. Scanning electron microscopy, performed after the bullae had been removed, showed the following epithelial surface changes of the middle ear homolaterally to the obstructed nostril: (a) a significant increase of nonciliated elements with a secretory behavior as compared to controls, even of the floor where normally a large number of ciliated cells is present; (b) several ciliated cells were destroyed and their cilia were irregular and untidy; (c) thick mucous secretions covered the floor of the tympanic bulla; and (d) squamous metaplasia of the hypotympanic epithelium. Extrarotation of the eustachian tubes and developmental abnormalities of the skull base in growing rats, caused by nasal obstruction, seem to be able to induce pathological events of the middle ear.

  20. Selective matrix metalloproteinase inhibition increases breaking strength and reduces anastomotic leakage in experimentally obstructed colon

    DEFF Research Database (Denmark)

    Krarup, Peter-Martin; Eld, Mikkel; Jorgensen, Lars Nannestad

    2017-01-01

    PURPOSE: Colonic obstruction causes loss of collagen and impairment of anastomotic integrity by matrix metalloproteinases (MMPs). Unexpectedly, pharmacological MMP inhibition increased anastomotic leakage (AL) in obstructed colon possibly due to the non-selective nature of these compounds....... Isolated anastomotic wound tissue was analyzed on total collagen and pepsin-insoluble and pepsin-soluble collagen by hydroxyproline. The soluble collagens were further differentiated into native, measured by Sircol, and fragmented forms. RESULTS: Baseline breaking strength was maintained with AZD3342...

  1. Obstructive Jaundice Due to Tuberculosis of Distal CBD and ...

    African Journals Online (AJOL)

    Abdominal tuberculosis (TB) commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis ...

  2. Resectability in Malignant Obstructive Jaundice Bitta C , G

    African Journals Online (AJOL)

    KIGZ

    pancreatic carcinoma (21) though they did not correlate the levels with those of the patients found to have resectable lesions at surgery. Schliemann et al conducted a meta-analysis of patients who had undergone laparotomy for pancreatic cancer over a seven year period (1996-2002) in a tertiary care centre and all had pre ...

  3. Hemorrhage in a pancreatic pseudocyst: a case of obstructive jaundice

    OpenAIRE

    Rocha, C.; Almeida, S.; Leichsenring, C; Calado, J.,; Godinho, A.; Carneiro, F.

    2014-01-01

    Apesar dos avanços no diagnóstico e manuseamento dos pseudoquistos pancreáticos, a incidência de hemorragia intra- -pseudoquisto é entre 6 a 17%. É apresentado um caso clinico de icterícia obstructiva resultante da compressão da via biliar por uma hemorragia intra-pseudoquisto pancreático após rotura de um pseudoaneurisma, diagnosticado por tomografia computorizada, o qual é de rara ocorrência. Pela estabilidade hemodinâmica do doente, a embolização vascular foi a opção terapêutic...

  4. Jaundice in second intention wound healing in rats Icterícia na cicatrização por segunda intenção em ratos

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes Pessole Biondo-Simões

    2004-06-01

    Full Text Available PURPOSE: The objective of the present study was to monitor the process of second intention skin wound healing in rats with jaundice. METHODS: The study was divided into two steps. In the first, obstructive jaundice was induced in 68 male rats to investigate the biochemical changes and to determine the ideal time for the study of healing. In the second step, 54 rats were divided into two groups: control (normal and experimental (jaundiced. Seventy-two hours after jaundice induction, a standardized wound was produced in the dorsum by removing the skin and the subcutaneous net, whose contraction was assessed on the 3rd, 7th, 10th and 14th day and monitored with a computer program. After sacrifice, the tissue was submitted to histopathologic analysis. RESULTS: The most marked biochemical changes were detected between the 3rd and 5th day. The reduction of he wound area was slower in the jaundice group at all 4 time points studied (p3=0.0366, p7=0.0054, p10=0.0000. p14=0.0000. Collagen concentration was lower in the wound of jaundiced animals (p3=0.0000. p7=0.0000. p14=0.0000. CONCLUSION: Jaundice delays collagen deposition and maturation and wound contraction in wounds left to heal by second intention wound healing in rats.OBJETIVO: O objetivo do presente estudo foi monitorar o processo de cicatrização, por segunda intenção em ratos com icterícia. MÉTODOS: O estudo foi dividido em 2 etapas. Na primeira, icterícia obstrutiva foi induzida em 68 ratos machos para investigação das mudanças bioquímicas e para determinação do momento ideal para o estudo da cicatrização. Na segunda etapa, 54 ratos foram divididos em dois grupos: controle (normal e experimental (ictérico.Setenta e duas horas após a indução da icterícia, uma lesão padrão foi produzida na região dorsal dos animais com a remoção da pele e da tela subcutânea. A contração da ferida foi mensurada no 3.º, 7.º, 10.º e 14.º dia e monitorada com programa computadorizado

  5. Palliation of malingnant hilar obstruction at a single centre - review ...

    African Journals Online (AJOL)

    Introduction. Jaundice secondary to a malignant hilar obstruction can be relieved by operative bypass or percutaneous stenting. Comparative trials involving these techniques are scarce. We reviewed our experience with these competing techniques in the palliation of malignant hilar obstruction. Patients and methods.

  6. Short-acting sulfonamides near term and neonatal jaundice

    DEFF Research Database (Denmark)

    Klarskov, Pia; Andersen, Jon Trærup; Jimenez-Solem, Espen

    2013-01-01

    To investigate the association between maternal use of sulfamethizole near term and the risk of neonatal jaundice.......To investigate the association between maternal use of sulfamethizole near term and the risk of neonatal jaundice....

  7. THE EFFECT OF THE SOMATOSTATIN ANALOGUE OCTREOTIDE ON EXPERIMENTAL INTESTINAL OBSTRUCTION IN RATS

    Directory of Open Access Journals (Sweden)

    Paran Haim

    1998-01-01

    Full Text Available Background: Somatostatin has an inhibitory effect on the endocrine and exocrine secretions of the gut. It may have a beneficial effect in the conservative treatment of intestinal obstruction. The aim of the present study is to investigate the effect of octreotide in mechanical intestinal obstruction in rats. Method: Intestinal obstruction was induced in rats by ligation of a segment of the distal ileum. Animals were treated with the somatostatin analogue octreotide (n=16, or saline (n=16. Eight rats were operated but their intestine was not ligated (n=8 serving as sham controls. Forty eight hours after the operation, the animals were operated upon again and blood samples from the femoral vein were tested for electrolytes, urea, glucose, lactic acid, amylase, ph and bicarbonate. Portal vein blood samples were also obtained and tested for lactic acid and amylase. Results: Intestinal obstruction resulted, after 48 hours, in severe dilatation of bowel loops. A significant increase in plasma levels of urea, amylase and lactic acid was observed. Plasma pH decreased. In blood samples from the portal vein, a significant increase in lactic acid was observed, indicating metabolic acidosis, probably secondary to bowel ischemia. Octreotide treatment, resulted in less acidosis, with concomitant lower urea and lactic acid levels in the plasma and especially in the portal vein. Conclusion: Octreotide treatment may have a beneficial effect in the conservative treatment of selected cases of intestinal obstruction.

  8. Impact of Oral Zinc Sulfate on Uncomplicated Neonatal Jaundice

    Directory of Open Access Journals (Sweden)

    SH Nabavizadeh

    2015-09-01

    Full Text Available Background & aim: Jaundice is one of the most significant problems to consider in the neonatal period. The aim of this study was to determine the impact of oral zinc sulfate on uncomplicated neonatal jaundice using comparison of effect of just phototherapy with the effect of combination of phototherapy and oral zinc sulfate.   Methods: The present double blind randomized clinical trial was carried out on 78 normal term neonates with the age of 2-7 days who were admitted for uncomplicated jaundice in neonatal ward of Imam Sajjad Hospital of Yasuj University of Medical Sciences. These infants were divided to experimental group (40 cases and control group (38 cases using block random allocation. In the control group, phototherapy was done alone and experimental group received elemental zinc orally as 10 mg daily for 5 days in combination with phototherapy.  The total bilirubin serum levels were measured at the beginning of the study , 6 hours, 12 hours, and 24 hours after the beginning of the study, discharge, and one week after discharge. The collected data were analyzed by the Chi Square test, independent t-test, and analysis of variance with repeated measurement.   Results: There were no significant statistical difference between the experimental group and control group in sex, age, birth weight, hemoglobin, reticulocyte percentage, G6PD deficiency, and of serum total bilirubin level at the beginning of study(p>0.05. Analysis of variance with repeated measurement showed that there were no significant statistical difference between the total bilirubin serum level at 6 hours, 12 hours, 24 hours after beginning of the study, discharge, and one week after discharge (p>0.05. Also, the mean of hospitalization duration was not significantly different between the two groups (p>0.05.   Conclusion: Although oral zinc salts inhibit the enterohepatic circulation of bilirubin, however probably not effective in the treatment of neonatal physiologic

  9. Severe jaundice in two children with Kawasaki disease: a possible association with Gilbert syndrome.

    Science.gov (United States)

    Karpathios, Themistocles; Moustaki, Maria; Yiallouros, Panagiotis; Sharifi, Fariba; Attilakos, Achilleas; Papadopoulou, Anna; Fretzayas, Andrew

    2012-01-01

    Kawasaki disease is a systemic vasculitis, mainly encountered in children. It may affect any organ. Acute cholestasis and severe obstructive jaundice is an atypical manifestation of the disease. We herein present two children with Kawasaki disease and severe direct hypebilibirunemia who also were homozygous and heterozygous respectively for the (TA)(7) promoter polymorphism of Gilbert syndrome. Intravenous immunoglobulin was administered to both patients at the acute phase of the disease and the fever remitted within 24 hr following the immunoglobulin administration. Furthermore oral aspirin at a dose of 80-100 mg/kg/24 hr was also given. The first child did not develop any coronary ectasia or aneurysm, whereas dilation of the right coronary artery was identified in the second child, one month after the disease onset. We discuss the possible contribution of Gilbert syndrome to the development of jaundice in our patients.

  10. Cholestatic jaundice due to ackee fruit poisoning.

    Science.gov (United States)

    Larson, J; Vender, R; Camuto, P

    1994-09-01

    A 27-yr-old Jamaican male presented with a 2-month history of jaundice, pruritus, intermittent diarrhea, and right upper quadrant abdominal pain. Over the next month, his abdominal pain and diarrhea improved, but his jaundice and pruritus worsened. He was afebrile and profoundly jaundice, with a benign abdominal examination. Medical workup included a normal abdominal ultrasound, iron studies, ceruloplasm, and serum electrophoresis. Negative viral (Epstein-Barr virus, cytomegalovirus, mononucleosis, hepatitis A, B, C) studies, ANA, AMA, ASMA, RPR were noted. He denied any alcohol, drug, or toxin exposure. Liver tests revealed total bilirubin of 25.6 mg/dl, direct bilirubin of 13.9 mg/dl, alkaline phosphatase 278 IU/L, AST 45 IU/L, and ALT 71 IU/L. Liver biopsy demonstrated centrilobular zonal necrosis and cholestasis most consistent with a toxic reaction. The patient was again interviewed regarding potential toxins, and he admitted to the ingestion of ackee fruit, a native Jamaican fruit that is illegal in the United States. Shortly after he had ceased intake of the fruit, his symptoms resolved and his liver function tests returned to normal. We present a case of chronic ackee fruit ingestion that led to cholestatic jaundice, vomiting, and abdominal pain.

  11. Prenatal intestinal obstruction affects the myenteric plexus and causes functional bowel impairment in fetal rat experimental model of intestinal atresia.

    Directory of Open Access Journals (Sweden)

    Naziha Khen-Dunlop

    Full Text Available BACKGROUND: Intestinal atresia is a rare congenital disorder with an incidence of 3/10,000 birth. About one-third of patients have severe intestinal dysfunction after surgical repair. We examined whether prenatal gastrointestinal obstruction might effect on the myenteric plexus and account for subsequent functional disorders. METHODOLOGY/PRINCIPAL FINDINGS: We studied a rat model of surgically induced antenatal atresia, comparing intestinal samples from both sides of the obstruction and with healthy rat pups controls. Whole-mount preparations of the myenteric plexus were stained for choline acetyltransferase (ChAT and nitric oxide synthase (nNOS. Quantitative reverse transcription PCR was used to analyze mRNAs for inflammatory markers. Functional motility and permeability analyses were performed in vitro. Phenotypic studies were also performed in 8 newborns with intestinal atresia. In the experimental model, the proportion of nNOS-immunoreactive neurons was similar in proximal and distal segments (6.7±4.6% vs 5.6±4.2%, p = 0.25, but proximal segments contained a higher proportion of ChAT-immunoreactive neurons (13.2±6.2% vs 7.5±4.3%, p = 0.005. Phenotypic changes were associated with a 100-fold lower concentration-dependent contractile response to carbachol and a 1.6-fold higher EFS-induced contractile response in proximal compared to distal segments. Transcellular (p = 0.002 but not paracellular permeability was increased. Comparison with controls showed that modifications involved not only proximal but also distal segments. Phenotypic studies in human atresia confirmed the changes in ChAT expression. CONCLUSION: Experimental atresia in fetal rat induces differential myenteric plexus phenotypical as well as functional changes (motility and permeability between the two sides of the obstruction. Delineating these changes might help to identify markers predictive of motility dysfunction and to define guidelines for post

  12. Jaundice in typhoid patients: differentiation from other common causes of fever and jaundice in the tropics.

    Science.gov (United States)

    Ahmed, A; Ahmed, B

    2010-01-01

    While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics. This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters. Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6+/-9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38-165 micromol/l with mean of 117+/-14SD. Conjugated bilirubin ranged 31-150 micromol/l with mean of 95+/-8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients. Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.

  13. [Static-dynamic MR urography. Comparison with excretory urography and scintigraphy in experimentally-induced urinary tract obstruction].

    Science.gov (United States)

    Rohrschneider, W K; Hoffend, J; Becker, K; Darge, K; Wunsch, R; Clorius, J H; Kooijman, H; Tröger, J

    2001-02-01

    To assess the diagnostic value of combined static-dynamic MR urography (MRU) for the functional-morphological evaluation of experimentally induced urinary tract obstruction. Static-dynamic MRU--combination study with a respiratory-triggered 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA and furosemide--was obtained in comparison with 99mTc-MAG3 diuretic renal scintigraphy (DRS), excretory urography (EU) and ultrasound (US) in 29 healthy piglets and in 20 piglets with surgically induced ureteric stenosis (total of 50 postoperative examination blocks). MRU allowed complete depiction of the urinary tract in all controls, in operated piglets the stenosis was always correctly identified. Quality of MRU was superior to EU in 36 of 43 comparative studies. Calculation of single kidney function from parenchymal renograms, and assessment of urinary excretion from whole-kidney renograms resulted in a highly significant agreement of MRU with DRS. Static-dynamic MR urography allows excellent depiction of experimentally induced urinary tract obstruction, and reliable assessment of individual renal function and urinary excretion. Two advantages of the method stand out, it does not require radiation and it permits a functional-morphological correlation.

  14. Management of neonatal jaundice in primary care.

    Science.gov (United States)

    Wan, Asl; Mat Daud, S; Teh, S H; Choo, Y M; Kutty, F M

    2016-01-01

    The Clinical Practice Guidelines on Management of Neonatal Jaundice 2003 was updated by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2014. A systematic review of 13 clinical questions was conducted using evidence retrieved mainly from Medline and Cochrane databases. Critical appraisal was done using the Critical Appraisal Skills Programme checklist. Recommendations were formulated based on the accepted 103 evidences and tailored to local setting as stated below. Neonatal jaundice (NNJ) is a common condition seen in primary care. Multiple risk factors contribute to severe NNJ, which if untreated can lead to adverse neurological outcomes. Visual assessment, transcutaneous bilirubinometer (TcB) and total serum bilirubin (TSB) are the methods used for the detection of NNJ. Phototherapy remains the mainstay of the treatment. Babies with severe NNJ should be followed-up to detect and manage sequelae. Strategies to prevent severe NNJ include health education, identification of risk factors, proper assessment and early referral.

  15. [Neonatal hyperbilirubinemia and molecular mechanisms of jaundice].

    Science.gov (United States)

    Jirsa, M; Sticová, E

    2013-07-01

    The introductory summarises the classical path of heme degradation and classification of jaundice. Subsequently, a description of neonatal types of jaundice is given, known as Crigler Najjar, Gilberts, DubinJohnson and Rotor syndromes, emphasising the explanation of the molecular mechanisms of these metabolic disorders. Special attention is given to a recently discovered molecular mechanism of the Rotor syndrome. The mechanism is based on the inability of the liver to retrospectively uptake the conjugated bilirubin fraction primarily excreted into the blood, not bile. A reduced ability of the liver to uptake the conjugated bilirubin contributes to the development of hyperbilirubinemia in common disorders of the liver and bile ducts and to the toxicity of xenobiotics and drugs using transport proteins for conjugated bilirubin.

  16. Understanding Neonatal Jaundice: A Perspective on Causation

    Directory of Open Access Journals (Sweden)

    Ronald S. Cohen

    2010-06-01

    Full Text Available Neonatal jaundice can be best understood as a balance between the production and elimination of bilirubin, with a multitude of factors and conditions affecting each of these processes. When an imbalance results because of an increase in circulating bilirubin (or the bilirubin load to significantly high levels (severe hyperbilirubinemia, it may cause permanent neurologic sequelae (kernicterus. In most infants, an increase in bilirubin production (e.g., due to hemolysis is the primary cause of severe hyperbilirubinemia, and thus reducing bilirubin production is a rational approach for its management. The situation can become critical in infants with an associated impaired bilirubin elimination mechanism as a result of a genetic deficiency and/or polymorphism. Combining information about bilirubin production and genetic information about bilirubin elimination with the tracking of bilirubin levels means that a relative assessment of jaundice risk might be feasible. Information on the level of bilirubin production and its rate of elimination may help to guide the clinical management of neonatal jaundice.

  17. Water-soluble contrast media in obstructed and in ischemic intestine; A clinical and experimental study

    Energy Technology Data Exchange (ETDEWEB)

    Stordahl, A. (Rikshospitalet, Oslo (Norway))

    1989-01-01

    The present work was undertaken to study the diagnostic efficacy of the water-soluble contrast media iohexol and sodium diatrizoate in the gastrointestinal tract, and to establish a method for the discrimination between intestinal obstruction and ischemia. The effects of the two contrast media were evaluated in 50 patients and in rats. The study gave the following results: Iohexol is a good, or better alternative to sodium diatrizoate regarding taste acceptance and patient reactions. Water-soluble contrast media may have therapeutic effects on intestinal obstruction when preceded by conventional gastric suction using a short gastric tube. The water-soluble, low-osmolar contrast media seem promising as diagnostic aids in the examination of the gastrointestinal tract. Waster-soluble contrast media may aid the diagnosis of bowel ischemia and the evaluation of the degree of ischemic injury. The chief route of absorption of water-soluble contrast media from ischemic bowel to blood is transmural and transperitoneal (>90% of the total absorption) before subsequent excretion in the urine. The use of hyperosmolar contrast media in the ischemic small intestine may enhance intestinal ischemia and systematic dehydration, and provoke septic complications by the enteric microflora. 68 refs.

  18. A report of three cases of jaundice with thyrotoxicosis.

    Science.gov (United States)

    Akande, T O; Balogun, W O

    2013-09-01

    Jaundice and hepatic dysfunction have been reported in patients with thyrotoxicosis and could be due to different mechanisms. To describe three cases of jaundice occurring in patients with thyrotoxicosis and to illustrate the importance of early institution of thionamides when indicated. We present the clinical and laboratory features of three patients presenting within a year with thyrotoxicosis and jaundice and whose clinical conditions improved remarkably following treatment with thionamides. In addition, current literature on the subject is reviewed and summarised. The three patients presented with goitre and jaundice. None of the patients had received blood products, undergone scarification markings or experienced any previous episode of jaundice. Thyroid function tests in the three patients were consistent with a diagnosis of thyrotoxicosis. Liver function tests showed elevated bilirubin and transaminases. All patients improved remarkably following treatment with thionamides. It is important to rule out thyrotoxicosis in patients with jaundice of unknown cause and consider early use of thionamides for treatment of the thyrotoxicosis, if confirmed.

  19. Ways to Optimize Therapy of Prolonged Conjugation Jaundice in Infants

    Directory of Open Access Journals (Sweden)

    O.G. Shadrin

    2015-10-01

    Full Text Available The article is devoted to the optimization of the treatment of prolonged conjugation jaundice. Inclusion of ursodeoxycholic acid in the treatment of neonatal prolonged conjugation jaundice in a dose of 15–20 mg/kg of body mass per day increases the terms of regression of clinical and paraclinical signs of jaundice as much as 2 times and leads to cytolysis normalization. The preparation has a sufficient level of safety, there were not revealed side effects whilst its application.

  20. Ethno-medicinal plants used to cure jaundice by traditional healers of mashhad, iran.

    Science.gov (United States)

    Amiri, Mohammad Sadegh; Joharchi, Mohammad Reza; Taghavizadehyazdi, Mohammad Ehsan

    2014-01-01

    Jaundice is the commonest ailments affecting the citizens of both developed and poor Asians countries including Iran. An ethnobotanical survey of plants used by the traditional healers for the treatment of jaundice was conducted in the Mashhad city, Northeastern Iran. A total of 37 plants belonging to 32 genera and 26 families have been documented for their therapeutic use against jaundice. The plant families which contained the most commonly used species for their effects are: Fabaceae (5 species), Polygonaceae (4 sp.), Asteraceae (3 sp.), Plantaginaceae (2 sp.) and Salicaceae (2 sp.). The plants were arranged with correct nomenclature along with their common name, family, the part used and their medicinal value. The use of decoction is the most preferred method of herbal preparation. In all cases, the treatment involved oral administration of the extracts 2 to 3 times daily from a week to month till the problem disappears. Cichorium intybus, Salix alba, Cotoneaster nummularius, Descurainia sophia, Malva sylvestris, Berberis integrrima, Rumex acetosella, Phyllanthus emblica and Alhagi maurorum were repeatedly mentioned by the traditional healers as the most widely used for the treatment of jaundice in the study area. The study indicates that the local inhabitants rely on medicinal plants for treatment. This paper suggested that further clinical experimentation is needed to scientifically evaluate these widely used herbal remedies for possible bioactive effects.

  1. Destruction of the hepatocyte junction by intercellular invasion of Leptospira causes jaundice in a hamster model of Weil's disease.

    Science.gov (United States)

    Miyahara, Satoshi; Saito, Mitsumasa; Kanemaru, Takaaki; Villanueva, Sharon Y A M; Gloriani, Nina G; Yoshida, Shin-ichi

    2014-08-01

    Weil's disease, the most severe form of leptospirosis, is characterized by jaundice, haemorrhage and renal failure. The mechanisms of jaundice caused by pathogenic Leptospira remain unclear. We therefore aimed to elucidate the mechanisms by integrating histopathological changes with serum biochemical abnormalities during the development of jaundice in a hamster model of Weil's disease. In this work, we obtained three-dimensional images of infected hamster livers using scanning electron microscope together with freeze-cracking and cross-cutting methods for sample preparation. The images displayed the corkscrew-shaped bacteria, which infiltrated the Disse's space, migrated between hepatocytes, detached the intercellular junctions and disrupted the bile canaliculi. Destruction of bile canaliculi coincided with the elevation of conjugated bilirubin, aspartate transaminase and alkaline phosphatase levels in serum, whereas serum alanine transaminase and γ-glutamyl transpeptidase levels increased slightly, but not significantly. We also found in ex vivo experiments that pathogenic, but not non-pathogenic leptospires, tend to adhere to the perijunctional region of hepatocyte couplets isolated from hamsters and initiate invasion of the intercellular junction within 1 h after co-incubation. Our results suggest that pathogenic leptospires invade the intercellular junctions of host hepatocytes, and this invasion contributes in the disruption of the junction. Subsequently, bile leaks from bile canaliculi and jaundice occurs immediately. Our findings revealed not only a novel pathogenicity of leptospires, but also a novel mechanism of jaundice induced by bacterial infection. © 2014 The Authors. International Journal of Experimental Pathology © 2014 International Journal of Experimental Pathology.

  2. [Mechanical jaundice in extrahepatic portal hypertension].

    Science.gov (United States)

    Patsiora, M D; Tsatsanidi, K N; Eramishantsev, A K

    1978-06-01

    The authors consider the tactics of the treatment of mechanical jaundice in 9 patients suffering from an extrahepatic form of portal hypertension. The analysis of the results of the treatment proved that in case of pronounced bilirubinemia with colangitis manifestations and hepatic insufficiency it is indicated to use external controlled drainage of the thoracic lymphatic duct and transhepatic external drainage of the intrahepatic duct. The applied tactics allows to avoid carrying out emergent surgical interventions on extrahepatic bile passages, which is extremely dangerous, and to perform such operations when necessary only, under more favourable conditions after an adequate preparation of patients.

  3. Fever, jaundice and acute renal failure.

    Science.gov (United States)

    O'Toole, Sam M; Pathak, Neha; Toms, Graham C; Gelding, Susan V; Sivaprakasam, Venkat

    2015-02-01

    Leptospirosis is an uncommon infectious disease that has protean clinical manifestations ranging from an innocuous 'flu-like' illness to potentially life-threatening multi-organ failure. Here we describe a case of Weil's disease that presented on the acute medical take with fever, jaundice and acute renal failure. We highlight the importance of careful history taking at the time of admission and how understanding the epidemiology and pathophysiology of leptospirosis enables a definitive diagnosis to be reached. © 2015 Royal College of Physicians.

  4. Medicinal plants used for the treatment of jaundice and hepatitis ...

    African Journals Online (AJOL)

    The present study deals with socio-economic documentation of medicinal plant species against jaundice and hepatitis. A total of 30 plant species belonging to 24 families were reported by local practitioners for the treatment of jaundice and hepatitis. The most important plant species are Adiantum capillus, Boerhaavia ...

  5. Risk factors for neonatal jaundice in babies presenting at the

    African Journals Online (AJOL)

    Prof Ezechukwu

    2012-03-13

    Mar 13, 2012 ... drogenase enzyme deficiencies, use of native herbs and contact with naphthalene balls contaminated clothes have been identified for neonatal jaundice. Objective: To determine the risk factors for neonatal jaundice at Uni- versity of Benin Teaching Hospital,. Benin City. Methods: This retrospective study.

  6. Jaundice in typhoid patients: Differentiation from other common ...

    African Journals Online (AJOL)

    The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and ... or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations.

  7. [Usefulness of transcutaneous measurements of bilirubin in infants with jaundice].

    Science.gov (United States)

    Mościcka, A; Gadzinowski, J; Mościcki, A; Breborowicz, G H; Opala, T

    1994-06-01

    Traditionally, in neonatal jaundice, diagnosis is based on repetitive serum bilirubin measurements. The aim of this study was to analyse clinical usefulness of transcutaneous bilirubinometry as a noninvasive screening test in evaluating neonatal jaundice. The material consisted of 106 full-term infants in which 130 meter readings were performed. A Minolta/Air Shields Jaundice Meter 101 was used. Meter readings were compared with serum bilirubin measurements from these infants (correlation ratio was 0.56). After analysing the clinical data, the conclusion was, that transcutaneous bilirubinometer is a useful instrument for assessing neonatal jaundice for clinical purposes. The bilirubinometer can effectively identify infants whose degree of jaundice the need for serum bilirubin determination and can prevent unnecessary repetitive blood sampling in infants not requiring serum bilirubin determination.

  8. Comparison of infants with jaundice due to maternal diabetes and infants with unknown jaundice

    Directory of Open Access Journals (Sweden)

    Hassan Boskabadi

    2017-07-01

    Methods: In this cross-sectional study, among 2,800 infants with jaundice in Ghaem hospital in Mashhad during the 2007 to 2014, features of 59 infants of diabetic mother's (case group and 78 infants with unknown jaundice (control group were analyzed. After confirming of jaundice (Bilirubin ≥ 17 mg/dl in newborns based on examination of pediatrician and laboratory results, a researcher made questionnaire containing maternal demographic data, (maternal age, parity, maternal problems during pregnancy, route of delivery. Also neonatal characteristics including age, sex, birth weight, current weight, duration of hospitalization, current age, age of recovery and laboratory data (Bilirubin, direct bilirubin, hematocrit, platelet, sodium, potassium, blood urea nitrogen, Cr, TSH, T4 were assessed. After data collection and recording information in SPSS software, version 19.5 (IBM SPSS, Armonk, NY, USA, by using tables, charts and statistical indices, the study was evaluated. Data were analyzed using statistical tests such as Mann-Whitney, Chi-square tests after normality control. Comparison of the two groups in normal distribution with t-test and for non-standard data with Mann-Whitney test. Also for definitive variables Chi-square test was used. P-value less than 0.50 was the significant level minimum. Results: In this study, the prevalence of jaundice due to maternal diabetes was 2.10 percent. Birth weight (P=0.02, current age (P=0.003, parity (P=0.000, maternal age (P=0.000, age of recovery (P=0.04, cesarean section (P=0.001, prematurity (P=0.000, maternal problems during pregnancy (P=0.000, abnormal physical examinations (P=0.001 in diabetic mother's infants and Bilirubin (P=0.000, length of hospitalization (P=0.003, in infants with unknown jaundice were higher. Conclusion: The infant of diabetic mother are at increased risk of maternal and neonatal complications. Neonatal complications consist of high birth weight, preterm labor, more jaundice and late recovery

  9. An experimental model of rhinovirus induced chronic obstructive pulmonary disease exacerbations: a pilot study

    Directory of Open Access Journals (Sweden)

    Mallia Patrick

    2006-09-01

    Full Text Available Abstract Background Acute exacerbations of COPD are a major cause of morbidity, mortality and hospitalisation. Respiratory viruses are associated with the majority of exacerbations but a causal relationship has not been demonstrated and the mechanisms of virus-induced exacerbations are poorly understood. Development of a human experimental model would provide evidence of causation and would greatly facilitate understanding mechanisms, but no such model exists. Methods We aimed to evaluate the feasibility of developing an experimental model of rhinovirus induced COPD exacerbations and to assess safety of rhinovirus infection in COPD patients. We carried out a pilot virus dose escalating study to assess the minimum dose of rhinovirus 16 required to induce experimental rhinovirus infection in subjects with COPD (GOLD stage II. Outcomes were assessed by monitoring of upper and lower respiratory tract symptoms, lung function, and virus replication and inflammatory responses in nasal lavage. Results All 4 subjects developed symptomatic colds with the lowest dose of virus tested, associated with evidence of viral replication and increased pro-inflammatory cytokines in nasal lavage. These were accompanied by significant increases in lower respiratory tract symptoms and reductions in PEF and FEV1. There were no severe exacerbations or other adverse events. Conclusion Low dose experimental rhinovirus infection in patients with COPD induces symptoms and lung function changes typical of an acute exacerbation of COPD, appears safe, and provides preliminary evidence of causation.

  10. [A jaundiced patient with acute kidney injury

    NARCIS (Netherlands)

    Olde Bekkink, M.; Verhave, J.C.; Vervoort, G.M.

    2012-01-01

    A 56-year-old man with obstructive icterus due to pancreas cysts presented with acute kidney insufficiency and bilirubine casts in the urinary sediment as a sign of bilirubine-associated acute kidney injury.

  11. Neonatal Jaundice and Maternal Oxytocin Infusion

    Science.gov (United States)

    Davies, D. P.; Gomersall, R.; Robertson, R.; Gray, O. P.; Turnbull, A. C.

    1973-01-01

    A prospective study of 78 neonates provides evidence for an association between maternal oxytocin infusion and neonatal jaundice. On the second and fifth days infants of mothers whose labour had been induced by amniotomy followed immediately by intravenous oxytocin (group C) had mean total bilirubin levels significantly higher (P oxytocin (group A). Bilirubin levels in infants of mothers whose onset of labour was spontaneous but required oxytocin to accelerate progress (group B) did not differ significantly from group A. Though these findings suggest a dose dependent effect of oxytocin, other possible explanations are suggested which take into account other drugs administered to the mother and also differences in the corticosteroid status of the groups of infants. PMID:4726154

  12. Ethnopharmacological Approaches for Therapy of Jaundice: Part I

    Directory of Open Access Journals (Sweden)

    Devesh Tewari

    2017-08-01

    Full Text Available Jaundice is a very common symptom especially in the developing countries. It is associated with several hepatic diseases which are still major causes of death. There are many different approaches to jaundice treatment and the growing number of ethnomedicinal studies shows the plant pharmacology as very promising direction. Many medicinal plants are used for the treatment of jaundice, however a comprehensive review on this subject has not been published. The use of medicinal plants in drug discovery is highly emphasized (based on their traditional and safe uses in different folk medicine systems from ancient times. Many sophisticated analytical techniques are emerging in the pharmaceutical field to validate and discover new biologically active chemical entities derived from plants. Here, we aim to classify and categorize medicinal plants relevant for the treatment of jaundice according to their origin, geographical location, and usage. Our search included various databases like Pubmed, ScienceDirect, Google Scholar. Keywords and phrases used for these searches included: “jaundice,” “hyperbilirubinemia,” “serum glutamate,” “bilirubin,” “Ayurveda.” The first part of the review focuses on the variety of medicinal plant used for the treatment of jaundice (a total of 207 medicinal plants. In the second part, possible mechanisms of action of biologically active secondary metabolites of plants from five families for jaundice treatment are discussed.

  13. Ethnopharmacological Approaches for Therapy of Jaundice: Part I

    Science.gov (United States)

    Tewari, Devesh; Mocan, Andrei; Parvanov, Emil D.; Sah, Archana N.; Nabavi, Seyed M.; Huminiecki, Lukasz; Ma, Zheng Feei; Lee, Yeong Yeh; Horbańczuk, Jarosław O.; Atanasov, Atanas G.

    2017-01-01

    Jaundice is a very common symptom especially in the developing countries. It is associated with several hepatic diseases which are still major causes of death. There are many different approaches to jaundice treatment and the growing number of ethnomedicinal studies shows the plant pharmacology as very promising direction. Many medicinal plants are used for the treatment of jaundice, however a comprehensive review on this subject has not been published. The use of medicinal plants in drug discovery is highly emphasized (based on their traditional and safe uses in different folk medicine systems from ancient times). Many sophisticated analytical techniques are emerging in the pharmaceutical field to validate and discover new biologically active chemical entities derived from plants. Here, we aim to classify and categorize medicinal plants relevant for the treatment of jaundice according to their origin, geographical location, and usage. Our search included various databases like Pubmed, ScienceDirect, Google Scholar. Keywords and phrases used for these searches included: “jaundice,” “hyperbilirubinemia,” “serum glutamate,” “bilirubin,” “Ayurveda.” The first part of the review focuses on the variety of medicinal plant used for the treatment of jaundice (a total of 207 medicinal plants). In the second part, possible mechanisms of action of biologically active secondary metabolites of plants from five families for jaundice treatment are discussed. PMID:28860989

  14. Evaluation of the Sodium Serum Level in Infants with Jaundice

    Directory of Open Access Journals (Sweden)

    Hassan Boskabadi

    2015-05-01

    Full Text Available Background: Inadequate milk intake during the first year of neonate’s life can result in weight loss, severe hyperbilirubinemia, and sometimes hypernatremia. In this study, we aimed to determine the relationship between neonatal weight loss and hypernatremia in term breastfed infants with idiopathic jaundice, as well as the necessity of sodium concentration measurement in newborns with idiopathic jaundice via weight loss measurement. Methods: In this cross-sectional study, we examined 273 infants with jaundice of unknown etiology at Ghaem Hospital, Mashhad, in years 2008-2012. The study sample consisted of 226 infants in the control group (serum sodium concentration

  15. IMPORTANCE OF LIVER FUNCTION TESTS IN DIFFERENTIAL DIAGNOSIS OF JAUNDICE

    Directory of Open Access Journals (Sweden)

    Sandeep

    2015-11-01

    Full Text Available BACKGROUND: Liver function tests (LFT still play a pivotal role in investigating a case of jaundice and hence helps in the diagnosis of a liver disease. In a developing country like India, doctors come across multiple cases of jaundice in day to day practice. Liver functions tests continue to be one of the oldest and basic investigations which a clinician trusts upon to reach the diagnosis of underlying etiology. Liver function tests include liver enzyme studies – SGPT, SGOT, Alkaline phosphatase, GGTP along with S. Bilirubin and S. Protein levels. With the help of liver function tests we can easily assess the cause of jaundice, whether it is due to prehepatic causes, hepatic causes or posthepatic causes. MATERIAL AND METHODS: A study carried out at Parul Institute of Medical Sciences, Vadodara, Gujarat, included 200 patients with jaundice among which were men, women and children of age group – 1 day to 80 years. The study was carried out over a span of 6 months. Liver function tests were performed by collecting samples in plain vacutainer and tests were carried out on Fully Automated Biochemistry Analyzer – SELECTRA BY Merck diagnostics. All the patients had minimum serum total bilirubin levels of greater than 1.5 mg%. RESULTS: Our study included total 200 patients of jaundice with serum bilirubin >1.5 mg%. Among them 55 were females and 145 were males. Patients were of age group 1 day to 80 years. Data revealed that approximately 30% of patients had prehepatic jaundice, 60 % had hepatic type, whereas 10 % had post hepatic type. In pre-hepatic jaundice, liver function tests show increase in indirect bilirubin with minimal or slight increase in the liver enzymes. In hepatic jaundice there is marked elevation in serum enzyme levels principally SGPT and SGOT while slight elevation in alkaline phosphatase and GGTP, elevated serum bilirubin levels is mainly of direct type and serum protein levels were altered. In post hepatic jaundice there is

  16. Acute viral hepatitis C-induced jaundice in pregnancy.

    Science.gov (United States)

    Hsieh, Tsung-Ying; Yu, Chen-Hsiang; Kuo, Pao-Lin; Chang, Fong-Ming

    2006-06-01

    Acute viral hepatitis C-induced jaundice in pregnancy is very rare and may be fatal. Here, we report a complicated case with acute hepatitis C-induced jaundice in pregnancy with successful management. A 27-year-old pregnant woman, gravida 2, para 1, with gestational age of 36 weeks and 5 days, was referred to our hospital due to jaundice and elevated liver enzymes of undetermined cause. She had been suffering from general weakness, diarrhea and vomiting for 1 week, and jaundice with tea-colored urine for 3 days. At our medical center, acute viral hepatitis C-induced jaundice was suspected. Since her general condition deteriorated at 36 weeks and 6 days of gestation, we decided to induce labor. A male baby was born smoothly via the vaginal route, with birth weight 2,857 g, birth length 48.6 cm, and 1- and 5-minute Apgar scores of 7 and 9, respectively. Maternal condition improved dramatically after delivery and her serum liver enzymes and bilirubin levels gradually approached normal ranges. Mothers and fetuses with acute viral hepatitis C-induced jaundice during pregnancy are at great risk of mortality and morbidity. Timely termination may be one of the choices of treatment when fetal maturity has been reached and the maternal condition has deteriorated.

  17. Colorful story of phototherapy for neonatal jaundice

    Science.gov (United States)

    Agati, Giovanni; Fusi, Franco; Pratesi, Riccardo; Pratesi, Simone; Donzelli, Gian Paolo

    1996-12-01

    Colors have always attracted our fantasy and imagination. Medicine, like many other human activities, did not escape their attraction, sometimes with fatal consequences. The scientific literature, magazines, etc. are full of reports on the beneficial, miraculous effects of colors. Even nowadays, where photobiology and photomedicine have been put on very firm bases, chromopaths are still at work. The evolution of light therapy from chromotherapy to photomedicine is presented in brief, with the aim of contributing to the action against the unscientific behavior of researchers and clinicians who support biological and/or clinical results without serious and well documented work. Colors have played an important role in the phototherapy of neonatal jaundice. It is an interesting example of how even a rigorous scientific search for the optimal color has progressed in part by change, due to the lack of an action spectrum, too hurried extrapolations of animal results to man, unsuspected dynamical behavior of bilirubin molecules, etc. The story of its evolution up to present knowledge is reported in this paper.

  18. Gene replacement therapy for genetic hepatocellular jaundice.

    Science.gov (United States)

    van Dijk, Remco; Beuers, Ulrich; Bosma, Piter J

    2015-06-01

    Jaundice results from the systemic accumulation of bilirubin, the final product of the catabolism of haem. Inherited liver disorders of bilirubin metabolism and transport can result in reduced hepatic uptake, conjugation or biliary secretion of bilirubin. In patients with Rotor syndrome, bilirubin (re)uptake is impaired due to the deficiency of two basolateral/sinusoidal hepatocellular membrane proteins, organic anion-transporting polypeptide 1B1 (OATP1B1) and OATP1B3. Dubin-Johnson syndrome is caused by a defect in the ATP-dependent canalicular transporter, multidrug resistance-associated protein 2 (MRP2), which mediates the export of conjugated bilirubin into bile. Both disorders are benign and not progressive and are characterised by elevated serum levels of mainly conjugated bilirubin. Uridine diphospho-glucuronosyl transferase 1A1 (UGT1A1) is responsible for the glucuronidation of bilirubin; deficiency of this enzyme results in unconjugated hyperbilirubinaemia. Gilbert syndrome is the mild and benign form of inherited unconjugated hyperbilirubinaemia and is mostly caused by reduced promoter activity of the UGT1A1 gene. Crigler-Najjar syndrome is the severe inherited form of unconjugated hyperbilirubinaemia due to mutations in the UGT1A1 gene, which can cause kernicterus early in life and can be even lethal when left untreated. Due to major disadvantages of the current standard treatments for Crigler-Najjar syndrome, phototherapy and liver transplantation, new effective therapeutic strategies are under development. Here, we review the clinical features, pathophysiology and genetic background of these inherited disorders of bilirubin metabolism and transport. We also discuss the upcoming treatment option of viral gene therapy for genetic disorders such as Crigler-Najjar syndrome and the possible immunological consequences of this therapy.

  19. Jaundice associated pruritis: a review of pathophysiology and treatment.

    Science.gov (United States)

    Bassari, Ramez; Koea, Jonathan B

    2015-02-07

    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.

  20. [Experimental substantiation of use of sodium hypochlorite and ozone at a formation of intestinal anastomosis in conditions of acute intestinal obstruction and peritonitis].

    Science.gov (United States)

    Lelianov, A D; Ivliev, N V; Bazhenov, S M; Nesterov, A A

    2009-01-01

    Presented are the results of experimental research on 144 animals (the rats Wistar), on whom was carried out resection of a part of large intestine and a intestinal anastamosis was formed in the presents of acute intestinal obstruction and peritonitis. The sanitation of abdominal cavity in the basic group of animals (74) was performed using sodium hypochlorite solution and dissolved ozone. The intestinal lavage was carried out by dissolved ozone with the subsequent introduction of ozonized oil Ozonide in the area of intestinal anastamosis. The combined application of ozone and sodium produces an expressed samative effect which leads to healing of intestinal anastamosis and decreases unstability of intestinal sutures and mortality.

  1. Antioxidant status in neonatal jaundice before and after phototherapy

    Directory of Open Access Journals (Sweden)

    S Ayyappan

    2015-01-01

    Full Text Available Background: Neonatal jaundice refers to yellow coloration of the skin and the sclera (whites of the eyes of newborn babies that result from the accumulation of bilirubin in the skin and mucous membranes. Because bilirubin is potentially toxic to the central nervous system. Genetic disorders of bilirubin conjugation, particularly the common Gilbert′s syndrome, can also contribute to neonatal hyperbilirubinemia. Objective: The aim of this study was to evaluate the lipid per-oxidation and antioxidant enzyme activities in patients with neonatal jaundice before and after phototherapy. Materials and Methods: The study includes 50 neonatal jaundice patients with average age 2-15 days. All patients of neonatal jaundice receiving phototherapy except feeding, cleaning. Subjects selected were from the patients attending Pediatrics Department. Plasma malondialdehyde (MDA, erythrocyte glutathione peroxidase (GPX, superoxide dismutase and catalase (CAT to monitor the bilirubin level. Results: The results show increased levels of bilirubin compared with controls (P < 0.001 shows the level of plasma MDA in control, before and after phototherapy. Represents the level of GPX was significantly increased in after the phototherapy group when compared with before phototherapy and control SPSS soft ware: (P < 0.001. Shows the reduced glutathione (GSH level in plasma was significantly decreased in the after phototherapy group when compared with before phototherapy and control (P < 0.001. And finally with ascorbic acid and CAT. Conclusion: It is evident from the study that increased oxidative stress in neonatal jaundice babies leads to decrease in the levels of antioxidants like GSH and ascorbic acid and disturb their metabolism, that weaken their ability to fight the growing stress. Intense oxidative stress and decreased antioxidants may contribute to neural cell death and alter the erythrocytomembrane structure processing in neonatal jaundice.

  2. Does experimental paradoxical sleep deprivation (EPSD) is an appropriate model for evaluation of cardiovascular complications of obstructive sleep apnea?

    Science.gov (United States)

    Joukar, Siyavash; Ghorbani-Shahrbabaki, Soodabe

    2016-05-01

    Some of the previous studies have used animal model of paradoxical sleep deprivation for investigation of sleep loss complications. The present study is designed to examine the effectiveness and reliability of this model for investigation and assessment of some cardiovascular complications of obstructive sleep apnea syndrome. The Wistar rat groups were divided into the control group, the Test48 and Test72 groups, who experienced paradoxical sleep deprivation for 48 and 72 h, and the Sham48 and Sham72 groups, who were exposed to environmental conditions same to test groups but without sleep deprivation, respectively. At the end of the experiment, blood pressure and heart rate variability were assessed. The results showed that 72 h rapid eye movements sleep deprivation significantly increased the systolic blood pressure compared to the control (p sleep deprivation may be a suitable model for induction and investigation of hemodynamic alterations which occurs in obstructive sleep apnea syndrome; however, it cannot be an alternative model to induce heart rate variability alterations similar to those reported in patient with obstructive sleep apnea.

  3. [Establishment and validation of a neonatal pig model of hemolytic jaundice].

    Science.gov (United States)

    Li, Yong-Fu; Ma, Yue-Lan; Nie, Ling; Chen, Shuan; Jin, Mei-Fang; Wang, San-Lan

    2016-05-01

    To establish a neonatal pig model of hemolytic jaundice. Twelve seven-day-old purebred Yorkshire pigs were randomly divided into an experimental group and a control group (n=6 each). Immunization of New Zealand white rabbits was used to prepare rabbit anti-porcine red blood cell antibodies, and rabbit anti-porcine red blood cell serum was separated. The neonatal pigs in the experimental group were given an intravenous injection of rabbit anti-porcine red blood cell serum (5 mL), and those in the control group were given an intravenous injection of normal saline (5 mL). Venous blood samples were collected every 6 hours for routine blood test and liver function evaluation. The experimental group had a significantly higher serum bilirubin level than the control group at 18 hours after the injection of rabbit anti-porcine red blood cell serum (64±30 μmol/L vs 20±4 μmol/L; Pjaundice simulates the pathological process of human hemolytic jaundice well and provides good biological and material bases for further investigation of neonatal hemolysis.

  4. Lactation Support and Breastfeeding Duration in Jaundiced Infants: A Randomized Controlled Trial

    OpenAIRE

    Catherine M Pound; Katherine Moreau; Kristina Rohde; Nick Barrowman; Mary Aglipay; Farion, Ken J.; Plint, Amy C.

    2015-01-01

    Objectives Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period. We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants. Study Design We conducted a randomized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants

  5. Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. II. Findings in experimentally induced ureteric stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Rohrschneider, W.K.; Becker, K.; Hoffend, J.; Clorius, J.H.; Darge, K.; Kooijman, H.; Troeger, J. [Paediatric Radiology, Univ. of Heidelberg (Germany)

    2000-08-01

    Purpose. To assess the diagnostic value of combined static-dynamic MR urography (MRU) for the functional-morphological evaluation of experimentally induced urinary tract obstruction in the piglet. Materials and methods. In 20 piglets unilateral ureteric stenosis was created operatively. Post-surgery repeated comparative examinations were obtained with MRU, diuretic renal scintigraphy (DRS), excretory urography (EU) and ultrasound (US). MRU was performed as a combination study with a static 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA with frusemide administration. Results. MRU allowed complete depiction of the prestenotic urinary tract and of the stenosis in all cases. In 43 comparative studies MRU was superior to EU in 36, EU to MRU in 2. When single kidney function was calculated with both MRU and DRS, results were highly correlated (r = 0.92). When urinary excretion was compared, significant agreement was achieved with concordant findings in 86 % and slightly discordant results in 12 %. Conclusions. Static-dynamic MR urography permits excellent depiction of experimentally induced urinary tract obstruction in piglets and reliable assessment of individual renal function and urinary excretion. Two advantages of the method stand out - it does not require radiation and it permits functional-morphological correlation. (orig.)

  6. Neonatal Jaundice: A Survey of Perinatal Correlates among Mothers ...

    African Journals Online (AJOL)

    Multistage sampling was used to select four immunization clinics from three wards in the LGA. Using astructured interviewer-administered questionnaire, data were obtained from 394 mothers on their socio-demographic characteristics, ANC and birth history, history of neonatal jaundice and how it was managed.

  7. A report of three cases of jaundice with thyrotoxicosis

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... liver biopsy in any of the patients, partly due to financial constraints, and partly because our patients all responded to treatment of thyrotoxicosis. Conclusion. Patients with thyrotoxicosis may have abnormal results of liver function test ranging from mild to severe. Patients presenting with jaundice of unknown.

  8. Neonatal jaundice and its management: Knowledge, attitude, and ...

    African Journals Online (AJOL)

    The objective of the study was to assess the knowledge, attitude and practice of expectant mothers about neonatal jaundice and its management. Materials and Methods: The study was descriptive cross-sectional, carried out among 389 expectant mothers who were attending the antenatal clinic at the University of Benin ...

  9. Biliary Atresia – An Easily Missed Cause of Jaundice amongst ...

    African Journals Online (AJOL)

    ... presents with jaundice, acholic stools / dark urine and hepatomegaly. This disease rapidly leads to liver cirrhosis and liver failure if untreated surgically. The main objective was to establish the epidemiology of patients presenting with biliary atresia and immediate surgical outcome. Methods: A review of a prospective data ...

  10. Neonatal jaundice and birth asphyxia as major causes of cerebral ...

    African Journals Online (AJOL)

    Background: Cerebral Palsy is permanent sequela of severe nonprogressive insult to the immature brain of children. In Nigeria, kernicterus from neonatal jaundice and hypoxic ischaemic encephalopathy form severe birth asphyxia have been identified as among the leading causes of this scourge. Poor management of ...

  11. A report of three cases of jaundice with thyrotoxicosis

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... She did not have a past history of jaundice or history of indiscriminate use of injections, multiple sexual ... on the left and right lateral lobes. Other systems were essentially normal. An assessment of .... induces a relative decrease in blood flow to certain areas of the liver resulting in hypoxic injury. Thyroid.

  12. Acute Viral Hepatitis C-Induced Jaundice in Pregnancy

    Directory of Open Access Journals (Sweden)

    Tsung-Ying Hsieh

    2006-06-01

    Conclusion: Mothers and fetuses with acute viral hepatitis C-induced jaundice during pregnancy are at great risk of mortality and morbidity. Timely termination may be one of the choices of treatment when fetal maturity has been reached and the maternal condition has deteriorated.

  13. Neonatal jaundice and birth asphyxia as major causes of cerebral ...

    African Journals Online (AJOL)

    McRoy

    International Journal of Medicine and Biomedical Research. Volume 2 Issue 3 September – December 2013 ... cerebral palsy in Nigeria: are doctors' wrong beliefs and practices part of the problem? Okperi B.O ... training programs. Key words: Neonatal jaundice, birth asphyxia, cerebral palsy, health institutions, practice ...

  14. [Current comprehensive diagnosis of pancreatobiliary cancer complicated by jaundice syndrome].

    Science.gov (United States)

    Kharchenko, V P; Liutfaliev, T A; Kunda, M A

    2000-01-01

    The study was undertaken to enhance the efficiency of diagnosis of pancreatobiliary cancer complicated by jaundice by using the potentialities of currently available instrumental studies at most. The data of examination of 256 patients with this disease are presented. Based on diagnostic findings, the authors have constructed a diagnostic model of precision recognition of cancer of the extrahepatic bile ducts, pancreatic head, Vater's papilla.

  15. Observation of renal function in patients with surgical jaundice

    Directory of Open Access Journals (Sweden)

    Ansul Kumar

    2014-04-01

    Conclusion: Each case of surgical jaundice should be considered as a potential case likely to pass in acute renal failure, and hence, a close monitoring of renal functions should be started at the very beginning and should be continued until the final outcome of the treatment.

  16. What Do Expectant Mothers Know about Neonatal Jaundice?

    Science.gov (United States)

    Ogunfowora, Olusoga B.; Adefuye, Peter O.; Fetuga, Musili B.

    2006-01-01

    Neonatal jaundice (NNJ) is a common disorder worldwide and many affected babies become brain-damaged due to delay in seeking medical consultation. In order to assess the awareness and knowledge of expectant mothers about NNJ, women who registered for antenatal care at a tertiary health facility in the South-western part of Nigeria were…

  17. Decision support for the differential diagnosis of jaundice

    NARCIS (Netherlands)

    R.W. Segaar (Robert)

    1991-01-01

    textabstractMaking a diagnosis is always a challenge for the clinician who faces a jaundiced patient. A diagnosis provides a basis for prognosis, and guides therapeutic action. Modeling of the diagnostic process provides an understanding of the contributing elements. In addition, diagnostic

  18. The jaundiced newborn: which early monitoring for a safe discharge?

    Directory of Open Access Journals (Sweden)

    S. Pratesi

    2013-08-01

    Full Text Available Neonatal jaundice is one of the most common causes of prolonged hospital stay or readmission of a near-term or term baby. Reason of concern at early discharge of a jaundiced newborn is that of bilirubin neurotoxicity, even if a serum bilirubin concentration surely toxic for the brain is still unknown. Kernicterus and severe neonatal hyperbilirubinemia are still problems in the third millennium and the American Academy of Pediatrics claimed the pediatric community to increase vigilance in order to reduce the occurrence of these dramatic events. The only existing kernicterus registry is the pilot USA kernicterus registry whose data on 125 kernicteric term and near term babies from 1992 to 2004 have been recently published. Nobody of the kenicteric babies into the USA register had a serum bilirubin levels below 20 mg/dL. All the babies who suffered from kernicteric sequelae were discharged as healthy from hospital and then, 86% of them, readmitted in the first ten days of life. In the majority of babies (69% a cause of the severe hyperbilirubinemia was not found. Current knowledge on mechanism of neurological damage induced by bilirubin, unfortunately, does not allow to have a universal evidenced based guideline on how to manage neonatal jaundice. Thus, the existing national guidelines contain inevitable differences in the recommended procedure. Waiting for the future italian guidelines the paper illustrates a proposal of management of neonatal jaundice in term or near term newborns based on available scientific evidence and national guidelines published in english language.

  19. Neonatal jaundice and birth asphyxia as major causes of cerebral ...

    African Journals Online (AJOL)

    McRoy

    Background: Cerebral Palsy is permanent sequela of severe non- progressive insult to the immature brain of children. In Nigeria, kernicterus from neonatal jaundice and hypoxic ischaemic encephalopathy form severe birth asphyxia have been identified as among the leading causes of this scourge. Poor management of ...

  20. Prevalence of Neonatal Jaundice on Central Hospital, Warri, Delta ...

    African Journals Online (AJOL)

    Glucose-6-phosphate dehydrogenase deficiency, ABO incompatibility and low birth weight were found to be major predisposing/etiologic factors. Conclusion: Neonatal jaundice was common among the babies in the health facility studied and was higher among mothers who had low level of education and babies whose ...

  1. Haemolytic Uraemic Syndrome: An Unusual Cause of Jaundice ...

    African Journals Online (AJOL)

    In the course of investigating the cause of her symptoms, a diagnosis of HUS was made and she was commenced on therapeutic plasma exchange and hemodialysis. Conclusion: The main lesson is to raise awareness of HUS as a possible cause of jaundice among physicians, especially those in the emergency care.

  2. Supra-treatment threshold neonatal jaundice: Incidence in HIV ...

    African Journals Online (AJOL)

    admitted were retrieved and information on birth date, gestational age, birth weight ... as toxoplasmosis, rubella, cytomegalovirus, herpes, and syphilis.2. Risk factors of neonatal jaundice include low birth weight, prematurity, ABO incompatibility, and sepsis.3 In ... threshold levels for gestational age and postpartum age. If.

  3. Obstructive Sleep Apnea

    Science.gov (United States)

    ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ...

  4. Malignant duodenal obstructions: palliative treatment with covered expandable nitinol stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Chul; Jung, Gyoo Sik; Lee, Sang Hee; Kim, Sung Min; Oh, Kyung Seung; Huh, Jin Do; Cho, Young Duk [College of Medicine, Kosin Univ, Pusan (Korea, Republic of); Song, Ho Young [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-04-01

    To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ten patients, and no procedural complications occuured. In one of two patients in whom there was technical failure, and in whom the obstructions were located in part III, the stent was placed transgastrically. Stent migration occurred in one patient four days after the procedure, and treatment involved the palcement of a second, uncovered, nitinol stent. After stent placement, symptoms improved in all patients. During follow-up, obstructive symptoms due to stent stenosis (n=1), colonic obstruction (n=1), and multiple small bowel obstruction (n=1) recurred in three patients. Two of these were treated by placing additional stents in the duodenum and colon, respectively. One of the eight patients in whom a stent was placed in the second portion of the duodenum developed jaundice. The patients died a mean 14 (median, 9) weeks after stent placement. The placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible, safe and effective for the palliative treatment of malignant

  5. Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis.

    Science.gov (United States)

    Jäger, Bernhard; Drolz, Andreas; Michl, Barbara; Schellongowski, Peter; Bojic, Andja; Nikfardjam, Miriam; Zauner, Christian; Heinz, Gottfried; Trauner, Michael; Fuhrmann, Valentin

    2012-12-01

    Hypoxic hepatitis (HH) is the most frequent cause of acute liver injury in critically ill patients. No clinical data exist about new onset of jaundice in patients with HH. This study aimed to evaluate the incidence and clinical effect of jaundice in critically ill patients with HH. Two hundred and six consecutive patients with HH were screened for the development of jaundice during the course of HH. Individuals with preexisting jaundice or liver cirrhosis at the time of admission (n = 31) were excluded from analysis. Jaundice was diagnosed in patients with plasma total bilirubin levels >3 mg/dL. One-year-survival, infections, and cardiopulmonary, gastrointestinal (GI), renal, and hepatic complications were prospectively documented. New onset of jaundice occurred in 63 of 175 patients with HH (36%). In patients who survived the acute event of HH, median duration of jaundice was 6 days (interquartile range, 3-8). Patients who developed jaundice (group 1) needed vasopressor treatment (P jaundice (group 2). One-year survival rate was significantly lower in group 1, compared to group 2 (8% versus 25%, respectively; P jaundice was associated with an increased frequency of complications during follow-up (54% in group 1 versus 35% in group 2; P Jaundice is a common finding during the course of HH. It leads to an increased rate of complications and worse outcome in patients with HH. Copyright © 2012 American Association for the Study of Liver Diseases.

  6. Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum

    Directory of Open Access Journals (Sweden)

    Anastasios J. Karayiannakis

    2012-07-01

    Full Text Available Periampullary duodenal diverticula are not uncommon and are usually asymptomatic although complications may occasionally occur. Here, we report the case of a 72-year-old woman who presented with painless obstructive jaundice. Laboratory tests showed abnormally elevated serum concentrations of total and direct bilirubin, of alkaline phosphatase, of γ-glutamyl transpeptidase, and of aspartate and alanine aminotransferases. Serum concentrations of the tumor markers carbohydrate antigen 19-9 and carcinoembryonic antigen were normal. Abdominal ultrasonography showed dilatation of the common bile duct (CBD, but no gallstones were found either in the gallbladder or in the CBD. The gallbladder wall was normal. Computed tomography failed to detect the cause of CBD obstruction. Magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed a periampullary diverticulum measuring 2 cm in diameter and compressing the CBD. The pancreatic duct was normal. Hypotonic duodenography demonstrated a periampullary diverticulum with a filling defect corresponding to the papilla. CBD compression by the diverticulum was considered as the cause of jaundice. The patient was successfully treated by surgical excision of the diverticulum. In conclusion, the presence of a periampullary diverticulum should be considered in elderly patients presenting with obstructive jaundice in the absence of CBD gallstones or of a tumor mass. Non-interventional imaging studies should be preferred for diagnosis of this condition, and surgical or endoscopic interventions should be used judiciously for the effective and safe treatment of these patients.

  7. Kaposiform hemangioendothelioma causing intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Bassel Salman

    2018-01-01

    Full Text Available A previously healthy toddler with bilious vomiting and erythematous gluteal rash over 2 weeks had intermittent pain, constipation and decreased appetite. All labs were negative with the exception of fecal occult blood. Abdominal x-ray and ultrasound revealed dilated air-filled loops of bowel and partial small bowel obstruction. After persistent worsening abdominal pain and vomiting a CT scan with IV contrast (Fig. 1 suggested small bowel obstruction. Emergent surgery was performed and diagnostic laparoscopy revealed about 61 cm of necrotic bowel causing stricture formation and mesenteric shortening in the distal small bowel. 56 cm of inflamed bowel was resected with end-to-end anastomosis. Final pathology report indicated diffuse intestinal angiomatosis with transmural involvement and focal erosion consistent with KHE (Fig. 2. Presentation is varied, consists of cutaneous lesion, retroperitoneal mass, intestinal obstruction, jaundice, intussusception, or multifocal neoplasms. Complete surgical resection with wide margins is the best therapeutic option and has achieved the best outcomes. If not treated in sufficient time, KHE has a relatively high mortality rate of 30%, with most deaths occurring due to its locally invasive effects [5]. There are limited reports of identifying features of KHE on imaging. Of 165 cases of KHE none were presented in the small bowel [5]. We report the unique case of KHE presenting as a hypervascular mass causing obstruction in the distal small bowel. Although extremely rare, KHE should be considered as a reason for severe GI stricture or obstruction in infants and children in obscure cases and included in the differential.

  8. Biliary tract obstruction secondary to Burkitt lymphoma; Linfoma de Burkitt associado a obstrucao de vias biliares

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, Wellington L.; Bezerra, Alanna Mara P.S.; Carvalho Filho, Nevicolino P.; Coelho, Robson C. [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Dept. de Pediatria; Soares, Fernando A. [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Dept. de Patologia; Pecora, Marcela S. [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Dept. de Imagem; Chapchap, Paulo [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Servico de Cirurgia Pediatrica

    2004-09-01

    The abdomen, in particular the ileocecal region, appendix and colon, is the most common primary site for Burkitt non Hodgkin's lymphoma (NHL). Involvement of the bile duct is rare. The authors describe a patient with abdominal NHL in which jaundice due to bile duct obstruction was the first clinical sign. Case report: a 3 year old white boy presented with one month of progressive jaundice, clay-colored stools, tea colored urine and increase of abdominal volume. Physical examination showed jaundice 3+/4+ and pale mucosa. The abdomen was moderately distended and timpanous and the liver was enlarged. Laboratory examinations confirmed cholestasis with total bilirubin of 8.2 mg/dl (direct bilirubin of 7.8 mg/dl), and microcytic and hypochromic anemia. Ultrasonography (US) and abdominal CT showed two solid tumors in hepatic hilar topography, and dilated intrahepatic biliary tree. The Doppler US showed hepatic artery and portal vein dislocation by the nodules. Comment: although jaundice occurs frequently as a late manifestation of NHL, it is rarely seen as the presenting sign. When jaundice is the first clinical sign and image studies show hepatic hilar tumor and bile duct obstruction, NHL should be considered in the differential diagnosis. (author)

  9. The natural history of autoimmune hepatitis presenting with jaundice.

    Science.gov (United States)

    Panayi, Vasilis; Froud, Oliver J; Vine, Louisa; Laurent, Paul; Woolson, Kathy L; Hunter, Jeremy G; Madden, Richard G; Miller, Catherine; Palmer, Jo; Harris, Nicola; Mathew, Joe; Stableforth, Bill; Murray, Iain A; Dalton, Harry R

    2014-06-01

    Forty percent of patients with autoimmune hepatitis (AIH) present with acute jaundice/hepatitis. Such patients, when treated promptly, are thought to have a good prognosis. The objective of this study was to describe the natural history of AIH in patients presenting with jaundice/hepatitis and to determine whether the diagnosis could have been made earlier, before presentation. This study is a retrospective review of 2249 consecutive patients who presented with jaundice to the Jaundice Hotline clinic, Truro, Cornwall, UK, over 15 years (1998-2013) and includes a review of the laboratory data over a 23-year period (1990-2013). Of the 955 patients with hepatocellular jaundice, 47 (5%) had criterion-referenced AIH: 35 female and 12 male, the median age was 65 years (range 15-91 years); the bilirubin concentration was 139 μmol/l (range 23-634 μmol/l) and the alanine transaminase level was 687 IU/l (range 22-2519 IU/l). Among the patients, 23/46 (50%) were cirrhotic on biopsy; 11/47 (23%) died: median time from diagnosis to death, 5 months (range 1-59); median age, 72 years (range 59-91 years). All 8/11 patients who died of liver-related causes were cirrhotic. Weight loss (P=0.04) and presence of cirrhosis (P=0.004) and varices (P=0.015) were more common among those who died. Among patients who died from liver-related causes, 6/8 (75%) died less than 6 months from diagnosis. Cirrhosis at presentation and oesophageal varices were associated with early liver-related deaths (P=0.011, 0.002 respectively). Liver function test results were available in 33/47 (70%) patients before presentation. Among these patients, 16 (49%) had abnormal alanine transaminase levels previously, and eight (50%) were cirrhotic at presentation. AIH presenting as jaundice/hepatitis was mainly observed in older women: 50% of the patients were cirrhotic, and liver-related mortality was high. Some of these deaths were potentially preventable by earlier diagnosis, as the patients had abnormal liver

  10. The Pitfalls of Febrile Jaundice. A Case Report

    Directory of Open Access Journals (Sweden)

    Obreja Maria

    2016-04-01

    Full Text Available Jaundice in sepsis is usually caused by cholestasis, and its onset can precede other manifestations of the infection. Inflammation-induced cholestasis is a common complication in patients with an extrahepatic infection or those with inflammatory processes. We describe the case of a 47 years old female who presented with low back pain and paravertebral muscular contracture. She subsequently developed a cholestatic syndrome with clinical manifestations such as jaundice, followed by fever and sepsis with multiple organ dysfunction. Initially labeled as biliary sepsis, the diagnosis was crucially reoriented as the blood cultures were positive for Streptococcus pyogenes and the magnetic resonance imaging (MRI findings suggested spondylodiscitis as well as a paravertebral abscess.

  11. Sonic hedgehog (SHH) and glioblastoma-2 (Gli-2) expressions are associated with poor jaundice-free survival in biliary atresia.

    Science.gov (United States)

    Jung, Hae Yoen; Jing, Jin; Lee, Kyoung Bun; Jang, Ja-June

    2015-03-01

    Biliary atresia (BA) causes biliary obstruction in neonates. Although the Kasai operation can successfully treat certain BA cases, many patients exhibit recurrent jaundice and secondary biliary cirrhosis requiring liver transplantation. Consequently, studies of the prognostic factors of the Kasai operation are needed. Accordingly, sonic hedgehog (SHH) pathway expression at the extrahepatic bile duct (EHBD), an important bile duct repair mechanism, will be investigated via immunohistochemistry in patients with BA to examine the association with post-Kasai operation prognosis. Fifty-seven EHBD specimens were obtained during Kasai operations from 1992 to 2009. The SHH, patched (PTCH), and glioblastoma-2 (Gli-2) immunohistochemical staining results were analyzed quantitatively. Overall, 57.9% of patients had bile flow normalization after the Kasai operation; 43.1% did not. High preoperative serum total bilirubin, direct bilirubin, and aspartate aminotransferase levels were associated with sustained jaundice post-Kasai operation, as was an age ≥65days at the time of surgery (all pjaundice relapse. Strong Gli-2 and SHH expression in the EHBD might be a poor prognostic factor in Kasai operation-treated patients with BA. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Features of History, Anthropometric Data and Individual Functions of the Liver in Children with Prolonged Jaundice

    Directory of Open Access Journals (Sweden)

    O.V. Tyajka

    2016-11-01

    Full Text Available Background. Neonatal jaundice is one of the urgent problems in neonatology. There is a tendency to increase the incidence of prolonged jaundice. The aim of our study was to explore the features of history, anthropometric data and some liver functions in children with prolonged jaundice. Materials and methods. The study involved 111 children with prolonged jaundice aged from 3 weeks to 3 months. In all children with prolonged jaundice, we have examined complete blood count, urinalysis, blood chemistry (determination of total bilirubin and fractions, total protein, albumin, glucose and used instrumental methods of examination — ultrasound of the abdominal cavity and cranial ultrasonography, electrocardiography. Most children with prolonged jaundice were breastfed and were term infants. Results. Indicators of physical development at birth (body weight, body length, head circumference, chest circumference in children with prolonged jaundice and in healthy children had not statistically significant differences. Neonatal jaundice was prolonged in children, who were born from the first pregnancy, — 60 children (54.1 %. A high level of total and indirect bilirubin was accompanied by a low level of albumin in the blood serum of children with prolonged jaundice. Protein-synthesis function of the liver was reduced in children with prolonged jaundice.

  13. FLUCTUATING JAUNDICE IN THE ADENOCARCINOMA OF THE AMPULLA OF VATER: a classic sign or an exception?

    Science.gov (United States)

    Alves, José Roberto; Amico, Enio Campos; Souza, Dyego Leandro Bezerra de; Oliveira, Patrick Vanttinny Vieira de; Maranhão, Ícaro Godeiro de Oliveira

    2015-01-01

    Some authors consider the fluctuating jaundice as a classic sign of the adenocarcinoma of the ampulla of Vater. Assessing the frequency of fluctuating jaundice in their forms of its depiction in the patients with adenocarcinoma of the ampulla of Vater. Observational and retrospective study, conducted through analyses of medical records from patients subjected to pancreatic cephalic resections between February 2008 and July 2013. The pathological examination of the surgical specimen was positive to adenocarcinoma of the ampulla of Vater. Concepts and differences on clinical and laboratory fluctuating jaundice were standardized. It was subdivided into type A and type B laboratory fluctuating jaundice. Twenty patients were selected. One of them always remained anicteric, 11 patients developed progressive jaundice, 2 of them developed clinical and laboratory fluctuating jaundice, 5 presented only laboratory fluctuating jaundice and one did not present significant variations on total serum bilirubin levels. Among the seven patients with fluctuating jaundice, two were classified as type A, one as type B and four were not classified due to lack information. Finally, progressive jaundice was the prevailing presentation form in these patients (11 cases). This series of cases suggested that clinical fluctuating jaundice is a uncommon signal in adenocarcinoma of the ampulla of Vater.

  14. The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer.

    Science.gov (United States)

    Yang, Xin-wei; Yuan, Jian-mao; Chen, Jun-yi; Yang, Jue; Gao, Quan-gen; Yan, Xing-zhou; Zhang, Bao-hua; Feng, Shen; Wu, Meng-chao

    2014-09-03

    Preoperative jaundice is frequent in gallbladder cancer (GBC) and indicates advanced disease. Resection is rarely recommended to treat advanced GBC. An aggressive surgical approach for advanced GBC remains lacking because of the association of this disease with serious postoperative complications and poor prognosis. This study aims to re-assess the prognostic value of jaundice for the morbidity, mortality, and survival of GBC patients who underwent surgical resection with curative intent. GBC patients who underwent surgical resection with curative intent at a single institution between January 2003 and December 2012 were identified from a prospectively maintained database. A total of 192 patients underwent surgical resection with curative intent, of whom 47 had preoperative jaundice and 145 had none. Compared with the non-jaundiced patients, the jaundiced patients had significantly longer operative time (p jaundice was the only independent predictor of postoperative complications. The jaundiced patients had lower survival rates than the non-jaundiced patients (p jaundiced patients. The survival rates of the jaundiced patients with preoperative biliary drainage (PBD) were similar to those of the jaundiced patients without PBD (p = 0.968). No significant differences in the rate of postoperative intra-abdominal abscesses were found between the jaundiced patients with and without PBD (n = 4, 21.1% vs. n = 5, 17.9%, p = 0.787). Preoperative jaundice indicates poor prognosis and high postoperative morbidity but is not a surgical contraindication. Gallbladder neck tumors significantly increase the surgical difficulty and reduce the opportunities for radical resection. Gallbladder neck tumors can independently predict poor outcome. PBD correlates with neither a low rate of postoperative intra-abdominal abscesses nor a high survival rate.

  15. [Transhepatic drainage in focal liver diseases complicated by mechanical jaundice].

    Science.gov (United States)

    Zhuravlev, V A; Bakhtin, V A

    1986-11-01

    Results of using transhepatic drains in 43 patients with focal alterations of the liver complicated by a mechanical jaundice are described (55 operations). Transhepatic drains allowed widening the degree of surgical interventions in this group of patients. Risk of the operative interventions and lethality among these critical patients which were earlier thought to be inoperable became lower due to stage operations using the transhepatic drains.

  16. Approach to Clinical Syndrome of Jaundice and Encephalopathy in Tropics

    Science.gov (United States)

    Anand, Anil C.; Garg, Hitendra K.

    2015-01-01

    A large number of patients present with jaundice and encephalopathy in tropical country like India and acute liver failure is the usual cause. Clinical presentation like ALF is also a complication of many tropical infections, and these conditions may mimic ALF but may have subtle differences from ALF. Moreover, what hepatologists see as acute liver failure in tropics is different from what is commonly described in Western Textbooks. Paracetamol overdose, which is possibly the commonest cause of ALF in UK and USA, is hardly ever seen in India. Most common etiology here is viral hepatitis (hepatitis E > hepatitis B> hepatitis A). Apart from ALF, one may also come across subacute hepatic failure (SAHF) as well as acute-on-chronic liver failure (ACLF) due to viral hepatitis. Interestingly, a host of other conditions can mimic ALF because clinical presentation in these conditions can be dominated by jaundice and encephalopathy. Malarial hepatopathy is possibly the best-known condition out of these and is not an uncommon manifestation of severe malaria. A similar presentation can also be seen in other common infections in tropics such as dengue fever, typhoid fever, leptospirosis, scrub typhus, amoebic liver abscesses, tuberculosis and other bacterial and fungal infections with or without human immunodeficiency virus (HIV) related disease. In many of these conditions, liver failure may not be underlying pathophysiology. Some pregnancy related liver diseases could also present with jaundice and encephalopathy. This review summarizes the commonly seen presentations in tropical country like India, where jaundice and encephalopathy dominate the clinical picture. PMID:26041951

  17. Association Between Early Idiopathic Neonatal Jaundice and Urinary Tract Infections.

    Science.gov (United States)

    Özcan, Murat; Sarici, S Ümit; Yurdugül, Yüksel; Akpinar, Melis; Altun, Demet; Özcan, Begüm; Serdar, Muhittin A; Sarici, Dilek

    2017-01-01

    Etiologic role, incidence, demographic, and response-to-treatment characteristics of urinary tract infection (UTI) among neonates, its relationship with significant neonatal hyperbilirubinemia, and abnormalities of the urinary system were studied in a prospective investigation in early (⩽10 days) idiopathic neonatal jaundice in which all other etiologic factors of neonatal hyperbilirubinemia were ruled out. Urine samples for microscopic and bacteriologic examination were obtained with bladder catheterization from 155 newborns with early neonatal jaundice. Newborns with a negative urine culture and with a positive urine culture were defined as group I and group II, respectively, and the 2 groups were compared with each other. The incidence of UTI in whole of the study group was 16.7%. Serum total and direct bilirubin levels were statistically significantly higher in group II when compared with group I (P = .005 and P = .001, respectively). Decrease in serum total bilirubin level at the 24th hour of phototherapy was statistically significantly higher in group I compared with group II (P = .022). Urinary tract infection should be investigated in the etiologic evaluation of newborns with significant hyperbilirubinemia. The possibility of UTI should be considered in jaundiced newborns who do not respond to phototherapy well or have a prolonged duration of phototherapy treatment.

  18. Association Between Early Idiopathic Neonatal Jaundice and Urinary Tract Infections

    Directory of Open Access Journals (Sweden)

    Murat Özcan

    2017-03-01

    Full Text Available Background and purpose: Etiologic role, incidence, demographic, and response-to-treatment characteristics of urinary tract infection (UTI among neonates, its relationship with significant neonatal hyperbilirubinemia, and abnormalities of the urinary system were studied in a prospective investigation in early (≤10 days idiopathic neonatal jaundice in which all other etiologic factors of neonatal hyperbilirubinemia were ruled out. Patients and methods: Urine samples for microscopic and bacteriologic examination were obtained with bladder catheterization from 155 newborns with early neonatal jaundice. Newborns with a negative urine culture and with a positive urine culture were defined as group I and group II, respectively, and the 2 groups were compared with each other. Results: The incidence of UTI in whole of the study group was 16.7%. Serum total and direct bilirubin levels were statistically significantly higher in group II when compared with group I ( P = .005 and P = .001, respectively. Decrease in serum total bilirubin level at the 24th hour of phototherapy was statistically significantly higher in group I compared with group II ( P = .022. Conclusions: Urinary tract infection should be investigated in the etiologic evaluation of newborns with significant hyperbilirubinemia. The possibility of UTI should be considered in jaundiced newborns who do not respond to phototherapy well or have a prolonged duration of phototherapy treatment.

  19. Intelligent diagnosis of jaundice with dynamic uncertain causality graph model.

    Science.gov (United States)

    Hao, Shao-Rui; Geng, Shi-Chao; Fan, Lin-Xiao; Chen, Jia-Jia; Zhang, Qin; Li, Lan-Juan

    2017-05-01

    Jaundice is a common and complex clinical symptom potentially occurring in hepatology, general surgery, pediatrics, infectious diseases, gynecology, and obstetrics, and it is fairly difficult to distinguish the cause of jaundice in clinical practice, especially for general practitioners in less developed regions. With collaboration between physicians and artificial intelligence engineers, a comprehensive knowledge base relevant to jaundice was created based on demographic information, symptoms, physical signs, laboratory tests, imaging diagnosis, medical histories, and risk factors. Then a diagnostic modeling and reasoning system using the dynamic uncertain causality graph was proposed. A modularized modeling scheme was presented to reduce the complexity of model construction, providing multiple perspectives and arbitrary granularity for disease causality representations. A "chaining" inference algorithm and weighted logic operation mechanism were employed to guarantee the exactness and efficiency of diagnostic reasoning under situations of incomplete and uncertain information. Moreover, the causal interactions among diseases and symptoms intuitively demonstrated the reasoning process in a graphical manner. Verification was performed using 203 randomly pooled clinical cases, and the accuracy was 99.01% and 84.73%, respectively, with or without laboratory tests in the model. The solutions were more explicable and convincing than common methods such as Bayesian Networks, further increasing the objectivity of clinical decision-making. The promising results indicated that our model could be potentially used in intelligent diagnosis and help decrease public health expenditure.

  20. Transcutaneous billirubinometry to estimate total serum bilirubin in neonatal jaundice

    Directory of Open Access Journals (Sweden)

    Andra Kurnianto

    2017-02-01

    Full Text Available Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions. Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice. Methods Subjects were infants aged 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001.The correlation coefficients (r for TSB and TcB measurements on the forehead were 0.897 (P<0.001. Conclusion Transcutaneous bilirubinometry can be used to accurately estimate TSB levels in neonatal jaundice, and may be useful in clinical practice as a non-invasive method to reduce blood sampling.

  1. Evidence-Based Decompression in Malignant Biliary Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Chia Sing [University of Toronto, Toronto General Hospital, Toronto (Canada); Warkentin, Andrew E [University of Toronto, 1 King& #x27; s College Circle, Toronto (Canada)

    2012-02-15

    As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.

  2. [Obstructive shock].

    Science.gov (United States)

    Pich, H; Heller, A R

    2015-05-01

    An acute obstruction of blood flow in central vessels of the systemic or pulmonary circulation causes the clinical symptoms of shock accompanied by disturbances of consciousness, centralization, oliguria, hypotension and tachycardia. In the case of an acute pulmonary embolism an intravascular occlusion results in an acute increase of the right ventricular afterload. In the case of a tension pneumothorax, an obstruction of the blood vessels supplying the heart is caused by an increase in extravascular pressure. From a hemodynamic viewpoint circulatory shock caused by obstruction is closely followed by cardiac deterioration; however, etiological and therapeutic options necessitate demarcation of cardiac from non-cardiac obstructive causes. The high dynamics of this potentially life-threatening condition is a hallmark of all types of obstructive shock. This requires an expeditious and purposeful diagnosis and a rapid and well-aimed therapy.

  3. Chronic partial urethral obstruction in female rats: description of an experimental model and initial results Obstrução parcial uretral crônica em ratos: descrição de um modelo experimental e resultados iniciais

    Directory of Open Access Journals (Sweden)

    Silvio Tucci Jr

    2011-01-01

    Full Text Available PURPOSE: To develop an experimental model of infravesical urinary obstruction in female rats. METHODS: After median caudal laparotomy, the urethra of 14 female rats was delicately separated from the vagina and loosely wrapped with cellophane tape measuring 0.4 x 1.0 cm. The animals were evaluated 4 (n=7 and 8 (n=7 weeks later. Five additional control animals were only subjected to separation of the urethra and vagina and monitored for 12 weeks. RESULTS: After four weeks, three rats presented vesical dilation associated with discrete ureteral ectasis in 2 animals, with the third presenting discrete hydronephrosis in one kidney. After eight weeks, five rats (71.4% presented vesical distension with bilateral ureterohydronephrosis. No significant changes (p>0.05 in serum urea or creatinine occurred in any group compared to preoperative values. CONCLUSION: We present here an inexpensive and simple method for the slow induction of urethral obstruction in adult female rats, with the development of progressive vesical hypertrophy and ureterohydronephrosis, which may be used as an experimental model for the study of different aspects of obstructive nephropathy.OBJETIVO: Desenvolver modelo experimental de obstrução urinária infravesical em ratas. MÉTODOS: Após laparotomia caudal mediana, as uretras de 14 ratas foram delicadamente separadas da vagina e frouxamente envoltas com fita de celofane medindo 0.4 x 1.0 cm. Os animais foram avaliados 4 (n=7 e 8 (n=7 semanas depois. Cinco animais adicionais (controle foram submetidos apenas à separação da uretra e da vagina e monitoradas por 12 semanas. RESULTADOS: Após quatro semanas, três ratas apresentaram dilatação vesical associada a discreta ectasia ureteral em 2 animais, com o terceiro apresentando discreta hidronefrose em um rim. Após oito semanas, cinco ratas (71.4% apresentaram distensão vesical com ureterohidronefrose bilateral. Não ocorreram alterações significativas (p>0.05 nos valores

  4. Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

    Directory of Open Access Journals (Sweden)

    Diana Yamel Flores-Carmona

    Full Text Available Background and objective: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. Patients and methods: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents (n = 22 and group B (uncovered self-expandable metallic stents (n = 46. Results: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521. Migration was greater with covered stents but it was not statistically significant either (p = 0.101. Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476. Conclusion: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice.

  5. Potential Contribution of Phenotypically Modulated Smooth Muscle Cells and Related Inflammation in the Development of Experimental Obstructive Pulmonary Vasculopathy in Rats

    Science.gov (United States)

    Otsuki, Shoichiro; Sawada, Hirofumi; Yodoya, Noriko; Shinohara, Tsutomu; Kato, Taichi; Ohashi, Hiroyuki; Zhang, Erquan; Imanaka-Yoshida, Kyoko; Shimpo, Hideto; Maruyama, Kazuo; Komada, Yoshihiro; Mitani, Yoshihide

    2015-01-01

    We tested the hypothesis that phenotypically modulated smooth muscle cells (SMCs) and related inflammation are associated with the progression of experimental occlusive pulmonary vascular disease (PVD). Occlusive PVD was induced by combined exposure to a vascular endothelial growth factor receptor tyrosine kinase inhibitor Sugen 5416 and hypobaric hypoxia for 3 weeks in rats, which were then returned to ambient air. Hemodynamic, morphometric, and immunohistochemical studies, as well as gene expression analyses, were performed at 3, 5, 8, and 13 weeks after the initial treatment (n = 78). Experimental animals developed pulmonary hypertension and right ventricular hypertrophy, and exhibited a progressive increase in indices of PVD, including cellular intimal thickening and intimal fibrosis. Cellular intimal lesions comprised α smooth muscle actin (α SMA)+, SM1+, SM2+/-, vimentin+ immature SMCs that were covered by endothelial monolayers, while fibrous intimal lesions typically included α SMA+, SM1+, SM2+, vimentin+/- mature SMCs. Plexiform lesions comprised α SMA+, vimentin+, SM1-, SM2- myofibroblasts covered by endothelial monolayers. Immature SMC-rich intimal and plexiform lesions were proliferative and were infiltrated by macrophages, while fibrous intimal lesions were characterized by lower proliferative abilities and were infiltrated by few macrophages. Compared with controls, the number of perivascular macrophages was already higher at 3 weeks and progressively increased during the experimental period; gene expression of pulmonary hypertension-related inflammatory molecules, including IL6, MCP1, MMP9, cathepsin-S, and RANTES, was persistently or progressively up-regulated in lungs of experimental animals. We concluded that phenotypically modulated SMCs and related inflammation are potentially associated with the progression of experimental obstructive PVD. PMID:25714834

  6. Potential contribution of phenotypically modulated smooth muscle cells and related inflammation in the development of experimental obstructive pulmonary vasculopathy in rats.

    Directory of Open Access Journals (Sweden)

    Shoichiro Otsuki

    Full Text Available We tested the hypothesis that phenotypically modulated smooth muscle cells (SMCs and related inflammation are associated with the progression of experimental occlusive pulmonary vascular disease (PVD. Occlusive PVD was induced by combined exposure to a vascular endothelial growth factor receptor tyrosine kinase inhibitor Sugen 5416 and hypobaric hypoxia for 3 weeks in rats, which were then returned to ambient air. Hemodynamic, morphometric, and immunohistochemical studies, as well as gene expression analyses, were performed at 3, 5, 8, and 13 weeks after the initial treatment (n = 78. Experimental animals developed pulmonary hypertension and right ventricular hypertrophy, and exhibited a progressive increase in indices of PVD, including cellular intimal thickening and intimal fibrosis. Cellular intimal lesions comprised α smooth muscle actin (α SMA+, SM1+, SM2+/-, vimentin+ immature SMCs that were covered by endothelial monolayers, while fibrous intimal lesions typically included α SMA+, SM1+, SM2+, vimentin+/- mature SMCs. Plexiform lesions comprised α SMA+, vimentin+, SM1-, SM2- myofibroblasts covered by endothelial monolayers. Immature SMC-rich intimal and plexiform lesions were proliferative and were infiltrated by macrophages, while fibrous intimal lesions were characterized by lower proliferative abilities and were infiltrated by few macrophages. Compared with controls, the number of perivascular macrophages was already higher at 3 weeks and progressively increased during the experimental period; gene expression of pulmonary hypertension-related inflammatory molecules, including IL6, MCP1, MMP9, cathepsin-S, and RANTES, was persistently or progressively up-regulated in lungs of experimental animals. We concluded that phenotypically modulated SMCs and related inflammation are potentially associated with the progression of experimental obstructive PVD.

  7. Newborn jaundice and kernicterus--health and societal perspectives.

    Science.gov (United States)

    Bhutani, Vinod K; Johnson, Lois H

    2003-05-01

    Kernicterus, a preventable injury to the brain from severe neonatal jaundice, has re-emerged in the United States as a public and societal health concern. Kernicterus, in its usually recognized form, causes devastating disabilities, including athetoid cerebral palsy and speech and hearing impairment. This condition not only ranks amongst the highest cost per new case (per CDCs Financial Burden of Disability study, 1992), but also results in profound and uncompromising grief for the family and loss to siblings of healthy, talkative playmates. And for the child with kernicterus (usually remarkably intelligent, but trapped in an uncontrollable body), grief and frustration are enormous. In 2001 national healthcare organizations, including Centers for Disease Control (CDC), the Joint Commission for the Accreditation of Healthcare Organizations (JACHO) and the American Academy of Pediatrics (AAP) issued alerts to all accredited hospitals and public health professionals in the United States that all healthy infants are at potential risk of kernicterus if their newborn jaundice is unmonitored and inadequately treated. The re-emergence of kernicterus in the United States is the result of interacting phenomena including (a) Early hospital discharge (before extent of jaundice is known and signs of impending brain damage have appeared); (b) Lack of adequate concern for the risks of severe jaundice in healthy term and near newborns; (c) An increase in breast feeding; (d) Medical care cost constraints; (e) Paucity of educational materials to enable parents to participate in safeguarding their newborns; and (f) Limitations within in healthcare systems to monitor the outpatient progression of jaundice. A multidisciplinary approach that encompasses both healthcare and societal needs should be evaluated at a national level for practical and easy to implement strategies. An approach that is based on principles of evidence-based medicine, patient-safety and family centeredness is

  8. The treatment of jaundice with medicinal plants in indigenous communities of the Sub-Himalayan region of Uttarakhand, India.

    Science.gov (United States)

    Sharma, Jyotsana; Gairola, Sumeet; Gaur, R D; Painuli, R M

    2012-08-30

    , external and magico-religious remedies for jaundice, respectively by various communities in different parts of India. Most widely used hepatoprotective plant species for treatment of jaundice in India is Boerhavia diffusa L. followed by Tinospora cordifolia (Willd.) Miers, Saccharum officinarum L., Phyllanthus amarus Schumach. & Thonn., Ricinus communis L., Andrographis paniculata (Burm. f.) Nees., Oroxylum indicum (L.) Kurz, Lawsonia inermis L. and Eclipta prostrata (L.) L. The plants recorded in the present survey have also been discussed in relation to pharmacological studies and hepatoprotective phytoconstituents present in them. Most of the recorded plants have shown hepatoprotective effects on experimental animals in earlier studies but more studies are needed to assess hepatoprotective properties of some recorded medicinal plants viz., Averrhoa carambola L., Ehretia laevis Roxb., Holarrhena pubescens Wall., Mangifera indica L., Ocimum americanum L., Oroxylum indicum (L.) Kurz, Physalis divaricata D. Don, Solanum incanum L., Sphaeranthus senegalensis DC. and Tribulus terrestris L.. The plants enumerated in this study with high number of citations and wider distributions have given some useful leads for further biomedical research. Nevertheless more phytochemical, pharmaceutical and clinical studies are needed to evaluate hepatoprotective properties, efficacy and safety of all the claimed medicinal plants. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Resolution pattern of jaundice among children presenting with severe malaria in rural South-West Nigeria.

    Science.gov (United States)

    Osonuga, O A; Osonuga, A; Osonuga, A A; Osonuga, I O

    2012-07-01

    To compare the pattern of jaundice resolution among children with severe malaria treated with quinine and artemether. Thirty two children who fulfilled the inclusion criteria were recruited for the study from two hospitals with intensive care facilities. They were divided into two groups; 'Q' and 'A', receiving quinine and artemether, respectively. Jaundice was assessed by clinical examination. Sixteen out of 32 children recruited (representing 50%) presented with jaundice on the day of recruitment. The mean age was (7.00°C2.56) years. On day 3, four patients in 'A' and six patients in 'Q' had jaundice. By day 7, no child had jaundice. The study has shown that both drugs resolve jaundice although artemether relatively resolves it faster by the third day.

  10. The impact of high-resolution ultrasound in the differential diagnosis of non-hemolytic jaundice.

    Science.gov (United States)

    Rauh, Peter; Neye, Holger; Mönkemüller, Klaus; Malfertheiner, Peter; Rickes, Steffen

    2010-12-01

    Because jaundice is a common reason for hospital admission. A fast and correct differential diagnosis is very important to increase treatment efficacy. The aim of our study was to evaluate the impact of the high-resolution ultrasound in this kind of clinical setting. In a prospective study we included 30 patients and we divided them in patients with extrahepatic jaundice and patients with intrahepatic jaundice. We observed a high accuracy of the high-resolution sonography, with a sensitivity of 95% and a specificity of 100% for extrahepatic jaundice, and a sensitivity of 100% and a specificity of 95% for intrahepatic jaundice. We conclude that the high-resolution ultrasound should be used in the very beginning of the diagnostic algorithm for the evaluation of patients with unclear jaundice.

  11. Cigarette smoke extract-treated mast cells promote alveolar macrophage infiltration and polarization in experimental chronic obstructive pulmonary disease.

    Science.gov (United States)

    Li, Hong; Yang, Tian; Ning, Qian; Li, Feiyan; Chen, Tianjun; Yao, Yan; Sun, Zhongmin

    2015-01-01

    Cigarette smoking is the main cause of chronic obstructive pulmonary disease (COPD) and may modulate the immune response of exposed individuals. Mast cell function can be altered by cigarette smoking, but the role of smoking in COPD remains poorly understood. The current study aimed to explore the role of cigarette smoke extract (CSE)-treated mast cells in COPD pathogenesis. Cytokine and chemokine expression as well as degranulation of bone marrow-derived mast cells (BMMCs) were detected in cells exposed to immunoglobulin E (IgE) and various doses of CSE. Adoptive transfer of CSE-treated BMMCs into C57BL/6J mice was performed, and macrophage infiltration and polarization were evaluated by fluorescence-activated cell sorting (FACS). Furthermore, a coculture system of BMMCs and macrophages was established to examine macrophage phenotype transition. The role of protease serine member S31 (Prss31) was also investigated in the co-culture system and in COPD mice. CSE exposure suppressed cytokine expression and degranulation in BMMCs, but promoted the expressions of chemokines and Prss31. Adoptive transfer of CSE-treated BMMCs induced macrophage infiltration and M2 polarization in the mouse lung. Moreover, CSE-treated BMMCs triggered macrophage M2 polarization via Prss31 secretion. Recombinant Prss31 was shown to activate interleukin (IL)-13/IL-13Rα/Signal transducers and activators of transcription (Stat) 6 signaling in macrophages. Additionally, a positive correlation was found between Prss31 expression and the number of M2 macrophages in COPD mice. In conclusion, CSE-treated mast cells may induce macrophage infiltration and M2 polarization via Prss31 expression, and potentially contribute to COPD progression.

  12. Importance of mast cell Prss31/transmembrane tryptase/tryptase-γ in lung function and experimental chronic obstructive pulmonary disease and colitis.

    Science.gov (United States)

    Hansbro, Philip M; Hamilton, Matthew J; Fricker, Michael; Gellatly, Shaan L; Jarnicki, Andrew G; Zheng, Dominick; Frei, Sandra M; Wong, G William; Hamadi, Sahar; Zhou, Saijun; Foster, Paul S; Krilis, Steven A; Stevens, Richard L

    2014-06-27

    Protease serine member S31 (Prss31)/transmembrane tryptase/tryptase-γ is a mast cell (MC)-restricted protease of unknown function that is retained on the outer leaflet of the plasma membrane when MCs are activated. We determined the nucleotide sequences of the Prss31 gene in different mouse strains and then used a Cre/loxP homologous recombination approach to create a novel Prss31(-/-) C57BL/6 mouse line. The resulting animals exhibited no obvious developmental abnormality, contained normal numbers of granulated MCs in their tissues, and did not compensate for their loss of the membrane tryptase by increasing their expression of other granule proteases. When Prss31-null MCs were activated with a calcium ionophore or by their high affinity IgE receptors, they degranulated in a pattern similar to that of WT MCs. Prss31-null mice had increased baseline airway reactivity to methacholine but markedly reduced experimental chronic obstructive pulmonary disease and colitis, thereby indicating both beneficial and adverse functional roles for the tryptase. In a cigarette smoke-induced model of chronic obstructive pulmonary disease, WT mice had more pulmonary macrophages, higher histopathology scores, and more fibrosis in their small airways than similarly treated Prss31-null mice. In a dextran sodium sulfate-induced acute colitis model, WT mice lost more weight, had higher histopathology scores, and contained more Cxcl-2 and IL-6 mRNA in their colons than similarly treated Prss31-null mice. The accumulated data raise the possibility that inhibitors of this membrane tryptase may provide additional therapeutic benefit in the treatment of humans with these MC-dependent inflammatory diseases. © 2014 by The American Society for Biochemistry and Molecular Biology, Inc.

  13. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    OpenAIRE

    Kim, Ji Hyung

    2009-01-01

    Objective To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. Materials and Methods The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was pe...

  14. [Jaundice as the first symptom of HELLP syndrome--case report].

    Science.gov (United States)

    Szubert, Sebastian; Wójcicka, Katarzyna; Gaca, Michał; Linke, Krzysztof; Sajdak, Stefan

    2012-07-01

    Jaundice is a rare symptom of the HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) and is diagnosed in only 5% of the patients with this condition. However jaundice is related with sever presentation of the disease and associated with higher mortality The aim of this paper was to present a case of 24-year-old patient with jaundice as the first symptom of severe HELLP syndrome. A review of the literature about symptoms and treatment of HELLP syndrome and differential diagnosis of jaundice in pregnancy was done as well.

  15. Role of radical resection in patients with gallbladder carcinoma and jaundice.

    Science.gov (United States)

    Feng, Fei-ling; Liu, Chen; Li, Bin; Zhang, Bai-he; Jiang, Xiao-qing

    2012-03-01

    Gallbladder carcinoma (GBC) is a commonly-seen malignancy of the biliary tract characterized by difficult early diagnosis, rapid growth, early metastasis, and poor prognosis. Nearly half of GBC patients also have jaundice, which is a mark of the advanced stage of GBC. The role of radical resection in patients of gallbladder carcinoma with jaundice is still a matter of uncertainty, which we attempted to clarify in this study. Totally, 251 GBC patients who received treatment at the Eastern Hepatobiliary Surgery Hospital (EHBH) from December 2002 to January 2010 were recruited into this study. We divided them into group A (jaundice group, n=117) and group B (non-jaundice group, n=134). Clinical records and follow-up data were collected and retrospectively analyzed in both groups. Compared with group A, patients in group B had a longer median survival time ((6.0±0.5) months vs. (15.0±2.6) months, Pjaundice (n=111), was still longer than that in patients with jaundice (n=116) (Pjaundice patients and non-jaundice patients; (12.0±4.3) months vs. (18.0±3.0) months (P>0.05). GBC with jaundice usually implies advanced stage disease and a poor prognosis for the patients. However, our findings indicate that as long as the patient's condition allows, radical resection is still feasible for GBC patients with jaundice, and may achieve a prognosis close to those GBC patients without jaundice.

  16. Applying data mining techniques to improve diagnosis in neonatal jaundice.

    Science.gov (United States)

    Ferreira, Duarte; Oliveira, Abílio; Freitas, Alberto

    2012-12-07

    Hyperbilirubinemia is emerging as an increasingly common problem in newborns due to a decreasing hospital length of stay after birth. Jaundice is the most common disease of the newborn and although being benign in most cases it can lead to severe neurological consequences if poorly evaluated. In different areas of medicine, data mining has contributed to improve the results obtained with other methodologies.Hence, the aim of this study was to improve the diagnosis of neonatal jaundice with the application of data mining techniques. This study followed the different phases of the Cross Industry Standard Process for Data Mining model as its methodology.This observational study was performed at the Obstetrics Department of a central hospital (Centro Hospitalar Tâmega e Sousa--EPE), from February to March of 2011. A total of 227 healthy newborn infants with 35 or more weeks of gestation were enrolled in the study. Over 70 variables were collected and analyzed. Also, transcutaneous bilirubin levels were measured from birth to hospital discharge with maximum time intervals of 8 hours between measurements, using a noninvasive bilirubinometer.Different attribute subsets were used to train and test classification models using algorithms included in Weka data mining software, such as decision trees (J48) and neural networks (multilayer perceptron). The accuracy results were compared with the traditional methods for prediction of hyperbilirubinemia. The application of different classification algorithms to the collected data allowed predicting subsequent hyperbilirubinemia with high accuracy. In particular, at 24 hours of life of newborns, the accuracy for the prediction of hyperbilirubinemia was 89%. The best results were obtained using the following algorithms: naive Bayes, multilayer perceptron and simple logistic. The findings of our study sustain that, new approaches, such as data mining, may support medical decision, contributing to improve diagnosis in neonatal

  17. Trans-Cutaneous Bilirubinometery versus Serum Bilirubin in Neonatal Jaundice.

    Science.gov (United States)

    Mahram, Manoochehr; Oveisi, Sonia; Jaberi, Najmeh

    2015-12-01

    Hyperbilirubinemia is a common problem in neonates and causes serious complications. Thus, serial measurements of bilirubin should be done. This assessment is done through two methods of laboratory measurement in serum sample and transcutaneous bilirubinometer. This descriptive study compared transcutaneous bilirubin assessment and laboratory serum bilirubin. Bilirubin level was assessed among 256 neonates admitted to the Qods Children's Hospital in Qazvin- Iran, because of neonatal indirect jaundice, through two methods of transcutaneous bilirubinometery from two sites of forehead and sternum and laboratory measurement of bilirubin in serum. The cases were non-hemolytic icteric term neonates weighing 2500 gram or more and had not received phototherapy or other treatments. Neonates with hemolytic forms of jaundice, sepsis and suspicious to metabolic disorders were excluded. Assessments by means of KJ-8000 transcutaneous bilirubinometer from two sites of forehead and sternum and through laboratory measurement of serum bilirubin were registered and analyzed. The results of the current study showed that there was a correlation of 0.82 between serum bilirubin and transcutaneous forehead bilirubin assessment and for the used device sensitivity of 0.844; specificity of 0.842, Youden Index of 0.709 and Shortest of 0.042 for a cut-off of 12.4 in bilirubin of participants. Furthermore, Likelihood Ratio positive and negative (LR) were 5.665 and 0.164, respectively and diagnostic Odds Ratio (LR+/LR-) was 34.56. Transcutaneous bilirubinometery can be considered as a reliable tool to assess bilirubin for the screening of neonatal jaundice in term neonates.

  18. Trans-Cutaneous Bilirubinometery versus Serum Bilirubin in Neonatal Jaundice

    Directory of Open Access Journals (Sweden)

    Manoochehr Mahram

    2015-12-01

    Full Text Available Hyperbilirubinemia is a common problem in neonates and causes serious complications. Thus, serial measurements of bilirubin should be done. This assessment is done through two methods of laboratory measurement in serum sample and transcutaneous bilirubinometer. This descriptive study compared transcutaneous bilirubin assessment and laboratory serum bilirubin. Bilirubin level was assessed among 256 neonates admitted to the Qods Children’s Hospital in Qazvin- Iran, because of neonatal indirect jaundice, through two methods of transcutaneous bilirubinometery from two sites of forehead and sternum and laboratory measurement of bilirubin in serum. The cases were non-hemolytic icteric term neonates weighing 2500 gram or more and had not received phototherapy or other treatments. Neonates with hemolytic forms of jaundice, sepsis and suspicious to metabolic disorders were excluded. Assessments by means of KJ-8000 transcutaneous bilirubinometer from two sites of forehead and sternum and through laboratory measurement of serum bilirubin were registered and analyzed. The results of the current study showed that there was a correlation of 0.82 between serum bilirubin and transcutaneous forehead bilirubin assessment and for the used device sensitivity of 0.844; specificity of 0.842, Youden Index of 0.709 and Shortest of 0.042 for a cut-off of 12.4 in bilirubin of participants. Furthermore, Likelihood Ratio positive and negative (LR were 5.665 and 0.164, respectively and diagnostic Odds Ratio (LR+/LR- was 34.56. Transcutaneous bilirubinometery can be considered as a reliable tool to assess bilirubin for the screening of neonatal jaundice in term neonates.

  19. Applying data mining techniques to improve diagnosis in neonatal jaundice

    Directory of Open Access Journals (Sweden)

    Ferreira Duarte

    2012-12-01

    Full Text Available Abstract Background Hyperbilirubinemia is emerging as an increasingly common problem in newborns due to a decreasing hospital length of stay after birth. Jaundice is the most common disease of the newborn and although being benign in most cases it can lead to severe neurological consequences if poorly evaluated. In different areas of medicine, data mining has contributed to improve the results obtained with other methodologies. Hence, the aim of this study was to improve the diagnosis of neonatal jaundice with the application of data mining techniques. Methods This study followed the different phases of the Cross Industry Standard Process for Data Mining model as its methodology. This observational study was performed at the Obstetrics Department of a central hospital (Centro Hospitalar Tâmega e Sousa – EPE, from February to March of 2011. A total of 227 healthy newborn infants with 35 or more weeks of gestation were enrolled in the study. Over 70 variables were collected and analyzed. Also, transcutaneous bilirubin levels were measured from birth to hospital discharge with maximum time intervals of 8 hours between measurements, using a noninvasive bilirubinometer. Different attribute subsets were used to train and test classification models using algorithms included in Weka data mining software, such as decision trees (J48 and neural networks (multilayer perceptron. The accuracy results were compared with the traditional methods for prediction of hyperbilirubinemia. Results The application of different classification algorithms to the collected data allowed predicting subsequent hyperbilirubinemia with high accuracy. In particular, at 24 hours of life of newborns, the accuracy for the prediction of hyperbilirubinemia was 89%. The best results were obtained using the following algorithms: naive Bayes, multilayer perceptron and simple logistic. Conclusions The findings of our study sustain that, new approaches, such as data mining, may support

  20. Cholestatic jaundice as a result of combination designer supplement ingestion.

    Science.gov (United States)

    Vilella, Antonia L; Limsuwat, Chok; Williams, Dustyn R; Seifert, Charles F

    2013-01-01

    To report a case of cholestatic jaundice as a result of combination herbal and designer supplement use. A 50-year-old Hispanic male presented to the hospital with a 1-week history of significant painless jaundice; total bilirubin on admission was 29.4 mg/dL. He reported use of both herbal (creatine and whey protein) and designer (Incredible Bulk and Spartan 45) supplements concurrently for approximately 2 months. Upon admission, all supplements were discontinued and multiple laboratory and diagnostic tests were ordered. On day 6 of his hospital admission, a liver biopsy was performed, the results of which indicated drug-induced hepa to toxicity. On day 9 he was discharged with prescriptions for ursodeoxycholic acid and hydroxyzine. Three months post hospital discharge, the patient continued to be supplement-free and bilirubin had decreased substantially. Anabolic-androgenic steroids are capable of causing hepatotoxicity, and multiple cases reported in the literature support this. A case report described hepato toxicity secondary to both creatine and whey protein consumption, and several reports have described liver damage secondary to designer supplement use. To our knowledge, this is the first case to describe hepatotoxicity as a result of combination herbal and designer supplement use. The Roussel Uclaf Causality Assess ment Method (RUCAM) score for drug-induced hepatotoxicity indicated a highly probable correlation between the use of combination supplements and cholestatic jaundice. Health care professionals need to be aware of complications associated with designer supplement use and should be able to identify patients who would benefit from education on herbal and designer supplement use.

  1. [IgG4-related disease: a possible cause of obstructive jaundice].

    Science.gov (United States)

    Moreillon, M; Yan, P; Buss, G; Bart, P-A

    2015-04-08

    Immunoglobulin G4 related disease (IgG4-RD) has been recognized since early 2000s as an entity comprising a set of inflammatory diseases with common histopathological features. The disease may affect almost all organs and tissues, and often occurs in a subacute fashion in males over 50 years as a mass or diffuse enlargement of affected organs. The histopathological appearance is characterized by a lymphoplasmacytic infiltration with predominantly IgG4-positive plasma cells and progressive fibrosis. Its clinical and radiological features can make the distinction with a malignancy difficult. The disease responds well to systemic glucocorticoids however with a high rate of recurrence after treatment discontinuation.

  2. Endoscopically inserted biliary endoprosthesis in malignant obstructive jaundice. A survey of the literature

    DEFF Research Database (Denmark)

    Naggar, E; Krag, E; Matzen, Peter

    1990-01-01

    published more than once. These eight studies refer to data on 856 patients, of whom 702 are from four open series, whereas 154 are from four randomized trials comparing endoscopic insertion of endoprosthesis to percutaneous stents or surgical by-pass. Endoscopic insertion was successful in about 90......% of the patients. Stent diameters were 7-12 French. Patient survival was not affected as it is governed by the natural history of the underlying malignant disease. Endoscopic endoprosthesis was superior to percutaneous stenting and equal to surgical by-pass, but probably less resource consuming. The most important...

  3. Endoscopically inserted biliary endoprosthesis in malignant obstructive jaundice. A survey of the literature

    DEFF Research Database (Denmark)

    Naggar, E; Krag, E; Matzen, Peter

    1990-01-01

    % of the patients. Stent diameters were 7-12 French. Patient survival was not affected as it is governed by the natural history of the underlying malignant disease. Endoscopic endoprosthesis was superior to percutaneous stenting and equal to surgical by-pass, but probably less resource consuming. The most important...

  4. A late unusual complication after an open cholecystectomy: Amputation neuroma of the CBD causing obstructive jaundice

    OpenAIRE

    Youssef A. Sleiman; Hassoun, Ziad A.; Nasser, Haydar A.; Abs, Leila; Allouch, Mustafa

    2017-01-01

    Highlights ? Amputation Neuromas are benign lesions of the CBD that occur months to years following surgery. ? Almost all patients with amputation have had a history of open cholecystectomy. ? Surgery is the best treatment option for amputation neuroma of the CBD.

  5. Bile acids modulate glucocorticoid metabolism and the hypothalamic-pituitary-adrenal axis in obstructive jaundice

    DEFF Research Database (Denmark)

    McNeilly, Alison D; Macfarlane, David P; O'Flaherty, Emmett

    2010-01-01

    Suppression of the hypothalamic-pituitary-adrenal axis occurs in cirrhosis and cholestasis and is associated with increased concentrations of bile acids. We investigated whether this was mediated through bile acids acting to impair steroid clearance by inhibiting glucocorticoid metabolism by 5bet...

  6. Reversal of Jaundice in Two Patients with Inoperable Cholangiocarcinoma Treated with Cisplatin and Gemcitabine Combination

    Directory of Open Access Journals (Sweden)

    Maarten Criel

    2012-01-01

    Full Text Available Two patients are presented with severe jaundice, due to inoperable cholangiocarcinoma. The chemotherapeutic approach in patients with severe jaundice is discussed. Many schedules of chemotherapy were developed in this tumor type with normal serum bilirubin. We report here the first successful use of cisplatin and gemcitabine combination chemotherapy in these patients. Tolerability was good and liver function tests gradually improved.

  7. Neonatal jaundice and stool production in breast- or formula-fed term infants

    NARCIS (Netherlands)

    Buiter, Hannah D.; Dijkstra, Sebastiaan S. P.; Elferink, Rob F. M. Oude; Bijster, Peter; Woltil, Henk A.; Verkade, Henkjan J.

    It has remained unclear whether the amount of fecal fat excreted in the stool and stool production influences the severity of neonatal jaundice. We determined the relationship between stool production, fecal fat excretion and jaundice in healthy breast-fed (BF) or formula-fed (FF) (near-)term

  8. The influence of piroxicam, a non-selective cyclooxygenase inhibitor, on autonomic nervous system activity in experimental cyclophosphamide-induced hemorrhagic cystitis and bladder outlet obstruction in rats.

    Science.gov (United States)

    Dobrek, Łukasz; Baranowska, Agnieszka; Skowron, Beata; Thor, Piotr J

    2014-01-01

    Signs and symptoms of secondary overactive bladder (OAB) are observed both in course of infravesical obstruction of urine outflow in patients with benign prostatic hyperplasia, and as a result of development of hemorrhagic cystitis (HC) following administration of cyclophosphamide (CP). Non-steroidal antiinflammatory drugs (NSAIDs) alleviate symptoms of bladder overactivity reducing local synthesis of prostaglandins (PGs), but precise effects of those agents on functions of the autonomic nervous system (ANS) in course of OAB remain unknown. The purpose of this study was to evaluate the effect of piroxicam-induced prostaglandins (PGs) synthesis block on activity of the ANS in two experimental models of secondary OAB: bladder outlet obstruction (BOO) and cyclophosphamide-induced HC (CP-HC), by heart rate variability analysis (HRV). The experiment was performed on a group of rats with surgically induced 2-week BOO, and on a group of rats that were administered CP five times, with corresponding control groups. Study animals were given piroxicam (PRX) i.p. in two doses: 2 and 10 mg/kg b.w. In the BOO model, PRX in both doses revealed a trend for reduction of value of all non-normalized components of HRV. The lower PRX dose caused an increased nHF value, and PRX administered in the dose of 10 mg/kg b.w. caused an increase of the nLF value. In the CP-HC model, the lower PRX dose caused a trend for an increase of values of all non-normalized components, and the higher dose--for their decrease. Both doses of PRX in that model caused increase of the nLF value. Inhibition of PGs synthesis caused changes of ANS function in both models of OAB. Both in BOO and in CP-HC, PGs seem to be ANS-activating factors, responsible for maintenance of a high parasympathetic activity. In both models, inhibition of PGs synthesis with PRX administered at the dose of 10 mg/kg b.w. lead to functional reconstruction of ANS, with marked sympathetic predominance. That may contribute to reduction of

  9. Transcutaneous bilirubinometry as a screening tool for neonatal jaundice.

    Science.gov (United States)

    Suckling, R J; Laing, I A; Kirk, J M

    1995-02-01

    Between 25 and 50% of all term newborns develop clinical jaundice, and a serum bilirubin level above 260 microml/l (15 mg/dl) is found in 3% of normal term infants. In the United Kingdom many newborn infants with clinical jaundice have blood samples sent to biochemistry laboratories for assessment of the plasma bilirubin concentration. We planned to assess the cost in terms of finance, medical staff time, numbers of blood samples, and family delay in leaving hospital. We demonstrated that reflectance bilirubinometry is a reliable screening method for identifying which caucasian infants require to have plasma bilirubin concentrations measured in the laboratory. The Minolta Airshields transcutaneous bilirubinometer provided reproducible data, saved time and costs, and often spared infants a capillary or venous blood sample. The transcutaneous bilirubinometer provides a digital assessment of skin pigmentation by xenon reflectance. It has previously been shown to be possible to derive an estimate of plasma bilirubin from the number displayed by the meter and it is suggested as a method for identifying which infants need plasma bilirubin estimations.

  10. Physicians' diagnoses compared with algorithmic differentiation of causes of jaundice.

    Science.gov (United States)

    Boom, R; Chavez-Oest, J; Gonzalez, C; Cantu, M A; Rivero, F; Reyes, A; Aguilar, E; Santamaria, J

    1988-01-01

    Clinical data were collected in 194 cases of jaundiced patients treated at the "Adolfo Lopez Mateos" ISSSTE Hospital in Mexico City from July 1985 to July 1986. A copy of the clinical history of each patient was given to each of four physicians--one recently graduated from medical school, another in his first year of gastroenterology, and two others who were experienced gastroenterologists. The same clinical data were processed by a computer set up to use a modified Danish COMIC algorithm. All physicians and the computer technician were blinded to the "gold standard" pathologic diagnoses, with which their diagnoses were compared. Accuracy rates of the physicians in distinguishing intrahepatic (medical) from extrahepatic (surgical) jaundice were 78%, 86%, 86%, and 91%, and the accuracy of computer-assisted diagnoses was 96%. Chi-squared analysis of the diagnoses of three of the physicians and those of the computer showed significant differences (p between 0.1 and 0.01). For the diagnoses of the remaining physician, however, no significant difference was found after chi-squared continuity correction.

  11. Bioinformatics analysis on molecular mechanism of rheum officinale in treatment of jaundice

    Science.gov (United States)

    Shan, Si; Tu, Jun; Nie, Peng; Yan, Xiaojun

    2017-01-01

    Objective: To study the molecular mechanism of Rheum officinale in the treatment of Jaundice by building molecular networks and comparing canonical pathways. Methods: Target proteins of Rheum officinale and related genes of Jaundice were searched from Pubchem and Gene databases online respectively. Molecular networks and canonical pathways comparison analyses were performed by Ingenuity Pathway Analysis (IPA). Results: The molecular networks of Rheum officinale and Jaundice were complex and multifunctional. The 40 target proteins of Rheum officinale and 33 Homo sapiens genes of Jaundice were found in databases. There were 19 common pathways both related networks. Rheum officinale could regulate endothelial differentiation, Interleukin-1B (IL-1B) and Tumor Necrosis Factor (TNF) in these pathways. Conclusions: Rheum officinale treat Jaundice by regulating many effective nodes of Apoptotic pathway and cellular immunity related pathways.

  12. Portal Hypertensive Biliopathy: An Infrequent Cause of Biliary Obstruction.

    Science.gov (United States)

    Cardoso, Ricardo; Casela, Adriano; Lopes, Sandra; Agostinho, Cláudia; Souto, Paulo; Camacho, Ernestina; Almeida, Nuno; Mendes, Sofia; Gomes, Dário; Sofia, Carlos

    2015-01-01

    Biliary obstruction is usually caused by choledocholithiasis. However, in some circumstances, alternative or concurring unusual ethiologies such as portal hypertensive biliopathy (PHB) must be considered. We present the case of a 36-year-old female complaining of jaundice and pruritus. Liver function tests were compatible with biliary obstruction and the ultrasound scan of the abdomen showed dilatation of the intrahepatic biliary ducts, a dilated common bile duct (CBD) and biliary calculi. The computed tomography of the abdomen revealed a portal cavernoma encasing the CBD. Portal cavernoma, the hallmark of extrahepatic portal venous obstruction, can cause PHB. When symptomatic, chronic cholestasis is present if a dominant stricture exists whereas biliary pain and acute cholangitis occur when choledocholithiasis prevails. Management must be individualized and usually includes endoscopic therapy to address choledocholithiasis and shunt surgery for definitive treatment.

  13. [Application of Bayes Probability Model in Differentiation of Yin and Yang Jaundice Syndromes in Neonates].

    Science.gov (United States)

    Mu, Chun-sun; Zhang, Ping; Kong, Chun-yan; Li, Yang-ning

    2015-09-01

    To study the application of Bayes probability model in differentiating yin and yang jaundice syndromes in neonates. Totally 107 jaundice neonates who admitted to hospital within 10 days after birth were assigned to two groups according to syndrome differentiation, 68 in the yang jaundice syndrome group and 39 in the yin jaundice syndrome group. Data collected for neonates were factors related to jaundice before, during and after birth. Blood routines, liver and renal functions, and myocardial enzymes were tested on the admission day or the next day. Logistic regression model and Bayes discriminating analysis were used to screen factors important for yin and yang jaundice syndrome differentiation. Finally, Bayes probability model for yin and yang jaundice syndromes was established and assessed. Factors important for yin and yang jaundice syndrome differentiation screened by Logistic regression model and Bayes discriminating analysis included mothers' age, mother with gestational diabetes mellitus (GDM), gestational age, asphyxia, or ABO hemolytic diseases, red blood cell distribution width (RDW-SD), platelet-large cell ratio (P-LCR), serum direct bilirubin (DBIL), alkaline phosphatase (ALP), cholinesterase (CHE). Bayes discriminating analysis was performed by SPSS to obtain Bayes discriminant function coefficient. Bayes discriminant function was established according to discriminant function coefficients. Yang jaundice syndrome: y1= -21. 701 +2. 589 x mother's age + 1. 037 x GDM-17. 175 x asphyxia + 13. 876 x gestational age + 6. 303 x ABO hemolytic disease + 2.116 x RDW-SD + 0. 831 x DBIL + 0. 012 x ALP + 1. 697 x LCR + 0. 001 x CHE; Yin jaundice syndrome: y2= -33. 511 + 2.991 x mother's age + 3.960 x GDM-12. 877 x asphyxia + 11. 848 x gestational age + 1. 820 x ABO hemolytic disease +2. 231 x RDW-SD +0. 999 x DBIL +0. 023 x ALP +1. 916 x LCR +0. 002 x CHE. Bayes discriminant function was hypothesis tested and got Wilks' λ =0. 393 (P =0. 000). So Bayes

  14. [High incidence of jaundice in young calves in Southern Germany].

    Science.gov (United States)

    Metzner, M; Wieland, M; Rademacher, G; Weber, B K; Hafner-Marx, A; Langenmayer, M C; Ammer, H; Klee, W

    2012-10-17

    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. 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. 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. The results of the epidemiological survey and the feeding trial suggest a causal involvement of a dietary supplement feed. The toxic principle is unknown. Knowledge of the clinical picture and the probable feed-related context is important to detect this

  15. Advances in the radiology of jaundice: a symposium and review

    Energy Technology Data Exchange (ETDEWEB)

    Ferrucci, J.T. Jr.; Mueller, P.R. (Massachusetts General Hospital, Boston); Adson, M.A.; Stanley, R.J.; Stewart, E.T.

    1983-07-01

    New radiologic imaging and interventional techniques have transformed the clinical management of biliary obstruction. Selected aspects of their application were reviewed in a symposium conducted at the 12th annual meeting of the Society of Gastrointestinal Radiologists held recently at Banff, Alberta, Canada. There is a consensus that sonography is the preferred initial screening procedure for bile duct dilatation because of its accuracy and sensitivity although computed tomograph more precisely displays the level and cause of obstruction. Transhepatic drainage provides effective decompression for malignant obstruction, but the high rate of postprocedure catheter dysfunction suggests that an indwelling endoprosthesis may be more suitable for short-term palliation. Endoscopic papillotomy has proven to be successful nonoperative therapy for choledocholithiasis and also permits retrograde placement of transpapillary stents. Communication and collaboration among the radiologist, endoscopist, and biliary surgeon are essential if these new methods are to be applied optimally to the various clinical problems encountered with bile duct obstruction.

  16. Neonatal jaundice and its management: Knowledge, attitude, and ...

    African Journals Online (AJOL)

    2012-07-24

    Multiple responses; *Others include Intestinal Obstruction and maternal. Diabetes Mellitus. Table 3: Respondents' knowledge of the complications of neonatal .... Malaysia with 189 (100%) of the respondents, 225 (88.2%).

  17. Jaundice as a prognostic factor in patients undergoing radical treatment for carcinomas of the ampulla of Vater.

    Science.gov (United States)

    Zhou, Jianguo; Zhang, Qian; Li, Peng; Shan, Yi; Zhao, Dongbing; Cai, Jianqiang

    2014-01-01

    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. 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). 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.

  18. Evaluation of the use of laparoscopic-guided cholecystocholangiography and liver biopsy in definitive diagnosis of neonatal cholestatic jaundice

    Directory of Open Access Journals (Sweden)

    Khalid Shreef

    2016-01-01

    Full Text Available Background: Once it is established that a jaundiced infant has direct hyperbilirubinemia, the principal diagnostic concern is to differentiate hepatocellular from obstructive cholestasis. Traditional tests such as ultrasonography, percutaneous liver biopsy and technetium 99 m hepatobiliary iminodiacetic acid (HIDA scan are often not sufficiently discriminating. Definitive exclusion of biliary atresia (BA in the infant with cholestatic jaundice usually requires mini-laparotomy and intra-operative cholangiography. This approach has many drawbacks because those sick infants are subjected to a time-consuming procedure with the probability of negative surgical exploration. Aim of the Study: The aim of this study was to determine the feasibility of laparoscopic-guided cholecystocholangiography (LGCC and its accuracy and safety in the diagnosis of BA and thus preventing unnecessary laparotomy in infants whose cholestasis is caused by diseases other than BA. Patients and Methods: Twelve cholestatic infants with direct hyperbilirubinemia subjected to LGCC (age, 7–98 days; mean, 56 days after ultrasound scan and (99 mTc HIDA scan and percutaneous liver biopsy failed to provide the definitive diagnosis. Results: One patient had completely absent gall bladder (GB so the laparoscopic procedure was terminated and laparotomy was done (Kasai operation. Four patients had small size GB; they underwent LGCC that showed patent common bile duct with atresia of common hepatic duct, so laparotomy and Kasai operation was performed. Seven patients had well-developed GB, LGCC revealed patent biliary tree, so laparoscopic liver biopsies were taken for histopathology. Five of those patients had neonatal hepatitis, and two had cholestasis as a complication of prolonged TPN. No perioperative complications or mortalities were recorded. Conclusion: When the diagnosis neonatal cholestasis remains elusive after traditional investigations, LGCC is an accurate and simple method

  19. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Delden, Otto M. van; Lameris, Johan S. [Academic Medical Center of the University of Amsterdam, Department of Radiology, Amsterdam (Netherlands)

    2008-03-15

    Percutaneous biliary drainage and stenting (PTBD) for palliation of malignant obstructive jaundice has evolved to a safe and effective technique. PTBD is equally effective for treatment of distal and proximal bile obstruction. Metal self-expandable stents have proved superior to plastic stents and should therefore be used. Technical success is >90% en clinical success is >75% in all major series. There are a considerable number of complications, but most can be treated conservatively and procedure-related mortality is <2% in most series. Thirty-day mortality after PTBD is >10% in many series, but this is largely due to the underlying disease. About 10-30% of patients will have recurrent jaundice at some point in their disease after PTBD and require re-intervention. (orig.)

  20. [Neonatal jaundice: Clinical evaluation of a transcutaneous bilirubinometer].

    Science.gov (United States)

    Marco Lozano, N; Vizcaíno Díaz, C; Quiles Durá, J L; Alós Muñoz, A; Vargas Torcal, F

    2009-08-01

    Transcutaneous bilirubinometers provide non-invasive data on newborn jaundice. The aim of this study is to evaluate whether the measurement of transcutaneous bilirubin can be correlated with serum bilirubin, and to find out whether gestational age, weight birth, race or hours of life affect those measurements. Descriptive observational cross-sectional study on a sample of 65 simultaneous measurement of transcutaneous (TcB) and serum bilirubin (TSB). The correlation coefficient between both methods was 0.923. Race, gestational age and birth weight tends to not have any effects on the levels of transcutaneous bilirubin. Although bilirubinometer measurements tend to underestimate serum bilirubin, especially in patients with high levels, it is a useful technique as a screening tool in the evaluation of hyperbilirubinaemia.

  1. Jaundice in primary care: a cohort study of adults aged >45 years using electronic medical records.

    Science.gov (United States)

    Taylor, Anna; Stapley, Sally; Hamilton, William

    2012-08-01

    Jaundice is a rare but important symptom of malignant and benign conditions. When patients present in primary care, understanding the relative likelihood of different disease processes can help GPs to investigate and refer patients appropriately. To identify and quantify the various causes of jaundice in adults presenting in primary care. Historical cohort study using electronic primary care records. UK General Practice Research Database. Participants (186 814 men and women) aged >45 years with clinical events recorded in primary care records between 1 January 2005 and 31 December 2007. Data were searched for episodes of jaundice and explanatory diagnoses identified within the subsequent 12 months. If no diagnosis was found, the patient's preceding medical record was searched for relevant chronic diseases. From the full cohort, 277 patients had at least one record of jaundice between 1 January 2005 and 31 December 2006. Ninety-two (33%) were found to have bile duct stones; 74 (27%) had an explanatory cancer [pancreatic cancer 34 (12%), cholangiocarcinoma 13 (5%) and other diagnosed primary malignancy 27 (10%)]. Liver disease attributed to excess alcohol explained 26 (9%) and other diagnoses were identified in 24 (9%). Sixty-one (22%) had no diagnosis related to jaundice recorded. Although the most common cause of jaundice is bile duct stones, cancers are present in over a quarter of patients with jaundice in this study, demonstrating the importance of urgent investigation into the underlying cause.

  2. Probiotics Supplementation Therapy for Pathological Neonatal Jaundice: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Chen, Zhe; Zhang, Lingli; Zeng, Linan; Yang, Xiaoyan; Jiang, Lucan; Gui, Ge; Zhang, Zuojie

    2017-01-01

    Background: Neonatal jaundice is a relatively prevalent disease and affects approximately 2.4–15% newborns. Probiotics supplementation therapy could assist to improve the recovery of neonatal jaundice, through enhancing immunity mainly by regulating bacterial colonies. However, there is limited evidence regarding the effect of probiotics on bilirubin level in neonates. Therefore, this study aims at systematically evaluating the efficacy and safety of probiotics supplement therapy for pathological neonatal jaundice. Methods: Databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database (Wan Fang), Chinese Biomedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP) were searched and the deadline is December 2016. Randomized controlled trials (RCTs) of probiotics supplementation for pathological neonatal jaundice in publications were extracted by two reviewers. The cochrane tool was applied to assessing the risk of bias of the trials. The extracted information of RCTs should include efficacy rate, serum total bilirubin level, time of jaundice fading, duration of phototherapy, duration of hospitalization, adverse reactions. The main outcomes of the trials were analyzed by Review Manager 5.3 software. The relative risks (RR) or mean difference (MD) with a 95% confidence interval (CI) was used to measure the effect. Results: 13 RCTs involving 1067 neonatal with jaundice were included in the meta-analysis. Probiotics supplementation treatment showed efficacy [RR: 1.19, 95% CI (1.12, 1.26), P jaundice. It not only decreased the total serum bilirubin level after 3day [MD: −18.05, 95% CI (−25.51, −10.58), P jaundice fading [MD: −1.91, 95% CI (−2.06, −1.75), P jaundice. PMID:28713275

  3. Serological evidence of hepatitis E virus infection in pigs and jaundice among pig handlers in Bangladesh

    DEFF Research Database (Denmark)

    Haider, Najmul; Khan, M. S. U.; Hossain, M. B.

    2017-01-01

    the history of jaundice between pig handlers and people not exposed to pigs and pork. Blood and faecal samples were col-lected from 100 pigs derived from three slaughterhouses in the Gazipur district of Bangladesh from January to June, 2011. We also interviewed 200 pig handlers and 250 non- exposed people who...... with jaundice in the past 2 years. Pigs in Bangladesh demonstrated evidence of HEV infec-tion, and a history of jaundice was significantly more frequent in pig handlers. Identifying and genotyping HEV in pigs and pig handlers may provide further evidence of the pig’s role in zoonotic HEV transmission...... in Bangladesh....

  4. Obstructed uterus

    Energy Technology Data Exchange (ETDEWEB)

    Scott, W.W.; Rosenshein, N.B.; Siegelman, S.S.; Sanders, R.C.

    1981-12-01

    Eleven patients with an obstructed, fluid-filled uterus, due to carcinoma of the uterus or to its treatment by radiation therapy, were examined with computed tomography (CT) and/or ultrasound. It is important to recognize this abnormality to differentiate it from other causes of pelvic mass and to ensure prompt treatment of pyometra, should it develop. Both CT and ultrasound reliably identified this condition and differentiated it from other pelvic masses.

  5. Lipid peroxidation and antioxidant enzymes activity in Plasmodium vivax malaria patients evolving with cholestatic jaundice

    Science.gov (United States)

    2013-01-01

    Background Plasmodium vivax infection has been considered a benign and self-limiting disease, however, recent studies highlight the association between vivax malaria and life-threatening manifestations. Increase in reactive oxygen species has already been described in vivax malaria, as a result of the increased metabolic rate triggered by the multiplying parasite, and large quantities of toxic redox-active byproducts generated. The present study aimed to study the oxidative stress responses in patients infected with P. vivax, who developed jaundice (hyperbilirubinaemia) in the course of the disease, a common clinical complication related to this species. Methods An evaluation of the lipid peroxidation and antioxidant enzymes profile was performed in 28 healthy individuals and compared with P. vivax infected patients with jaundice, i.e., bilirubin jaundice (34 patients), on day 1 (D1) and day 14 (D14) after anti-malarial therapy. Results Hyperbilirubinaemia was more frequent among women and patients experiencing their first malarial infection, and lower haemoglobin and higher lactate dehydrogenase levels were observed in this group. Malondialdehyde levels and activity of celuroplasmin and glutathione reductase were increased in the plasma from patients with P. vivax with jaundice compared to the control group on D1. However, the activity of thioredoxin reductase was decreased. The enzymes glutathione reductase, thioredoxin reductase, thiols and malondialdehyde also differed between jaundiced versus non-jaundiced patients. On D14 jaundice and parasitaemia had resolved and oxidative stress biomarkers were very similar to the control group. Conclusion Cholestatic hyperbilirubinaemia in vivax malaria cannot be totally disassociated from malaria-related haemolysis. However, significant increase of lipid peroxidation markers and changes in antioxidant enzymes in patients with P. vivax-related jaundice was observed. These results suggest oxidative processes contributing

  6. Immunizations, neonatal jaundice, and animal-induced injuries.

    Science.gov (United States)

    Morris, Shaine A; Bernstein, Henry H

    2004-08-01

    Published studies during the past year about three topics important to the pediatric clinician-- immunizations, neonatal jaundice, and animal-induced injuries-are concisely reviewed. Recent updates regarding vaccines including the questionable link with autism, implementation of universal influenza vaccination for young children, the efficacy of pneumococcal vaccine against invasive disease, and new information on pertussis, varicella, hepatitis A, hepatitis B, measles, and rotavirus vaccination are discussed. No association between measles/mumps/rubella vaccine or thimerosal-containing pertussis vaccine and autism is evident. Universal influenza vaccination for children 6 to 23 months of age will be recommended for the 2004-2005 flu season, and this implementation should reduce significant school absenteeism as well as complications seen last year including encephalopathy, seizures, respiratory failure, and pneumonia. Pneumococcal vaccine significantly reduces rates of invasive pneumococcal vaccine in healthy and HIV-infected children, although it does not appear to greatly affect otitis media rates. A reduction in post-vaccine febrile seizures appears to be present since the introduction of acellular pertussis vaccine. Multiple outbreaks in varicella have been reported since the introduction of the varicella vaccine, and a booster vaccination may be necessary in the future. Methods for detecting and preventing severe neonatal hyperbilirubinemia are reviewed, as well as anticipated recommendations from the American Academy of Pediatrics for the detection and management of hyperbilirubinemia. High bilirubin levels in preterm infants may result in hearing dysfunction and developmental impairment. The American Academy of Pediatrics has recommended a higher level of monitoring for newborn jaundice and treatment of hyperbilirubinemia in an effort to prevent kernicterus and sequelae from elevated bilirubin levels, including post-discharge follow-up appointment by day 3

  7. Portal Vein Stenting for Portal Biliopathy with Jaundice.

    Science.gov (United States)

    Hyun, Dongho; Park, Kwang Bo; Lim, Seong Joo; Hwang, Jin Ho; Sinn, Dong Hyun

    2016-04-01

    Portal biliopathy refers to obstruction of the bile duct by dilated peri- or para-ductal collateral channels following the main portal vein occlusion from various causes. Surgical shunt operation or endoscopic treatment has been reported. Herein, we report a case of portal biliopathy that was successfully treated by interventional portal vein recanalization.

  8. Portal Vein Stenting for Portal Biliopathy with Jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Dongho, E-mail: mesentery@naver.com; Park, Kwang Bo, E-mail: kbjh.park@samsung.com [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center (Korea, Republic of); Lim, Seong Joo [Konyang University, Department of Radiology, College of Medicine, Konyang University Hospital (Korea, Republic of); Hwang, Jin Ho [Hallym University Sacred Heart Hospital, Department of Radiology (Korea, Republic of); Sinn, Dong Hyun [Sungkyunkwan University School of Medicine, Department of Medicine, Samsung Medical Center (Korea, Republic of)

    2016-04-15

    Portal biliopathy refers to obstruction of the bile duct by dilated peri- or para-ductal collateral channels following the main portal vein occlusion from various causes. Surgical shunt operation or endoscopic treatment has been reported. Herein, we report a case of portal biliopathy that was successfully treated by interventional portal vein recanalization.

  9. Pancreatic Calculus Causing Biliary Obstruction: Endoscopic Therapy for a Rare Initial Presentation of Chronic Pancreatitis.

    Science.gov (United States)

    Shetty, Anurag J; Pai, C Ganesh; Shetty, Shiran; Balaraju, Girisha

    2015-09-01

    Biliary obstruction in chronic calcific pancreatitis (CCP) is often caused by inflammatory or fibrotic strictures of the bile duct, carcinoma of head of pancreas or less commonly by compression from pseudocysts. Pancreatic calculi causing ampullary obstruction and leading to obstructive jaundice is extremely rare. The medical records of all patients with CCP or biliary obstruction who underwent endoscopic retrograde cholangiopancreatography (ERCP) over 4 years between 2010-2014 at Kasturba Medical College, Manipal were analyzed. Five patients of CCP with impacted pancreatic calculi at the ampulla demonstrated during ERCP were identified. All 5 presented with biliary obstruction and were incidentally detected to have CCP when evaluated for the same; 3 patients had features of cholangitis. All the patients were managed successfully by endoscopic papillotomy and extraction of pancreatic calculi from the ampulla with resolution of biliary obstruction. Pancreatic calculus causing ampullary obstruction, though very rare, should be considered as a possibility in patients with CCP complicated by biliary obstruction. Endoscopic therapy is affective in the resolution of biliary obstruction in such patients.

  10. Transcutaneous bilirubinometer in assessment of neonatal jaundice in northern India.

    Science.gov (United States)

    Mahajan, Gagan; Kaushal, R K; Sankhyan, Naveen; Sharma, R L; Nakra, Monica

    2005-01-01

    This study was undertaken from April 2002 to March 2003 to find out the correlation of transcutaneous bilirubinometer index with serum bilirubin levels in term, pre-term, small for gestation age babies, with and without phototherapy in neonates with jaundice. Another aim was to evaluate the transcutaneous bilirubinometer as a screening device for neonatal hyperbilirubinemia by finding the action levels for TcBI at forehead and sternum at which sample for serum bilirubin estimation should be taken. A total of 104 neonates were evaluated. Mean (SD) age (hours), birth weight (grams) and gestational age (weeks) were 100.4 (37.90), 2264.9 (634.4) and 36.8 (2.9) respectively. Mean serum bilirubin was 16.6 (6) mg/dL. Overall a correlation coefficient of 0.878 at forehead and 0.859 at sternum was observed. On excluding infants receiving phototherapy coefficients of 0.900 at forehead and 0.908 at sternum were noted. Correlation coefficient over forehead and sternum was found to drop from 0.85 to as low as 0.33 with duration of phototherapy exceeding 48 hrs. Lastly the determined action levels had a sensitivity of 77.8 to 100 % in assessing the need for serum bilirubin estimation in various groups.

  11. Painless Jaundice Caused by Clonorchis sinensis Infection: A Case Report.

    Science.gov (United States)

    Hao, Yuhua; Bao, Wanguo; Jin, Meishan; Li, Yuxiang; Wang, Feng

    2016-06-01

    A man with only yellowing of the skin and eye sclera was diagnosed with clonorchiasis, which rarely manifested jaundice as the initial symptom. However, because of a lack of evidence for a diagnostic gold standard, the time until definitive diagnosis was more than a week. The diagnostic process relied on inquiring about the patient's history, including the place of residence, dietary habits, and symptoms, as well as on serological findings, an imaging examination, and pathological findings. MRCP and CT results showed mild dilatation of intrahepatic ducts and increased periductal echogenicity. The eggs were ultimately found in stool by water sedimentation method after the negative report through direct smear. DNA sequencing of PCR production of the eggs demonstrated 98-100% homology with ITS2 of Clonorchis sinensis. After anti-parasite medical treatment, the patient's symptoms were gradually relieved. Throughout the diagnostic procedure, besides routine examinations, the sedimentation method or concentration method could be used as a sensitive way for both light and heavy C. sinensis infection in the definite diagnosis.

  12. Clinical features and risk factors of acute hepatitis E with severe jaundice.

    Science.gov (United States)

    Xu, Bin; Yu, Hai-Bin; Hui, Wei; He, Jia-Li; Wei, Lin-Lin; Wang, Zheng; Guo, Xin-Hui

    2012-12-28

    To compares the clinical features of patients infected with hepatitis E virus (HEV) with or without severe jaundice. In addition, the risk factors for HEV infection with severe jaundice were investigated. We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group. Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum. We used χ(2) analysis, Fisher's exact test, and Student's t test where appropriate in this study. Significant predictors in the univariate analysis were then included in a forward, stepwise multiple logistic regression model. No significant differences in symptoms, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or hepatitis B virus surface antigen between the two groups were observed. HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase (GGT) (median: 170.31 U/L vs 237.96 U/L, P = 0.007), significantly lower ALB levels (33.84 g/L vs 36.89 g/L, P = 0.000), significantly lower acetylcholine esterase (CHE) levels (4500.93 U/L vs 5815.28 U/L, P = 0.000) and significantly higher total bile acid (TBA) levels (275.56 μmol/L vs 147.03 μmol/L, P = 0.000) than those without severe jaundice. The median of the lowest point time tended to be lower in patients with severe jaundice (81.64% vs 96.12%, P = 0.000). HEV infected patients with severe jaundice had a significantly higher viral load (median: 134 vs 112, P = 0.025) than those without severe jaundice. HEV infected patients with severe jaundice showed a trend toward longer median hospital stay (38.17 d vs 18.36 d, P = 0.073). Multivariate logistic regression indicated that there were significant differences in age, sex, viral load, GGT, albumin, TBA, CHE, prothrombin index, alcohol

  13. Maternal factors in newborns breast feeding jaundice: a case control study

    Directory of Open Access Journals (Sweden)

    Alizadeh Taheri P

    2013-03-01

    Full Text Available Background: Neonatal jaundice, especially breast feeding jaundice is one of the most common causes of neonatal readmission during the first month of life. Breast feeding jaundice may be due to decreased milk intake with dehydration and/or reduced caloric intake.  The aim of this Study was to determine maternal risk factors of breast feeding jaundice in order to prevent it than before.Methods: This case- control study was performed at Bahrami University Hospital, Tehran, Iran and involved 75 term exclusively breast fed newborns admitted for hyperbilirubinemia, with a weight loss greater than 7%, with one positive lab data as: serum Na≥ 150meq/lit, urine specific gravity> 1012, serum urea≥ 40mgr/dl, without assigned cause for hyperbilirubinemia. They were compared with 75 matched controls with weight loss less than 7%, without dehydration and a known cause of hyperbilirubinemia.Results: In comparison with control group, in neonates with breast feeding jaundice, inappropriate feeding practice (P<0.033, delayed onset of lactation (P<0.0001, inverted nipple (P<0.001 were significantly higher. In our study, there was no significant difference between two groups in education level of mother, learning breast feeding practice before and after delivery, method of delivery (cesarean or vaginal delivery, primiparity or multiparity and use of supplements (water or glucose water.Conclusion: This study shows need for special attention and follows up of mothers and neonates at risk for breast feeding jaundice, especially those with inverted nipples or undergraduate for successful breast feeding. On the other hand this study shows encouraging mothers for early lactation especially in the first hour of life decreases the risk for this kind of jaundice.

  14. Parental infant jaundice colour card design successfully validated by comparing it with total serum bilirubin.

    Science.gov (United States)

    Xue, Guo-Chang; Ren, Ming-Xing; Shen, Lin-Na; Zhang, Li-Wen

    2016-12-01

    We designed a jaundice colour card that could be used by the parents of neonates and validated it by comparing it with total serum bilirubin levels. There were 106 term Chinese neonates in the study. The majority weighed between 2500 g and 3499 g (63%) and had a gestational age of 37-40 weeks (77%). The jaundice colour card and photometric determination were used to screen for neonatal jaundice and compared with serum bilirubin. The bilirubin levels were measured by mothers using the jaundice colour card, and 67% of the measurements were taken at 11-20 days (range 3-30). The measurements at the infant's forehead, cheek and sternum showed strong correlations with total serum bilirubin. The mean differences between the total serum bilirubin and the jaundice colour card measurements from the forehead, cheek and sternum were 1.9 mg/dL, 0.3 mg/dL and 1.5 mg/dL, respectively. When total serum bilirubin >13 mg/dL was used as the cut-off point, the areas under the receiver operating characteristics curves were 0.934 for the forehead, 0.985 for the cheek and 0.966 for the sternum. We established the validity of the jaundice colour card as a parental measurement tool for jaundice in Chinese neonates, and the cheek was the best measurement site. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  15. Feto-Maternal Outcome of Jaundice in Pregnancy in a Tertiary Care Hospital.

    Science.gov (United States)

    Parveen, T; Begum, F; Akhter, N

    2015-07-01

    Acute viral hepatitis is the most common cause of jaundice in pregnancy. Amongst hepatitis E bears a deadly combination with pregnancy, leading to loss of very young lives. There is almost no data available in this aspect documenting prevalence, profile and effect of jaundice on outcome of pregnancy in Bangladesh. This observational study was done to determine and analyze the frequency, cause and outcome of jaundice in pregnancy among the admitted patients in the feto-maternal medicine wing of Bangabandhu Sheikh Mujib Medical University, for a 2 years period from August 2009 to July 2011. Management was done in collaboration with the hepatologists, hematologists and intensive care unit specialist. Outcome was noted in terms of the mode of delivery, maternal complications, need of blood transfusion and fresh frozen plasma and maternal end result. Fetal outcome was assessed by birth weight, Apgar score, neonatal admission, and perinatal mortality. Prevalence of jaundice was found 2.5% among all high risk and 1.3% among all obstetric admissions. Hepatitis E was the commonest cause and responsible for 80.4% cases of jaundice and next was cholestatic jaundice. Almost half of the patients (43.4%) faced complications like post partum haemorrhage (15.3%), hepatic encephalopathy (10.8%), ante partum hemorrhage (6.5%). Preterm delivery was noted in 71.1% cases. Out of 46 patients with jaundice four (4) mothers died due to hepatic encephalopathy in hepatitis E group. Regarding perinatal outcome 55.8% were of low birth weight, 35.3% had low Apgar score and perinatal mortality was 6.4%.

  16. [Jaundice and urinary tract infection in neonates: simple coincidence or real consequence?].

    Science.gov (United States)

    Abourazzak, S; Bouharrou, A; Hida, M

    2013-09-01

    In neonates, jaundice may be one of the initial symptoms related to urinary tract infection (UTI). The routine testing of the urine in jaundiced neonates is controversial. This study aimed to evaluate the related factors of neonatal infants with the initial presentation of hyperbilirubinemia and the final diagnosis of UTI by evaluating data that help diagnose UTI early in apparently healthy newborns with jaundice. We retrospectively investigated the medical records of neonates who had been admitted for management of jaundice (n=26) and compared with neonates with jaundice but without UTI (n=26). There was a significant difference between the two groups in male gender and maternal conditions (prolonged rupture of membranes, maternal UTI). There was also a significant difference between the two groups in their age at the time jaundice started (4 ± 3 days vs 2 ± 1 days) in the UTI and non-UTI groups, respectively (P>0.05). The cases in the UTI group had significantly lower total bilirubin levels (183 ± 71 mg/l) vs (227 ± 40 mg/l) in the non-UTI group, but a higher indirect bilirubin rate than the non-UTI group (Pjaundiced infants with UTI presented conjugated hyperbilirubinemia. Therefore, urinary tests for UTI should not be absolutely excluded or neglected in neonates in the early stage with unconjugated hyperbilirubinemia. Performing urinary tests to exclude the possibility of coincidental UTI may be necessary for admitted jaundiced infants younger than if they have a high level of indirect bilirubin, especially in male newborns with group B blood and in the presence of maternal urinary infection. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. Correlation between Hemolysis and Jaundice in Glucose 6-Phosphate Dehydrogenase Deficient Neonates

    Directory of Open Access Journals (Sweden)

    Marzban Asghar

    2009-10-01

    Full Text Available Glucose 6-phosphate dehydrogenase (G6PD deficiency is an enzyme deficiency of the red blood cells and the most important disease of hexose monophosphate pathway. The role of hemolysis in the pathophysiology of neonatal jaundice due to G6PD deficiency is in contencious. Our aim is to study the role of hemolysis in neonatal jaundice associated with G6PD deficiency. This prospective descriptive study has been done on 244 neonates who were admitted with the symptoms and signs of icter to the Ali-Asghar Children Hospital, affiliated to Iran University of Medical Sciences, Tehran, Iran, during April 2006 to April 2007. Two groups of the babies, G6PD-defcient with neonatal jaundice and G6PD-normal with neonatal jaundice, were compared based on the parameters related to hemolysis such as hemoglobin, reticulocyte count and bilirubin level. The criteria of hemolysis in our study were reticulocyte count more than >5% and hemoglobin less than <14 mg/dl. Our data have shown that 14 (5.7% of 244 neonates with the chief complain of icter suffered G6PD-deficiency with high male to female ratio (3.6 to 1. The mean hemoglobin levels and reticulocyte counts (16.72 vs. 16.97 and %2.48 vs. %2.79 respectively did not differ significantly between both groups (P>0.05. The present study indicate, G6PD- deficiency as a major cause of neonatal jaundice "nand hemolysis is not a main determinant of neonatal jaundice in G6PD-deficient babies and most of them have non hemolytic jaundice.

  18. Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas

    Science.gov (United States)

    Strasberg, Steven M; Gao, Feng; Sanford, Dominic; Linehan, David C; Hawkins, William G; Fields, Ryan; Carpenter, Danielle H; Brunt, Elizabeth M; Phillips, Carolyn

    2014-01-01

    Objectives: Jaundice impairs cellular immunity, an important defence against the dissemination of cancer. Jaundice is a common mode of presentation in pancreatic head adenocarcinoma. The purpose of this study was to determine whether there is an association between preoperative jaundice and survival in patients who have undergone resection of such tumours. Methods: Thirty possible survival risk factors were evaluated in a database of over 400 resected patients. Univariate analysis was used to determine odds ratio for death. All factors for which a P-value of jaundice, age, positive node status, poor differentiation and lymphatic invasion were significant indicators of poor outcome in multivariate analysis. Absence of jaundice was a highly favourable prognostic factor. Interaction emerged between jaundice and nodal status. The benefit conferred by the absence of jaundice was restricted to patients in whom negative node status was present. Five-year overall survival in this group was 66%. Jaundiced patients who underwent preoperative stenting had a survival advantage. Conclusions: Preoperative jaundice is a negative risk factor in adenocarcinoma of the pancreas. Additional studies are required to determine the exact mechanism for this effect. PMID:23600768

  19. Previously undiagnosed hereditary spherocytosis in a patient with jaundice and pyelonephritis: a case report.

    Science.gov (United States)

    Tateno, Yuki; Suzuki, Ryoji; Kitamura, Yukihiro

    2016-12-01

    Hereditary spherocytosis is autosomal dominant inherited extravascular hemolytic disorder and is the commonest cause of inherited hemolysis in northern Europe and the United States. The classical clinical features of hereditary spherocytosis are anemia, jaundice, and splenomegaly. However, all of these classical features are not always revealed in the case of mild hemolysis or when hemolysis is well compensated. Patients with hereditary spherocytosis may remain undiagnosed for years if their hemolysis is mild. A 42-year-old Asian woman presented to our clinic with a sudden onset of high fever with shaking chills and jaundice, suggesting septicemia; however, following detailed investigation, the patient was diagnosed with pyelonephritis and accelerated hemolysis of hereditary spherocytosis due to infection. It is important to note that transient anemia or jaundice can sometimes be the only initial presenting symptoms in cases of undiagnosed latent hereditary spherocytosis. This case also highlights the fact that physicians should consider concomitant hemolytic disease in patients in whom jaundice and infections that rarely cause jaundice coexist.

  20. [Diagnosis of congenital endocrinological disease in newborns with prolonged jaundice and hypoglycaemia].

    Science.gov (United States)

    Braslavsky, D; Keselman, A; Chiesa, A; Bergadá, I

    2012-03-01

    The association of prolonged neonatal jaundice and hypoglycaemia may be secondary to an endocrinological disease. Pituitary insufficiency and primary adrenal insufficiency are the most likely endocrine diseases that need to be ruled out. We retrospectively analysed the clinical and laboratory characteristics of thirteen patients referred to the Hospital de Niños Ricardo Gutiérrez between years 2003 and 2008 due to prolonged neonatal jaundice and hypoglycaemia secondary to pituitary insufficiency in twelve patients, and in one secondary to primary adrenal insufficiency. All patients had a history of neonatal hypoglycaemia. Ten patients had conjugated hyperbilirubinaemia and six also had elevated transaminases. Combined pituitary hormone deficiency was observed in the twelve hypopituitarism patients. Hormonal replacement normalised liver function and resolved the prolonged jaundice in all the patients. None of them underwent liver biopsy. Hypoglycaemia also remitted after hormonal therapy. Prolonged or cholestatic jaundice associated with neonatal hypoglycaemia is highly likely to be due to pituitary hormone deficiency or primary adrenal insufficiency. Early diagnosis and treatment of these children reverts the prolonged jaundice and prevents morbidity and mortality due to recurrent hypoglycaemia and hormone deficiencies. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  1. Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal.

    Science.gov (United States)

    Scrafford, Carolyn G; Mullany, Luke C; Katz, Joanne; Khatry, Subarna K; LeClerq, Steven C; Darmstadt, Gary L; Tielsch, James M

    2013-11-01

    To quantify the incidence of and risk factors for neonatal jaundice among infants referred for care from a rural, low-resource, population-based cohort in southern Nepal. Study participants were 18,985 newborn infants born in Sarlahi District in southern Nepal from May 2003 through January 2006 who participated in a cluster-randomised, placebo-controlled, community-based trial to evaluate the effect of newborn chlorhexidine cleansing on neonatal mortality and morbidity. Jaundice was assessed based on visual assessment of the infant by a study worker and referral for care. Adjusted relative risks (RR) were estimated to identify risk factors for referral for neonatal jaundice using Poisson regression. The incidence of referral for neonatal jaundice was 29.3 per 1000 live births (95% confidence interval: 26.9, 31.7). Male sex, high birth weight, breastfeeding patterns, warm air temperature, primiparity, skilled birth attendance, place of delivery, prolonged labour, oil massage, paternal education and ethnicity were significant risk factors (P-values population. Future research should investigate the role of an infant's difficulty in feeding as a potential modifier in the association between exclusive breastfeeding and jaundice. © 2013 John Wiley & Sons Ltd.

  2. Marked bengal pink. A dynamic test using marking doses; its value in jaundice diagnosis; Rose bengale marque. Epreuve dynamique a doses tracantes; sa valeur dans le diagnostic des icteres

    Energy Technology Data Exchange (ETDEWEB)

    Kellershohn, C.; Desgrez, A. [Commissariat a l' Energie Atomique, Service Frederic Joliot, Service de Biologie, Saclay (France).Centre d' Etudes Nucleaires; Caroli, J. [Hopital Saint Antoine, 75 - Paris (France); Delaloye, B. [Lausanne (Switzerland)

    1961-07-01

    The authors do a historic calling back of the differential study of jaundices thanks to the semi logarithmic gradients of expurgation of bromine sulphone-phthalein and thanks to the time of appearance of this material in the bile collected by duodenal tubing. They sum up likewise the foreign works which lead to take the place of this test, the outside count at the level of the head, the liver, and the abdomen after intravenous injection of a running dose of marked Rose Bengal. They specify the technical conditions of this test and report an experience which corroborate its value, its accuracy and the interest of its using in the different types of jaundices (hepatitis and obstructive types). (author) [French] Les auteurs font un rappel historique de l'etude differentielle des icteres grace aux pentes semi-logarithmiques d'epuration de la bromesulfonephtaleine et grace au temps d'apparition de cette substance dans la bile recueillie par tubage duodenal. Ils resument egalement les travaux etrangers qui tendent a substituer a cette epreuve le comptage externe au niveau de la tete, du foie et de l'abdomen, apres injection intraveineuse d'une dose tracante de rose bengale marque. Ils precisent les conditions techniques de cette epreuve et rapportent une experience qui confirme sa valeur, son exactitude et l'interet de son utilisation dans les differentes categories d'icteres par hepatite et par obstruction. (auteur)

  3. An unusual cause of jaundice in a patient with breast cancer.

    Science.gov (United States)

    Lacey, Rachel; Evans, Alex

    2014-12-24

    A 48-year old woman with metastatic breast cancer and extensive bone marrow infiltration was admitted with extreme lethargy, jaundice and deranged liver function tests. She had been started on anastrozole in May 2013 for bony metastases, detected on a bone scan. A CT scan performed at that time had shown no evidence of metastatic or nodal disease elsewhere. Over the subsequent 2 months, the patient had become progressively jaundiced. Outpatient abdominal ultrasound and CT liver had shown a fatty liver with no focal lesions. She was admitted in August 2013 with bilirubin 567, alkaline phosphatase 385, alanine aminotransferase 98, albumin 25 and international normalised ratio 1.9. The patient ultimately had a liver biopsy, which demonstrated features of drug-induced steatohepatitis, and anastrozole was found to have been the probable cause. This case explores the differentials of jaundice in a patient with cancer and describes a rare cause of drug-induced liver injury. 2014 BMJ Publishing Group Ltd.

  4. [IMPACT OF RONCOLEUKIN ON BALANCE OF CYTOKINS IN COMPLEX TREATMENT OF OBTURATION JAUNDICE OF NONTUMORAL GENESIS].

    Science.gov (United States)

    Gajiyev, J N; Tagiyev, E G; Gadjiyev, N J

    2016-02-01

    The results of surgical treatment of 137 patients, suffering obturation jaundice of non-tumoral etiology, were analyzed. In all the patients the cause of obturation jaundice was choledocholithiasis. Roncoleukin was infused intravenously additionally in a complex of therapy. A degree of hepatic dysfunction was determined, taking into account the cholestasis markers. In 23 patients purulent cholangitis have occurred on background of obturation jaundice. Concentration of cytokins TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10 in sera were determined, using immunoassay analysis. The cytokins dysbalance severity preoperatively and dynamics of its changes have depended upon the hepatic dysbalance degree and presence of purulent cholangitis; a dysbalance is deeper, when the hepatic dysfunction is higher. Application of pathogenetically substantiated purposeful cytokinotherapy, including roncoleukin, have promoted the cytokins dysbalance elimination and improvement of the patients treatment results.

  5. Hepatitis E as a Cause of Acute Jaundice Syndrome in Northern Uganda, 2010–2012

    Science.gov (United States)

    Gerbi, Gemechu B.; Williams, Roxanne; Bakamutumaho, Barnabas; Liu, Stephen; Downing, Robert; Drobeniuc, Jan; Kamili, Saleem; Xu, Fujie; Holmberg, Scott D.; Teshale, Eyasu H.

    2015-01-01

    Hepatitis E virus (HEV) is a common cause of acute viral hepatitis in developing countries; however, its contribution to acute jaundice syndrome is not well-described. A large outbreak of hepatitis E occurred in northern Uganda from 2007 to 2009. In response to this outbreak, acute jaundice syndrome surveillance was established in 10 district healthcare facilities to determine the proportion of cases attributable to hepatitis E. Of 347 acute jaundice syndrome cases reported, the majority (42%) had hepatitis E followed by hepatitis B (14%), malaria (10%), hepatitis C (5%), and other/unknown (29%). Of hepatitis E cases, 72% occurred in Kaboong district, and 68% of these cases occurred between May and August of 2011. Residence in Kaabong district was independently associated with hepatitis E (adjusted odds ratio = 13; 95% confidence interval = 7–24). The findings from this surveillance show that an outbreak and sporadic transmission of hepatitis E occur in northern Uganda. PMID:25448237

  6. Coexistence of gilbert syndrome and hereditary spherocytosis in a child presenting with extreme jaundice.

    Science.gov (United States)

    Lee, Jae Hee; Moon, Kyung Rye

    2014-12-01

    Gilbert syndrome is the most common inherited disorder of bilirubin glucuronidation. It is characterized by intermittent episodes of jaundice in the absence of hepatocellular disease or hemolysis. Hereditary spherocytosis is the most common inherited hemolytic anemia and is characterized by spherical, osmotically fragile erythrocytes that are selectively trapped by the spleen. The patients have variable degrees of anemia, jaundice, and splenomegaly. Hereditary spherocytosis usually leads to mild-to-moderate elevation of serum bilirubin levels. Severe hyperbilirubinemia compared with the degree of hemolysis should be lead to suspicion of additional clinical conditions such as Gilbert syndrome or thalassemia. We present the case of a 12-year-old boy with extreme jaundice and nausea. The diagnosis of hereditary spherocytosis was confirmed by osmotic fragility test results and that of Gilbert syndrome by genetic analysis findings.

  7. Mothers’ perception of neonatal jaundice in Lagos, Nigeria: An urgent need for greater awareness

    Directory of Open Access Journals (Sweden)

    Chinyere Ezeaka

    2016-12-01

    Full Text Available Background. Neonatal jaundice remains a leading cause of preventable brain damage, mental handicap, physical disabilities and early death among infants. The high mortality and morbidity from neonatal jaundice is exacerbated by the poor understanding and mismanagement of this common neonatal problem by the general populace, leading to dangerous delays and complications. Objective. To assess the knowledge of pregnant women on the causative factors, treatment modalities and sequelae of neonatal jaundice. Methods. Data were obtained from all consecutive women who attended the antenatal clinic of the Lagos University Teaching Hospital, Nigeria, from January 2013 to April 2013, using a pretested questionnaire focusing on knowledge of neonatal jaundice and its causes, treatment and complications. Results. The study participants numbered 395, of whom 213 (53.9% were within the age range of 30 - 39 years. Only 101 (25.6% participants gave a correct definition of neonatal jaundice. The highest proportion of those who did not give a correct definition were from the lower socioeconomic groups V and IV (χ2=12.08, p=0.017. Participants who did not know the causes numbered 313 (79.2%, while 325 (82.2% participants chose ineffective treatment options. Furthermore, 296 (74.9% respondents, especially those with a low level of education, did not identify the complications correctly (χ2=12.61, p=0.006. Conclusion. Women in the study showed inadequate knowledge of and misconceptions regarding neonatal jaundice, which must be addressed in order to reduce significantly the devastating consequences of this common condition. We advocate for improved female literacy and mass health enlightenment programmes.

  8. [Dark urine and jaundice as warning signs in Plasmodium falciparum malaria in Colombia].

    Science.gov (United States)

    Tobón Castaño, Alberto; del Mar Cortina, Ana; Felipe Miranda, Andrés; Blair Trujillo, Silvia

    2010-01-01

    early recognition of warning signs in malarial patients allows timely identification of the patient at risk of severe malaria and provides opportune treatment. Jaundice and dark urine are frequent signs that can alert to the occurrence of severe malaria. to study the relationship between jaundice and dark urine with impaired liver and/or kidney function and anemia in malarial patients, and explore their role as warning signs. clinical and laboratory data from 199 patients with Plasmodium falciparum malaria, belonging to a case control study conducted in Colombia, were analyzed, the association between dark urine and jaundice with impairment in the urine analysis, the hepatic and renal function test, and hemoglobin were studied. there was association between dark urine and hemoglobinuria (OR = 236, 63-867), hematuria (OR = 3.2, 1.6-6.6), proteinuria (OR = 2.3, 1-5.3) and bilirubinuria (OR = 2.1, 1-4.4). Jaundice was present in 31 % of patients who had renal dysfunction (OR = 2.7, 1.1-6.4) and in 22 % of those with liver dysfunction (OR = 2.1, 0.9-4.5). Jaundice was more likely in patients with total bilirubin > 25.6 micromol/L (OR = 6.1, 2.7-13.4) and blood ureic nitrogen > 7.14 mmol/L (OR = 3.5, 1.4-8.5). jaundice in patients with malaria may be considered as a warning sign associated with liver and kidney dysfunction. Dark urine was not associated with kidney or liver dysfunction, but was related to bilirubinuria, hematuria and proteinuria, which can be early indicators of failure; dark urine must be studied to clarify its relationship with liver and kidney failure in malaria.

  9. Ethnomedicine for neonatal jaundice: A cross-sectional survey in Qom, Iran.

    Science.gov (United States)

    Heydari, Mojtaba; Heydari, Hosein; Saadati, Alireza; Gharehbeglou, Mohammad; Tafaroji, Javad; Akbari, Abolfazl

    2016-12-04

    Traditional Medicine (TM) is popularly used for neonatal jaundice in Iran. to provides evidence for characteristics of traditional medicine use in the treatment of neonatal jaundice in Qom, Iran. Field surveys were carried out during July 2015 - August 2015 in Qom through structured questionnaire in Persian from 212 parents of children with neonatal jaundice. All plant species recorded for the treatment of neonatal jaundice were sampled. Samples were identified by a botanist and obtained a voucher specimens number and deposited in the Shiraz School of Pharmacy Herbarium. The information such as scientific name, family, local name, parts used and preparation method were provided. The Use Value (UV), Frequency of Citation (FC), Relative Frequency of Citation (RFC) and Relative Family Importance Value (FIV) are also calculated. In total, 165 (78%) of participants reported the use of traditional methods for their neonates. The use of herbal remedies was the most popular form of these traditional interventions. A total of 8 plant species belonging to 7 families were identified. Cotoneaster nummularioides Pojark. Cichorium intybus L. Alhagi maurorum Medik. Descurainia sophia (L.) Webb ex Prantl were most frequent herbs used by neonates and their feeding mother to treat jaundice. Manna was the most popular plant part and distillation and soaking were most frequent preparation methods in these patients. The use of TM in these patients is associated with their previous experience on TM use and their view on its potential risk. This study provided information on the prevalence, associated factors and characteristics of traditional medicine use along with ethnomedicinal knowledge from Qom in Iran on neonatal jaundice. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Pathological jaundice in full-term newborns and Gilbert’s syndrome

    Directory of Open Access Journals (Sweden)

    Danijela Furlan

    2011-03-01

    Full Text Available Background: In the course of our research on polymorphism in the UGT1A1 gene of healthy full-term newborns, we studied the relationship between pathological jaundice and the newborn’s genotype. The latter could be one of the risk factors for hyperbilirubinemia. The possibility of a pharmacogenetic approach for treating individuals with Gilbert’s syndrome was investigated since the polymorphism may influence the toxic metabolism of certain therapeutic drugs. Methods: Blood was collected from 185 healthy full-term newborns, born in May 2009, on the third day of life. Bilirubin was measured according to the Jendrassik-Grof method and all samples were genotyped (dHPLC method. ANOVA, χ2–test and t – test were used for statistical analysis. Results: A significant association of genotype with bilirubin levels was observed (p< 0.001, the highest bilirubin level occurring with the genotype (TA7/7, characteristic of Gilbert ‘s syndrome; 68 of the 185 newborns had pathological jaundice; 20 cases were so severe that they needed phototherapy during hospitalization. Differences in bilirubin levels between the groups with clinical characteristics of jaundice were statistically significant (physiological / pathological (p< 0.001 and irradiated / nonirradiated (p = 0,034. The genotype (TA7/7 was significantly more frequent in the group with pathological jaundice than in the group with physiological jaundice (p = 0,028. The results confirm that Gilbert’s syndrome can be one of the factors contributing to pathological jaundice in healthy full-term newborns. polymorphism in the UGT1A1 gene of healthy full-term newborns, we studied the relationship between pathological jaundice and the newborn’s genotype. The latter could be one of the risk factors for hyperbilirubinemia. The possibility of a pharmacogenetic approach for treating individuals with Gilbert’s syndrome was investigated since the polymorphism may influence the toxic metabolism of certain

  11. Follow-up Of Neonatal Jaundice In Term And Late Premature Newborns.

    OpenAIRE

    Facchini, Fernando P; Mezzacappa,Maria Aparecida; Rosa, Izilda R; Mezzacappa Filho,Francisco; Aranha-Netto, Abimael; Marba, Sergio Tadeu

    2015-01-01

    Objective: To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. Methods: Neonates were referred to the follow-up clinic with weight ≥ 2,000 g and/or gestational age ≥ 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram develop...

  12. [Jaundice after Herbage Walking Tour of a 44 Year Old Man].

    Science.gov (United States)

    Sawatzki, Mikael; Haller, Christoph; Henz, Samuel

    2015-06-03

    We report about a 44-year old patient with severe acute hepatitis E after herbage walking-to ur. Transmission occurred with ingestion of contaminated herbs. Symptoms were jaundice, dark urine, rheumatic pains and distinctive fatigue. We could document a benign self-limiting course under regular clinical controls. Hepatitis Eisa worldwide common cause for acute hepatitis with jaundice. In Switzerland contamination of this autochthonic infection is aquired by consumption of pork and venison (seroprevalence up to 22%). Infection can be without symptoms but also can result in acute liver failure. Extrahepatic symptoms are not uncommon.

  13. Obstructive sleep apnea - adults

    Science.gov (United States)

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  14. Serological evidence of hepatitis E virus infection in pigs and jaundice among pig handlers in Bangladesh.

    Science.gov (United States)

    Haider, N; Khan, M S U; Hossain, M B; Sazzad, H M S; Rahman, M Z; Ahmed, F; Zeidner, N S

    2017-11-01

    Hepatitis E virus (HEV) is the most common cause of viral hepatitis in humans. Pigs may act as a reservoir of HEV, and pig handlers were frequently identified with a higher prevalence of antibodies to HEV. The objectives of this study were to identify evidence of HEV infection in pigs and compare the history of jaundice between pig handlers and people not exposed to pigs and pork. Blood and faecal samples were collected from 100 pigs derived from three slaughterhouses in the Gazipur district of Bangladesh from January to June, 2011. We also interviewed 200 pig handlers and 250 non-exposed people who did not eat pork or handled pigs in the past 2 years. We tested the pig sera for HEV-specific antibodies using a competitive ELISA and pig faecal samples for HEV RNA using real-time RT-PCR. Of 100 pig sera, 82% (n = 82) had detectable antibody against HEV. Of the 200 pig handlers, 28% (56/200) demonstrated jaundice within the past 2 years, whereas only 17% (43/250) of controls had a history of jaundice (p Bangladesh demonstrated evidence of HEV infection, and a history of jaundice was significantly more frequent in pig handlers. Identifying and genotyping HEV in pigs and pig handlers may provide further evidence of the pig's role in zoonotic HEV transmission in Bangladesh. © 2017 Blackwell Verlag GmbH.

  15. Is Neonatal Jaundice Associated with Autism Spectrum Disorders: A Systematic Review

    Science.gov (United States)

    Amin, Sanjiv B.; Smith, Tristram; Wang, Hongyue

    2011-01-01

    Using guidelines of the Meta-analysis of Observational Studies in Epidemiology Group, we systematically reviewed the literature on neonatal jaundice (unconjugated hyperbilirubinemia) and Autism Spectrum Disorder (ASD) in term and preterm infants. Thirteen studies were included in a meta-analysis. Most used retrospective matched case-control…

  16. Clinical presentation of (subclinical) jaundice - The Euricterus project in The Netherlands

    NARCIS (Netherlands)

    Reisman, Y; Gips, CH; Lavelle, SM; Wilson, JHP

    1996-01-01

    Background: From a primary clinical database, rue wanted to obtain insight in disease distribution and clinical presentation of adult jaundiced patients in a Western country. Materials and Methods: As part of the Euricterus project, 24 Dutch general and academic hospitals in a period of 2 years

  17. Neonatal jaundice in a Special Care Baby Unit (SCBU) in Port ...

    African Journals Online (AJOL)

    There was therefore need for prompt recognition and treatment of septicaemia and efforts should be focused at the community level to encourage mothers to present early in hospital as soon as jaundice is noticed. Keywords: Neonatal unconjugated hyperbilirubinaemia, Associated factors, Kernicterus, Outcome PHMJ Vol.

  18. Point-of-care device to diagnose and monitor neonatal jaundice in low-resource settings.

    Science.gov (United States)

    Keahey, Pelham A; Simeral, Mathieu L; Schroder, Kristofer J; Bond, Meaghan M; Mtenthaonnga, Prince J; Miros, Robert H; Dube, Queen; Richards-Kortum, Rebecca R

    2017-12-04

    Newborns are at increased risk of jaundice, a condition in which excess bilirubin accumulates in blood. Left untreated, jaundice can lead to neurological impairment and death. Jaundice resulting from unconjugated hyperbilirubinemia is easily treated with exposure to blue light, and phototherapy systems have been developed for low-resource settings; however, there are no appropriate solutions to diagnose and monitor jaundice in these settings. To address this need we present BiliSpec, a low-cost reader and disposable lateral flow card designed to measure the concentration of total bilirubin from several drops of blood at the point of care. We evaluated the performance of BiliSpec, using blood from normal volunteers spiked with varying amounts of bilirubin; results measured using BiliSpec correlated well with a reference laboratory bilirubinometer (r = 0.996). We then performed a pilot clinical study using BiliSpec to measure total bilirubin in neonates at risk for jaundice at Queen Elizabeth Central Hospital in Blantyre, Malawi. Concentrations measured using BiliSpec correlated well with those measured using a laboratory reference standard in 94 patient samples ranging from 1.1 mg/dL to 23.0 mg/dL in concentration (r = 0.973). The mean difference between bilirubin levels measured with BiliSpec and the reference standard was 0.3 mg/dL (95[Formula: see text] CI: -1.7-2.2 mg/dL). Copyright © 2017 the Author(s). Published by PNAS.

  19. Closure of the cystic duct during laparoscopic cholecystectomy with a new feedback-controlled bipolar sealing system in case of biliary obstruction--an experimental study in pigs.

    Science.gov (United States)

    Shamiyeh, A; Vattay, P; Tulipan, L; Schrenk, P; Bogner, S; Danis, J; Wayand, W

    2004-01-01

    The excellent results of new devices like the new bipolar feedback-controlled sealing system (LigaSure) for closure of blood vessels encouraged surgeons to use these instruments for other structures like bile ducts. The aim of this study was to evaluate the feasibility of closure of cystic duct in case of biliary obstruction. Ten domestic pigs underwent laparoscopic cholecystectomy sealing the cystic duct with LigaSure. The common bile duct was closed with an endoclip to create a biliary hypertension. On the 12th postoperative day blood samples were taken for liver enzymes. At autopsy on day 15 the pigs were investigated for bile leaks or biliary peritonitis. The cystic duct was resected for histological examination. Seven pigs survived, one pig died during introduction of anesthesia, one on the 1st and one on the 2nd postoperative day without any findings at the autopsy. One pig out of 7 had a bile leak; the other 6 were without any sign of leakage. Histologically 3 pigs had a regular coagulation zone at the cystic duct, 3 had a total necrosis, one a partial necrosis of the mucosa only. Though there was only one insufficiency, the feedback-controlled bipolar vessel sealer cannot be recommended for biliary surgery with regard to the high rate of necrosis stated in our experiment.

  20. Efficacy of percutaneous intraductal radiofrequency ablation combined with biliary stenting in treatment of malignant biliary obstruction

    Directory of Open Access Journals (Sweden)

    ZHANG Kai

    2015-05-01

    Full Text Available ObjectiveTo investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation (palliative therapy in the treatment of malignant obstructive jaundice. MethodsThis study included 20 patients with unresectable malignant obstructive jaundice, who were treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to March 2014. Nine of them (test group underwent percutaneous intraductal radiofrequency ablation plus metallic biliary stent placement. The other 11 similar cases (control group underwent metallic biliary stent placement alone after successful percutaneous transhepatic cholangiography. Operative complications and remission of jaundice were observed, and the stent patency after at 3 and 6 months after operation was evaluated and compared between the two groups. ResultsAll patients were followed completely by outpatient or telephone. The stent patency rate at 3 months after operation was 9/9 in the test group and 8/11 in the control group (χ2=2.888, P=0.218, and the stent patency rates at 6 months were 7/8 and 3/11, respectively (χ2=6.739, P=0.02. During follow-up, one case in the test group died of gastrointestinal bleeding at 113 d after operation; one case in the control group died of liver failure at 57 d after operation and one case died of disseminated intravascular coagulation at 142 d. ConclusionPercutaneous intraductal radiofrequency ablation is safe and feasible in the treatment of malignant biliary obstruction, and the preliminary efficacy in prolonging the patency of self-expanding metallic stent is satisfactory. However, this therapy needs to be further verified via large-sample randomized controlled studies.

  1. Kinin B1 receptor antagonism is equally efficient as angiotensin receptor 1 antagonism in reducing renal fibrosis in experimental obstructive nephropathy, but is not additive.

    Directory of Open Access Journals (Sweden)

    Antoine eHuart

    2015-02-01

    Full Text Available Background: Renal tubulointerstitial fibrosis is the pathological hallmark of chronic kidney disease. Currently, inhibitors of the renin angiotensin system (RAS remain the sole therapy in human displaying antifibrotic properties. Further antifibrotic molecules are needed. We have recently reported that the delayed blockade of the bradykinin B1 receptor (B1R reduced the development of fibrosis in two animal models of renal fibrosis. The usefulness of new drugs also resides in outperforming the gold standards and eventually being additive or complementary to existing therapies. Methods: In this study we compared the efficacy of a B1R antagonist (B1Ra with that of an angiotensin type 1 receptor antagonist (AT1a in the unilateral ureteral obstruction (UUO model of renal fibrosis and determined whether bi-therapy presented higher efficacy than any of the drugs alone. Results: B1R antagonism was as efficient as the gold-standard AT1a treatment. However bitherapy did not improve the antifibrotic effects at the protein level. We sought for the reason of the absence of this additive effect by studying the expression of a panel of genes involved in the fibrotic process. Interestingly, at the molecular level the different drugs targeted different players of fibrosis that, however, in this severe model did not result in improved reduction of fibrosis at the protein level. Conclusions: As the B1R is induced specifically in the diseased organ and thus potentially displays low side effects it might be an interesting alternative in cases of poor tolerability to RAS inhibitors.

  2. Kinin B1 receptor antagonism is equally efficient as angiotensin receptor 1 antagonism in reducing renal fibrosis in experimental obstructive nephropathy, but is not additive

    Science.gov (United States)

    Huart, Antoine; Klein, Julie; Gonzalez, Julien; Buffin-Meyer, Bénédicte; Neau, Eric; Delage, Christine; Calise, Denis; Ribes, David; Schanstra, Joost P.; Bascands, Jean-Loup

    2015-01-01

    Background: Renal tubulointerstitial fibrosis is the pathological hallmark of chronic kidney disease (CKD). Currently, inhibitors of the renin–angiotensin system (RAS) remain the sole therapy in human displaying antifibrotic properties. Further antifibrotic molecules are needed. We have recently reported that the delayed blockade of the bradykinin B1 receptor (B1R) reduced the development of fibrosis in two animal models of renal fibrosis. The usefulness of new drugs also resides in outperforming the gold standards and eventually being additive or complementary to existing therapies. Methods: In this study we compared the efficacy of a B1R antagonist (B1Ra) with that of an angiotensin type 1 receptor antagonist (AT1a) in the unilateral ureteral obstruction (UUO) model of renal fibrosis and determined whether bi-therapy presented higher efficacy than any of the drugs alone. Results: B1R antagonism was as efficient as the gold-standard AT1a treatment. However, bitherapy did not improve the antifibrotic effects at the protein level. We sought for the reason of the absence of this additive effect by studying the expression of a panel of genes involved in the fibrotic process. Interestingly, at the molecular level the different drugs targeted different players of fibrosis that, however, in this severe model did not result in improved reduction of fibrosis at the protein level. Conclusions: As the B1R is induced specifically in the diseased organ and thus potentially displays low side effects it might be an interesting alternative in cases of poor tolerability to RAS inhibitors. PMID:25698969

  3. Risk factors and outcome of neonatal jaundice in a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Bedowra Zabeen

    2010-07-01

    Full Text Available Neonatal jaundice is a common cause of newborn hospital admission. The risk factors, the characteristics and outcomes related to neonatal jaundice in Bangladesh has not been studied so far. This study addressed the outcomes, characteristics and risks of the jaundiced newborn admitted into hospital. The babies who had significant jaundice and required phototherapy and /or exchange transfusion were investigated. A detailed history of delivery with gestational age was noted and clinical examination of the admitted newborn was done. Birth weight was recorded. The investigations included complete blood count, ABO and Rh compatibility, serum bilirubin, glucose 6 phosphate dehydrogenase (G6PD, thyroid stimulating hormone (TSH and ultrasonography (USG of brain. The newborns were closely monitored for the prognosis. The requirement of individualized phototherapy and exchange transfusion were also noted. Finally, the outcomes were recorded. Overall, 60 (m v. f = 58.3 v. 41.7% newborns were found who developed significant jaundice and were investigated. Of them, 35% had gestational age less than 32wks and only 32% had equal to or greater than 35wks. Regarding delivery, 83.3 % had the history of caesarean section. ABO- and Rh– incompatibilities were found in 13.3% and 3.3%, respectively. Septicemia was diagnosed among 26.7% though blood culture yielded growth only in 20%. Compared with the higher gestational age-group ( 35 wks the lower group (<32 wks showed significantly higher rate of septicemia (12.5 v. 68.8%, p<0.005. G6PD deficiency was found in only one (1.7% case. Birth asphyxia was found as a concomitant factor in three patients. Exchange transfusion was done only in 2 (3.3% babies. Among them one was preterm IDM with septicemia and other had G6PD deficiency. None of these babies developed kernicterus. Five (8.3% babies died, all of them had septicemia and one baby also had intraventricular hemorrhage (IVH with PDA. The study revealed that a

  4. [Etiologies of non-hemolytic jaundice in infants: a retrospective analysis of 3113 cases].

    Science.gov (United States)

    Peng, Xiaorong; Xu, Hongmei

    2015-06-01

    To investigate the causes of non-hemolytic jaundice among infants in Chongqing, China from the period of 1982 to 2011 and to determine whether the etiologies have changed over the past 30 years. The medical records of 3 113 infants,aged 1 month to 1 year,admitted to our hospital with non-hemolytic jaundice were collected and stratified according to decade-long time periods: group A (1982-1991), n=537; group B (1992-2001), n=786; group C (2002-2011), n=1 790. Data on sex, age, etiology and bilirubin level were retrospectively assessed using the chi-square test. In the three groups, boys consistently accounted for the majority of cases (group A:74.3%, group B:66.7%, group C:62.6%). In group A, 52% of the patients were 1-2 months of age; the peak age of patients in both group B and C was 2-3 months (group B:67.8%, group C:61.0%). Group A showed the highest level of patients with mildly elevated total bilirubin level (80.3%); however, moderately elevated total bilirubin level was most frequent in group B (53.4%) and group C (49.7%). The main etiologic diagnoses of the patients in group A were cytomegalovirus (CMV) infection (31.7%), sepsis (18.2%), hepatitis B virus (HBV) (1.3%), and biliary tract anomalies (1.3%); 46.6% of the cases had unclear cause. The main etiologic diagnoses of the cases in group B were CMV infection (36.0%), sepsis (21.5%), breast milk jaundice (2.0%), and HBV (1.9%); 37.9% of the cases had unclear cause. The main etiologic diagnoses of the cases in group C were CMV infection (42.6%), sepsis (7.5%), breast milk jaundice (17.7%), and biliary tract anomalies (2.46%); 29.1% of the cases had unclear cause. In Chongqing, infective factors, especially CMV, remain the main cause of nonhemolytic jaundice in infants, but bacterial etiologies have declined over the past 30 years.Non-infective factors, such as biliary tract anomalies and inherited metabolic diseases, have trended upwards. Although there has been great progress in the clinical management of

  5. Percutaneous management of tumoral biliary obstruction in children

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

    2007-10-15

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  6. Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group.

    Science.gov (United States)

    Regimbeau, J M; Fuks, D; Bachellier, P; Le Treut, Y P; Pruvot, F R; Navarro, F; Chiche, L; Farges, O

    2011-06-01

    Jaundice is frequent in patients with gallbladder cancer (GBC) and indicates advanced disease and, according to some teams, precludes routine operative exploration. The present study was designed to re-assess the prognostic value of jaundice in patients with GBC. Patients with GBC operated from 1998 to 2008 were included in a retrospective multicenter study (AFC). The main outcome measured was the prognostic value of jaundice in patients with GBC focusing on morbidity, mortality and survival. A total of 110 of 429 patients with GBC presented with jaundice, with a median age of 66 years (range: 31-88). The resectability rate was 45% (n=50) and the postoperative mortality and morbidity rates were 16% and 62%, respectively; 71% had R0 resection and 46% had lymph node involvement. Overall 1- and 3-year survivals of the 110 jaundiced patients were 41% and 15%, respectively. For the 50 resected patients, 1- and 3-year survivals were 48% and 19%, respectively (real 5-year survivors n=4) which were significantly higher than that of the 60 non-resected patients (31%, 0%, p=0.001). Among the resected jaundiced patients, T-stage, N and M status were found to have a significant impact on survival. R0 resection did not increase the overall survival in all resected patients, but R0 increased median survival in the subgroup of N0 patients (20 months versus 6 months, p=0.01). This series confirms that jaundice is a poor prognostic factor. However, the presence of jaundice does not preclude resection, especially in highly selected patients (N0). Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Spectral matching technology for light-emitting diode-based jaundice photodynamic therapy device

    Science.gov (United States)

    Gan, Ru-ting; Guo, Zhen-ning; Lin, Jie-ben

    2015-02-01

    The objective of this paper is to obtain the spectrum of light-emitting diode (LED)-based jaundice photodynamic therapy device (JPTD), the bilirubin absorption spectrum in vivo was regarded as target spectrum. According to the spectral constructing theory, a simple genetic algorithm as the spectral matching algorithm was first proposed in this study. The optimal combination ratios of LEDs were obtained, and the required LEDs number was then calculated. Meanwhile, the algorithm was compared with the existing spectral matching algorithms. The results show that this algorithm runs faster with higher efficiency, the switching time consumed is 2.06 s, and the fitting spectrum is very similar to the target spectrum with 98.15% matching degree. Thus, blue LED-based JPTD can replace traditional blue fluorescent tube, the spectral matching technology that has been put forward can be applied to the light source spectral matching for jaundice photodynamic therapy and other medical phototherapy.

  8. Comparison between Bilistick System and transcutaneous bilirubin in assessing total bilirubin serum concentration in jaundiced newborns.

    Science.gov (United States)

    Greco, C; Iskander, I F; Akmal, D M; El Houchi, S Z; Khairy, D A; Bedogni, G; Wennberg, R P; Tiribelli, C; Coda Zabetta, C D

    2017-09-01

    To compare the performance and accuracy of the JM-103 transcutaneous bilirubinometer and Bilistick System in measuring total serum bilirubin for the early identification of neonatal hyperbilirubinemia. The study was performed on 126 consecutive term and near-term (⩾36 weeks' gestational age) jaundiced newborns in Cairo University Children Hospital NICU, Egypt. Total serum bilirubin was assayed concurrently by the clinical laboratory and Bilistick System and estimated using the JM-103 transcutaneous bilirubin instrument. Bland-Altman analysis was used to evaluate the agreement between determinations. The limits of agreement of the Bilistick System (-5.8 to 3.3 mg dl-1) and JM-103 system (-5.4 to 6.0 mg dl-1) versus the clinical laboratory results were similar. The Bilistick System is an accurate alternative to transcutaneous (TcB) determination for early diagnosis and proper management of the neonatal jaundice.

  9. Jaundice and life-threatening hemobilia: an uncommon presentation of choledochal cyst.

    Science.gov (United States)

    Koh, Peng Soon; Yoong, Boon Koon; Vijayananthan, Anushya; Nawawi, Ouzreiah; Mahadeva, Sanjiv

    2013-08-01

    Hemobilia with jaundice as a result of cholestasis and bleeding from choledochal cyst is uncommon. Ascertaining the diagnosis is often challenging and delayed diagnosis can lead to significant consequences due to hemodynamic instability, particularly in elderly patients. Although surgery remains the definitive treatment modality, interventional radiology for hemostasis has been increasingly recognized as an option. In this manuscript, we described two Malaysian cases of jaundice and hemobilia associated with choledochal cysts and the challenges related with clinical diagnosis and management. © 2013 The Authors. Journal of Digestive Diseases © 2013 Wiley Publishing Asia Pty Ltd and Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine.

  10. Glucose-6-phosphate dehydrogenase deficiency: an unusual cause of acute jaundice after paracetamol overdose.

    Science.gov (United States)

    Phillpotts, Simon; Tash, Elliot; Sen, Sambit

    2014-11-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the commonest human enzyme defect causing haemolytic anaemia after exposure to specific triggers. Paracetamol-induced haemolysis in G6PD deficiency is a rare complication and mostly reported in children. We report the first case (to the best of our knowledge) of acute jaundice without overt clinical features of a haemolytic crisis, in an otherwise healthy adult female following paracetamol overdose, due to previously undiagnosed G6PD deficiency. It is important that clinicians consider this condition when a patient presents following a paracetamol overdose with significant and disproportionate jaundice, without transaminitis or coagulopathy. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Static-dynamic MR urography. Comparison with excretory urography and scintigraphy in experimentally induced urinary tract obstruction (UTO); Statisch-dynamische MR-Urographie. Vergleich mit Ausscheidungsurographie und Szintigraphie bei experimentell induzierter Harntransportstoerung (HTS)

    Energy Technology Data Exchange (ETDEWEB)

    Rohrschneider, W.K.; Wunsch, R.; Troeger, J. [Paediatrische Radiologie, Univ. Heidelberg (Germany); Hoffend, J. [Nuklearmedizinische Klinik, Univ. Heidelberg (Germany); Becker, K. [Inst. fuer Versuchstierkunde, Univ. Heidelberg (Germany); Darge, K.; Clorius, J.H. [Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum, Heidelberg (Germany); Kooijman, H. [Philips Medizin-Systeme, Hamburg (Germany)

    2001-02-01

    Purpose: To assess the diagnostic value of combined static-dynamic MR urography (MRU) for the functional-morphological evaluation of experimentally induced urinary tract obstruction. Methods: Static-dynamic MRU - combination study with a respiratory-triggered 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA and furosemide - was obtained in comparison with {sup 99m}Tc-MAG3 diuretic renal scintigraphy (DRS), excretory urography (EU) and ultrasound (US) in 29 healthy piglets and in 20 piglets with surgically induced ureteric stenosis (total of 50 postoperative examination blocks). Results: MRU allowed complete depiction of the urinary tract in all controls, in operated piglets the stenosis was always correctly identified. Quality of MRU was superior to EU in 36 to 43 comparative studies. Calculation of single kidney function from parenchymal renograms, and assessment of urinary excretion from whole-kidney renograms resulted in a highly significant agreement of MRU with DRS. Conclusion: Static-dynamic MR urography allows excellent depiction of experimentally induced urinary tract obstruction, and reliable assessment of individual renal function and urinary excretion. Two advantages of the method stand out, it does not require radiation and it permits a functional-morphological correlation. (orig.) [German] Ziel: Einschaetzung der Wertigkeit der kombinierten statisch-dynamischen MR-Urographie (MRU) zur umfassenden funktionell-morphologischen Diagnostik tierexperimentell induzierter Harntransportstoerungen. Methodik: Die statisch-dynamische MRU-Kombination aus einer atemgetriggerten 3D-IR-TSE-Sequenz und einer dynamischen 2D-FFE-Sequenz nach Gd-DTPA und Furosemid - wurde im Vergleich zu {sup 99m}Tc-MAG3-Diurese-Nierenszintigraphie (DNS), Ultraschall (US) und Ausscheidungsurographie (AUG) bei 29 gesunden Ferkeln sowie bei 20 Ferkeln mit operativ indizierter Harnwegsstenose (insgesamt 50 postoperative Untersuchungsbloecke) durchgefuehrt. Ergebnisse: Die MRU

  12. Clinical practices among healthcare professionals concerning neonatal jaundice and pale stools.

    Science.gov (United States)

    Santos Silva, Ermelinda; Moreira Silva, Helena; Azevedo Lijnzaat, Lia; Melo, Cláudia; Costa, Elísio; Martins, Esmeralda; Lopes, Ana Isabel

    2017-03-01

    Jaundice and pale stools are major indicators of neonatal liver disease. Prognosis depends on timely diagnosis and management. We evaluated the clinical practices among healthcare professionals concerning jaundiced newborns and their ability to recognize pale stools. We supplied a questionnaire and a panel with eight photographs of stools, both locally validated, to physicians and nurses of the National Healthcare Service. Analysis was conducted according to professional status, specialization and years of experience of professionals and level of healthcare. Questionnaires were administered to 266 participants (100 physicians, 166 nurses). The decision to send patients to medical observation depended on the intensity of jaundice for a significant percentage of nurses. Concerning jaundiced newborns breastfed and otherwise healthy, 28.9% of physicians would never request a conjugated bilirubin assay, and only 43.3% would request it after 14 days old; for those with other signs/symptoms of disease, only 69.1% of physicians would request it immediately. Multiple linear regression analysis identified specialization as an independent variable significantly associated with the ability to recognize pale stools. A significant percentage of healthcare professionals assumed clinical practices that preclude the timely recognition of cholestasis/pale stools, reinforcing the idea of educational needs. Specialization, rather than years of experience of professionals, was associated with better skills and practices. What is Known: • Neonatal cholestasis is a condition with some rare underlying entities having high mortality and morbidity. Early diagnosis is crucial to improve prognosis. Yet, many cases remain late recognized and referred. • Studies evaluating the ability of healthcare professionals to recognize neonatal cholestasis are scarce. What is New: • In this study, a significant percentage of professionals assumed clinical practices that preclude timely recognition

  13. Detection of hyperbilirubinaemia in jaundiced full-term neonates by eye or by bilirubinometer?

    Science.gov (United States)

    Szabo, Peter; Wolf, Martin; Bucher, Hans Ulrich; Fauchère, Jean-Claude; Haensse, Daniel; Arlettaz, Romaine

    2004-12-01

    The aim of this study was to compare predictions of hyperbilirubinaemia by eye, performed by trained physicians and nurses, with predictions obtained using two commercial bilirubinometers. Jaundice was assessed in 92 white and 48 non-white healthy full-term neonates using three non-invasive methods and by total serum bilirubin as the reference method. Clinical assessment of cephalocaudal progression of jaundice was carried out independently by a physician and by nurses. Simultaneously, the Minolta Airshields JM-102 was applied on the sternum, the BiliCheck on both the forehead and the sternum, and finally, serum bilirubin concentrations were determined. The Minolta JM-102 showed the best performance with r2 = 0.90, an intraclass correlation coefficient (ICC) of 0.93, and a 95% confidence interval (CI) of +/- 4 units (approx. 56 micromol/l). The BiliCheck performed slightly better on the forehead than over the sternum with r2=0.90, an ICC of 0.88, and a CI of +/- 62 microtmol/l. Assessment of jaundice by eye was least accurate with r2 = 0.74, an ICC of 0.67, and a CI of +/- 1.5 zones (corresponding to 75 Lmol/l). Skin pigmentation and ambient light both adversely affected noninvasive bilirubin estimation. All three non-invasive methods are well suited for estimation of serum bilirubin but show large confidence intervals. In healthy term newborns, hyperbilirubinaemia (>250 Lmol/l) can be safely ruled out by eye if jaundice does not reach the abdomen or the extremities (Kramer zones 1 and 2), with < 22 units ( < 230 micromol/l) for the Minolta JM-102, or with a cut-off of 190 microlmol/l for the Bili-Check. If these respective thresholds are exceeded, serum bilirubin concentrations should be measured.

  14. Lead Poisoning From a Ceramic Jug Presenting as Recurrent Abdominal Pain and Jaundice

    OpenAIRE

    Mohamed, Mahmod; Ugarte-Torres, Alejandra; Groshaus, Horacio; Rioux, Kevin; Yarema, Mark

    2016-01-01

    Lead poisoning may present with non-specific symptoms that may result in unnecessary investigations. We report a case of acute lead poisoning in a previously healthy 28-year-old man who presented with recurrent abdominal pain, jaundice, constipation, and weight loss. An extensive diagnostic work-up was completed with inconclusive results. A detailed history revealed an unusual source of lead exposure. Chelation therapy resulted in substantial clinical and biochemical improvement.

  15. Evaluation of MBJ20® Transcutaneous Bilirubinometer in the Assessement of Severity of Neonatal Jaundice

    OpenAIRE

    Chinelo Madubuike; Ebele F. Ugochukwu; Obumneme Ezeanosike; John Chukwuka; Henry Okpara

    2016-01-01

    The objective of this study was to evaluate the MBJ20® transcutaneous bilirubinonometer by Beijing M&B Electronic Instrument Co. Ltd. (Beijing, China) in the assessment of severity of neonatal jaundice. Two hundred and twenty-two paired samples from 88 newborns aged between 28 and 44 weeks of gestation at Nnamdi Azikiwe University Teaching Hospital, Nnewi Anambra State, were analyzed. These infants had total serum bilirubin (TSB) levels measured on clinical indication, and transcutaneous ...

  16. Fasciola hepatica as a cause of jaundice after chewing khat: a case report.

    Science.gov (United States)

    de Bree, L C J; Bodelier, A G L; Verburg, G P

    2013-11-01

    Fasciola hepatica is a worldwide distributed zoonotic trematode incidentally infecting humans. Although often symptomatic, fascioliasis can cause a wide spectrum of disease. The diagnosis can be established by stool examination detecting ova of the parasite, although serological testing has a higher sensitivity and specificity in the acute phase of disease. This case presents a 24-year-old Somalian man admitted with jaundice and abdominal discomfort due to fascioliasis after chewing khat. The patient was treated successfully with a single dose of triclabendazole.

  17. Congenital jaundice in bovine aborted foetuses: an emerging syndrome in southern Belgium.

    Science.gov (United States)

    Delooz, L; Mori, M; Petitjean, T; Evrard, J; Czaplicki, G; Saegerman, C

    2015-04-01

    Southern Belgium faces an unusual recent increase of icteric bovine aborted foetuses. In the necropsy room, the majority of foetuses presented jaundice and splenomegaly. Despite a wide range of analyses, no definitive cause of abortion has yet been established but some analysis results support the leptospirosis hypothesis. This first description of cases will help veterinary practitioners to recognize more cases and to conduct those to the laboratory for future investigations. © 2015 Blackwell Verlag GmbH.

  18. Jaundice and bilirubinemia as manifestations of canine distemper in raccoons and ferrets

    Science.gov (United States)

    Kilham, L.; Habermann, R.T.; Herman, C.M.

    1956-01-01

    1) Two strains of distemper virus have been isolated from wild raccoons and one strain from ferrets. 2) All strains isolated have induced bilirubinemia in raccoons and ferrets. Many raccoons with bilirubinemia also had jaundice. 3) Identification of these strains as members of the canine distemper virus complex has been by clinical and pathological findings consistent with this diagnosis as well as by cross-immunity tests.

  19. Identification of the traditional methods of newborn mothers regarding jaundice in Turkey.

    Science.gov (United States)

    Aydin, Diler; Karaca Ciftci, Esra; Karatas, Hulya

    2014-02-01

    To detect traditional methods applied for the treatment of newborn jaundice by mothers in Turkey. Traditional methods are generally used in our society. Instead of using medical services, people often use already-known traditional methods to treat the disease. In such cases, the prognosis of the disease generally becomes worse, the treatment period longer and healthcare costs higher, and more medicine is used. A cross-sectional descriptive study. The participants of this study were 229 mothers with newborn babies aged 0-28 days in one university hospital and one public children's hospital in Sanliurfa. The study was conducted between March and May 2012. In this research, the Beliefs and Traditional Methods of Mothers for Jaundice Questionnaire, which was formed by searching the relevant literature, is used as a data collection tool. The data are evaluated by percentage distributions. Mothers apply conventional practices in cases of health problems such as jaundice, and application of these methods is important to mothers. Moreover, mothers reported applying hazardous conventional methods in cases of neonatal jaundice, such as cutting the area between the baby's eyebrows with a blade, cutting the back of the ear and the body and burning the body, which are not applied in different cultures. Education regarding the effects of conventional methods being applied in families should be provided, and the results of this study should serve to guide further studies in assessing the effects of such education. This approach can support beneficial practices involving individual care and prevent the negative health effects of hazardous practices. © 2013 John Wiley & Sons Ltd.

  20. Severe hyperbilirubinaemia and kernicterus: more caution is needed in newborn jaundice surveillance.

    Science.gov (United States)

    Allen, N M; Mohammad, F; Foran, A; Corcoran, D; Clarke, T

    2009-01-01

    Since the 1990s, there has been a re-emergence of cases of severe hyperbilirubinaemia and kernicterus. The current UK incidence of bilirubin encephalopathy is 0.9/100,000 with a higher reported incidence in some countries. Three otherwise healthy newborn infants, who presented with severe hyperbilirubinaemia, including one who developed kernicterus, are reported here. Some of the current challenges in newborn jaundice surveillance are highlighted.

  1. Prevention of predicted neonatal isoerythrolysis with jaundice foal agglutination test in a newborn foal

    OpenAIRE

    ÜNER, Aykut Göktürk; KAYA, Güney; OLTU, Aydın

    2014-01-01

    This case report aims to highlight the utility of the jaundice foal agglutination (JFA) test used in the prevention of neonatal foal death caused by equine neonatal isoerythrolysis. The colostrum and the serum of a Friesian mare with repeated neonatal foal deaths and the whole blood of her newborn foal were tested for 5 days with the JFA test to detect a probable incompatibility. For the first 2 days, the JFA test gave a significantly positive reaction, indicating the existence of antibodies ...

  2. Development of a System Model for Non-Invasive Quantification of Bilirubin in Jaundice Patients

    Science.gov (United States)

    Alla, Suresh K.

    Neonatal jaundice is a medical condition which occurs in newborns as a result of an imbalance between the production and elimination of bilirubin. Excess bilirubin in the blood stream diffuses into the surrounding tissue leading to a yellowing of the skin. An optical system integrated with a signal processing system is used as a platform to noninvasively quantify bilirubin concentration through the measurement of diffuse skin reflectance. Initial studies have lead to the generation of a clinical analytical model for neonatal jaundice which generates spectral reflectance data for jaundiced skin with varying levels of bilirubin concentration in the tissue. The spectral database built using the clinical analytical model is then used as a test database to validate the signal processing system in real time. This evaluation forms the basis for understanding the translation of this research to human trials. The clinical analytical model and signal processing system have been successful validated on three spectral databases. First spectral database is constructed using a porcine model as a surrogate for neonatal skin tissue. Samples of pig skin were soaked in bilirubin solutions of varying concentrations to simulate jaundice skin conditions. The resulting skins samples were analyzed with our skin reflectance systems producing bilirubin concentration values that show a high correlation (R2 = 0.94) to concentration of the bilirubin solution that each porcine tissue sample is soaked in. The second spectral database is the spectral measurements collected on human volunteers to quantify the different chromophores and other physical properties of the tissue such a Hematocrit, Hemoglobin etc. The third spectral database is the spectral data collected at different time periods from the moment a bruise is induced.

  3. Severe hyperbilirubinaemia and kernicterus: more caution is needed in newborn jaundice surveillance.

    LENUS (Irish Health Repository)

    Allen, N M

    2012-02-01

    Since the 1990s, there has been a re-emergence of cases of severe hyperbilirubinaemia and kernicterus. The current UK incidence of bilirubin encephalopathy is 0.9\\/100,000 with a higher reported incidence in some countries. Three otherwise healthy newborn infants, who presented with severe hyperbilirubinaemia, including one who developed kernicterus, are reported here. Some of the current challenges in newborn jaundice surveillance are highlighted.

  4. COPD (Chronic Obstructive Pulmonary Disease)

    Science.gov (United States)

    ... To Health Topics / COPD COPD Also known as Chronic Obstructive Pulmonary Disease , Emphysema Leer en español What Is Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema. COPD, or chronic obstructive ...

  5. Development and optimization of a noncontact optical device for online monitoring of jaundice in human subjects

    Science.gov (United States)

    Polley, Nabarun; Saha, Srimoyee; Singh, Soumendra; Adhikari, Aniruddha; Das, Sukhen; Choudhury, Bhaskar Roy; Pal, Samir Kumar

    2015-06-01

    Jaundice is one of the notable markers of liver malfunction in our body, revealing a significant rise in the concentration of an endogenous yellow pigment bilirubin. We have described a method for measuring the optical spectrum of our conjunctiva and derived pigment concentration by using diffused reflection measurement. The method uses no prior model and is expected to work across the races (skin color) encompassing a wide range of age groups. An optical fiber-based setup capable of measuring the conjunctival absorption spectrum from 400 to 800 nm is used to monitor the level of bilirubin and is calibrated with the value measured from blood serum of the same human subject. We have also developed software in the LabVIEW platform for use in online monitoring of bilirubin levels in human subjects by nonexperts. The results demonstrate that relative absorption at 460 and 600 nm has a distinct correlation with that of the bilirubin concentration measured from blood serum. Statistical analysis revealed that our proposed method is in agreement with the conventional biochemical method. The innovative noncontact, low-cost technique is expected to have importance in monitoring jaundice in developing/underdeveloped countries, where the inexpensive diagnosis of jaundice with minimally trained manpower is obligatory.

  6. Occurrence of acute respiratory infection, diarrhea and jaundice among Afghan pilgrims, 2010.

    Science.gov (United States)

    Saeed, Khwaja Mir Islam; Mofleh, Jawad; Rasooly, M Hafiz; Aman, M Iabal

    2012-12-01

    Annually 30,000 Afghans attend the Hajj in Saudi Arabia that is one of the largest mass gathering events in the world. We aimed to determine the prevalence of three syndromes of interest diarrhea, acute respiratory infections (ARI) and jaundice-among Hajjis gathering at the four transit sites in Afghanistan before, during, and after their voyage. A total of 1659 Hajjis at four transit sites were selected and included a cross-sectional study. Information was collected prior Hajjis departure and upon their return from Saudi Arabia regarding demographics and experience of diarrhea, ARI and jaundice. Standardized case definitions were used for the three health outcomes of interest. The occurrence of diarrhea and jaundice remained constant over time. However, ARI increased from 1.4% at pre-transit to 4% at transit area and 37% during the Hajj. ARI rates among residents from the Central and Northern regions of Afghanistan were significantly higher at the post-Hajj stage, at 50% and 69%, respectively. There was no difference in ARI by sex among Hajjis. There is a need to review the quality and effectiveness of the flu vaccine. Authorities should come up with the sound strategies to overcome ARI problems during Hajj. Copyright © 2012 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  7. Hepatitis E as a cause of acute jaundice syndrome in northern Uganda, 2010-2012.

    Science.gov (United States)

    Gerbi, Gemechu B; Williams, Roxanne; Bakamutumaho, Barnabas; Liu, Stephen; Downing, Robert; Drobeniuc, Jan; Kamili, Saleem; Xu, Fujie; Holmberg, Scott D; Teshale, Eyasu H

    2015-02-01

    Hepatitis E virus (HEV) is a common cause of acute viral hepatitis in developing countries; however, its contribution to acute jaundice syndrome is not well-described. A large outbreak of hepatitis E occurred in northern Uganda from 2007 to 2009. In response to this outbreak, acute jaundice syndrome surveillance was established in 10 district healthcare facilities to determine the proportion of cases attributable to hepatitis E. Of 347 acute jaundice syndrome cases reported, the majority (42%) had hepatitis E followed by hepatitis B (14%), malaria (10%), hepatitis C (5%), and other/unknown (29%). Of hepatitis E cases, 72% occurred in Kaboong district, and 68% of these cases occurred between May and August of 2011. Residence in Kaabong district was independently associated with hepatitis E (adjusted odds ratio = 13; 95% confidence interval = 7-24). The findings from this surveillance show that an outbreak and sporadic transmission of hepatitis E occur in northern Uganda. © The American Society of Tropical Medicine and Hygiene.

  8. The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos

    Science.gov (United States)

    Syhavong, Bounkong; Rasachack, Bouachanh; Smythe, Lee; Rolain, Jean-Marc; Roque-Afonso, Anne-Marie; Jenjaroen, Kemajittra; Soukkhaserm, Vimone; Phongmany, Simmaly; Phetsouvanh, Rattanaphone; Soukkhaserm, Sune; Thammavong, Te; Mayxay, Mayfong; Blacksell, Stuart D.; Barnes, Eleanor; Parola, Philippe; Dussaix, Elisabeth; Raoult, Didier; Humphreys, Isla; Klenerman, Paul; White, Nicholas J.; Newton, Paul N.

    2010-01-01

    Summary There is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A, B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (≥ × 3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis. PMID:20378138

  9. Treatment of malignant biliary obstruction with wallstent endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Geun Seok; Kim, Sung Woo; Kim, Won Ho; Kim, Yong Joo [Kyung-pook National University Hospital, Daegu (Korea, Republic of)

    1995-01-15

    The purpose of this study was to evaluate the patency, procedure related complications and effectiveness of Wallstent application to the malignant biliary obstruction as a palliative treatment. We retrospectively reviewed the clinical results, duration of survival, patency rate and complication of the Wallstent application on 33 patients who had had obstructive jaundice by the malignant lesion in recent 3 years. One or two step procedures were mainly taken with 10 mm diameter Wallstents. Grouping according to place the stent at the hilum or not, and grouping according to place the stent through the ampulla or not were done to evaluate the difference of the patency and survival rate between the groups. Biliary endoprosthesis with Wallstent were successfully placed in all patients without difficulty. Procedure related short-term complication rate was about 18.1% (n = 6/33). Complications were fever (n = 4), cholecystitis (n = 1) and sepsis (n = 1). Long-term complications were mainly obstruction (n = 9/31) of the Wallstent during the follow-up period. Also cholecystitis occurred in one patient 3 months later. Mean survival duration was 139.72 (46-237) days among those who expired. Mean patency duration of stents was 139.67 (26-310) days. Survival rates were 93.5% at the second month, 68.8% at the third month, 61.2% at the 4th month, 53.5% at the 5th month, 49.1% at the 7th month and 35.7% at the 9th month. Patency rates were 93.7% at the second month, 84.2% at the 4th month, 66.9% at the 5th month, 59.5% at the 7th month and 39.6% at the 10th month. The application was repeated in the 6 patients with stent occlusion. Significant statistical difference could not be found between the groups according to placing the stent at the hilum and according to placing the stent through the ampulla. Patency rates were higher than survival rates in the follow-up period. Wallstent application provides good palliation with little discomfort and few complications in the patients with

  10. Obstructive sleep apnea therapy

    NARCIS (Netherlands)

    Hoekema, A.; Stegenga, B.; Wijkstra, P. J.; van der Hoeven, J. H.; Meinesz, A. F.; de Bont, L. G. M.

    In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned

  11. adhesive intestinal obstruction

    African Journals Online (AJOL)

    2006-06-01

    Jun 1, 2006 ... ABSTRACT. Background: Adhesions after abdominal and pelvic surgery are a major cause of intestinal obstruction in the western world and the pathology is steadily gaining prominence in our practice. Objective: To determine the magnitude of adhesive intestinal obstruction; to determine the types.

  12. adhesive intestinal obstruction

    African Journals Online (AJOL)

    2006-06-01

    Jun 1, 2006 ... obstruction. Brit. I. Surg. 1998; 85: 1071-1074. The acute abdomen: Intestinal obstruction. In: Primary surgery, Vol. 1. Edited by Maurice King et al. Oxford. Med. PubL, Oxford. 1990; 142-169. Fluids and electrolyte management. In: Essentials of pediatric surgery. Edited by Marc Rowe et al. Mosby,. St. Louis ...

  13. Phenotypic assessment of pulmonary hypertension using high-resolution echocardiography is feasible in neonatal mice with experimental bronchopulmonary dysplasia and pulmonary hypertension: a step toward preventing chronic obstructive pulmonary disease.

    Science.gov (United States)

    Reynolds, Corey L; Zhang, Shaojie; Shrestha, Amrit Kumar; Barrios, Roberto; Shivanna, Binoy

    2016-01-01

    Bronchopulmonary dysplasia (BPD) and chronic obstructive pulmonary disease (COPD) are chronic lung diseases of human infants and adults, respectively, that are characterized by alveolar simplification. One-third of the infants with severe BPD develop pulmonary hypertension (PH). More importantly, PH increases morbidity and mortality in BPD patients. Additionally, COPD is a common respiratory morbidity in former BPD patients. The lack of an appropriate small animal model wherein echocardiography (Echo) can demonstrate PH is one of the major barriers to understand the molecular mechanisms of the disease and, thereby, develop rational therapies to prevent and/or treat PH in BPD patients. Thus, the goal of this study was to establish a model of experimental BPD and PH and investigate the feasibility of Echo to diagnose PH in neonatal mice. Since hyperoxia-induced oxidative stress and inflammation contributes to the development of BPD with PH, we tested the hypothesis that exposure of newborn C57BL/6J mice to 70% O2 (hyperoxia) for 14 days leads to lung oxidative stress, inflammation, alveolar and pulmonary vascular simplification, pulmonary vascular remodeling, and Echo evidence of PH. Hyperoxia exposure caused lung oxidative stress and inflammation as evident by increased malondialdehyde adducts and inducible nitric oxide synthase, respectively. Additionally, hyperoxia exposure caused growth restriction, alveolar and pulmonary vascular simplification, and pulmonary vascular remodeling. At 14 days of age, Echo of these mice demonstrated that hyperoxia exposure decreased pulmonary acceleration time (PAT) and PAT/ejection time ratio and increased right ventricular free wall thickness, which are indicators of significant PH. Thus, we have demonstrated the feasibility of Echo to phenotype PH in neonatal mice with experimental BPD with PH, which can aid in discovery of therapies to prevent and/or treat BPD with PH and its sequelae such as COPD in humans.

  14. Percutaneous transluminal biopsy using 7F forceps for diagnosing malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Bahn, Young Eun; Kim, Young Hwan; An, Eun Jung; Kim, See Hyung [Keimyung Univ. College of Medicine, Daegu (Korea, Republic of)

    2012-07-15

    To evaluate the usefulness of the percutaneous transluminal biopsy using 7-F forceps for diagnosing malignant biliary obstruction. One hundred and seven consecutive patients with obstructive jaundice underwent transluminal forceps biopsy. The lesions involved the common bile duct (n = 33), common hepatic duct (n = 13), hilum (n = 17), right or left intrahepatic bile duct (n = 32), multiple sites (extra and intrahepatic ducts, n = 7), or anastomotic sites (n = 5). In each patient, an average of three specimens was taken with 7F biopsy forceps through a transhepatic biliary drainage tract. The final diagnosis was confirmed with pathologic findings, or a clinical and radiologic follow up. The final diagnoses showed malignancies in 75 patients and benign biliary obstructions in 32 patients. Pathologic classifications of malignancies established by forceps biopsy included 67 adenocarcinomas, 1 adenosquamous cell carcinoma, and 1 hepatocelluar carcinoma. There were 6 false-negative diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstruction had a sensitivity of 92%, specificity of 100%, positive predictive value of 100%, a negative predictive value of 84.2%, and an accuracy of 94.2%. Percutaneous transluminal forceps biopsy is a safe procedure that is easy to perform through a transhepatic biliary drainage tract. It is a highly accurate technique for diagnosing malignant biliary obstructions.

  15. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    Science.gov (United States)

    Yamasaki, Shuuji

    2016-01-01

    Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails. PMID:27698669

  16. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    Directory of Open Access Journals (Sweden)

    Takashi Obana

    2016-01-01

    Full Text Available Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD. A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy, followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

  17. Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Er-jiao [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China); Zheng, Rong-qin, E-mail: zhengrq@mail.sysu.edu.cn [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China); Su, Zhong-zhen; Li, Kai; Ren, Jie; Guo, Huan-yi [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China)

    2012-12-15

    Objectives: The aimed of this study was to investigate the value of intra-biliary contrast-enhanced ultrasound (IB-CEUS) for evaluating biliary obstruction during percutaneous transhepatic biliary drainage (PTBD). Materials and methods: 80 patients with obstructive jaundice who underwent IB-CEUS during PTBD were enrolled. The diluted ultrasound contrast agent was injected via the drainage catheter to perform IB-CEUS. Both conventional ultrasound and IB-CEUS were used to detect the tips of the drainage catheters and to compare the detection rates of the tips. The obstructive level and degree of biliary tract were evaluated by IB-CEUS. Fluoroscopic cholangiography (FC) and computer tomography cholangiography (CTC) were taken as standard reference for comparison. Results: Conventional ultrasound displayed only 43 tips (43/80, 53.8%) of the drainage catheters within the bile ducts while IB-CEUS identified all 80 tips (80/80, 100%) of the drainage catheters including 4 of them out of the bile duct (P < 0.001). IB-CEUS made correct diagnosis in 44 patients with intrahepatic and 36 patients with extrahepatic biliary obstructions. IB-CEUS accurately demonstrated complete obstruction in 56 patients and incomplete obstruction in 21 patients. There were 3 patients with incomplete obstruction misdiagnosed to be complete obstruction by IB-CEUS. The diagnostic accuracy of biliary obstruction degree was 96.3% (77/80). Conclusion: IB-CEUS could improve the visualization of the drainage catheters and evaluate the biliary obstructive level and degree during PTBD. IB-CEUS may be the potential substitute to FC in the PTBD procedure.

  18. Improvement of Liver Function, Quality of Life and Survival after Insertion of Endoprosthesis in Advance Malignant Biliary Obstruction.

    Science.gov (United States)

    Ullah, A A; Rahman, A; Chowdhury, L H; Bhuiya, A H

    2017-01-01

    Obstructive jaundice due to advance malignancy is a fatal problem. It most commonly occurs at the distal common bile duct or at the hilum of liver. Magnetic Resonance Cholangio Pancreatography (MRCP) and Computed Tomography (CT) are most useful in identifying the underlying cause as well as localize the position of the stricture. For those patients with unresectable disease, progressive jaundice constitutes an immediate threat to their survival, in addition to significant loss to their quality of life secondary to pruritus, malaise and cholangitis. Effective and lasting decompression of the biliary tree is a priority and consists of positioning of a biliary endoprosthesis (stent). To observe the improvement of liver function, quality of life and survival after successful insertion of endoprosthesis (stenting) in malignant biliary obstruction, a study was performed in the department of surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2013 to August 2014, in 50 patients with clinically visible jaundice and unresectable disease. There were significant (p<0.001) reductions in the levels of serum bilirubin, serum alkaline phosphatase, serum SGPT and Prothrombin time from the time of admission to 2 weeks and 3 weeks after stenting. Physical and functional quality of life was greatly improved 2-4 weeks after stenting, where emotional quality remained the same throughout the study period. Successful palliation by stenting of malignant biliary obstruction is a priority to achieve improvements in liver function, quality of life and prolong survival. Endoscopic stent placement appears to be safe, well tolerated and can be offered without delay as a primary treatment option for all patients with unresectable malignant biliary lesion.

  19. Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Seo, In Ho; Yu, Jung Rim; Mok, Young Jae; Oh, Joo Hyeong [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kwon, Se Hwan [Dept. of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Kim, Sam Soo [Dept. of Radiology, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Kim, Seung Kwon [Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2013-10-15

    To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

  20. Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988-2005.

    Science.gov (United States)

    Burke, Bryan L; Robbins, James M; Bird, T Mac; Hobbs, Charlotte A; Nesmith, Clare; Tilford, John Mick

    2009-02-01

    Recent reports have raised global concerns about a reemergence of kernicterus. Accurate information on the incidence of kernicterus is unavailable because of the rarity of the condition and the lack of a systematic surveillance strategy. We used nationally representative hospital discharge data to evaluate trends in the diagnosis and management of neonatal jaundice and the incidence of kernicterus in relation to the American Academy of Pediatrics hyperbilirubinemia clinical practice guideline. The data came from the Healthcare Cost and Utilization Project family of databases. The Nationwide Inpatient Sample and the Kids' Inpatient Database were combined to generate trend data for the years 1988-2005. All neonatal discharges with primary or secondary International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses codes for jaundice or kernicterus occurring within the first 30 days of life were selected with population incidence rates calculated from estimates of term and preterm newborn hospitalizations derived from the Healthcare Cost and Utilization Project data. To increase the reliability of identified kernicterus hospitalizations, newborns with a diagnosis of kernicterus and a procedure code for phototherapy or exchange transfusion were included as cases. Hospital diagnosis codes for kernicterus likely included a substantial number of rule-out cases, because approximately 70% did not include a procedure code for phototherapy or exchange transfusion. Including only cases with a procedure code for phototherapy or exchange transfusion resulted in 2.7 per 100000 diagnosed with kernicterus over the entire study period. A diagnosis code for jaundice was recorded for 15.6% of newborns. The diagnosis of jaundice and kernicterus differed according to race and gender. Rates also were elevated in preterm relative to term infants for both jaundice and kernicterus. Trends in diagnosis for newborn jaundice were u-shaped, with rates falling in the

  1. BiliCheck transcutaneous bilirubinometer: a screening tool for neonatal jaundice in the Chinese population.

    Science.gov (United States)

    Ho, E Y W; Lee, S Y R; Chow, C B; Chung, J W Y

    2006-04-01

    To verify the usefulness of the BiliCheck transcutaneous bilirubin meter as a screening device for neonatal jaundice in a Chinese population compared with the Minolta bilirubin meter. A prospective correlation study that compared transcutaneous bilirubin measurements with serum bilirubin levels. Obstetric ward and a neonatal unit of a regional hospital in Hong Kong. Neonates with gestation above 32 weeks with neonatal jaundice who were admitted between April 2001 and February 2002. Transcutaneous measurements of serum bilirubin obtained from the forehead and the sternum with two instruments: BiliCheck and Minolta Airshields JM 102. A total of 77 term and six near-term babies (gestation, 32-37 weeks) were recruited. The mean age at the time of data collection was 3.96 days (range, 2-9 days). The correlations between serum bilirubin and transcutaneous bilirubin measurements of the two devices at the two sites were high, with a coefficient of 0.718 (95% confidence interval, 0.610-0.800; n=100) for forehead measurements, and 0.814 (95% confidence interval, 0.740-0.870; n=99) for sternum using the Minolta Airshields JM 102; and a coefficient of 0.757 (95% confidence interval, 0.657-0.827; n=98) for forehead measurements, and 0.794 (95% confidence interval, 0.700-0.862; n=92) for sternum using the BiliCheck. For BiliCheck, a cut-off point of 250 micromol/L at the forehead and 260 micromol/L at the sternum had a specificity of 61.9% and 70.0%, respectively with a sensitivity of 100% for the detection of serum bilirubin concentrations of 250 micromol/L or higher. This level is commonly used as the level for initiation of treatment such as phototherapy. BiliCheck is a useful screening tool for neonatal jaundice in the Chinese population and is comparable with the Minolta Airshields JM 102.

  2. Effect of Probiotics on Serum Bilirubin Level in Term Neonates with Jaundice; A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Yadollah Zahed Pasha

    2017-10-01

    Full Text Available Background In recent years, tendency to use drugs has been increasing in the treatment of neonatal jaundice. Several drugs have been used since then, but the effect of probiotics on serum bilirubin level (SBL is not so clear. This study was conducted to evaluate the effect of probiotics on SBL and the duration of phototherapy in term neonates with hyperbilirubinemia. Materials and Methods: In this randomized clinical trial, we studied 150 term neonate with jaundice hospitalized for phototherapy in Amirkola Children’s Hospital, Babol- Iran, during October 5, 2016 till May 19, 2017. Eligible neonates were randomly divided into two; intervention (n=75, and control (n=75 groups. Both groups received standard conventional phototherapy, but the intervention group received 10 drop/day of probiotics (Pedilact Zisttakhmir. Co. Iran, until hospital discharge. The outcome variables were SBL and the duration of phototherapy. The data was analyzed by SPSS 22.0 and   the P 0.05.After 24, 48 and 72hours it decreased to 13.73±1.72, 10.92±1.87 and 10.25±1.32 in the intervention and 13.66±1.91, 11.01±1.69 and10.09 ±1.38 in the control groups, respectively but comparison of the amount of SBL reduction  between the two groups was not significant (P>0.05. The duration of phototherapy in the intervention group and the control group was 3.61±1.17 days and 3.72±1.18 days respectively (P>0.05. Conclusion Oral probiotics in neonates with jaundice has no significant effect on SBL and the duration of phototherapy. Further studies are needed to with longer time follow-up.

  3. Hepatobiliary transporter expression and post-operative jaundice in patients undergoing partial hepatectomy.

    Science.gov (United States)

    Bernhardt, Gerwin A; Zollner, Gernot; Cerwenka, Herwig; Kornprat, Peter; Fickert, Peter; Bacher, Heinz; Werkgartner, Georg; Müller, Gabriele; Zatloukal, Kurt; Mischinger, Hans-Jörg; Trauner, Michael

    2012-01-01

    Post-operative hyperbilirubinaemia in patients undergoing liver resections is associated with high morbidity and mortality. Apart from different known factors responsible for the development of post-operative jaundice, little is known about the role of hepatobiliary transport systems in the pathogenesis of post-operative jaundice in humans after liver resection. Two liver tissue samples were taken from 14 patients undergoing liver resection before and after Pringle manoeuvre. Patients were retrospectively divided into two groups according to post-operative bilirubin serum levels. The two groups were analysed comparing the results of hepatobiliary transporter [Na-taurocholate cotransporter (NTCP); multidrug resistance gene/phospholipid export pump(MDR3); bile salt export pump (BSEP); canalicular bile salt export pump (MRP2)], heat shock protein 70 (HSP70) expression as well as the results of routinely taken post-operative liver chemistry tests. Patients with low post-operative bilirubin had lower levels of NTCP, MDR3 and BSEP mRNA compared to those with high bilirubin after Pringle manoeuvre. HSP70 levels were significantly higher after ischaemia-reperfusion (IR) injury in both groups resulting in 4.5-fold median increase. Baseline median mRNA expression of all four transporters prior to Pringle manoeuvre tended to be lower in the low bilirubin group whereas expression of HSP70 was higher in the low bilirubin group compared to the high bilirubin group. Higher mRNA levels of HSP70 in the low bilirubin group could indicate a possible protective effect of high HSP70 levels against IR injury. Although the exact role of hepatobiliary transport systems in the development of post-operative hyper bilirubinemia is not yet completely understood, this study provides new insights into the molecular aspects of post-operative jaundice after liver surgery. © 2011 John Wiley & Sons A/S.

  4. Wrecks and Obstructions

    Data.gov (United States)

    Department of Homeland Security — In 1981, NOAA�s National Ocean Service (NOS) implemented the Automated Wreck and Obstruction Information System (AWOIS) to assist in planning hydrographic survey...

  5. Bladder outlet obstruction

    Science.gov (United States)

    ... Names BOO; Lower urinary tract obstruction; Prostatism; Urinary retention - BOO Images Kidney anatomy Female urinary tract Male ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  6. OBSTRUCTIVE NEPHROPATHY: ITS PHYSIOPATHOLOGY

    Directory of Open Access Journals (Sweden)

    Musso C

    2011-01-01

    Full Text Available Obstructive nephropathy is the functional and /or parenchymal renal damage secondary to the urinary tract occlusion at any part of it. The inducing urinary obstruction diseases can vary depending on the patient´s age and gender. There are many renal dysfunction inducing mechanisms involved in this entity: increase in the intra-luminal pressure, ureteral dilatation with ineffective ureteral peristalsis, glomerular ultrafiltration net pressure reduction, intra-renal glomerular blood flux reduction due to vasoconstriction, and local disease of chemotactic substances. Obstructive nephropathy can also lead to hypertension (vasoconstriction-hypervolemia, hyperkalemia, metabolic acidosis (aldosterone resistance, diabetes insipidus (vasopressine resistance. In conclusion, since obstructive nephropathy is a potentially reversible cause of renal dysfunction, it should always be taken into account among the differential diagnosis of renal failure inducing mechanisms.

  7. A jaundiced bodybuilder Cholestatic hepatitis as side effect of injectable anabolic-androgenic steroids.

    Science.gov (United States)

    Boks, Marije N; Tiebosch, Anton T; van der Waaij, Laurens A

    2017-11-01

    The use of anabolic steroids is prevalent in recreational athletes. This case report describes a young amateur bodybuilder who was referred to our outpatient clinic with jaundice and loss of appetite due to cholestatic hepatitis. Additional tests including a liver biopsy made it likely that the hepatitis was caused by the injectable anabolic steroid trenbolone enanthate. Cholestatic hepatitis may not be limited to the use of oral anabolic-androgenic steroids, as is widely assumed. Therefore, and because of other side effects, the recreational use of all forms of anabolic steroids should be discouraged.

  8. Severe jaundice due to coexistence of Dubin-Johnson syndrome and hereditary spherocytosis: a case report.

    Science.gov (United States)

    Korkmaz, Uğur; Duman, Ali Erkan; Oğütmen Koç, Deniz; Gürbüz, Yeşim; Dındar, Gökhan; Ensaroğlu, Fatih; Sener, Selçuk Yusuf; Sentürk, Omer; Hülagü, Sadettin

    2011-08-01

    Dubin-Johnson syndrome is a chronic, benign, intermittent jaundice, mostly of conjugated hyperbilirubinemia. The level of bilirubin is not expected to be more than 20 mg/dl in this syndrome. In this article, we report a patient who was evaluated for hyperbilirubinemia and liver function test abnormalities and diagnosed with Dubin-Johnson syndrome coexisting with hereditary spherocytosis. We suggest that other diseases should be investigated if patients with Dubin-Johnson syndrome present with severe hyperbilirubinemia. Dubin-Johnson syndrome accompanied by hemolytic diseases might also have high coproporphyrin levels (as in Rotor's syndrome) than expected in pure Dubin-Johnson syndrome.

  9. Severe jaundice due to intrahepatic cholestasis after initiating anticoagulation with rivaroxaban.

    Science.gov (United States)

    Aslan, Abdullah N; Sari, Cenk; Baştuğ, Serdal; Sari, Sevil Ö; Akçay, Murat; Durmaz, Tahir; Bozkurt, Engin

    2016-03-01

    Rivaroxaban, a highly selective direct factor Xa inhibitor, is a new oral anticoagulant approved by the US Food and Drug Administration in November 2011 for stroke prophylaxis in patients with nonvalvular atrial fibrillation. Because of its efficacy and once-a-day dosing, it is commonly preferred in patients with nonvalvular atrial fibrillation and intolerance to warfarin in clinical practice. However, it can result in some adverse effects such as bleeding, rashes and liver injury. Here, we described a very rare adverse reaction of rivaroxaban, jaundice due to intrahepatic cholestasis, appeared in a 71-year-old male patient after taking rivaroxaban.

  10. Treatment of malignant gastroduodenal obstruction with using a newly designed complex expandable nitinol stent: initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Mi Hee; Ko, Ji Ho; Lee, Eun Jung; Oh, Kyeng Seung; Huh, Jin Do; Cho, Young Duk; Park, Seun Ja [College of Medicine, Kosin University, Busan (Korea, Republic of); Jung, Gyoo Sik [Ulsan Hospital, Ulsan (Korea, Republic of)

    2005-12-15

    We wanted to evaluate the usefulness of a new type of a complex expandable nitinol stent that was designed to reduce the stent's propensity to migration during the treatment of malignant gastroduodenal obstructions. Two types of expandable nitinol stent were constructed by weaving a single thread of 0.2mm nitinol wire in a tubular configuration: an uncovered stent 18mm in diameter and a covered stent 16mm in diameter. Both ends of the covered stent were fabricated by coaxially inserting the covered stent into the tubular uncovered stent and then attaching the two stents together with using nylon monofilament. Under fluoroscopic guidance, the stent was placed in 29 consecutive patients (20 men and 9 women, mean age: 65 years) who were suffering with malignant gastric outlet obstruction (n=20), duodenal obstruction (n=6) or combined obstruction (n=3). Clinical improvement was assessed by comparing the food intake capacity before and after the procedure. The complications were investigated during the follow up period. Stent placement was successful in all the patients. After stent placement, the symptoms improved in all but one patient. During the follow up, stent migration occurred in one patient (3%) at 34 days after the procedure. Despite the stent migration, the patient was able to resume a soft diet. Six patients developed recurrent symptoms of obstruction with tumor overgrowth at a mean of 145 days after the procedure; all the patients underwent coaxial placement of an additional stent with good results. One patient showed recurrence of obstruction due to tumor in-growth, and this was treated by placement of a second stent. Two patients with stent placement in the duodenum suffered from jaundice 26 days and 65 days, respectively, after their procedures. Placement of the newly designed complex expandable nitinol stent seems to be effective for the palliative treatment of malignant gastroduodenal obstructions. The new stent also seems to help overcome the

  11. A polymorphism near IL28B is associated with spontaneous clearance of acute hepatitis C virus and jaundice.

    Science.gov (United States)

    Tillmann, Hans L; Thompson, Alex J; Patel, Keyur; Wiese, Manfred; Tenckhoff, Hannelore; Nischalke, Hans D; Lokhnygina, Yuliya; Kullig, Ulrike; Göbel, Uwe; Capka, Emanuela; Wiegand, Johannes; Schiefke, Ingolf; Güthoff, Wolfgang; Grüngreiff, Kurt; König, Ingrid; Spengler, Ulrich; McCarthy, Jeanette; Shianna, Kevin V; Goldstein, David B; McHutchison, John G; Timm, Jörg; Nattermann, Jacob

    2010-11-01

    A single nucleotide polymorphism (SNP) upstream of the IL28B gene has been associated with response of patients with chronic hepatitis C to therapy with pegylated interferon and ribavirin and also with spontaneous clearance of acute hepatitis C in a heterogeneous population. We analyzed the association between IL28B and the clinical presentation of acute hepatitis C virus (HCV) infection in a homogeneous population. We analyzed the SNP rs12979860 in 190 women from the German anti-D cohort (infected with HCV genotype 1b via contaminated rhesus prophylaxis) and its association with spontaneous clearance. Clinical data were available in 136 women with acute infection who were also evaluated for IL28B genotype. Based on results of a TaqMan polymerase chain reaction assay, the rs12979860 SNP genotypes studied were C/C, C/T, or T/T. Spontaneous clearance was more common in patients with the C/C genotype (43/67; 64%) compared with C/T (22/90; 24%) or T/T (2/33; 6%) (P Jaundice during acute infection was more common among patients with C/C genotype (32.7%) than non-C/C patients (with C/T or T/T) (16.1%; P = .032). In C/C patients, jaundice during acute infection was not associated with an increased chance of spontaneous clearance (56.3%) compared with those without jaundice (60.6%). In contrast, in non-C/C patients, jaundice was associated with a higher likelihood of spontaneous clearance (42.9%) compared with those without jaundice (13.7%). The SNP rs12979860 upstream of IL28B is associated with spontaneous clearance of HCV. Women with the C/T or T/T genotype who did not develop jaundice had a lower chance of spontaneous clearance of HCV infection. Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

  12. The effect of clofibrate and phototherapy on physiological jaundice in term newborns

    Directory of Open Access Journals (Sweden)

    Amir Hosein Hashemian

    2011-09-01

    Full Text Available Background: Clofibrate is an effective anti lipid agent that induces glucuronyltransferase could increase bilirubin conjugation. The aim of this study was to evaluate effect of clofibrate on neonatal physiologic jaundice.Methods: Randomized clinical trial sampling method used and 60 healthy term neonates which were admitted in Imam Reza Hospital of Kermanshah-Iran because of indirect hyperbilirubinemia enrolled into the study. 30 neonates (case group were treated with single oral dose of clofibrate (100/mg plus phototherapy and 30 neonates (control group received only phototherapy. Serum total and direct bilirubin levels were measured at admission, 12 hours later, and then every 24 hours until 96 hours. Results: There were no significant difference between two groups regarding to gender, age, weight and total serum bilirubin level at the admission. Mean values for total bilirubin of serum in case group 12, 24 and 48 hours after admission were significantly lower than control group (P<0.001. The mean of needed time for phototherapy in case group was significantly less than the control group (P<0.00l.Conclusion: It seems that clofibrate plus phototherapy is effective for treatment of neonatal physiologic jaundice in healthy term newborns, although further studies are necessary for evaluation of clofibrate safety as a routine treatments.

  13. Evaluation of Minolta jaundicemeter and icterometer for assessment of neonatal jaundice.

    Science.gov (United States)

    Bhardwaj, H P; Narang, A; Bhakoo, O N

    1989-02-01

    Neonatal jaundice is an important disorder, because of its potential complication of kernicterus. Biochemical estimation of bilirubin can be unreliable with lots of interpersonal and interlaboratory variability. Minolta jaundicemeter and perspex icterometer were evaluated for their usefulness in assessment of neonatal jaundice. Thirty premature babies with hyperbilirubinemia were simultaneously studied with jaundicemeter, icterometer and their plasma bilirubin were estimated by AO Bilirubinometer. Babies were subdivided into three groups, viz., Group I upto 1500 g birth weight, Group II 1501-2500 g with gestation 33-34 weeks and Group III 1501-2500 g with gestation 35-36 weeks. There was a good correlation between minolta Jaundicemeter and plasma bilirubin with 'r' values of 0.84, 0.89 and 0.72 in Groups I, II and III, respectively. Except for Group III (r = 0.67), good correlation was found between icterometer and plasma bilirubin with 'r' value of 0.84 and 0.82 in Groups I and II, respectively.

  14. Evaluation of MBJ20® Transcutaneous Bilirubinometer in the Assessement of Severity of Neonatal Jaundice

    Directory of Open Access Journals (Sweden)

    Chinelo Madubuike

    2016-10-01

    Full Text Available The objective of this study was to evaluate the MBJ20® transcutaneous bilirubinonometer by Beijing M&B Electronic Instrument Co. Ltd. (Beijing, China in the assessment of severity of neonatal jaundice. Two hundred and twenty-two paired samples from 88 newborns aged between 28 and 44 weeks of gestation at Nnamdi Azikiwe University Teaching Hospital, Nnewi Anambra State, were analyzed. These infants had total serum bilirubin (TSB levels measured on clinical indication, and transcutaneous bilirubin (TcB levels were obtained at the forehead and sternum within 10 min of the TSB levels. There was a close correlation between TSB and TcBF and between TSB and TcBS for all the paired readings (n = 222, r = 0.904; n = 222, r = 0.917, respectively. MBJ20 values differed on average from the TSB values by 3.2 mg/dL for TcBF and 2.0 mg/dL for TcBs. We conclude that TcB measurements using the MBJ20 jaundice meter correlate very closely with TSB levels over the range of TSB encountered in this study and that estimation of TcB should be done at both the forehead and sternum.

  15. Causes of prolonged jaundice in infancy: 3-year experience in a tertiary paediatric centre.

    Science.gov (United States)

    Andre, Margaret; Day, Andrew S

    2016-01-29

    Although prolonged jaundice (PJ) commonly occurs in infancy, there is not yet agreement as to the appropriate extent of investigations, particularly in otherwise well children. Significant pathologies may present with PJ in this age group and need to be considered. The aim of this retrospective study was to ascertain the causes of PJ in infants referred to a single tertiary paediatric centre. Infants referred with PJ over a 3-year period were identified. Clinical documentation, electronic notes and results of investigations performed prior to and after referral were reviewed. One hundred and sixty-seven infants with PJ were seen. Fifty-eight percent were over 28 days of age. Four patients had conjugated hyperbilirubinaemia. Eighteen percent of patients were found to have a specific medical diagnosis causing or contributing to PJ, almost half of whom had normal clinical examination. The single most common pathological cause for PJ was hypothyroidism found in six patients. This study demonstrates that normal clinical examination and exclusion of conjugated hyperbilirubinaemia are insufficient to exclude pathological causes of PJ. Overall, these children were referred late. Guidelines, in conjunction with education initiatives, are required to optimise the management of prolonged jaundice in infancy.

  16. Therapeutic effect of turquoise versus blue light with equal irradiance in preterm infants with jaundice.

    Science.gov (United States)

    Ebbesen, Finn; Madsen, Poul; Støvring, Søren; Hundborg, Heidi; Agati, Giovanni

    2007-06-01

    To compare the efficiency of turquoise light with that of TL52 blue in treatment of preterm infants with jaundice at the same level of body irradiance. Infants with gestational age 28-37 weeks and non-haemolytic hyperbilirubinemia were treated for 24 h with either turquoise light (OSRAM L18W/860 fluorescent lamps) or blue light (Philips TL20W/52 fluorescent lamps). The concentrations of serum total bilirubin and bilirubin isomers were measured by the Vitros routine method and by HPLC, respectively. The decrease in serum concentrations of total bilirubin, total bilirubin isomers and the toxic Z,Z-bilirubin was greatest for infants treated with turquoise light. Further, the increase in Z,E-bilirubin was smaller and there was a trend towards a higher rise in E,Z-bilirubin. Turquoise light has a greater bilirubin reducing effect than TL52 blue light with equal irradiance, expressed both by serum total bilirubin, total bilirubin isomers and Z,Z-bilirubin, i.e. the turquoise spectral range is more efficient than the blue. This is in accordance with deeper penetration into the skin, lower production of the Z,E-bilirubin and greater production of E,Z-bilirubin and lumirubin, in infants under turquoise light. This suggests, given equal irradiances, that light in the turquoise spectral range is preferable to the TL52 blue in treatment of newborn jaundiced infants.

  17. Neonatal Jaundice

    DEFF Research Database (Denmark)

    Maimburg, Rikke Damkjær; Væth, Michael; Schendel, Diana

    2008-01-01

    In a previous study, we found that infants transferred to a neonatal ward after delivery had an almost twofold increased risk of being diagnosed with infantile autism later in childhood in spite of extensive controlling of obstetric risk factors. We therefore decided to investigate other reasons .......7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism....

  18. Infant Jaundice

    Science.gov (United States)

    ... Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family HealthInfants and Toddlers Kids and Teens Pregnancy and ... Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family HealthInfants and Toddlers Kids and Teens Pregnancy and ...

  19. Hepatocellular Carcinoma Complicated by Gastroduodenal Obstruction: Palliative Treatment with Metallic Stent Placement

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ye Jin; Kim, Jin Hyoung, E-mail: m1fenew@daum.net; Song, Ho-Young; Park, Jung-Hoon; Na, Han Kyu; Kim, Pyeong Hwa; Fan, Yong [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center (Korea, Republic of)

    2012-10-15

    Purpose: To evaluate the clinical effectiveness of self-expandable metallic stents in seven patients with malignant gastroduodenal obstruction caused by inoperable hepatocellular carcinoma (HCC). Methods: Seven patients with gastroduodenal obstruction caused by advanced HCC underwent metallic stent placement from 2003 to 2010. These patients had total dysphagia (n = 5) or were able to eat only liquids (n = 2) before stent placement. Patients had Eastern Cooperative Oncology Group performance scores of 2 or 3, and Child-Pugh classification B or C. Results: Stent placement was technically successful in all seven patients (100%) and clinically successful in six (86%). Five patients could eat a soft diet, and one patient tolerated regular diet after stent placement. Stent-related obstructive jaundice occurred in one patient. One patient had hematemesis 11 days after stent placement. Overall mean survival was 51 days (range, 10-119 days). Stent patency was preserved in six patients with clinical success until death. Conclusion: Placement of a covered self-expandable metallic stent may offer good palliation in patients with gastroduodenal obstruction due to advanced HCC.

  20. Chronic obstructive pulmonary disease - adults - discharge

    Science.gov (United States)

    ... adults - discharge; Chronic obstructive airways disease - adults - discharge; Chronic obstructive lung disease - adults - discharge; Chronic bronchitis - adults - discharge; Emphysema - adults - ...

  1. Chronic Obstructive Pulmonary Disease (COPD)

    Science.gov (United States)

    Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease that makes it difficult to empty air out of the lungs. This difficulty in ...

  2. Occupational chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Omland, Oyvind; Würtz, Else Toft; Aasen, Tor Brøvig

    2014-01-01

    Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures....

  3. [The use of Enterogel in the combined treatment of patients with viral hepatitis B and mechanical jaundice].

    Science.gov (United States)

    Garnitskaia, L A

    1994-01-01

    Enterosgel was studied for its effect in the treatment of viral hepatitis B. No side reactions (allergic or dyspeptic) were noted in patients on enterosgel. The agent may be used in complex therapy of viral hepatitis B in the presence of mechanical jaundice.

  4. Ethnopharmacological Approaches for Therapy of Jaundice: Part II. Highly Used Plant Species from Acanthaceae, Euphorbiaceae, Asteraceae, Combretaceae, and Fabaceae Families

    Directory of Open Access Journals (Sweden)

    Devesh Tewari

    2017-08-01

    Full Text Available In many developing countries, jaundice is the common symptom of hepatic diseases which are a major cause of mortality. The use of natural product-based therapies is very popular for such hepatic disorders. A great number of medicinal plants have been utilized for this purpose and some facilitated the discovery of active compounds which helped the development of new synthetic drugs against jaundice. However, more epidemiological studies and clinical trials are required for the practical implementation of the plant pharmacotherapy of jaundice. The focus of this second part of our review is on several of the most prominent plants used against jaundice identified in the analysis performed in the first part of the review viz. Andrographis paniculata (Burm.f. Nees, Silybum marianum (L. Gaertn., Terminalia chebula Retz., Glycyrrhiza glabra L. and some species of genus Phyllanthus. Furthermore, we discuss their physiological effects, biologically active ingredients, and the potential mechanisms of action. Some of the most important active ingredients were silybin (also recommended by German commission, phyllanthin and andrographolide, whose action leads to bilirubin reduction and normalization of the levels of relevant serum enzymes indicative for the pathophysiological status of the liver.

  5. Obstructive Uropathy in Sudanese Patients

    Directory of Open Access Journals (Sweden)

    El Imam M

    2006-01-01

    Full Text Available In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66% patients presented with chronic obstruction and 175 (34% with acute obstruction. Of the study patients, 210 (40% presented with significant renal impairment; 50 (23% of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.

  6. Resistive Index in Obstructive Uropathy

    NARCIS (Netherlands)

    A.A. Shokeir

    1999-01-01

    textabstractThe diagnosis of urinary tract obstruction is a difficult and perplexing problem particularly in children. Pyelocalyectasis is seen not only in obstruction but also in other conditions, such as residual dilatation afler relief of obstruction, vesicoureteral reflux and pyelonephritis.

  7. Epidemiology and Risk Factors for Neonatal Jaundice in Infants Admitted to NICU of Imam Sajjad Hospital, Yasooj

    Directory of Open Access Journals (Sweden)

    Z. Mahmodi

    2016-01-01

    Full Text Available Introduction & Objective: Jaundice is a common problem in infants in the first days after birth. Jaundice due to serious complications such as kernicterus requires special attention. The objective of this study was to determine the prevalence and risk factors affecting neonatal jaundice. Material & Methods: In this cross-sectional study of 579 infants admitted to the Imam Sajjad Yasouj hospital in 2014 were studied using, convenience non_probability sampling method. By reviewing data type and RH, hemoglobin, G6PD, direct Coombs test - total bilirubin, unconjugated bilirubin was extracted. Gender, weight, gestational age, Apgar score, method of delivery, number of previous breast feeding and jaundice in infants were examined. Using SPSS software, descriptive statistics and independent t-test, ANOVA and chi score ,data analysis was performed. Result: In this study on 3461 newborns, 579 infants (72.16% had jaundice. G6PD deficiency in infants was 12.95%. In this study, the prevalence of risk factors for premature yellowing was ABO incompatibility and G6PD deficiency pre-maturity, pottery hematoma, and RH incompatibility, respectively. Of total number of 579 cases, 58.2% were born through normal vaginal delivery and the rest through cesarean section and also 53.2% were boys and the rest were girls. The most common blood groups were A and AB and the most common blood group of mothers was O. The mothers’ mean gestational age was 38± 2 . Among infants with jaundice, 15.9% were premature (35-37week and 3.45% (20 cases suffered from neonatal infections due to their mothers’ infection during pregnancy. There was no significant relationship between sex, type of delivery, birth weight, Apgar score, history of mothers’ drug use in the birth prevalence of premature hepatitis (P> 0.05. But, a significant relationship between the frequency of breast-feeding, pre-maturity, ABO incompatibility and G6PD and jaundice was found (P<0.05. Conclusion: The

  8. Biliary obstruction caused by intra-biliary tumor growth from recurred hepatocellular carcinoma after radiofrequency ablation: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Ji Hyun; Kim, Jae Won [Dept. of Radiology, Yeungnam University College of Medicine, Daegu (Korea, Republic of)

    2014-04-15

    A 59-year-old man with a known central hepatocellular carcinoma (HCC) underwent a trans-arterial-chemo-embolization (TACE) and a post-TACE percutaneous radiofrequency ablation (PRFA). Two months after the PRFA, the patient presented jaundice and an abdominal computed tomography was obtained. An arterial enhancing mass adjacent to the ablated necrotic lesion with a continuously coexisting mass inside the right hepatic duct, suggestive of a HCC recurrence with a direct extension to the biliary tract was found. Finally a biliary tumor obstruction has been developed and a percutaneous transhepatic biliary drainage was performed. This case of biliary obstruction caused by directly invaded recurred HCC after PRFA will be reported because of its rare occurrence.

  9. Inducible laryngeal obstruction

    DEFF Research Database (Denmark)

    Halvorsen, Thomas; Walsted, Emil Schwarz; Bucca, Caterina

    2017-01-01

    Inducible laryngeal obstruction (ILO) describes an inappropriate, transient, reversible narrowing of the larynx in response to external triggers. ILO is an important cause of a variety of respiratory symptoms and can mimic asthma. Current understanding of ILO has been hampered by imprecise nomenc...

  10. Obstructive sleep apnea

    DEFF Research Database (Denmark)

    Jennum, Poul; Tønnesen, Philip; Ibsen, Rikke

    2017-01-01

    OBJECTIVE: Most studies have used cardiovascular and cerebrovascular disease (CVD) end-points to measure the effect of continuous positive airway pressure (CPAP), but pre-diagnostic morbidities involve a range of comorbidities that may influence the consequences of obstructive sleep apnea (OSA). We...

  11. Idiopathic Pulmonary Hemosiderosis Presenting as Anemia, Failure to Thrive, and Jaundice in a Toddler.

    Science.gov (United States)

    Chen, Carol C; McManemy, Julie K; Vece, Timothy J; Cruz, Andrea T

    2016-04-01

    Idiopathic pulmonary hemosiderosis (IPH) is a rare disease characterized by the triad of hemoptysis, pulmonary infiltrates on chest radiograph, and anemia. Its diagnosis should be considered in any child presenting with moderate to severe anemia and failure to thrive of unclear etiology. Consideration of the differential diagnosis in such a child should include the review of both extravascular and intravascular causes of hemolysis. Systemic treatment of IPH with glucocorticoids has been shown to decrease morbidity, mortality, and disease progression to pulmonary fibrosis. Thus, diagnostic delays can impact prognosis. Here, we present a case of a 15-month-old boy with IPH who presented with anemia, jaundice, and failure to thrive, as well as a history of hemoptysis that was not initially elicited.

  12. Laser Transcutaneous Bilirubin Meter: A New Device For Bilirubin Monitoring In Neonatal Jaundice

    Science.gov (United States)

    Hamza, Mostafa; Hamza, Mohammad

    1988-06-01

    Neonates with jaundice require monitoring of serum bilirubin which should be repeated at frequent intervals. However, taking blood samples from neonates is not always an easy job, plus being an invasive and traumatising procedure with the additional risk of blood loss. In this paper the authors present the theory and design of a new noninvasive device for transcutaneous bilirubinometry, using a differential absorption laser system. The new technique depends upon illuminating the skin of the neonate with radiation from a two wave-length oscillation laser. The choice of the wavelengths follows the principles of optical bilirubinometry. For obtaining more accurate measurements, different pairs of two wave-lengths are incorporated in the design. The presence of hemoglobin is corrected for by appropriate selection of the laser wavelengths. The new design was tested for accuracy and precision using an argon ion laser. Correlation study between serum bilirubin determination by laser transcutaneous bilirubinometry and by American optical bilirubinometer was highly significant.

  13. Prolonged hepatitis and jaundice: a rare complication of paediatric Epstein-Barr virus infection.

    Science.gov (United States)

    Tan, Zhen Han; Phua, Kong Boo; Ong, Christina; Kader, Ajmal

    2015-07-01

    We herein report the case of a 14-year-old girl with Epstein-Barr virus (EBV) infectious mononucleosis who developed prolonged hepatitis and jaundice. At presentation, she had tender hepatomegaly with a markedly deranged liver function test. Abdominal ultrasonography showed hepatomegaly and a thickened gallbladder wall. During the subsequent 11 weeks, her transaminases showed two further peaks, which corresponded with clinical deterioration. Her highest alanine transaminase level was 1,795 µ/L and total bilirubin level was 154 µmol/L. She recovered fully with conservative management. EBV-related liver involvement is typically mild and self-limiting. We believe that tender hepatomegaly and gallbladder thickening may be important predictors of significant liver involvement. Although multiple transaminase peaks may occur, we do not consider this an indication for antiviral or immunosuppressive therapy. In the absence of strong evidence supporting the use of any specific therapy, we recommend a conservative approach for an immunocompetent patient.

  14. The influence of zinc sulfate on neonatal jaundice: a systematic review and meta-analysis.

    Science.gov (United States)

    Yang, Li; Wu, De; Wang, Baotian; Bu, Xiaosong; Tang, Jiulai

    2018-05-01

    Zinc sulfate may be a promising approach to treat neonatal jaundice. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of zinc sulfate on hyperbilirubinemia among neonates. PubMed, EMbase, Web of science, EBSCO, Cochrane library databases, Ovid, BMJ database, and CINAHL were systematically searched. Randomized controlled trials (RCTs) assessing the effect of zinc sulfate versus placebo on the prevention of jaundice in neonates were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were total serum bilirubin (TSB) on three days and seven days, the incidence of hyperbilirubinemia. Meta-analysis was performed using random- or fixed-effect models. Five RCTs involving 645 patients were included in the meta-analysis. Overall, compared with placebo, zinc sulfate supplementation failed to significantly reduce TSB on three days (mean difference (MD) = 0.09 mg/dL; 95% confidence interval (CI) = -0.49 to 0.67; p = .77), TSB on seven days (MD = -0.37 mg/dL; 95% CI = -98 to 0.25; p = .25) as well as the incidence of hyperbilirubinemia (OR = 1.14; 95% CI = 0.74 to 1.76; p = .56). Zinc sulfate showed no influence on phototherapy requirement (OR = 0.90; 95% CI = 0.41 to 1.98; p = .79), but resulted in significantly decreased duration of phototherapy (MD = -16.69 h; 95% CI = -25.09 to -8.3 h; p < .0001). Zinc sulfate could not reduce the TSB on three days and seven days, the incidence of hyperbilirubinemia and phototherapy requirement, but lead to significantly decreased duration of phototherapy.

  15. Biliverdin-induced brainstem auditory evoked potential abnormalities in the jaundiced Gunn rat.

    Science.gov (United States)

    Rice, Ann C; Shapiro, Steven M

    2006-08-30

    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.

  16. Follow-up of neonatal jaundice in term and late premature newborns.

    Science.gov (United States)

    Facchini, Fernando P; Mezzacappa, Maria Aparecida; Rosa, Izilda R; Mezzacappa Filho, Francisco; Aranha-Netto, Abimael; Marba, Sergio Tadeu

    2007-01-01

    To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. Neonates were referred to the follow-up clinic with weight >/= 2,000 g and/or gestational age >/= 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram developed by Bhutani. All infants treated with phototherapy while in hospital were reassessed by laboratory methods 24 hours after withdrawal of treatment. Patients were rehospitalized for intensive phototherapy if their level was greater than or equal to 20 mg/dL. From a total sample of 11,259 neonates, 2,452 (21.8%) were referred to the follow-up clinic, 87.2% (2,140) of whom did return. Eighty returned neonates were readmitted. Return appointments were set for 2,452 patients, 180 (7.3%) of whom had bilirubinemia >/= 15 mg/dL at discharge. Of these 180, 151 returned for follow-up. Twenty (13.2%) were readmitted for treatment. Of the total number of readmitted patients, two newborn infants had levels >/= 25 mg/dL and none >/= 30 mg/dL. All responded rapidly to intensive phototherapy, and there was no need for exchange transfusions. Our results suggest that the regime adopted is effective for detecting and preventing hyperbilirubinemia at risk of causing bilirubin-induced encephalopathy in term and near term newborn infants.

  17. Imaging of obstructive azoospermia

    Energy Technology Data Exchange (ETDEWEB)

    Cornud, F. [Clinique Radiologique, 15 Avenue Robert Schuman, F-75 007 Paris (France)]|[Service de Radiologie, Hopital Necker, 169 rue de Sevres, F-75 015 Paris (France); Belin, X. [Clinique Radiologique, 15 Avenue Robert Schuman, F-75 007 Paris (France)]|[Service de Radiologie, Hopital Necker, 169 rue de Sevres, F-75 015 Paris (France); Delafontaine, D. [Medicine de la Reproduction, 8 rue Jean Richepin, F-75 016 Paris (France); Amar, T. [Uro-Andrologist, 19 Avenue Victor Hugo, F-75016, Paris (France); Helenon, O. [Service de Radiologie, Hopital Necker, 169 rue de Sevres, F-75 015 Paris (France); Moreau, J.F. [Service de Radiologie, Hopital Necker, 169 rue de Sevres, F-75 015 Paris (France)

    1997-09-01

    Obstructive azoospermia represents approximately 10 % of cases of male hypofertility. It is classified according to the volume of ejaculate. When the latter is normal a proximal obstruction is suspected. Scrotal sonography can help to detect dilation of the epididymal head when clinical findings are equivocal. Ejaculatory duct obstruction (EDO) is suspected when the volume of ejaculate is low. The use of transrectal ultrasonography (TRUS) plays a major role in the investigation of these patients, and endorectal MRI is a very useful adjunct in selected cases. The most common cause of EDO is congenital bilateral absence of vas deferens, which is now thought to be a genital form of cystic fibrosis in 80 % of cases. Consequently, a definitive diagnosis must be made before any attempt at in vitro fertilization. TRUS accurately visualizes abnormalities of the caudal junction of the vas deferens and seminal vesicles, yielding a definitive diagnosis without scrototomy. Other causes of EDO are congenital cysts compressing the distal part of the ejaculatory ducts and inflammatory distal stenosis. The former are accurately identified by TRUS, but the latter give more or less marked signs of obstruction which are only of value in azoospermic patients with a low-volume ejaculate. More invasive imaging is required to diagnose partial obstruction of the ED. Surgical vasography is still the reference, but puncture of the seminal vesicles under TRUS guidance is an attractive alternative, as it permits aspiration of seminal fluid (to seek motile sperm) and vasography without scrototomy. Lastly, endorectal MRI well assesses the relationships between the proximal prostatic urethra and the posterior wall of the ejaculatory ducts, which need to be precisely known when endoscopic resection of the ejaculatory ducts is planned. (orig.). With 9 figs.

  18. Phototherapy with blue and green mixed-light is as effective against unconjugated jaundice as blue light and reduces oxidative stress in the Gunn rat model.

    Science.gov (United States)

    Uchida, Yumiko; Morimoto, Yukihiro; Uchiike, Takao; Kamamoto, Tomoyuki; Hayashi, Tamaki; Arai, Ikuyo; Nishikubo, Toshiya; Takahashi, Yukihiro

    2015-07-01

    Phototherapy using blue light-emitting diodes (LED) is effective against neonatal jaundice. However, green light phototherapy also reduces unconjugated jaundice. We aimed to determine whether mixed blue and green light can relieve jaundice with minimal oxidative stress as effectively as either blue or green light alone in a rat model. Gunn rats were exposed to phototherapy with blue (420-520 nm), filtered blue (FB; 440-520 nm without 1.00), respectively. Blue plus green phototherapy is as effective as blue phototherapy and it attenuates irradiation-induced oxidative stress. Combined blue and green spectra might be effective against neonatal hyperbilirubinemia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Evaluation of the causes of neonatal jaundice, based on the infant’s age at disease onset and age at hospital admission

    Directory of Open Access Journals (Sweden)

    Hassan Boskabadi

    2016-01-01

    Full Text Available Background: Jaundice is the most common cause of neonatal admission within the first month after birth. Therefore, by identifying the causes of jaundice based on the infant’s age at disease onset and age at hospital admission and providing the required training, jaundice can be managed and its associated complications can be prevented. This study was performed to evaluate the causes of neonatal jaundice, based on the infant’s age at disease onset and age at hospital admission. Methods: In this cross-sectional study, out of 3,130 infants with jaundice, referring to Ghaem Hospital, Mashhad, Iran, from 2003 to 2015, 2,658 newborns were selected. Causes of jaundice are determined based on hematocrit, direct and indirect bilirubin, Coombs test, reticulocyte count, blood group and Rh of mother and neonate, thyroid tests, glucose-6-phosphate dehydrogenase (G6PD enzyme testing, urinalysis, urine culture, and If necessary, Na, blood urea nitrogen, creatinine and other tests depending on the doctor's supervision. After confirming jaundice in infants, based on the physician’s diagnosis and laboratory results, a researcher-made questionnaire including the infant’s characteristics, was completed. Results: Based on our study, 27.9% of infants had identified as causes of jaundice. Known causes of jaundice were blood group incompatibility (40%, infection (19%, G6PD enzyme deficiency (12%, endocrine disorders (8%, neonatal hypernatremic dehydration (7%, polycythemia (6%, congenital heart disease (CHD (4%, occult bleeding (3% and Crigler-Najjar syndrome (2%. The most common time of hospital admission of jaundice was 4-6 days after birth due to blood incompatibilities, occult bleeding, endocrine disorders, hypernatremic dehydration, CHD, polycythemia and G6PD enzyme deficiency. Moreover, the most common time of admission due to infection was after the first week of birth. Conclusion: The most common age of onset of jaundice was first three days of birth

  20. Accuracy of Contrast-Enhanced Ultrasound in the Diagnosis of Bile Duct Obstruction

    Science.gov (United States)

    Fontán, F. J. P.; Reboredo, Á. R.; Siso, A. R.

    2015-01-01

    Purpose: To investigate the ability of contrast-enhanced ultrasound (CEUS) to differentiate benign from malignant lesions causing biliary duct obstruction. Materials and Methods: Between November 2006 and December 2013, 59 patients with bile duct obstruction of undetermined cause in baseline ultrasound underwent CEUS study. The enhancement and posterior washout were analyzed in real time all along the study duration (5′). The final diagnosis suggested by CEUS was compared with histologic diagnosis (47.5%) or with radiologic follow-up with TC, RM or ERCP. Results: Final diagnoses included 42 malignant lesions (cholangiocarcinoma n=22, metastases n=6, pancreatic carcinoma n=6, hepatocarcinoma n=4, gallbladder carcinoma n=2, ampullary carcinoma n=1 and lymphoma n=1) and 17 benign lesions (lithiasis or biliary sludge n=15, xanthogranulomatous cholecystitis n=1 and indeterminate n=1). CEUS accuracy compared with final diagnoses based on combined reference standard was 86.4%. CEUS correctly identified 36 of 42 malignant lesions (sensibility 85.7%) and 15 of 17 benign lesions (specificity 88.2%). The positive predictive value of CEUS for malignancy was 94.7%, while the negative predictive value was 71.4%. Conclusion: CEUS is useful to differentiate between benign and malignant causes of obstructive jaundice. This technique improves the detection of bile duct invasion in hepatic neoplasms and permits better evaluation of intra- and extraductal extension of hilar hepatobiliary tumors. PMID:27689143

  1. Improved transcutaneous bilirubinometry: comparison of SpectR(X) BiliCheck and Minolta Jaundice Meter JM-102 for estimating total serum bilirubin in a normal newborn population.

    Science.gov (United States)

    Robertson, Alex; Kazmierczak, Steve; Vos, Paul

    2002-01-01

    To compare a new transcutaneous bilirubinometer, which uses multiple wavelength analysis of reflectance data (BiliCheck system), and the commonly used two-wavelength bilirubinometer (Jaundice Meter JM-102) to estimate serum bilirubin. Jaundiced newborn term infants (101 babies) had transcutaneous bilirubinometry (TCB) using each bilirubinometer, a determination of skin color using a skin color chart, and a total serum bilirubin determination. The variability of the BiliCheck system was less than the variability of the Jaundice Meter JM-102. The accuracy of the BiliCheck system was not affected by skin color, whereas the Jaundice Meter JM-102 was affected. Multiple wavelength analysis, as used in the BiliCheck system, is a significant improvement in TCB.

  2. Family socio-demographic factors and maternal obstetric factors influencing appropriate health-care seeking behaviours for newborn jaundice in Sagamu, Nigeria.

    Science.gov (United States)

    Ogunlesi, Tinuade A; Ogunlesi, Funmilayo B

    2012-04-01

    Poor care-seeking behaviour of families may be responsible for the high prevalence of complications of newborn jaundice in the developing world. To examine the influence of family socio-demographic characteristics and maternal obstetric factors on health care-seeking behaviours for newborn jaundice and the inter-relationship between this behavior and severity of newborn jaundice. Mothers whose babies were referred to a Nigerian tertiary hospital with jaundice were studied in a cross-sectional survey for appropriate health-care seeking behaviours as well as the need for exchange transfusion and the occurrence of kernicterus in their babies. Out of 182 mother-baby pairs, 127 (69.8%) mothers recognized jaundice in their infants, 34.1% delayed care for ≥48 h, 40.6% sought medical care in orthodox health facilities while 20.9% did not seek care outside the home. In all, 61.5% mothers administered various medications to jaundiced babies. Appropriate health care-seeking behaviours were recorded among 28.6% mothers. Low maternal education had a significant relationship with delayed health care-seeking and the use of home remedies for newborn jaundice. A significantly higher proportion of babies who had home remedies had delayed care. Delayed care for ≥48 h was also significantly associated with high Total Serum Bilirubin on admission, higher requirement for exchange transfusion and higher occurrence of kernicterus. Intensive health education of families may help improve their health care-seeking behaviours for neonatal jaundice.

  3. Predisposing factors for neonatal jaundice in patients discharged from neonatal ICU, in los Ángeles children’s Hospital in Pasto

    OpenAIRE

    Angie Lizeth Galíndez-González; Sara Raquel Carrera-Benavides; Angely Alejandra Díaz-Jiménez; Mavir Bibiana Martínez-Burbano

    2017-01-01

    Introduction: Neonatal jaundice is one of the most common conditions in newborns; however, improper treatment can be harmful to the patient, despite being benign. Objective: To determine the predisposing factors of neonatal jaundice in patients discharged from the neonatal ICU of Los Angeles children's Hospital in the city of Pasto (Nariño) between January 2007and August 2011. Materials and methods: An observational, descriptive, retrospective and quantitative study was conducted. 608 clinica...

  4. Cicatrização de anastomoses colônicas na vigência de obstrução intestinal: Estudo experimental em ratos The effect of colon obstruction on colonic anastomotic healing

    Directory of Open Access Journals (Sweden)

    Bezuti MT

    2002-01-01

    can be noticed and the colonic obstruction has been as one of the main factors. OBJECTIVE: Study the anastomotic healing in the colon of rats after intestinal obstruction. METHODS: The animals (n=39 were divided in: Group I (submitted to intestinal obstruction induced four days before of the anastomoses, n=22 and Group II (Controls, n=22. The colonic anastomosis were made by a standardized technique and, seven days later, the segments which them were reviewed, resected and analyzed for a hydroxyproline dosage. RESULTS: The complications were more usual in the animals with obstruction (11 rats: 50% than in the controls (3 rats: 17,7%, p0,05. CONCLUSION: The anastomosis in the rat's colon with intestinal obstruction is related to more complications. This can be explained by the following factor's: more technical difficulty in the preparation of the anastomosis caused by different diameter of the bowel, higher undernourishment, proximal faecal retention, bacterial translocation and ischaemia. The statistical similarity between the groups regarding to the dosage of hydroxyproline suggests that the healing of the rats' colonic anastomosis with intestinal obstruction, in the absence of complications, follows the same process of collagen synthesis as the controls ones.

  5. The Value of Bilicheck® as a Screening Tool for Neonatal Jaundice in the South of Iran

    OpenAIRE

    Fariba Hemmati; Neamat Allah Kiyani Rad

    2013-01-01

    The gold standard to assess jaundice in neonates is the serum bilirubin measurement. Blood sampling for the determination of total serum bilirubin (TSB) is painful for newborns and stressful for parents. The Bilicheck?, a new transcutaneous bilirubinometer, is considered as a more accurate measurement of bilirubin compared to the previous bilirubinometers courtesy of its advanced technology. The objective of this study was to evaluate the correlation between transcutaneous bilirubin (TcB) mea...

  6. Randomised clinical trial: enteral nutrition does not improve the long-term outcome of alcoholic cirrhotic patients with jaundice.

    Science.gov (United States)

    Dupont, B; Dao, T; Joubert, C; Dupont-Lucas, C; Gloro, R; Nguyen-Khac, E; Beaujard, E; Mathurin, P; Vastel, E; Musikas, M; Ollivier, I; Piquet, M-A

    2012-05-01

    Malnutrition and jaundice are independent prognostic factors in cirrhosis. To assess the impact of enteral nutrition on the survival of alcoholic cirrhotic patients with jaundice but without acute alcoholic hepatitis. The study was a multicentre prospective randomised controlled trial comparing effects of enteral nutrition vs. a symptomatic support in patients with alcoholic cirrhosis and jaundice (bilirubin ≥51 µmol/L) but without severe acute alcoholic hepatitis. A total of 99 patients were randomised to receive either the conventional symptomatic treatment (55 patients) or the symptomatic support associated with 35 kcal/Kg/day of enteral nutrition during 4 weeks followed by an oral nutritional support during 2 months (44 patients). Randomisation was stratified on nutritional status. One-year survival curves were compared using the Kaplan-Meier method and Logrank test. Populations in both arms were similar. One-year survival was similar in the overall population (27/44 patients (61.4%) in the enteral nutrition arm vs. 36/55 (65.5%) in the control arm; Logrank P = 0.60) and in the subgroup suffering from malnutrition [18/29 patients (62.1%) in the enteral nutrition arm vs. 20/32 (62.5%) in the control arm; Logrank P = 0.99]. There was no statistical difference for bilirubin, prothrombin rate, Child-Pugh score, albumin or nutritional assessment. Complications during treatment (bleeding, encephalopathy, infection) occurred in 23% of patients in the enteral nutrition group (10/44) vs. 16% (9/55) of the control patients (P = 0.59). Enteral nutrition does not improve the survival and hepatic or nutritional parameters of cirrhotic patients with jaundice. © 2012 Blackwell Publishing Ltd.

  7. Comparison of conventional phototherapy and phototherapy along with Kangaroo mother care on cutaneous bilirubin of neonates with physiological jaundice.

    Science.gov (United States)

    Goudarzvand, Laleh; Dabirian, Akram; Nourian, Manijeh; Jafarimanesh, Hadi; Ranjbaran, Mehdi

    2017-11-27

    One of the adjuvant and desirable therapies is skin contact between mother and baby or Kangaroo mother care (KMC) that is a cheap, accessible, relaxing, noninvasive and easy method. This study aimed to compare the effect of conventional phototherapy method and phototherapy along with KMC on cutaneous bilirubin in neonates with physiological jaundice. In this randomized clinical trial, all infants with physiological jaundice who referred for phototherapy to Mofid Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran were selected by convenience sampling based on inclusion criteria and were randomly assigned into two groups of conventional phototherapy (n = 35) and phototherapy along with KMC (n = 35). The results showed that there was a significant difference in the average volume of skin bilirubin before treatment with cutaneous bilirubin every 24 h after treatment (p < .001). This significant difference was present in both intervention and control groups. Although the average volume of skin bilirubin every 24 h after treatment was lower in the intervention group than the control group, this difference was not statistically significant (p = .236). Mean duration of hospitalization of infants in the intervention group was significantly lower than the control group (2.09 versus 3.03 d, p < .001). Although KMC along with phototherapy has a favorable effect on the reduction of cutaneous bilirubin in neonates with physiological jaundice, there are not significant differences in routine care. This may need to do KMC for a longer time (more than 1 h) which must be surveyed in the future studies. KMC was effective in reduction of the duration of hospitalization in jaundiced infants.

  8. Piscine reovirus, but not Jaundice Syndrome, was transmissible to Chinook Salmon, Oncorhynchus tshawytscha (Walbaum), Sockeye Salmon, Oncorhynchus nerka (Walbaum), and Atlantic Salmon, Salmo salar L.

    Science.gov (United States)

    Garver, Kyle A.; Marty, Gary D.; Cockburn, Sarah N.; Richard, Jon; Hawley, Laura M.; Müller, Anita; Thompson, Rachel L.; Purcell, Maureen K.; Saksida, Sonja M.

    2015-01-01

    A Jaundice Syndrome occurs sporadically among sea-pen-farmed Chinook Salmon in British Columbia, the westernmost province of Canada. Affected salmon are easily identified by a distinctive yellow discolouration of the abdominal and periorbital regions. Through traditional diagnostics, no bacterial or viral agents were cultured from tissues of jaundiced Chinook Salmon; however, piscine reovirus (PRV) was identified via RT-rPCR in all 10 affected fish sampled. By histopathology, Jaundice Syndrome is an acute to peracute systemic disease, and the time from first clinical signs to death is likely Salmon, Sockeye Salmon and Atlantic Salmon, intraperitoneally inoculated with a PRV-positive organ homogenate from jaundiced Chinook Salmon, developed no gross or microscopic evidence of jaundice despite persistence of PRV for the 5-month holding period. The results from this study demonstrate that the Jaundice Syndrome was not transmissible by injection of material from infected fish and that PRV was not the sole aetiological factor for the condition. Additionally, these findings showed the Pacific coast strain of PRV, while transmissible, was of low pathogenicity for Atlantic Salmon, Chinook Salmon and Sockeye Salmon.

  9. Efficacy evaluation of bifidobacterium tetragenous viable bacteria tablets-assisted blu-ray irradiation in treatment of neonatal jaundice

    Directory of Open Access Journals (Sweden)

    Qun-Ying Ma

    2016-02-01

    Full Text Available Objective: To investigate the efficacy of bifidobacterium tetragenous viable bacteria tabletsassisted blu-ray irradiation in treatment of neonatal jaundice. Methods: A total of 118 cases of children with neonatal jaundice were randomly divided into observation group (n=59 and control group (n=59, control group received blu-ray irradiation treatment alone, observation group received bifidobacterium tetragenous viable bacteria tablets-assisted blu-ray irradiation treatment and then levels of bilirubin-related indicators, nerve damage indexes and liver function indexes of two groups were compared. Results: 3 d after treatment, total serum bilirubin (TSB, direct bilirubin (DB and transcutaneous bilirubin (TCB levels of observation group were lower than those of control group and differences were statistically significant; 3 d after treatment, serum neuron specific enolase (NSE, amyloid β-protein (A β and astrocytederived protein (S100 β levels of observation group were lower than those of control group and differences were statistically significant; 3 d after treatment, alanine aminotransferase (ALT and aspartate aminotransferase (AST levels of observation group were lower than those of control group and differences were statistically significant. Conclusion: Bifidobacterium tetragenous viable bacteria tablets-assisted blu-ray irradiation has better effect in treatment of neonatal jaundice and has advantages in reducing bilirubin level, protecting nerve function and liver function and other aspects.

  10. Estimating the Burden of Maternal and Neonatal Deaths Associated With Jaundice in Bangladesh: Possible Role of Hepatitis E Infection

    Science.gov (United States)

    Halder, Amal K.; Streatfield, Peter K.; Sazzad, Hossain M.S.; Nurul Huda, Tarique M.; Hossain, M. Jahangir; Luby, Stephen P.

    2012-01-01

    Objectives. We estimated the population-based incidence of maternal and neonatal mortality associated with hepatitis E virus (HEV) in Bangladesh. Methods. We analyzed verbal autopsy data from 4 population-based studies in Bangladesh to calculate the maternal and neonatal mortality ratios associated with jaundice during pregnancy. We then reviewed the published literature to estimate the proportion of maternal deaths associated with liver disease during pregnancy that were the result of HEV in hospitals. Results. We found that 19% to 25% of all maternal deaths and 7% to 13% of all neonatal deaths in Bangladesh were associated with jaundice in pregnant women. In the published literature, 58% of deaths in pregnant women with acute liver disease in hospitals were associated with HEV. Conclusions. Jaundice is frequently associated with maternal and neonatal deaths in Bangladesh, and the published literature suggests that HEV may cause many of these deaths. HEV is preventable, and studies to estimate the burden of HEV in endemic countries are urgently needed. PMID:23078501

  11. Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jung Gu; Jung, Gyoo-Sik; Yun, Jong Hyouk [Kosin University College of Medicine, Department of Radiology, Seo-gu, Busan (Korea, Republic of); Yun, Byung Chul; Lee, Sang Uk; Han, Byung Hoon [Kosin University College of Medicine, Department of Internal Medicine, Busan (Korea, Republic of); Ko, Ji Ho [Busan Medical Center, Department of Radiology, Busan (Korea, Republic of)

    2017-10-15

    To evaluate predictive factors for false-negative diagnosis of percutaneous forceps biopsies in patients suspected of having a malignant biliary obstruction Two hundred seventy one consecutive patients with obstructive jaundice underwent percutaneous forceps biopsy. In each patient, three to five specimens (mean, 3.5 specimens) were collected from the lesion. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Univariate and multivariate logistic regression analysis was used to identify risk factors associated with false-negative diagnosis. One hundred ninety four of 271 biopsies resulted in correct diagnoses of malignancy, while 20 biopsy diagnoses were proved to be true-negative. There were 57 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 77.2%; specificity, 100%; and accuracy, 78.9%; positive predictive value, 100%, negative predictive value; 25.9%. Periampullary segment of common bile duct, intrahepatic bile duct and metastatic disease were the significant risk factors of false-negative diagnosis. Percutaneous forceps biopsy provides relatively high accuracy in the diagnosis of malignant biliary obstructions. The predictive factors of false-negative biopsy were determined to be biopsy site and origin of primary tumour. (orig.)

  12. Self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent for the palliative treatment of malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Oong; Jung, Gyoo Sik; Han, Byung Hoon; Shin, Dong Hoon [Gospel Hospital, College of Medicine, Kosin University, Busan (Korea, Republic of); Ko, Ji Ho [Masan Samsung Medical Center, Sungkyunkwan University School of Medicine, Masan (Korea, Republic of)

    2008-06-15

    We wanted to determine the technical and clinical efficacy of placing a self-expandable PTFE-covered nitinol stent for the management of inoperable malignant biliary obstruction. Thirty six patients with inoperable malignant biliary obstructions were treated by placement of self-expandable PTFE-covered nitinol stents (S and G Biotech Corporation, Seongnam, Korea). Clinical evaluation was done with assessment of the serum bilirubin and alkaline phosphatase levels, which were measured before and after stent placement within 1 week, at 1 month and at 3 months. The patient survival rate and stent patency rate were calculated with performing Kaplan-Meier survival analysis. Successful stent placement was achieved in all the patients without procedure-related complication. Pancreatitis as an early complication occurred in two cases. The serum bilirubin and alkaline phosphatase levels were significantly decreased after the procedure. During the follow-up, recurrent obstructive jaundice occurred in six cases; stent migration occurred in four cases and tumor overgrowth occurred in two cases. The survival rates were 97%, 80%, 67% and 59% at 1, 3, 6 and 9 months, respectively. The stent patency rates were 96%, 92%, 86% and 86% at 1, 3, 6 and 9 months, respectively. Self-expandable PTFE-covered nitinol stent placement seems to be technically feasible and effective for the palliative treatment of malignant biliary obstruction.

  13. Case report on babesiosis associated pre-hepatic jaundice in a malabari goat

    Directory of Open Access Journals (Sweden)

    Y. Ajith

    2017-06-01

    Full Text Available Pre-hepatic jaundice associated with babesiosis in a malabari goat and its successful management is described. The animal was presented with muco-purulent nasal discharge, dyspnoea, coughing, icteric sclera and oral mucosa, bloated abdomen, diarrhoea, hematochezia and coffee coloured urine. History of tick infestation was reported by the owner. Clinical examination revealed pyrexia, tachycardia, tachypnea, pre-scapular and pre-femoral lymphadenopathy and respiratory wheezes. Laboratory investigations revealed anaemia, neutrophilia, thrombocytopaenia, hypoproteinemia, hyperbilirubinemia and haemoglobinuria. On microscopic examination, small pyriform Babesia sp. (probably B. ovis could be detected in Giemsa stained peripheral blood smear. The animal had undergone babesicidal therapy using diminazene aceturate (3.5 mg/kg bodyweight deep IM, two doses at 48hr interval and oxytetracycline (10 mg/kg body weight once daily for 5 days, and supportive therapy using NSAIDs, polyionic isotonic fluids, antihistamines, B complex vitamins, stomachic and iron supplements. The animal made an uneventful clinical recovery after two weeks.

  14. Severe Hemolytic Jaundice in a Neonate with a Novel COL4A1 Mutation

    Directory of Open Access Journals (Sweden)

    Seiichi Tomotaki

    2016-12-01

    Full Text Available We report our experience with a preterm infant with severe hemolytic jaundice who required exchange transfusion just after birth. The patient was negative for alloimmune hemolysis as a result of maternal–fetal blood type incompatibility, and tests for inherited defects in erythrocyte metabolism, membrane function, and hemoglobin synthesis were normal. We also performed a bone marrow examination, but could not identify the cause of hemolysis. The patient had several other complications, including porencephaly, epilepsy, elevated serum levels of creatine kinase, and persistent microscopic hematuria. Later, we detected a genetic mutation in COL4A1, which was recently found to be associated with hemolytic anemia. We therefore believe that all of the patient's clinical features, including hemolytic anemia, were due to the mutation in COL4A1. Genetic testing for COL4A1 mutations is recommended in neonates who exhibit hemolytic disease of unknown etiology, especially when other complications compatible with COL4A1-related disorders are present.

  15. An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice.

    Science.gov (United States)

    Tziatzios, Georgios; Gkolfakis, Paraskevas; Papanikolaou, Ioannis S; Dimitriadis, George; Triantafyllou, Konstantinos

    2016-04-01

    Despite the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of choledocholithiasis, various complications have been described. We herein report the first case of prolonged post-ERCP jaundice due to toxicity of the contrast agent Iobitridol (®XENETIX, Guerbet, Roissy CdG Cedex, France) in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and normalization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, excluding possible remaining choledocholithiasis. Nevertheless, serum direct bilirubin increased further up to 15 mg/dL. Other potential causes of direct hyperbilirubinemia were ruled out and patient's liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.

  16. Method for Estimating Bilirubin Isomerization Efficiency in Phototherapy to Treat Neonatal Jaundice

    Science.gov (United States)

    Lisenko, S. A.; Kugeiko, M. M.

    2014-11-01

    We propose a method for quantitative assessment of the efficacy of phototherapy to treat neonatal jaundice using the diffuse reflectance spectrum for the newborn's skin, based on the analytical dependence of the measured spectrum on the structural and morphological parameters of the skin, affecting the optical conditions in the medium, and an algorithm for rapid calculation of the bilirubin photoisomerization rate in the skin tissues as a function of the structural and morphological parameters of the skin and the wavelength of the exciting radiation. From the results of a numerical simulation of the process of radiation transport in the skin, we assess the stability of our method to variations in the scattering properties of the skin and the concentrations of its optically active chromophores (melanin, oxyhemoglobin, deoxyhemoglobin). We show that in order to achieve the maximum efficacy of phototherapy, we should use light from the range 484-496 nm. In this case, the intensity of the exciting radiation should be selected individually for each newborn according to the bilirubin photoisomerization rate characteristic for it.

  17. Spectral matching research for light-emitting diode-based neonatal jaundice therapeutic device light source

    Science.gov (United States)

    Gan, Ruting; Guo, Zhenning; Lin, Jieben

    2015-09-01

    To decrease the risk of bilirubin encephalopathy and minimize the need for exchange transfusions, we report a novel design for light source of light-emitting diode (LED)-based neonatal jaundice therapeutic device (NJTD). The bilirubin absorption spectrum in vivo was regarded as target. Based on spectral constructing theory, we used commercially available LEDs with different peak wavelengths and full width at half maximum as matching light sources. Simple genetic algorithm was first proposed as the spectral matching method. The required LEDs number at each peak wavelength was calculated, and then, the commercial light source sample model of the device was fabricated to confirm the spectral matching technology. In addition, the corresponding spectrum was measured and the effect was analyzed finally. The results showed that fitted spectrum was very similar to the target spectrum with 98.86 % matching degree, and the actual device model has a spectrum close to the target with 96.02 % matching degree. With higher fitting degree and efficiency, this matching algorithm is very suitable for light source matching technology of LED-based spectral distribution, and bilirubin absorption spectrum in vivo will be auspicious candidate for the target spectrum of new LED-based NJTD light source.

  18. Severe Hemolytic Jaundice in a Neonate with a Novel COL4A1 Mutation.

    Science.gov (United States)

    Tomotaki, Seiichi; Mizumoto, Hiroshi; Hamabata, Takayuki; Kumakura, Akira; Shiota, Mitsutaka; Arai, Hiroshi; Haginoya, Kazuhiro; Hata, Daisuke

    2016-12-01

    We report our experience with a preterm infant with severe hemolytic jaundice who required exchange transfusion just after birth. The patient was negative for alloimmune hemolysis as a result of maternal-fetal blood type incompatibility, and tests for inherited defects in erythrocyte metabolism, membrane function, and hemoglobin synthesis were normal. We also performed a bone marrow examination, but could not identify the cause of hemolysis. The patient had several other complications, including porencephaly, epilepsy, elevated serum levels of creatine kinase, and persistent microscopic hematuria. Later, we detected a genetic mutation in COL4A1, which was recently found to be associated with hemolytic anemia. We therefore believe that all of the patient's clinical features, including hemolytic anemia, were due to the mutation in COL4A1. Genetic testing for COL4A1 mutations is recommended in neonates who exhibit hemolytic disease of unknown etiology, especially when other complications compatible with COL4A1-related disorders are present. Copyright © 2014. Published by Elsevier B.V.

  19. [Bile duct cysts; an unusual cause of jaundice in paediatrics. Presentation of a case series].

    Science.gov (United States)

    López Ruiz, Rocío; Aguilera Alonso, David; Muñoz Aguilar, Gemma; Fonseca Martín, Rosa

    2016-01-01

    Cysts of the bile duct or choledochal cysts are rare diseases in our area. The aetiology is unknown, with the most accepted hypothesis being a pancreatobiliary maljunction anomaly. To analyse the clinical data, diagnosis and treatment of a number of patients with choledochal cyst, as well as presenting an update on this condition. A retrospective descriptive study was performed on paediatric patients diagnosed with choledochal cyst in the last 20 years in a tertiary hospital. A total of 4 choledochal cyst cases in childhood, predominantly female, are pre- sented. The most frequent reason for consultation was vomiting, and presenting with jaundice and choluria in all cases. Patients with choledochal cyst were classified as type I in 3 cases, and one case of type IVa. In all cases surgical treatment was performed; any patient had complications to date. Cysts of the bile ducts have a low prevalence. The treatment of choice is surgical, requiring close monitoring due to the risk of cholangiocarcinoma. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Deliberate Perspectival Obstructions

    DEFF Research Database (Denmark)

    Mikkelsen, Henrik Hvenegaard; Rasmussen, Anders Emil

    2017-01-01

    This article discusses the collaborative use of what the authors call ‘perspectival obstructions’. Taking its outset in the events revolving around a series of challenges given to each other, as well as to their interlocutors, in Papua New Guinea, the article unfolds how obstructions may be tied...... may help elicit perspectives that are otherwise kept hidden (deliberately or not), such as power-relations or the occluded side of a friendship or a kinship relation. This, in turn, also poses a danger to the otherwise collaborative ideal of modern ethnographic fieldwork in literally challenging...... and affecting ‘the natives' point of view’....

  1. Pediatric Obstructive Sleep Apnea.

    Science.gov (United States)

    Ehsan, Zarmina; Ishman, Stacey L

    2016-12-01

    Screening for obstructive sleep apnea (OSA) with in-laboratory polysomnography is recommended for children with sleep disordered breathing. Adenotonsillectomy is the first-line therapy for pediatric OSA, although intranasal steroids and montelukast can be considered for those with mild OSA and continuous positive airway pressure for those with moderate to severe OSA awaiting surgery, poor surgical candidates or persistent OSA. Bony or soft tissue upper airway surgery is reasonable for children failing medical management or those with persistent OSA following adenotonsillectomy. Weight loss and oral appliance therapy are also useful. A multi-modality approach to diagnosis and treatment is preferred. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Obstructive sleep apnea.

    Science.gov (United States)

    Qureshi, Asher; Ballard, Robert D

    2003-10-01

    Obstructive sleep apnea is an increasingly well-recognized disease characterized by periodic collapse of the upper airway during sleep. This leads to either complete or partial obstruction of the airway, resulting in apneas, hypopneas, or both. This disorder causes daytime somnolence, neurocognitive defects, and depression. It affects almost every system in the body, resulting in an increased incidence of hypertension, cardiovascular disease, stroke, pulmonary hypertension, cardiac arrhythmias, and altered immune function. It also increases the risk of having an accident, presumably as a result of associated somnolence. The gold standard for the diagnosis of sleep apnea is an overnight polysomnogram. Split-night studies are becoming increasingly common and allow for quicker implementation of therapy at a reduced cost. Treatment options for sleep apnea include weight loss, positional therapy, oral devices, continuous positive airway pressure (CPAP), and upper airway surgery. CPAP is the most efficacious and widely used therapy. Its complications include nasal congestion or dryness, mask discomfort, and claustrophobia. Heated humidifiers, newer types of masks, and nasal steroids have improved tolerance of this therapy. Bilevel positive-pressure therapy can be considered for patients who find it difficult to exhale against the consistently increased pressure of CPAP. The disease requires aggressive treatment to improve quality of life and prevent its complications.

  3. Closed loop obstruction: pictorial essay.

    Science.gov (United States)

    Mbengue, A; Ndiaye, A; Soko, T O; Sahnoun, M; Fall, A; Diouf, C T; Régent, D; Diakhaté, I C

    2015-02-01

    Closed loop obstruction occurs when a segment of bowel is incarcerated at two contiguous points. The diagnosis is based on multiple transitional zones. The incarcerated loops appear in U or C form or present a radial layout around the location of the obstruction. It's very important to specify the type of obstruction because, in patients with simple bowel obstruction, a conservative approach is often advised. On the other hand, a closed loop obstruction immediately requires a surgical approach because of its high morbidity and the risk of death in case of a late diagnosis. Copyright © 2013 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  4. Influence of skin colour on diagnostic accuracy of the jaundice meter JM 103 in newborns.

    Science.gov (United States)

    Samiee-Zafarghandy, S; Feberova, J; Williams, K; Yasseen, A S; Perkins, S L; Lemyre, B

    2014-11-01

    To assess the diagnostic accuracy of the JM 103 as a screening tool for neonatal jaundice and explore differential effects based on skin colour. We prospectively compared the transcutaneous bilirubin (TcB) and serum bilirubin (TSB) measurements of newborns over a 3 month-period. Skin colour was assigned via reference colour swatches. Diagnostic measures of the TcB/TSB comparison were made and clinically relevant TcB cut-off values were determined for each skin colour group. 451 infants (51 light, 326 medium and 74 dark skin colour) were recruited. The association between TcB and TSB was high for all skin colours (rs>0.9). The Bland-Altman analysis showed an absolute mean difference between the two measures of 13.3±26.4 µmol/L with broad limits of agreement (-39.4-66.0 µmol/L), with TcB underestimating TSB in light and medium skin colours and overestimating in dark skin colour. Diagnostic measures were also consistently high across skin colours, with no clinically significant differences observed. The JM 103 is a useful screening tool to identify infants in need of serum bilirubin, regardless of skin colour. The effect of skin colour on the accuracy of this device at high levels of serum bilirubin could not be assessed fully due to small numbers in the light and dark groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Single liver lobe repopulation with wildtype hepatocytes using regional hepatic irradiation cures jaundice in Gunn rats.

    Directory of Open Access Journals (Sweden)

    Hongchao Zhou

    Full Text Available BACKGROUND AND AIMS: Preparative hepatic irradiation (HIR, together with mitotic stimulation of hepatocytes, permits extensive hepatic repopulation by transplanted hepatocytes in rats and mice. However, whole liver HIR is associated with radiation-induced liver disease (RILD, which limits its potential therapeutic application. In clinical experience, restricting HIR to a fraction of the liver reduces the susceptibility to RILD. Here we test the hypothesis that repopulation of selected liver lobes by regional HIR should be sufficient to correct some inherited metabolic disorders. METHODS: Hepatocytes (10(7 isolated from wildtype F344 rats or Wistar-RHA rats were engrafted into the livers of congeneic dipeptidylpeptidase IV deficient (DPPIV(- rats or uridinediphosphoglucuronateglucuronosyltransferase-1A1-deficient jaundiced Gunn rats respectively by intrasplenic injection 24 hr after HIR (50 Gy targeted to the median lobe, or median plus left liver lobes. An adenovector expressing hepatocyte growth factor (10(11 particles was injected intravenously 24 hr after transplantation. RESULTS: Three months after hepatocyte transplantation in DPPIV(- rats, 30-60% of the recipient hepatocytes were replaced by donor cells in the irradiated lobe, but not in the nonirradiated lobes. In Gunn rats receiving median lobe HIR, serum bilirubin declined from pretreatment levels of 5.17 ± 0.78 mg/dl to 0.96 ± 0.30 mg/dl in 8 weeks and remained at this level throughout the 16 week observation period. A similar effect was observed in the group, receiving median plus left lobe irradiation. CONCLUSIONS: As little as 20% repopulation of 30% of the liver volume was sufficient to correct hyperbilirubinemia in Gunn rats, highlighting the potential of regiospecific HIR in hepatocyte transplantation-based therapy of inherited metabolic liver diseases.

  6. Bronchiolitis with airflow obstruction.

    Science.gov (United States)

    Epler, G R

    1995-03-01

    Bronchiolar lesions are becoming increasingly recognized as an important cause of airflow obstruction. For this reason, it is helpful to have an update of the current clinical, radiographic, and immunologic perspective. Among the bronchiolar airflow disorders, diffuse panbronchiolitis is related to HLA antigen Bw54, and low-dose, long-term erythromycin appears to be effective therapy. Bronchiolitis obliterans can be classified histologically as constrictive bronchiolitis and as proliferative bronchiolitis obliterans. Idiopathic, postfume, postinfectious, and connective tissue disease bronchiolitis obliterans continue to be rare and often have a poor prognosis. Bronchiolitis obliterans associated with lung transplantation is undergoing intensive investigation with regard to pathogenesis, immunologic study, early detection, and treatment. The lesion appears to be a form of chronic organ rejection. The recognition of the distinctive differences among the bronchiolar airflow disorders by clinicians and clinical investigators is essential for improved patient care, for a greater understanding of the pathogenesis of the disorder, and for development of new therapeutic advances.

  7. Childhood Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    R Dayal

    2014-03-01

    Full Text Available Obstructive sleep apnea (OSA is a common condition in childhood and can result insevere complications if left untreated. It is showing a rising trend in India. A significantassociation with obesity has been observed; however, some children with enlargedtonsils and/or adenoids may even be underweight. The patient usually presents withsnoring and other respiratory problems like mouth breathing, choking and gaspingepisodes in night. Poor school performance and neurocognitive deficits have beenreported. Pulmonary hypertension and cor pulmonale are seen in severe cases. Besidesthe history and clinical examination, for definitive diagnosis an overnightpolysomnographic evaluation is the gold standard. In all cases, the specific treatmentranges from simple lifestyle modifications and medications to surgeries likeadenotonsillectomy. Early diagnosis is vital.Key words: Childhood OSA, Obesity, adenotonsillar hypertrophy

  8. Chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    V K Vijayan

    2013-01-01

    Full Text Available The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec to FVC (forced vital capacity ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure, hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity, bone disease (osteoporosis and osteopenia, stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease

  9. Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

    LENUS (Irish Health Repository)

    Lee, Ruth

    2011-03-01

    Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome.

  10. PROSPECTIVE STUDY OF ETIOLOGY, CLINICAL PROFILE AND OUTCOME IN PATIENTS WITH FEVER, JAUNDICE AND ACUTE KIDNEY INJURY

    Directory of Open Access Journals (Sweden)

    Pradeep

    2015-09-01

    Full Text Available OBJECTIVE: To study etiology, risk factors, various clinical and lab parameters and outcome of patients presenting with fever, jaundice and acute kidney injury. MATERIALS AND METHODS : An open prospective study was done on 100 patients presented with triad of fever, jaundice and acute kidney injury (AKI in the Depar tment of Medicine of G R Medical College and JA Group of Hospitals, Gwalior, MP from September 2011 to November 2012. Patients having temperature more than >100 0 F, serum creatinine ≥1.3 mg/dL or a 50 % increase from baseline or a reduction in urine output (documented oliguria of 6 hours, serum bilirubin >1.8 mg/dL were included in the study. A detailed history, clinical examination and investigations were done to find the cause of these derangements and all the patients were managed acc ordingly. RESULTS: A total 100 patients were included in study out of which 70% were males. Out of 100 patients, 50% were of septicemia, 34% were having malaria, 12% had acute pancreatitis and 4% patients were of dengue. Out of 50 septicemia patients, 35(7 0% were male, out of which 11(31.42% were of 56 - 65 years of age. Out of 17 deaths, 13(76% were males. Among total death, 11(22% were in septicemia followed by 5(14.70% in malaria patients. CONCLUSION: Many infectious and non - infectious diseases like malaria, septicemia, acute pancreatitis, dengue fever etc. can present with fever, jaundice and deranged renal functions. This triad of presentation is associated wi th high morbidity and mortality and the advanced age, male gender presences of anemia were the risk factors for high mortality. AKI occurs most commonly in association with P. falciparum malaria. Early diagnosis and prompt management including dialysis can reduce mortality and expedite recovery of renal function

  11. The Value of Bilicheck® as a Screening Tool for Neonatal Jaundice in the South of Iran

    Directory of Open Access Journals (Sweden)

    Fariba Hemmati

    2013-06-01

    Full Text Available The gold standard to assess jaundice in neonates is the serum bilirubin measurement. Blood sampling for the determination of total serum bilirubin (TSB is painful for newborns and stressful for parents. The Bilicheck®, a new transcutaneous bilirubinometer, is considered as a more accurate measurement of bilirubin compared to the previous bilirubinometers courtesy of its advanced technology. The objective of this study was to evaluate the correlation between transcutaneous bilirubin (TcB measurements using the Bilicheck® device and TSB in some Iranian neonates and to determine the most reliable cut-off value with the highest sensitivity and desirable specificity for bilirubin measured by the Bilicheck® on the forehead. This prospective observational study was conducted in 2011 on 560 healthy neonates with jaundice. TcB was measured using the Bilicheck® (Respironic, USA within 30 minutes of TSB measurement via direct spectrophotometry. The results were assessed by simple linear regression analysis and receiver operative characteristic curve. There was good a correlation between TcB and TSB (r=0.969, r2=0.94, and this was not affected by sex, gestational age, postnatal age, and birth weight. TSB can be calculated through the measurement of TcB and use of the linear regression equation: TSB=-0.99+1.06TcB. Sensitivity and specificity of the Bilicheck® at the most reliable cut-off value (15 mg/dl were 96.6% and 99%, respectively. The findings of the present study indicate that the Bilicheck® is a non-invasive, simple, easy, and reliable method for bilirubin measurement in neonatal jaundice, especially in neonates with bilirubin levels ≤15 mg/dl.

  12. The value of bilicheck® as a screening tool for neonatal jaundice in the South of iran.

    Science.gov (United States)

    Hemmati, Fariba; Kiyani Rad, Neamat Allah

    2013-06-01

    The gold standard to assess jaundice in neonates is the serum bilirubin measurement. Blood sampling for the determination of total serum bilirubin (TSB) is painful for newborns and stressful for parents. The Bilicheck®, a new transcutaneous bilirubinometer, is considered as a more accurate measurement of bilirubin compared to the previous bilirubinometers courtesy of its advanced technology. The objective of this study was to evaluate the correlation between transcutaneous bilirubin (TcB) measurements using the Bilicheck® device and TSB in some Iranian neonates and to determine the most reliable cut-off value with the highest sensitivity and desirable specificity for bilirubin measured by the Bilicheck® on the forehead. This prospective observational study was conducted in 2011 on 560 healthy neonates with jaundice. TcB was measured using the Bilicheck® (Respironic, USA) within 30 minutes of TSB measurement via direct spectrophotometry. The results were assessed by simple linear regression analysis and receiver operative characteristic curve. There was good a correlation between TcB and TSB (r=0.969, r(2)=0.94), and this was not affected by sex, gestational age, postnatal age, and birth weight. TSB can be calculated through the measurement of TcB and use of the linear regression equation: TSB=-0.99+1.06TcB. Sensitivity and specificity of the Bilicheck® at the most reliable cut-off value (15 mg/dl) were 96.6% and 99%, respectively. The findings of the present study indicate that the Bilicheck® is a non-invasive, simple, easy, and reliable method for bilirubin measurement in neonatal jaundice, especially in neonates with bilirubin levels ≤15 mg/dl.

  13. The Effect of the Use of Oxytocin in Labor on Neonatal Jaundice: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Robabe Seyedi

    2017-12-01

    Full Text Available Background: Neonatal Jaundice is a common problem that occurs in most preterm and term neonates. This systematic review aimed to examine the evidence for the effects of oxytocin in labor on neonatal jaundice. Materials and Methods: In this systematic review study, English databases including PubMed, Google Scholar, Embase, Cochrane Library, Scopus, Web of Sciences, and Persian databases including SID, Magiran, and Barakat Knowledge Network System Were searched from Jan 1980 to Dec 2017. Persian and English human clinical trials were targeted. The review was limited to human clinical trials examining the effect of oxytocin in labor on neonatal jaundice. The searched MESH vocabulary was "neonatal hyperbilirubinemia" OR "jaundice" in combination with "oxytocin in labor" OR "induction of labor". Two authors examined the articles separately and the disagreements were resolved through discussion. Results: Out of 583 articles searched in the databases, 440 title, 83 abstracts, and 60 full texts were reviewed, of which 5 English language articles entered the study and 4 articles entered the meta-analysis. Meta-analysis results showed that oxytocin did not affect the serum bilirubin level of the umbilical cord (Mean difference: 1.60; 95% confidence interval [CI]:-2.50 to 5.69; P=0.44; I2=78%. Furthermore, administering oxytocin in labor did not significantly affect serum bilirubin level on days 1 (-0.32; -1.36 to 0.71; P=0.54; I2=72%, and day 3 (3.75; -11.76 to 18.90; P=0.65; I2=63%, while it significantly affected serum bilirubin level on day 2 (-1.63; -2.81 to -0.45; P=0.007; I2=0%. Conclusion: The result of meta-analysis showed that the administration of oxytocin during labor does not affect serum bilirubin level on days 1 and 3, while induction of labor with oxytocin causes serum bilirubin to increase on the second postnatal day. However, due to the high heterogeneity of the studies, better designed clinical trials are recommended to achieve better

  14. Treatment of neonatal jaundice with filtered sunlight in Nigerian neonates: study protocol of a non-inferiority, randomized controlled trial.

    Science.gov (United States)

    Slusher, Tina M; Olusanya, Bolajoko O; Vreman, Hendrik J; Wong, Ronald J; Brearley, Ann M; Vaucher, Yvonne E; Stevenson, David K

    2013-12-28

    Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries, particularly in sub-Saharan Africa. The standard treatment for jaundice using conventional phototherapy (CPT) with electric artificial blue light sources is often hampered by the lack of (functional) CPT devices due either to financial constraints or erratic electrical power. In an attempt to make phototherapy (PT) more readily available for the treatment of pathologic jaundice in underserved tropical regions, we set out to test the hypothesis that filtered sunlight phototherapy (FS-PT), in which potentially harmful ultraviolet and infrared rays are appropriately screened, will be as efficacious as CPT. This prospective, non-blinded randomized controlled non-inferiority trial seeks to enroll infants with elevated total serum/plasma bilirubin (TSB, defined as 3 mg/dl below the level recommended by the American Academy of Pediatrics for high-risk infants requiring PT) who will be randomly and equally assigned to receive FS-PT or CPT for a total of 616 days at an inner-city maternity hospital in Lagos, Nigeria. Two FS-PT canopies with pre-tested films will be used. One canopy with a film that transmits roughly 33% blue light (wavelength range: 400 to 520 nm) will be used during sunny periods of a day. Another canopy with a film that transmits about 79% blue light will be used during overcast periods of the day. The infants will be moved from one canopy to the other as needed during the day with the goal of keeping the blue light irradiance level above 8 μW/cm²/nm. FS-PT will be as efficacious as CPT in reducing the rate of rise in bilirubin levels. Secondary outcome: The number of infants requiring exchange transfusion under FS-PT will not be more than those under CPT. This novel study offers the prospect of an effective treatment for infants at risk of severe neonatal jaundice and avoidable exchange transfusion in

  15. Intestinal obstruction repair - series (image)

    Science.gov (United States)

    The most common causes of intestinal obstruction in adults are adhesions, hernias, and colon cancer. Adhesions are scars that form between loops of intestine, usually caused by prior surgery, which causes such scar formation. ...

  16. OBSTRUCTION IN A 35 YEAR OLD MALE

    African Journals Online (AJOL)

    It is associated with gallstones, or alcohol abuse in 75% of cases'. ... previous history of alcohol abuse but no jaundice. He was .... in animal models“. If the operation is done earlier, when the cyst wall is not mature, it may not hold sutures making internal drainage unsuccessful. If it is done too late, complications may develop.

  17. Prevalence of significant weight loss and hypernatremia in breast feeding jaundice infants readmitted to Phramongkutklao Hospital within 1 month of age.

    Science.gov (United States)

    Suksumek, Nithipun; Pirunnet, Tanin; Chamnanvanakij, Sangkae; Saengaroon, Preyapan

    2010-11-01

    Neonatal jaundice, especially breast feeding jaundice is the most common cause of neonatal re-admission within the first month of life. Good maternal support and closed follow-up of newborn infants can promote successful breast feeding without causing any complications. To determine the rate of significant weight loss and hypernatremia in infants with breast feeding jaundice readmitted to Phramongkutklao Hospital within 1 month of age. Cross-sectional descriptive study was conducted in infants of gestational age > or = 35 weeks and birth weight > or = 2,000 grams who had breast feeding jaundice readmitted between January, 1st and December 31st, 2008. Maternal and neonatal history, laboratory result, complications and treatment were reviewed. Rates of significant weight loss and hypernatremia were calculated. The associations between weight loss and factors, serum sodium, serum bilirubin and weight loss were analyzed using Chi-square and Mann-Whitney U test. There were 30 infants in the study. 12 (40%) were male. The median gestational age and birth weight were 37 (35-40) weeks and 2,945 (2,100-3,810) grams, respectively. Three infants had significant weight loss more than 10% of birth weights. No infant had hyperbilirubinemia. Severity of weight loss was associated with weight loss at the time before discharge from hospital. Weight loss was not associated with gestational age, sex, parity, cesarean section, exclusive breast feeding, serum sodium level, and serum bilirubin level. Complications of dehydration such as hypernatremia was not observed in infants with breast feeding jaundice in this study. Maternal education, serial weight measurements and awareness of breast-feeding jaundice problems are helpful strategies to promote successful breast feeding.

  18. Efficacy of the New Double-Layer Stent for Unresectable Distal Malignant Biliary Obstruction: A Single-Center Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ken Ito

    2012-01-01

    Full Text Available Background and Aims. For distal malignant biliary obstruction in cases with short life expectancy, occlusion of plastic stents (PSs does not usually occur before death, and the application of such a procedure is considered adequate from the viewpoint of cost-effectiveness. Methods and Setting. A new commercially available DLS with side holes, a conventional DLS, and, uncovered self-expanding metal stents (SEMSs were retrospectively evaluated in patients with jaundice due to unresectable distal malignant biliary obstruction. Results. A total of 64 patients received endoscopic biliary stenting (23 patients with the new DLS, 24 patients with conventional DLS, and 17 patients with uncovered SEMS from December 2002 to August 2009. Median patency time was found to be 198 days for the new DLS group and 99 days for the conventional DLS group, revealing a significant difference between devices. There was, however, no significant difference in median patency time between the new DLS and the uncovered SEMS (198 days versus 344 days. Conclusion. The new DLS is efficient and safe and may be considered the first choice for unresectable distal malignant obstruction in cases with short life expectancy.

  19. Obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Steven D. Brass

    2011-11-01

    Full Text Available Obstructive sleep apnea (OSA affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual’s risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  20. HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

    Directory of Open Access Journals (Sweden)

    A. G. Osiev

    2015-01-01

    Full Text Available Hypertrophic cardiomyopathy (HCMP is a relatively common disease with genetic predisposition, that is widely spread irrespective of gender, race or ethnicity. The cause of this pathology are mutations of genes encoding synthesis of contracting proteins. Degree and type of mutations define clinical manifestation of the disease and its prognosis. HCMP is classified according to four main criteria: depending on morphology, presence of left ventricular outlet obstruction, pressure gradient and hemodynamic parameters. Its prevalence amounts to 1:500, and in the recent years mortality has decreased significantly to 1%. Main symptoms of HCMP include dyspnoea, dizziness, syncope, angina, and heart arrhythmias. HCMP does not manifest obligatorily with all above mentioned signs and symptoms. Presence and severity of any symptoms depend on morphological particulars of the disease. Particular attention should be paid to arrhythmias, with atrial fibrillation among them, that may cause hazardous and occasionally lethal complications. Electrocardiography and echocardiography are recognized as the “golden standard” of HCMP diagnostics, while in the recent years, magnetic resonance imaging has become a highly informative diagnostic tool. Radionuclide diagnostics is used less frequently, while physical examination and assessments have been moving backwards. At present, main strategies in HCMP include medical treatment with β-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors and anti-arrhythmics. There are two techniques for surgical treatment, i.e. myectomy by Morrow and alcohol septal ablation that is becoming increasingly popular. The article reviews literature on state-of-the-art diagnostics and treatment of HCMP patients.

  1. Light emitting diodes versus compact fluorescent tubes for phototherapy in neonatal jaundice: a multi center randomized controlled trial.

    Science.gov (United States)

    Kumar, Praveen; Murki, Srinivas; Malik, G K; Chawla, Deepak; Deorari, Ashok K; Karthi, N; Subramanian, Sreeram; Sravanthi, Jonnala; Gaddam, Pramod; Singh, S N

    2010-02-01

    To evaluate whether light-emitting diode (LED) phototherapy is as efficacious as compact fluorescent tube (CFT) phototherapy for the treatment of non-hemolytic jaundice in healthy term and late preterm neonates. Multi centre open label randomized controlled trial. Four tertiary care neonatal units. Healthy term and late preterm neonates with non-hemolytic jaundice. Single-surface LED or CFT phototherapy. Duration of phototherapy. A total of 272 neonates were randomized to receive LED (n=142) or CFT (n=130) phototherapy. The baseline demographic and biochemical variables were similar in the two groups. The median duration of phototherapy (IQR) in the two groups was comparable (26 (22-36) h vs. 25(22-36) h; P=0.44). At any time point, a similar proportion of neonates were under phototherapy in the two groups (log-rank test, P=0.38). The rate of fall of serum total bilirubin (STB) during phototherapy and the incidence of failure of phototherapy were also not different. An equal proportion of neonates had a rebound increase in STB needing restarting of phototherapy. Side effects were rare, comparable in the two groups and included hypothermia, hyperthermia, rash, skin darkening and dehydration. LED and CFT phototherapy units were equally efficacious in the management of non-hemolytic hyperbilirubinemia in healthy term and late preterm neonates.

  2. Red Cell Glucose-6-Phosphate Dehydrogenase Deficiency—A Newly Recognized Cause of Neonatal Jaundice and Kernicterus in Canada

    Science.gov (United States)

    Naiman, J. Lawrence; Kosoy, Martin H.

    1964-01-01

    Seven male newborns of Chinese, Greek and Italian origin presented with severe hemolytic jaundice due to red cell glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. In five, the hemolysis was precipitated by inhalation of mothball vapours in the home. Kernicterus was evident upon admission in six infants and was fatal in four of these. G-6-PD deficiency should be suspected as a cause of jaundice in all full-term male infants of these ethnic groups. The diagnosis can be confirmed in any hospital by the methemoglobin reduction test. In areas similar to Toronto, Canada, where these high-risk ethnic groups prevail, the following measures are recommended: (1) detection of G-6-PD deficient newborns by screening cord bloods of all infants of these ethnic groups; (2) protection of affected infants from potentially hemolytic agents such as naphthalene, certain vitamin K preparations, and sulfonamides; and (3) observation of serum bilirubin levels to assess the need for exchange transfusion for hyperbilirubinemia. ImagesFig. 1 PMID:14226101

  3. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Pantaree Aswanetmane

    2014-07-01

    Full Text Available Obstructive sleep apnea (OSA and chronic obstructive pulmonary disease (COPD are common disorders in clinical practice and are associated with significant cardiovascular morbidity. The simultaneous occurrence of OSA and COPD happens frequently and is referred to as an overlap syndrome. These patients often have very poor quality sleep and more nocturnal hypoxemia. This combination may increase the severity of metabolic complications and cardiovascular disease, and these patients have increased mortality when compared to patients with either COPD or OSA alone. The treatment of overlap syndrome should focus on both coexisting diseases and includes continuous positive airway pressure, oxygen supplementation, and medications for chronic lung disease.

  4. Obstructive mesenteric cyst is not always the cause of obstruction

    NARCIS (Netherlands)

    Rassouli-Kirchmeier, R.; Hulscher, J. B. F.; de Langen, Z. J.

    2008-01-01

    Background: In newborns presenting with clinical signs of obstruction of the small bowel, atresia of the small bowel as well as mesenteric cyst can be one of the differential diagnoses. Whereas clinically these two different diagnoses cannot be distinguished from each other, the operative therapy is

  5. Childhood intestinal obstruction in Northwestern Nigeria

    African Journals Online (AJOL)

    of childhood intestinal obstruction in this study agrees with those reportedis'gi m3 from other parts of the coun- try. Mortality from childhood intestinal obstruction is still high in our environment. References. 1. Otu AA. Tropical surgical abdominal emergencies: acute intestinal obstruction. Postgrad. Doctor (Afr) 1992; 14: 51. 2.

  6. Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature.

    Science.gov (United States)

    Barr, David A; Ramdial, Pravistadevi K

    2012-10-14

    The development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI).Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) as a cause of liver disease in patients initiating HAART, which could also cause jaundice. We report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART) for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa.All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) in the other four.In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated - in addition to epithelioid histiocytes and Langhans giant cells - neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response. In this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be useful to clinicians in low resource settings dealing with this challenging

  7. Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature

    Directory of Open Access Journals (Sweden)

    Barr David A

    2012-10-01

    Full Text Available Abstract Background The development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI.Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS as a cause of liver disease in patients initiating HAART, which could also cause jaundice. Case presentations We report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa. All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS in the other four. In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated – in addition to epithelioid histiocytes and Langhans giant cells – neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response. Conclusion In this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be

  8. The use of the head louse as a remedy for jaundice in Spanish folk medicine: an overview

    Science.gov (United States)

    2013-01-01

    Background In Spain, head lice are considered a therapeutic resource for the treatment of jaundice. All folk remedies based on the ingestion of these insects meet in the present document, previously dispersed among a large number of references. Methods An overview of the Spanish literature has been carried out. The most important databases have been consulted. All related works have been examined. Results Although the method of preparation is diverse and the dose varies, the primary recommendation is a transference ritual consisting of taking nine live lice for nine days on an empty stomach without the patient’s knowledge. This traditional knowledge survives in Spanish society, and constitutes an example of the interrelation between Spanish and Latin American folk medicines. Conclusions The survival of this therapy in the worldview of certain rural communities suggests the need to take into account the beliefs, ideas and behaviour patterns of popular culture in relation to health and disease. PMID:23876126

  9. Screening for G6PD Deficiency Among Neonates with Neonatal Jaundice Admitted to Tertiary Care Center: A Need in Disguise.

    Science.gov (United States)

    Kumar, Kishwer; Sohaila, Arjumand; Tikmani, Shiyam Sunder; Khan, Iqtidar Ahmed; Zafar, Anila

    2015-08-01

    This study was conducted to determine the association of Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency among neonates admitted with jaundice at the neonatal intensive care unit, well baby nursery and neonatal step down nursery of the Aga Khan University Hospital, Karachi, Pakistan, from January to June 2010. A total of 205 neonates following the selection criteria were included. All selected neonates have their venous blood drawn, saved in EDTA bottle and sent to laboratory of The Aga Khan University Hospital (AKUH). The laboratory results of whether G-6-PD deficiency was present or not was recorded in the proforma. G-6-PD was deficient in 19 neonates (9.3%). All neonates were male.

  10. Bacterial translocation in an experimental intestinal obstruction model: C-reactive protein reliability? Translocação bacteriana no modelo experimental de obstrução intestinal: A proteína C-reativa é confiável?

    Directory of Open Access Journals (Sweden)

    Saleh Ibrahim El-Awady

    2009-04-01

    Full Text Available BACKGROUND: Bacterial translocation occurs in preseptic conditions such as intestinal obstruction through unclear mechanism. The C-reactive protein is an acute phase reactant and a marker of ischemia. METHODS: 45 albino male rats were divided into 3 groups each 15 rats. GI control, GII simple intestinal-obstruction and GIII strangulated obstruction. Outcome measures were: (1 Bacteriologic count and typing for intestinal contents, intestinal wall, liver, mesenteric lymph nodes and blood (cardiac and portal (2 Histopathologic: mucosal injury score, inflammatory cell infiltrate in the wall, MLN, liver, (3 Biochemical: serum CRP, IL-10, mucosal stress pattern (glutathione peroxidase-malonyldialdhyde tissue levels. RESULTS: (1 Intestinal obstruction associates with BT precursors (Bact-overgrowth, mucosal-acidosis, immuno-incomptence, (2 Bacterial translocation (frequency and density was found higher in strangulated I.O, that was mainly enteric (aerobic and anaerobic and mostly E.coli, (3 The pathogen commonality supports the gut origin hypothesis but the systemic inflammatory response goes with the cytokine generating one. (4 The CRP median values for GI, II, III were 0.5, 6.9, 8.5 mg/L, for BT +ve 8 mg/L and 0.75 mg/L for BT -ve rats. CONCLUSION: Bacterial translocation occurs bi-directional (systemic-portal in intestinal obstruction and the resultant inflammatory response pathogenesis is mostly 3 hit model. The CRP is a non selective marker of suspected I.O cases. However, it is a reliable marker of BT, BT density and vascular compromise during I.O.OBJETIVO: Translocação bacteriana ocorre em condições pré-sépticas como na obstrução intestinal por mecanismo não esclarecido. A proteína C-reativa é um marcador de ischemia em fase aguda. A proposição é investigar os possíveis efeitos da obstrução intestinal no equilíbrio ecológico microbiano. MÉTODOS: 45 ratos machos albinos foram distribuídos em três grupos de 15 ratos. GI

  11. Diagnostic Dilemma in a Patient with Jaundice: How to Differentiate between Autoimmune Pancreatitis, Primary Sclerosing Cholangitis and Pancreas Carcinoma

    Directory of Open Access Journals (Sweden)

    Matthias Buechter

    2012-04-01

    Full Text Available A 68-year-old male patient was referred to our institution in May 2011 for a suspected tumor in the pancreatic head with consecutive jaundice. Using magnetic resonance imaging, further differentiation between chronic inflammation and a malignant process was not possible with certainty. Apart from cholestasis, laboratory studies showed increased values for CA 19-9 to 532 U/ml (normal <37 U/ml and hypergammaglobulinemia (immunoglobulin G, IgG of 19.3% (normal 8.0–15.8% with an elevation of the IgG4 subtype to 2,350 mg/l (normal 52–1,250 mg/l. Endoscopic retrograde cholangiopancreatography revealed a prominent stenosis of the distal ductus hepaticus communis caused by pancreatic head swelling and also a bihilar stenosis of the main hepatic bile ducts. Cytology demonstrated inflammatory cells without evidence of malignancy. Under suspicion of autoimmune pancreatitis with IgG4-associated cholangitis, immunosuppressive therapy with steroids and azathioprine was started. Follow-up endoscopic retrograde cholangiopancreatography after 3 months displayed regressive development of the diverse stenoses. Jaundice had disappeared and blood values had returned to normal ranges. Moreover, no tumor of the pancreatic head was present in the magnetic resonance control images. Due to clinical and radiological similarities but a consecutive completely different prognosis and therapy, it is of fundamental importance to differentiate between pancreatic cancer and autoimmune pancreatitis. Especially, determination of serum IgG4 levels and associated bile duct lesions induced by inflammation should clarify the diagnosis of autoimmune pancreatitis and legitimate immunosuppressive therapy.

  12. Addition of Molecular Adsorbent Recirculating System (MARS® Albumin Dialysis for the Preoperative Management of Jaundiced Patients with Hilar Cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Jean-Marc Regimbeau

    2013-09-01

    Full Text Available The preoperative management of hilar cholangiocarcinoma (HC with jaundice focuses on decreasing the total serum bilirubin level (SBL by performing preoperative biliary drainage (PBD. However, it takes about 6-8 weeks for the SBL to fall at a sufficient extent. The objective of this preliminary study was to evaluate the impact of Molecular Adsorbent Recirculating System (MARS® dialysis (in association with PBD on SBL decrease. From January 2010 to January 2011, we prospectively selected all jaundiced patients admitted to our university hospital for resectable HC and requiring PBD prior to major hepatectomy. The PBD was followed by 3 sessions of MARS dialysis over a period of 72 h. A total of 10 patients with HC were screened and two of them were included (Bismuth-Corlette stage IIIa, gender ratio 1, median age 68 years. The initial SBL in the two patients was 328 and 242 μmol/l, respectively. After three MARS dialysis sessions, the SBL had fallen by 30 and 52%, respectively. After the end of each session, there was a SBL rebound of about 10 μmol/l. The MARS decreased the serum creatinine level, the platelet count and the prothrombin index, but did not modify the serum albumin level. Pruritus disappeared after one and two sessions, respectively. MARS-related morbidity included hypotension (n = 1, tachycardia (n = 1, thrombocytopenia (n = 2 and anaemia (n = 1. When combined with PBD, MARS dialysis appears to accelerate the decrease in SBL and thus may enable earlier surgery. This hypothesis must be validated in a larger study.

  13. 'Halving the heel pricks': evaluation of a neonatal jaundice protocol incorporating the use of a transcutaneous bilirubinometer.

    Science.gov (United States)

    Hartshorn, David; Buckmaster, Adam

    2010-10-01

    This study aimed to assess the impact of implementing a new jaundice protocol incorporating the use of the Konica Minolta/Air Shields JM 103 Jaundice Meter (JM103) (Konica Minolta Sensing Inc., Osaka, Japan) in the setting of an Australian post-natal ward. A before-and-after study was completed following the introduction of a protocol integrating the use of the JM103 monitor on to the post-natal ward. Eligible infants were ≥ 36 weeks gestation, > 24 h and < 8 days of age. The number of Total Serum Bilirubin tests (TSBRs) were compared for the 12 months prior (T1) with a 6-month period and 6 months after protocol introduction (T2). Transcutaneous bilirubin (TcBR) results were also collected in T2. Rates of phototherapy and peak TSBRs at commencement were also compared as measures of safety. Four hundred and twenty-six of the 2197 live births in T1 required one or more TSBRs compared with 119 of the 1169 live births in T2. This represents an odds ratio of 0.47 (95% confidence interval 0.38-0.58) for infants in T2 having ≥ 1 TSBR compared with T1. There was no difference between the groups for rates of phototherapy (3.8% vs. 3.0%; P= 0.2) nor any difference between the groups for peak SBR during phototherapy (301.9 µmol/L (standard deviation, SD 58) for T1 vs. 303.2 µmol/L (SD 54) for T2; P= 0.45). The estimated cost saving per year is $6966.00. TcBR measurement in conjunction with our protocol significantly reduces painful procedures and costs without increasing the risk of delaying treatment with phototherapy. © 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  14. Comparison of intensive light-emitting diode and intensive compact fluorescent phototherapy in non-hemolytic jaundice.

    Science.gov (United States)

    Takcı, Sahin; Yiğit, Sule; Bayram, Gülperi; Korkmaz, Ayşe; Yurdakök, Murat

    2013-01-01

    In severe and rapidly increasing jaundice, the use of intensive phototherapy provides greater effectiveness and a faster decrement in bilirubin levels compared to conventional phototherapy. The aim of this study was to compare the effectiveness of two types of intensive phototherapy: intensive compact fluorescent tube (CFT) and intensive light-emitting diode (LED) phototherapy. Forty-three infants over 35 weeks of gestation with severe non-hemolytic hyperbilirubinemia were enrolled in the prospective study. All infants received multidirectional (circular-shaped) intensive phototherapy. Of these, 20 infants received CFT while 23 infants received LED phototherapy. Bilirubin levels and body temperatures were measured periodically, and the rates of bilirubin decrement were calculated. Mean serum bilirubin level of the 43 infants was 20.5±1.5 mg/dl at the beginning of the therapy and mean duration of phototherapy was 20.6±1.1 hours. The rate of mean bilirubin decline was 47.2% and the decrease was more prominent in the first four hours (0.84 ± 0.41 mg/dl/h). The rates of bilirubin decrement were comparable between the LED and CFT groups. Slightly elevated mean body temperature (37.1ºC) was determined in the CFT group (p<0.05). Intensive phototherapy units with both LED and CFT were effective, showing a decline of half the initial value of bilirubin during the study period in infants with non-hemolytic jaundice. This study shows that intensive phototherapy with either CFT or LED can provide rapid decrease in bilirubin levels in the first few hours. This rapid decline is important in cases that have high risk of bilirubin encephalopathy.

  15. Characterization of an Optical Device with an Array of Blue Light Emitting Diodes LEDS for Treatment of Neonatal Jaundice.

    Science.gov (United States)

    Sebbe, Priscilla Fróes; Villaverde, Antonio G. J. Balbin; Nicolau, Renata Amadei; Barbosa, Ana Maria; Veissid, Nelson

    2008-04-01

    Phototherapy is a treatment that consists in irradiating a patient with light of high intensity, which promotes beneficial photochemical transformations in the irradiated area. The phototherapy for neonates is applied to break down the bilirubin, an organic pigment that is a sub product of the erythrocytes degradation, and to increase its excretion by the organism. Neonates should be irradiated with light of wavelength that the bilirubin can absorb, and with spectral irradiances between 4 and 16 μW/cm2/nm. The efficiency of the treatment depends on the irradiance and the area of the body that is irradiated. A convenient source of light for treatment of neonatal jaundice is the blue Light Emitter Diode (LED), emitting in the range of 400 to 500 nm, with power of the order of 10-150 mW. Some of the advantages for using LEDS are: low cost, operating long lifetime (over 100,000 hours), narrow emission linewith, low voltage power supply requirement and low heating. The aim of this work was to build and characterize a device for phototherapy treatment of neonatal jaundice. This consists of a blanket with 88 blue LEDs (emission peak at 472 nm), arranged in an 8×11 matrix, all connected in parallel and powered by a 5V-2A power supply. The device was characterized by using a spectroradiometer USB2000 (Ocean Optics Inc, USA), with a sensitivity range of 339-1019 nm. For determination of light spatial uniformity was used a calibrated photovoltaic sensor for measuring light intensity and mapping of the light intensity spatial distribution. Results indicate that our device shows a uniform spatial distribution for distances from the blanket larger than 10 cm, with a maximum of irradiance at such a distance. This device presenting a large and uniform area of irradiation, efficient wavelength emission and high irradiance seems to be promising for neonates' phototherapy treatment.

  16. Falciform ligament abscess from left sided portal pyaemia following malignant obstructive cholangitis

    Directory of Open Access Journals (Sweden)

    Warren Leigh R

    2012-12-01

    Full Text Available Abstract Abscess formation of the falciform ligament is incredibly rare and perplexing when encountered for the first time. It is reported to occur in the setting of cholecystitis and cholangitis, but the pathophysiology is poorly understood. In this case report, we present a 73-year-old man with falciform ligament abscess following cholangitis from an obstructive ampullary carcinoma. The patient was referred to the Royal Adelaide Hospital from a country hospital, with progressive jaundice, anorexia and nausea. Prior to transfer, he deteriorated with cholangitis, dehydration and renal failure. On arrival, his abdomen was exquisitely tender along the course of the falciform ligament. His blood tests revealed an elevated white cell count of 14.9 x 103/μl, bilirubin of 291μmol/l and creatinine of 347 μmol/l. His CA 19-9 was markedly elevated at 35,000 kU/l. A non-contrast computed tomography (CT demonstrated gross biliary dilatation and a collection tracking along the path of the falciform ligament to the umbilicus. The patient was commenced on intravenous antibiotics and underwent an urgent endoscopic retrograde cholangiopancreatogram (ERCP with sphincterotomy and biliary stent drainage. Cholangiogram revealed a grossly dilated biliary tree, with abrupt transition at the ampulla, which on biopsy confirmed an obstructing ampullary carcinoma. Following ERCP, his jaundice and abdominal tenderness resolved. He was optimized over 4 weeks for an elective pancreaticoduodenectomy. At operation, we found abscess transformation of the falciform ligament. Copious amounts of pus and necrotic material was drained. Part of the round ligament was resected along the undersurface of the liver. Histology showed that there was prominent histiocytic inflammation with granular acellular eosinophilic components. The patient recovered slowly but uneventfully. A contrast CT scan undertaken 2 weeks post-operatively (approximately 7 weeks after the initial CT revealed

  17. Bochdalek hernia with obstructive uropathy.

    Science.gov (United States)

    Song, Young S; Hassani, Cameron; Nardi, Peter M

    2011-06-01

    Bochdalek hernias are postero-medial diaphragmatic defects that usually contain peritoneal fat and often remain asymptomatic. We present a unique case in which involvement of the adjacent ureter in the hernia defect resulted in obstructive uropathy. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Anaesthesia and subglottic airway obstruction

    African Journals Online (AJOL)

    2009-07-14

    Jul 14, 2009 ... Keywords: shared airway; jet ventilation; TIVA/TCI; laser excision; monitoring. Abstract. In this article, we describe the anaesthetic management and laser excision of a subglottic tumour that caused upper airway obstruction. Stridor was the presenting feature. A good history and careful assessment will ...

  19. Electrochemical Machining Removes Deep Obstructions

    Science.gov (United States)

    Catania, Mark J.

    1987-01-01

    Electrochemical machining (ECM) is effective way of removing obstructing material between two deep holes supposed to intersect but do not because of misalignment of drilling tools. ECM makes it possible to rework costly castings otherwise scrapped. Method fast even for tough or hard alloys and complicated three-dimensional shapes.

  20. Bolus obstruction by Ascaris lumbricoides

    African Journals Online (AJOL)

    returning to normal after treatment.4 The complication rate is 2 per 1000 infested children per year, I being maximal when the worm burden exceeds 100,2 Obstruction of the intestine by a bolus of worms, biliary ascariasis,3.6 pancreatitis and acute appendicitis are the commonest complications necessitating sur-.

  1. Oxidative stress in obstructive nephropathy

    NARCIS (Netherlands)

    Dendooven, Amelie; Ishola, David A.; Nguyen, Tri Q.; Van der Giezen, Dionne M.; Kok, Robbert Jan; Goldschmeding, Roel; Joles, Jaap A.

    P>Unilateral ureteric obstruction (UUO) is one of the most commonly applied rodent models to study the pathophysiology of renal fibrosis. This model reflects important aspects of inflammation and fibrosis that are prominent in human kidney diseases. In this review, we present an overview of the

  2. Reversibility of chronic airflow obstruction

    NARCIS (Netherlands)

    Postma, Dirkje Sjoukje

    1984-01-01

    This thesis deals with variations in airway diameter in patients with chronic, partly reversible airflow obstruction. The patients studied in this thesis have been addressed in the literature with terms as CAO, COPD, CNSLD. The confusion caused by combining patients in one descriptive term, e.g.

  3. Intestinal Obstruction from an Adhesion

    African Journals Online (AJOL)

    Intestinal Obstruction from an Adhesion. Bahd Mimicking Peritonitis due to a _. Complicated Induced Unsafe Abortion: A Case Report. ABSTRACT. Miss EN. a 19—year old nullipara presented at the Accidents and Emergency unit of the Ebonyi State University. Teaching Hospital (EBSUTH), Abakaliki on the 17/5/06 with ...

  4. Metastatic colon cancer from extrahepatic cholangiocarcinoma presenting as painless jaundice: case report and literature review.

    Science.gov (United States)

    Vabi, Benjamin W; Carter, Jeffrey; Rong, Rong; Wang, Minhua; Corasanti, James G; Gibbs, John F

    2016-04-01

    Cholangiocarcinoma (CCA) is a rare cancer of the biliary epithelium comprising only about 3% of all gastrointestinal malignancies. It is a highly aggressive malignancy and confers a dismal prognosis with majority of patients presenting with metastatic disease. Metastatic CCA to the colon is extremely rare with only few cases reported in the literature. We present a 61-year-old patient with incidental synchronous metastatic colonic adenocarcinoma from extra-hepatic CCA. Laboratory data revealed significant indirect hyperbilirubinemia and transaminitis. Imaging study showed intrahepatic bile ducts prominence without mass lesions. Incidentally, there was diffuse colonic thickening without mass lesions or obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) showed a common bile duct stricture. Brushings were consistent with CCA. Screening colonoscopy identified nodularity and biopsy and immunostaining were consistent with CCA metastasis to colon. The patient elected for palliative and comfort care. Metastatic CCA to the colon is a rare pattern of distant spread that may pose a diagnostic challenge. Some salient characteristics may assist in the differentiation of primary colon cancer and metastatic colon cancer from CCA. Little remains known about the pathogenic behavior of metastatic secondary colorectal cancer. And more so, the management approach to such metastatic cancer still remains to be defined. Screening colonoscopy in patients presenting with resectable CCA may alter management. Furthermore, whether patients with history of resected CCA may benefit from a more frequent screening colonoscopy remains to be validated.

  5. Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

    LENUS (Irish Health Repository)

    Lee, Ruth

    2012-02-01

    PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome. RECENT FINDINGS: The severity of obstructive ventilatory impairment and hyperinflation, especially the inspiratory capacity to total lung capacity (TLC) ratio, correlates with the severity of sleep-related breathing disturbances. Early treatment with continuous positive airway pressure (CPAP) improves survival, reduces hospitalization and pulmonary hypertension, and also reduces hypoxemia. Evidence of systemic inflammation and oxidative stress in COPD and sleep apnea provides insight into potential interactions between both disorders that may predispose to cardiovascular disease. Long-term outcome studies of overlap patients currently underway should provide further evidence of the clinical significance of the overlap syndrome. SUMMARY: Studies of overlap syndrome patients at a clinical, physiological and molecular level should provide insight into disease mechanisms and consequences of COPD and sleep apnea, in addition to identifying potential relationships with cardiovascular disease.

  6. [Obstructive sleep apnea syndrome: a cause of cognitive disorders in the elderly?].

    Science.gov (United States)

    Kinugawa, K; Nguyen-Michel, V H; Mariani, J

    2014-10-01

    Obstructive sleep apnea syndrome is a chronic disease characterized by repeated upper airway obstructions during sleep, resulting in fragmented sleep with arousals, nocturnal intermittent hypoxemia and diurnal dysfunctions. Despite its high prevalence in elderly, sleep apnea syndrome seems to be underestimated and difficult to be recognized because of the lack of clinical symptoms specificity in this population. Among the numerous consequences of the obstructive sleep apnea syndrome, cognitive impairment prevails on the attention, executive functions and memory. Neuroimaging studies in human and experimental models allowed to highlight neural correlates of these cognitive dysfunctions in obstructive sleep apnea syndrome. The obstructive sleep apnea syndrome with cognitive impairment shares some features with Alzheimer's disease, involving genetic predisposition ApoE4, hippocampus and synaptic plasticity abnormalities. In this context, the question arises whether obstructive sleep apnea syndrome is a possible etiological or aggravating factor of cognitive decline in elderly with mild cognitive impairment or Alzheimer's disease. Although there are conflicting results in studies evaluating therapeutic efficiency of continuous positive air pressure, obstructive sleep apnea syndrome seems nevertheless as a correctable factor, at least for its impact on some cognitive consequences. Looking for sleep apnea syndrome in elderly with cognitive decline should be considered in a global, diagnosis and therapeutic management. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  7. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Doros, Attila [Semmelweis University, Radiology Unit, Department of Transplantation and Surgery (Hungary); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom)

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  8. Cervicomedullary neurocysticercosis causing obstructive hydrocephalus.

    Science.gov (United States)

    Wang, Doris D; Huang, Michael C

    2015-09-01

    We present a 45-year-old man with tussive headache and blurred vision found to have obstructive hydrocephalus from a neurocysticercal cyst at the cervicomedullary junction who underwent surgical removal of the cyst. We performed a suboccipital craniectomy to remove the cervicomedullary cyst en bloc. Cyst removal successfully treated the patient's headaches without necessitating permanent cerebrospinal fluid diversion. Neurocysticercosis is the most common parasite infection of the central nervous system causing seizures and, less commonly, hydrocephalus. Intraventricular cysts or arachnoiditis usually cause hydrocephalus in neurocysticercosis but craniocervical junction cysts causing obstructive hydrocephalus are rare. Neurocysticercosis at the craniocervical junction may cause Chiari-like symptoms. In the absence of arachnoiditis and leptomeningeal enhancement, surgical removal of the intact cyst can lead to favorable outcomes. Published by Elsevier Ltd.

  9. Rhinoscleroma Causing Upper Airway Obstruction

    Directory of Open Access Journals (Sweden)

    Geetika Verma

    2005-01-01

    Full Text Available Rhinoscleroma is a chronic granulomatous condition of the respiratory tract, and is not uncommon in tropical regions; particularly, Mexico, Central America and the Middle East. A few cases have been reported in North America, primarily involving immigrants from endemic countries. The causative organism is Klebsiella rhinoscleromatis, a Gram-negative coccobacillus. Diagnosis is made on the basis of culture of the organism and the characteristic pathology of Mikulicz cells on light microscopy. The condition primarily affects the upper airway, and frequently presents with nasal discharge, nasal obstruction or frontal facial pain. Despite the term 'rhinoscleroma', there may be involvement of the entire respiratory tract. Although the condition is slowly progressive, its natural course portends extensive destruction. Laryngotracheal involvement occurs in approximately 15% to 80% of cases, but patients rarely present with isolated laryngotracheal disease. In the present paper, a case of rhinoscleroma presenting with symptoms of upper airway obstruction is described.

  10. Coagulability in Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Christina Liak

    2011-01-01

    Full Text Available BACKGROUND: Obstructive sleep apnea (OSA is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity/mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity.

  11. Pharmacotherapy of obstructive sleep apnea.

    Science.gov (United States)

    Lin, Chia Mo; Huang, Yu Shu; Guilleminault, Christian

    2012-04-01

    Obstructive sleep apnea syndrome is a common public health problem in the general population. The important health-related consequences of obstructive sleep apnea include cardiovascular disorders, such as myocardial infarction and hypertension, stroke, sudden death and difficult blood sugar control related to diabetes mellitus. The current main treatment options include body weight loss, continuous positive airway pressure, oral appliances and surgical treatment. The effects of pharmacotherapy on sleep apnea continue to be controversial and supplemental only. Current medications for sleep apnea mainly act through reducing risk factors, treating predisposing endocrine disorders, improving residual sleepiness post management and controlling associated hypertension and metabolic disorders. This article discusses the pharmacotherapy of sleep apnea, including ventilatory stimulants, serotoninergic and REM sleep suppressant agents, acetylcholinesterase inhibitors, medications for predisposing endocrine disorders, stimulants, associated sleep apnea health problems and sleep apnea patient anesthetic precaution. Weight loss is not a direct pharmacological approach and is only briefly mentioned. At present, there is no appropriate pharmacological treatment for obstructive sleep apnea. There are adjunct treatments such as anti-allergy treatment, and, if residual sleepiness is present, nonamphetaminic stimulants can help. Usage of these stimulants will, however, produce negative effects in an anticipated rate of about 10% of subjects taking these medications.

  12. Stents for malignant ureteral obstruction

    Directory of Open Access Journals (Sweden)

    Kristina Pavlovic

    2016-07-01

    Full Text Available Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician's ability to treat the underlying cancer. There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents (DJS, tandem DJS, nephrostomy tubes, and then more specialized products such as solid metal stents (e.g., Resonance Stent, Cook Medical and polyurethane stents reinforced with nickel-titanium (e.g., UVENTA stents, TaeWoong Medical. In patients who require long-term stenting, a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously. We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage. These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device. Factors that were identified to predict drainage failure included low serum albumin, bilateral hydronephrosis, elevated C-reactive protein, and the presence of pleural effusion. Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency. Discussions with the patient should take into consideration the frequency that exchanges will be needed, the need for externalized hardware (with nephrostomy tubes, or severe urinary symptoms in the case of internal DJS. This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.

  13. Obstructive Sleep Apnea in MPS

    Directory of Open Access Journals (Sweden)

    Abhijit Ricky Pal MBBChir, MA, MD, FRCS(ORL-HNS

    2015-11-01

    Full Text Available The mucopolysaccharidoses (MPSs are a group of inherited, metabolic disorders characterized by progressive multisystem accumulation of partially degraded glycosaminoglycans. This manifests with multilevel airway obstruction, presenting with obstructive sleep apnea (OSA. We systematically reviewed the literature to determine the severity and prevalence of OSA in MPS based on polysomnography analysis. Fifteen studies with 294 participants met the inclusion criteria for review. The pretreatment prevalence of OSA in MPS was 81% with a mean apnea–hypopnea index (AHI of 10.4. Patients with MPS I are most significantly affected, with 75% suffering with moderate to severe OSA (mean AHI, 16.6. Enzyme replacement therapy (ERT results in an almost significant reduction in OSA in MPS I ( P = .06, while adenotonsillar surgery significantly improves AHI ( P = .002. Obstructive sleep apnea least affects MPS III. There is a lack of long-term post-ERT and hematopoietic stem cell transplant data relating to OSA outcomes in this population, with further prospective studies required to determine the ongoing response to treatment.

  14. Fetomaternal outcome in obstructed labor in a peripheral tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Sabyasachi Mondal

    2013-01-01

    49.8%, urinary tract infection (UTI 10.9%, wound infection 7.7%] and post-partum hemorrhage (PPH; 33.9%. Other complications were rupture uterus (2.56%, subinvolution (9.3%, shock (2.2%, bladder injury (1.9%, hysterectomy (1.6%, broad ligament hematoma (1.28%, maternal death (1.6%, vesico-vaginal fistula (VVF; 0.6%, and rectovaginal fistula (RVF; 0.3%. Perinatal mortality rate was 71/313 (22.68%, still birth rate was 57/313 (18.21%, and live birth rate was 256/313 (81.79%. Perinatal morbidity (in 198 cases was most commonly due to birth asphyxia (29.68%, jaundice (16.80%, septicemia (14.84%, and meconium aspiration syndrome (9.77%. Incidence of PPH, still birth, perinatal mortality, and cesarean section was significantly higher among multiparous women. Conclusions: Cephalopelvic disproportion is the commonest cause of obstructed labor, and proper antenatal care, early diagnosis, and timely intervention may result in decrease in incidence of morbidity and mortality.

  15. Vascular biliopathy as a cause of common bile duct obstruction successfully treated by mesocaval shunt and endoscopic retrograde cholangiopancreatography biliary stent placement.

    Science.gov (United States)

    Rosenthal, Martin D; White, Geoffrey H; Stephen, Michael S; Gallagher, James J; Sandroussi, Charbel

    2008-01-01

    Common bile duct stenosis owing to extrahepatic portal varices is termed "portal hypertensive biliopathy" (PHB) and is a rare occurrence. We report a case of PHB owing to portal vein thrombosis with cavernous transformation successfully managed by mesocaval shunt and endoscopic retrograde cholangiopancreatography (ERCP) biliary stent placement. A 44-year-old male, who presented with hematemesis, melena, jaundice, and abdominal pain, underwent gastroscopy, which revealed bleeding gastric varices. Computed tomography with arterial and venous imaging demonstrated portal vein thrombosis with cavernous transformation and extensive extrahepatic varices within the porta hepatis causing common bile duct obstruction from extrinsic compression. Biliary decompression was achieved with ERCP, and a small common bile duct stone was retrieved. A mesocaval shunt with a 16 mm Dacron graft successfully treated the portal hypertension. PHB is rare. We report a case successfully treated by mesocaval shunt and ERCP.

  16. Robotic surgery twice performed in the treatment of hilar cholangiocarcinoma with deep jaundice: delayed right hemihepatectomy following the right-hepatic vascular control.

    Science.gov (United States)

    Zhu, Zhenyu; Liu, Quanda; Chen, Junzhou; Duan, Weihong; Dong, Maosheng; Mu, Peiyuan; Cheng, Di; Che, Honglei; Zhang, Tao; Xu, Xiaoya; Zhou, Ningxin

    2014-10-01

    To explore and find a new method to treat hilar cholangiocarcinoma with deep jaundice assisted by Da Vinci robot. A hilar cholangiocarcinoma patient of type Bismuch-Corlette IIIa was found with deep jaundice (total bilirubin: 635 µmol/L). On the first admission, we performed Da Vinci robotic surgery including drainage of left hepatic duct, dissection of right hepatic vessels (right portal vein and right hepatic artery), and placement of right-hepatic vascular control device. Three weeks later on the second admission when the jaundice disappeared we occluded right-hepatic vascular discontinuously for 6 days and then sustained later. On the third admission after 3 weeks of right-hepatic vascular control, the right hemihepatectomy was performed by Da Vinci robot for the second time. The future liver remnant after the right-hepatic vascular control increased from 35% to 47%. The volume of left lobe increased by 368 mL. When the total bilirubin and liver function were all normal, right hemihepatectomy was performed by Da Vinci robot 10 weeks after the first operation. The removal of atrophic right hepatic lobe with tumor in bile duct was found with no pathologic cancer remaining in the margin. The patient was followed up at our outpatient clinic every 3 months and no tumor recurrence occurs by now (1 y). Under the Da Vinci robotic surgical system, a programmed treatment can be achieved: first, the hepatic vessels were controlled gradually together with biliary drainage, which results in liver's partial atrophy and compensatory hypertrophy in the other part. Then a radical hepatectomy could be achieved. Such programmed hepatectomy provides a new treatment for patients of hilar cholangiocarcinoma with deep jaundice who have the possibility of radical heptolobectomy.

  17. Resolution of parenteral nutrition-associated jaundice on changing from a soybean oil emulsion to a complex mixed-lipid emulsion.

    Science.gov (United States)

    Muhammed, Rafeeq; Bremner, Ronald; Protheroe, Sue; Johnson, Tracey; Holden, Chris; Murphy, M Stephen

    2012-06-01

    Resolution of parenteral nutrition (PN)-associated jaundice has been reported in children given a reduced dose of intravenous fat using a fish oil-derived lipid emulsion. The aim of the present study was to examine the effect on PN-associated jaundice of changing from a soybean oil-derived lipid to a mixed lipid emulsion derived from soybean, coconut, olive, and fish oils without reducing the total amount of lipid given. Retrospective cohort comparison examining serum bilirubin during 6 months in children with PN-associated jaundice who changed to SMOFlipid (n=8) or remained on Intralipid (n=9). At entry, both groups received most of their energy as PN (SMOFlipid 81.5%, range 65.5-100 vs Intralipid 92.2%, range 60.3-100; P=0.37). After 6 months, both tolerated increased enteral feeding but still received large proportions of their energy as PN (SMOFlipid 68.4%, range 36.6-100 vs Intralipid 50%, range 37.6-76; P=0.15). The median bilirubin at the outset was 143 μmol/L (range 71-275) in the SMOFlipid group and 91 μmol/L (range 78-176) in the Intralipid group. After 6 months, 5 of 8 children in the SMOFlipid and 2 of 9 children in the Intralipid group had total resolution of jaundice. The median bilirubin fell by 99 μmol/L in the SMOFlipid group but increased by 79 μmol/L in the Intralipid group (P=0.02). SMOFlipid may have important protective properties for the liver and may constitute a significant advance in PN formulation. Randomised trials are needed to study the efficacy of SMOFlipid in preventing PN liver disease.

  18. Postoperative Airway Obstruction by a Bone Fragment

    Directory of Open Access Journals (Sweden)

    Patrick Schober

    2017-01-01

    Full Text Available Postoperative airway obstructions are potentially life-threatening complications. These obstructions may be classified as functional (sagging tongue, laryngospasm, or bronchospasm, pathoanatomical (airway swelling or hematoma within the airways, or foreign body-related. Various cases of airway obstruction by foreign bodies have previously been reported, for example, by broken teeth or damaged airway instruments. Here we present the exceptional case of a postoperative airway obstruction due to a large fragment of the patient’s maxillary bone, left accidentally in situ after transoral surgical tumor resection. Concerning this type of airway obstruction, we discuss possible causes, diagnosis, and treatment options. Although it is an exceptional case after surgery, clinicians should be aware of this potentially life-threatening complication. In summary, this case demonstrates that the differential diagnosis of postoperative airway obstructions should include foreign bodies derived from surgery, including tissue and bone fragments.

  19. Clinical features of sinusoidal obstruction syndrome: an analysis of 35 cases and literature review

    Directory of Open Access Journals (Sweden)

    ZHANG Yanting

    2013-12-01

    Full Text Available ObjectiveTo summarize the clinical features, diagnosis, and treatment of sinusoidal obstruction syndrome (SOS and review relevant literature and to improve the clinical diagnosis of this disease. MethodsA retrospective analysis was performed on the medical histories, clinical manifestations, laboratory results, imaging findings, liver histopathology, treatments, and prognosis of 35 patients with SOS who were hospitalized at the First Affiliated Hospital of Nanjing Medical University from August 2008 to May 2013. ResultsOf all patients, 31 (88.6% had taken Gynura segetum, 2 had received other traditional Chinese medicines, and 2 had undergone allogeneic hematopoietic stem cell transplantation. The main symptoms included abdominal distention (100%, ascites (91.4%, hepatalgia (62.9%, and jaundice (48.6%, as well as varying degrees of liver function damage. Ultrasound examination revealed unclear or thinner hepatic veins and slower or no blood flow. CT scans showed map-like heterogeneous enhancement in the liver. Pathological examination demonstrated local sinusoidal congestion, steatosis of some hepatocytes, hemorrhage in some liver tissue, and massive chronic inflammatory cell infiltration in the liver tissue and portal area. After treatment, 15 cases (42.9% showed improvement, and 20 cases (57.1% showed no response and were discharged. ConclusionTaking Gynura segetum is still the main cause of SOS in China. Early diagnosis and timely use of drugs for improving hepatic microcirculation and glucocorticoids are effective in improving the prognosis of SOS.

  20. Definitive diagnosis of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids.

    Science.gov (United States)

    Gao, Hong; Li, Na; Wang, Ji Yao; Zhang, Shun Cai; Lin, Ge

    2012-01-01

    Hepatic sinusoidal obstruction syndrome (HSOS) induced by a Chinese medicinal herb Tusanqi is increasingly being reported in recent years. The aim of the study was to investigate the possibility of using blood pyrrole-protein adducts test as a confirmatory diagnostic method. Patients with HSOS according to international diagnostic criteria associated with Tusanqi from January 2006 to August 2010 in Zhongshan Hospital Fudan University were included and clinical features were collected. Pyrrole-protein adducts in blood sample were determined with ultra performance liquid chromatography-mass spectrometry (UPLC-MS) while pyrrolizidine alkaloids (PAs) in available herbal preparations were analyzed by high performance liquid chromatography-ultraviolet (HPLC-UV). Five patients (age 41-72 years, median age 54 years, all women) were included. Ascites (5/5), jaundice (5/5) and hepatomegaly (4/5) were common manifestations. The imaging features were diffused, patchy hepatic enhancement, periportal edema and ascites. Pathology ascertained that blood flow was obstructive at the site of sinusoid. PAs (Seneionine and seneciphylline) were identified in all the three available herbal preparations ingested by the HSOS patients. Pyrrole-protein adducts were unequivocally found in all the five blood samples. Two patients recovered, two developed chronic illness and one died due to liver failure and hepatic encephalopathy. The detection of blood pyrrole-protein adducts using a UPLC-MS approach is a specific, reliable, unambiguous and confirmatory test for HSOS induced by PA, and should be used together with the conventional HSOS clinical diagnostic criteria for the definitive diagnosis of PA-induced HSOS. © 2011 The Authors. Journal of Digestive Diseases © 2011 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.

  1. Treatment of malignant biliary obstructions via the percutaneous approach; Interventionen bei malignen Gallenwegstenosen

    Energy Technology Data Exchange (ETDEWEB)

    Radeleff, B.A.; Lopez-Benitez, R.; Hallscheidt, P.; Grenacher, L.; Libicher, M.; Richter, G.M.; Kauffmann, G.W. [Radiologische Klinik der Ruprecht-Karls-Universitaet Heidelberg (Germany). Abteilung fuer Radiodiagnostik

    2005-11-01

    This paper gives an overview of experience and success of percutaneous transhepatic interventions in malignant biliary obstruction. Even after exhaustion of surgical and endoscopic therapy options, the percutaneously inserted stents provide effective palliation. The palliative treatment of malignant jaundice using a stent is an established procedure in clinical practice, particularly whenever the endoscopic, transpapillary approach is not possible due to high obstructions or previous surgery. The technical success rate is very high (about 95-100%), and the complication rate is about 10-30%. Since the patency rate of stents is higher than that of plastic endoprostheses, their primary use is justified despite higher costs, provided the patients are adequately selected. (orig.) [German] Vorgelegt wird eine Uebersicht ueber den gegenwaertigen Stellenwert radiologischer Interventionen bei malignen Gallenwegstenosen, die nur bei 10-20% der Patienten heilbar sind. Wenn ein endoskopisch transpapillaerer Zugang nicht moeglich ist, z. B. bei hohen Obstruktionen oder nach frueheren Eingriffen, ermoeglichen die perkutane transhepatische Punktion und Implantation von Metallendoprothesen eine gute Palliation. Die perkutane Gallengangdrainage und Stentplatzierung sind fuer den erfahrenen, interventionell taetigen Radiologen wenig kompliziert und mit einer Erfolgsrate von 95-100% dem endoskopischen Vorgehen deutlich ueberlegen. Morbiditaet und Mortalitaet der endoskopischen Verfahren waren in aelteren Arbeiten noch geringer als die der perkutanen Methoden. Aktuellen Studien zufolge sind beide Verfahren gleichwertig, wahrscheinlich aufgrund technischer Verbesserungen der perkutanen Interventionen. Die technische Erfolgsrate bei der Stentapplikation liegt ueber 95%. Mittels perkutaner transhepatischer biliaerer Drainageneinlage (PTCD) eingelegte Metallstents bleiben haeufiger und laenger offen als Plastikstents. Bei entsprechender Lebenserwartung des Patienten ist ihr Einsatz daher

  2. Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

    Science.gov (United States)

    Slats, Annelies; Taube, Christian

    2016-02-01

    Asthma and chronic obstructive pulmonary disease (COPD) are different disease entities. They are both clinical diagnoses, with diagnostic tools to discriminate between one another. However, especially in older patients (>55 years) it seems more difficult to differentiate between asthma and COPD. This has led to the definition of a new phenotype called asthma COPD overlap syndrome (ACOS). However, our understanding of ACOS is at a very preliminary stage, as most research has involved subjects with existing diagnoses of asthma or COPD from studies with different definitions for ACOS. This has led to different and sometimes opposing results between studies on several features of ACOS, also depending on the comparison with COPD alone, asthma alone or both, which are summarized in this review.We suggest not using the term ACOS for a patient with features of both asthma and COPD, but to describe a patient with chronic obstructive airway disease as completely as possible, with regard to characteristics that determine treatment response (e.g. eosinophilic inflammation) and prognosis (such as smoking status, exacerbation rate, fixed airflow limitation, hyperresponsiveness, comorbidities). This will provide a far more clinically relevant diagnosis, and would aid in research on treatment in more homogenous groups of patients with chronic airways obstruction. More research is certainly needed to develop more evidence-based definitions for this patient group and to evaluate biomarkers, which will help to further classify these patients, treat them more adequately and unravel the underlying pathophysiological mechanism. © The Author(s), 2015.

  3. Managing neonatal bowel obstruction: clinical perspectives

    Directory of Open Access Journals (Sweden)

    Desoky SM

    2018-02-01

    Full Text Available Sarah M Desoky,1 Ranjit I Kylat,2 Unni Udayasankar,1 Dorothy Gilbertson-Dahdal1 1Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA; 2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA Abstract: Neonatal intestinal obstruction is a common surgical emergency and occurs in approximately 1 in 2,000 live births. The causes of obstruction are diverse with varied embryological origins, and some underlying etiologies are not yet well described. Some findings of neonatal bowel obstruction can be detected prenatally on ultrasound imaging. The obstruction is classified as “high” when the level of obstruction is proximal to the ileum, and “low” when the level of obstruction is at the ileum or colon. Early diagnosis of the type of intestinal obstruction and localization of the obstructive bowel segment guides timely and appropriate management of the underlying pathologic entity. Neonatal bowel obstructions are ideally managed at specialized centers with a large volume of neonatal surgery and dedicated pediatric surgical and anesthesia expertise. Although surgical intervention is necessary in most cases, initial management strategies often target underlying metabolic, cardiac, or respiratory abnormalities. Imaging plays a key role in early and accurate diagnosis of the abnormalities. When bowel obstruction is suspected clinically, initial imaging workup usually involves abdominal radiography, which may direct further evaluation with fluoroscopic examination such as upper gastrointestinal (UGI contrast study or contrast enema. This article provides a comprehensive review of clinical and radiological features of common and less common causes of intestinal obstruction in the neonatal age group, including esophageal atresia, enteric duplication cysts, gastric volvulus, congenital microgastria, hypertrophic pyloric stenosis, duodenal atresia

  4. Endoscopic intervention in obstructive renal papillary necrosis

    Directory of Open Access Journals (Sweden)

    V Chandrashekar Rao

    2004-01-01

    Full Text Available To evaluate the usefulness of ultrasonography, endoscopic retrieval, and the outcome of patients with diabetes mellitus presenting with ureteric obstruction caused by necrosed renal papillae. Material And Methods: Eleven seriously ill patients with diabetes mellitus, admitted into medical wards, were found to have ureteric obstruction complicated by urinary infection. The diagnosis was made by ultrasonography alone. Prompt relief followed endoscopic extraction of the offending necrosed papillae. Results: Ten patients improved dramatically. One patient died from septicemia. Conclusions: Ultrasonography appears to be a useful diagnostic method to diagnose ureteric obstruction. It is cheap, fast, and extremely reliable. Endoscopic extraction of the obstructing papilla offers the best chance for successful outcome.

  5. Preliminary report on management of neonatal jaundice in maternity clinics of São Paulo city, Brazil

    Directory of Open Access Journals (Sweden)

    Fernando Bastos

    2007-03-01

    Full Text Available Objective: The treatment of neonatal hyperbilirubinemia remains aproblem because it can lead to sequelae in both children and adults. Theobjective of this study was to evaluate how neonatal jaundice is treatedin maternity hospitals in the city of São Paulo. Methods: Prospective andtransversal study on maternity hospitals in the city of São Paulo, Brazil. Aquestionnaire was applied to doctors working at neonatal wards withinmaternity hospitals in the city of São Paulo, divided into public (n = 6 andprivate maternity clinics (n = 18. The results obtained from the differentitems of the questionnaire were then compared. Statistical analysis wasperformed using the Student’s t test, chi-square test and Mann-Whitneytest when appropriate, and a p value < 0.005 was considered significant.Results: There were no significant differences between the two typesof maternity hospitals in relation to the treatment method for neonataljaundice. However, among private maternities there were some that didnot have written guidelines (5/17 and those that performed exchangetransfusion (3/18. Teaching was significantly more present amongpublic (100% than private maternity hospitals (17.6%. The mean serumbilirubin levels to initiate treatment did not show significant differencesbetween the two types of maternities. Some clinical practices in use bymaternity hospitals are not evidence based. Conclusions: The presentdata were considered preliminary and showed that further research inthe area is required and if our findings are confirmed, indicate the needfor continuous medical education on the part of health professionals incharge of newborns.

  6. Aggressive natural killer-cell leukemia with jaundice and spontaneous splenic rupture: a case report and review of the literature.

    Science.gov (United States)

    Gao, Li-min; Liu, Wei-ping; Yang, Qun-pei; Li, Hui-fang; Chen, Jun-jie; Tang, Yuan; Zou, Yan; Liao, Dian-Ying; Liu, Yan-mei; Zhao, Sha

    2013-03-11

    Aggressive natural killer cell leukemia/lymphoma (ANKL) is a rare aggressive form of NK-cell neoplasm. We report an uncommon case of 36-year-old male who showed jaundice and spontaneous splenic rupture. The diagnosis was established by the biopsy of liver and spleen. The monomorphous medium-size neoplastic cells infiltrated into portal areas and sinus of liver as well as the cords and sinus of the spleen. Necrosis, mitotic figures and significant apoptosis could be seen easily. These neoplastic cells demonstrated a typical immunophenotype of CD3ε+, CD56+, CD16+, Granzyme B+, TIA-1+. T-cell receptor γ (TCR-γ) gene rearrangement analysis showed germline configuration and the result of in situ hybridization for Epstein-Barr virus-encoded RNA (EBER-ISH) was positive. The patient has undergone an aggressive clinical course and died of multi-organ function failure 14 days later after admission. To the best of our knowledge, this is the first case of ANKL with spontaneous splenic rupture, and we should pay more attention to recognize it. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2048154883890867.

  7. Clinical system model for monitoring the physiological status of jaundice by extracting bilirubin components from skin diffuse reflectance spectra

    Science.gov (United States)

    Kumar, Alla S.; Clark, Joseph; Beyette, Fred R., Jr.

    2009-02-01

    Neonatal jaundice is a medical condition which occurs in newborns as a result of an imbalance between the production and elimination of bilirubin. The excess bilirubin in the blood stream diffuses into the surrounding tissue leading to a yellowing of the skin. As the bilirubin levels rise in the blood stream, there is a continuous exchange between the extra vascular bilirubin and bilirubin in the blood stream. Exposure to phototherapy alters the concentration of bilirubin in the vascular and extra vascular regions by causing bilirubin in the skin layers to be broken down. Thus, the relative concentration of extra vascular bilirubin is reduced leading to a diffusion of bilirubin out of the vascular region. Diffuse reflectance spectra from human skin contains physiological and structural information of the skin and nearby tissue. A diffuse reflectance spectrum must be captured before and after blanching in order to isolate the intravascular and extra vascular bilirubin. A new mathematical model is proposed with extra vascular bilirubin concentration taken into consideration along with other optical parameters in defining the diffuse reflectance spectrum from human skin. A nonlinear optimization algorithm has been adopted to extract the optical properties (including bilirubin concentration) from the skin reflectance spectrum. The new system model and nonlinear algorithm have been combined to enable extraction of Bilirubin concentrations within an average error of 10%.

  8. Cost-effectiveness analysis of a system-based approach for managing neonatal jaundice and preventing kernicterus in Ontario.

    Science.gov (United States)

    Xie, Bin; da Silva, Orlando; Zaric, Greg

    2012-01-01

    To evaluate the incremental cost-effectiveness of a system-based approach for the management of neonatal jaundice and the prevention of kernicterus in term and late-preterm (≥35 weeks) infants, compared with the traditional practice based on visual inspection and selected bilirubin testing. Two hypothetical cohorts of 150,000 term and late-preterm neonates were used to compare the costs and outcomes associated with the use of a system-based or traditional practice approach. Data for the evaluation were obtained from the case costing centre at a large teaching hospital in Ontario, supplemented by data from the literature. The per child cost for the system-based approach cohort was $176, compared with $173 in the traditional practice cohort. The higher cost associated with the system-based cohort reflects increased costs for predischarge screening and treatment and increased postdischarge follow-up visits. These costs are partially offset by reduced costs from fewer emergency room visits, hospital readmissions and kernicterus cases. Compared with the traditional approach, the cost to prevent one kernicterus case using the system-based approach was $570,496, the cost per life year gained was $26,279, and the cost per quality-adjusted life year gained was $65,698. The cost to prevent one kernicterus case using the system-based approach is much lower than previously reported in the literature.

  9. Laparoscopic ureterocalicostomy in pigs - experimental study

    OpenAIRE

    Caldas, Paulo Fernando de Oliveira; Rocha, Luiz Carlos de Almeida; Oliveira, Marília Teresa de; Ataíde, Michelli Westphal de; Spagnolo, Julio David; Feranti, João Pedro Scussel; Souza, Fernando Wiecheteck de; Silva, Marco Augusto Machado; Brun, Maurício Veloso

    2015-01-01

    This study aimed to evaluated laparoscopic ureterocalicostomy as treatment of experimental ureteropelvic junction (UPJ) obstruction in pigs. Ten male Large White pigs weighting approximately 28.4 (±1.43) kg were used in the current study. The UPJ obstruction was created laparoscopically by double-clipping of the left ureter. After 14 days the animals underwent laparoscopic ureterocalicostomy f The animals were sacrificed for subsequent retrograde pyelography in order to assess the anastomotic...

  10. Severe Obstructive Sleep Apnea Due to Massive Cervical Lipohypertrophy.

    Science.gov (United States)

    Ugurlu, Alper Mete; Ersozlu, Tolga; Basat, Salih Onur; Ceran, Fatih

    2015-09-01

    Obstructive sleep apnea is a difficult problem to deal with. Many studies on the pathogenesis of obstructive sleep apnea were performed in the past, and we present cervical lipohypertrophy causing severe obstructive sleep apnea in this article.

  11. Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns.

    Science.gov (United States)

    Wennberg, Richard P; Ahlfors, Charles E; Bhutani, Vinod K; Johnson, Lois H; Shapiro, Steven M

    2006-02-01

    We sought to evaluate the sensitivity and specificity of total serum bilirubin concentration (TSB) and free (unbound) bilirubin concentration (Bf) as predictors of risk for bilirubin toxicity and kernicterus and to examine consistency between these findings and proposed mechanisms of bilirubin transport and brain uptake. A review of literature was undertaken to define basic principles of bilirubin transport and brain uptake leading to neurotoxicity. We then reviewed experimental and clinical evidence that relate TSB or Bf to risk for bilirubin toxicity and kernicterus. There are insufficient published data to precisely define sensitivity and specificity of either TSB or Bf in determining risk for acute bilirubin neurotoxicity or chronic sequelae (kernicterus). However, available laboratory and clinical evidence indicate that Bf is better than TSB in discriminating risk for bilirubin toxicity in patients with severe hyperbilirubinemia. These findings are consistent with basic pharmacokinetic principles involved in bilirubin transport and tissue uptake. Experimental and clinical data strongly suggest that measurement of Bf in newborns with hyperbilirubinemia will improve risk assessment for neurotoxicity, which emphasizes the need for additional clinical evaluation relating Bf and TSB to acute bilirubin toxicity and long-term outcome. We speculate that establishing risk thresholds for neurotoxicity by using newer methods for measuring Bf in minimally diluted serum samples will improve the sensitivity and specificity of serum indicators for treating hyperbilirubinemia, thus reducing unnecessary aggressive intervention and associated cost and morbidity.

  12. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

    2009-04-15

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

  13. Multidetector row computed tomography in bowel obstruction. Part 2. Large bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)]. E-mail: rakesh.sinha@uhl-tr.nhs.uk; Verma, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)

    2005-10-01

    Large bowel obstruction may present as an emergency as high-grade colonic obstruction and can result in perforation. Perforated large bowel obstruction causes faecal peritonitis, which can result in high morbidity and mortality. Multidetector row computed tomography (MDCT) has the potential of providing an accurate diagnosis of large bowel obstruction. The rapid acquisition of images within one breath-hold reduces misregistration artefacts than can occur in critically ill or uncooperative patients. The following is a review of the various causes of large bowel obstruction with emphasis on important pathogenic factors, CT appearances and the use of multiplanar reformatted images in the diagnostic workup.

  14. Computational fluid dynamics (CFD) investigation of impacts of an obstruction on airflow in underground mines.

    Science.gov (United States)

    Zhou, L; Goodman, G; Martikainen, A

    2013-01-01

    Continuous airflow monitoring can improve the safety of the underground work force by ensuring the uninterrupted and controlled distribution of mine ventilation to all working areas. Air velocity measurements vary significantly and can change rapidly depending on the exact measurement location and, in particular, due to the presence of obstructions in the air stream. Air velocity must be measured at locations away from obstructions to avoid the vortices and eddies that can produce inaccurate readings. Further, an uninterrupted measurement path cannot always be guaranteed when using continuous airflow monitors due to the presence of nearby equipment, personnel, roof falls and rib rolls. Effective use of these devices requires selection of a minimum distance from an obstacle, such that an air velocity measurement can be made but not affected by the presence of that obstacle. This paper investigates the impacts of an obstruction on the behavior of downstream airflow using a numerical CFD model calibrated with experimental test results from underground testing. Factors including entry size, obstruction size and the inlet or incident velocity are examined for their effects on the distributions of airflow around an obstruction. A relationship is developed between the minimum measurement distance and the hydraulic diameters of the entry and the obstruction. A final analysis considers the impacts of continuous monitor location on the accuracy of velocity measurements and on the application of minimum measurement distance guidelines.

  15. Airflow obstruction in young adults in Canada

    DEFF Research Database (Denmark)

    Al-Hazmi, Manal; Wooldrage, Kate; Anthonisen, Nicholas R.

    2007-01-01

    OBJECTIVE: Airflow obstruction is relatively uncommon in young adults, and may indicate potential for the development of progressive disease. The objective of the present study was to enumerate and characterize airflow obstruction in a random sample of Canadians aged 20 to 44 years. SETTING: The ...

  16. Airflow Obstruction in Young Adults in Canada

    Directory of Open Access Journals (Sweden)

    Manal Al-Hazmi

    2007-01-01

    Full Text Available OBJECTIVE: Airflow obstruction is relatively uncommon in young adults, and may indicate potential for the development of progressive disease. The objective of the present study was to enumerate and characterize airflow obstruction in a random sample of Canadians aged 20 to 44 years.

  17. [Anesthesia and restrictive and obstructive pulmonary diseases].

    Science.gov (United States)

    Bremerich, Dorothee H; Hachenberg, Thomas

    2007-05-01

    Restrictive and obstructive pulmonary diseases are major risk factors of perioperative morbidity and mortality. The incidence of pulmonary complications may be in the range of 3 and 40% (3), depending on the underlying disease and the type of surgery. In this review the specific pathophysiology, preoperative evaluation and suitable anesthesia procedures are discussed for patients with restrictive and obstructive pulmonary diseases.

  18. Non-pharmacological management of chronic obstructive ...

    African Journals Online (AJOL)

    non-pharmacological intervention for improving health status and quality of life in COPD patients ... Chronic obstructive pulmonary disease (COPD) is the third leading cause of morbidity and mortality globally, contributing to a substantial .... subsets of patients with COPD and coexisting obstructive sleep apnoea or obesity ...

  19. Danish Register of chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Lange, Peter; Tøttenborg, Sandra Søgaard; Sorknæs, Anne Dichmann

    2016-01-01

    Aim of database: The Danish Register of Chronic Obstructive Pulmonary Disease (DrCOPD) is a nationwide database aiming to describe the quality of treatment of all patients with chronic obstructive pulmonary disease (COPD) in Denmark. Study population: DrCOPD comprises data on all patients...

  20. Danish Register of chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Lange, Peter; Tøttenborg, Sandra Søgaard; Sorknæs, Anne Dichmann

    2016-01-01

    AIM OF DATABASE: The Danish Register of Chronic Obstructive Pulmonary Disease (DrCOPD) is a nationwide database aiming to describe the quality of treatment of all patients with chronic obstructive pulmonary disease (COPD) in Denmark. STUDY POPULATION: DrCOPD comprises data on all patients...

  1. Osteoporosis in chronic obstructive pulmonary disease patients

    DEFF Research Database (Denmark)

    Jørgensen, Niklas Rye; Schwarz, Peter

    2008-01-01

    The purpose of this review is to examine the state of knowledge and clinical practice in the association of chronic obstructive pulmonary disease to osteoporosis and fracture incidence.......The purpose of this review is to examine the state of knowledge and clinical practice in the association of chronic obstructive pulmonary disease to osteoporosis and fracture incidence....

  2. Gastric outlet obstruction in Northwestern Ethiopia

    African Journals Online (AJOL)

    2. Gastric outlet obstruction in Northwestern Ethiopia. Rerhanu Kotisso MD. Associale Professor of Surgey. 1:;iculry of Medicine, Addis Ababa University. Key Words: Gastric outlet obstruction, peptic ulcer, tuberculosis, gastric cancer. This was a three-year prospective study to assess the magnitude and spectrum of gastric.

  3. Accuracy of abdominal auscultation for bowel obstruction

    DEFF Research Database (Denmark)

    Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas

    2015-01-01

    AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed...

  4. Defining obstructive ventilatory defect in 2015

    African Journals Online (AJOL)

    2015-10-08

    Oct 8, 2015 ... obstructive pulmonary disease (COPD) is constantly increasing worldwide including African countries. (1, 2). These two chronic diseases, often having in com- mon an obstructive ventilatory defect (OVD), should be diagnosed more accurately by using spirometry (3, 4). However, there is no clear consensus ...

  5. Is nonoperative management of adhesive intestinal obstruction ...

    African Journals Online (AJOL)

    Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country.

  6. Gastric outlet obstruction in Northwestern Ethiopia

    African Journals Online (AJOL)

    pyloroplasty was performed. TABLE V Postoperative complication of GOO patients. ** Malignant obstruction. Discussion. Gastric outlet obstruction (GOO) is a frequent cause of surgical admissions to the Gondar Teaching. Hospital, comprising 2.6% of all surgical admissions and 14.6% of the general surgical problems12.

  7. Management of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    V K Vijayan

    2014-03-01

    Full Text Available Obstructive Sleep Apnea (OSA is an important public health problem and is associatedwith considerable morbidity and mortality. Therefore, treatment of this condition is ofparamount importance. The treatment of OSA includes general and behaviouralmeasures, mechanical measures including continuous positive airway pressure(CPAP, Bilevel positive airway pressure (BiPAP and Oral Appliances (OA,pharmacological treatment and surgical procedures. Continuous positive airwaypressure (CPAP treatment reverses the repetitive upper airway obstruction of sleepapnea and associated daytime sleepiness and is the most effective treatment for OSA.However maintaining patient adherence to CPAP therapy is a challenge. Weight lossshould be recommended to overweight patients with OSA, as it has been shown thatweight reduction has additional health benefits. Treatment of underlying medicalconditions such as hypothyroidism or acromegaly has profound effect onapnea/hypopnea index. A subset of patients with OSA may benefit from supplementaloxygen and positional therapy. Presently, there are no effective pharmacotherapeuticagents for treatment of patients with OSA and the role of surgical treatment in OSA iscontroversial. However, pharmacological treatment of persisting residual sleepiness,despite adequate positive airway pressure therapy delivery and adherence, is indicatedand may improve daytime sleepiness.Key words : CPAP, Oral appliances, Modafinil, CPAP complianceUvulopalatopharyngoplasty, positional therapy

  8. Hypertension and obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Phillips CL

    2013-05-01

    Full Text Available Craig L Phillips,1–3 Denise M O'Driscoll4,51Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia; 2National Health and Medical Research Council Center for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; 3Discipline of Sleep Medicine, Sydney Medical School, University of Sydney, Sydney, Australia; 4Monash Lung and Sleep, Monash Medical Centre, Monash University, Melbourne, Australia; 5Department of Medicine, Southern Clinical School, Monash University, Melbourne, AustraliaAbstract: Obstructive sleep apnea (OSA is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.Keywords: obstructive sleep apnea, hypertension, intermittent hypoxia, ambulatory blood pressure, sympathetic activation

  9. Trichophytobezoar duodenal obstruction in New World camelids.

    Science.gov (United States)

    Sullivan, Eileen K; Callan, Robert J; Holt, Timothy N; Van Metre, David C

    2005-01-01

    To describe clinical findings, surgical treatment, and outcome associated with trichophytobezoar duodenal obstruction in New World camelids. Retrospective study. Alpacas (7) and 1 llama. Historical and clinical data were obtained from the medical records of New World camelids with a diagnosis of trichophytobezoar duodenal obstruction confirmed by surgical exploration or necropsy. Seven camelids were camelids with abdominal distension and hypochloremic metabolic alkalosis. Right paracostal celiotomy can be used for access to the descending duodenum and third gastric compartment for surgical relief of obstruction. Duodenal obstruction from bezoars should be considered in New World camelids <1year of age with abdominal distension and hypochloremic metabolic alkalosis. Surgical relief of the obstruction by right paracostal celiotomy has a good prognosis.

  10. Gallstone ileus resulting in strong intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Israel Szajnbok

    Full Text Available Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecystenteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.

  11. Small Bowel Obstruction due to Intestinal Xanthomatosis

    Directory of Open Access Journals (Sweden)

    L. E. Barrera-Herrera

    2015-01-01

    Full Text Available Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

  12. Cardiorespiratory repercussions according to the abdominal circumference measurement of men with obstructive respiratory disorder submitted to respiratory physiotherapy.

    Science.gov (United States)

    Martinelli, Bruno; Pires Di Lorenzo, Valéria Amorim; Quitério, Robison José; Ambrozin, Alexandre Ricardo Pepe; Arca, Eduardo Aguilar; Jamami, Maurício

    2018-01-25

    To examine the effect of respiratory physiotherapy among men with obstructive respiratory disorder, in relation to abdominal circumference (AC). Quasi-experimental study including 26 men split into two groups according to AC(cm): 1) respiratory disorder, increased AC measurement limited the thoracoabdominal expansibility and induced a rise of the DBP. Respiratory physiotherapy promotes an increase of cardiac modulation and inspiratory capacity for men with obstructive respiratory disorder.

  13. Cholestatic jaundice, acute kidney injury and acute pancreatitis secondary to the recreational use of methandrostenolone: a case report

    Directory of Open Access Journals (Sweden)

    Kwan Peter

    2011-04-01

    Full Text Available Abstract Introduction Over the last few years the use of anabolic steroids has become increasingly common amongst amateur athletes and for aesthetic purposes. As a result, the adverse events related to their use are being seen more frequently. Methandrostenolone is an anabolic steroid which is widely available and has been used for both performance enhancement and aesthetic purposes. This drug has also been reported to cause cholestasis of the intra-hepatic bile ducts resulting in elevated aminotransferases, hyperbilirubinemia and clinical jaundice. However, to the best of our knowledge this agent has not been previously reported to cause pancreatitis or acute kidney injury. Case presentation In this paper, we report the case of a 50-year-old man of Indian descent who presented with a six week history of diffuse abdominal pain, anorexia and weight loss following an eight week cycle of methandrostenolone use. At initial presentation, his lipase level was 785 U/L, bilirubin was 922 μmol/L and creatinine was 200 U/L while his aspartate aminotransferase and alanine aminotransferase levels were only mildly elevated at 61 U/L and 56 U/L respectively. His lipase peaked on day nine at >3000 U/L whilst his creatinine level was 299 U/L. Imaging was consistent with acute pancreatitis while a liver biopsy was consistent with intra-hepatic cholestasis and a kidney biopsy revealed evidence of acute tubular necrosis. Conclusion Both acute pancreatitis and acute kidney injury have rarely been reported with anabolic steroid use and they have not been previously reported to occur in the same patient. This case demonstrates some potentially new and serious adverse consequences occurring with the use of anabolic steroids, of which physicians need to be aware.

  14. A novel mutation in the biliverdin reductase-A gene combined with liver cirrhosis results in hyperbiliverdinaemia (green jaundice).

    Science.gov (United States)

    Gåfvels, Mats; Holmström, Petra; Somell, Anna; Sjövall, Fredrik; Svensson, Jan-Olof; Ståhle, Lars; Broomé, Ulrika; Stål, Per

    2009-08-01

    Hyperbiliverdinaemia is a poorly defined clinical sign that has been infrequently reported in cases of liver cirrhosis or liver carcinoma, usually indicating a poor long-term prognosis. To clarify the pathogenesis of hyperbiliverdinaemia in an extended case report. A 64-year-old man with alcoholic cirrhosis was admitted to hospital with severe bleeding from oesophageal varices. Ultrasonography showed ascites, but no dilatation of the biliary tree. The skin, sclerae, plasma, urine and ascites of the patient showed a greenish appearance. Bilirubin levels were normal, and there were no signs of haemolysis. Biliverdin was analysed in plasma and urine with liquid chromatography coupled to mass spectrometry. The seven exonic regions of the biliverdin reductase-A (BVR-A) gene was amplified by polymerase chain reaction and sequenced. Biliverdin was present in plasma and urine. In nucleotide 52 of exon I of the DNA isolated from the hyperbiliverdinaemic patient, we discovered a novel heterozygous C-->T nonsense mutation converting an arginine (CGA) in position 18 into a stop codon (TGA) (R18Stop) predicted to truncate the protein N-terminally to the active site Tyr97. Two children of the proband were heterozygous for the identical mutation in the BVR-A gene, but had no clinical signs of liver disease and had normal levels of biliverdin. The BVR-A gene mutation was not found in 200 healthy volunteers or nine patients with end-stage liver cirrhosis. Hyperbiliverdinaemia (green jaundice) with green plasma and urine may be caused by a genetic defect in the BVR-A gene in conjunction with decompensated liver cirrhosis.

  15. Chronic Obstructive Pulmonary Disease Biomarkers

    Directory of Open Access Journals (Sweden)

    Tatsiana Beiko

    2016-04-01

    Full Text Available Despite significant decreases in morbidity and mortality of cardiovascular diseases (CVD and cancers, morbidity and cost associated with chronic obstructive pulmonary disease (COPD continue to be increasing. Failure to improve disease outcomes has been related to the paucity of interventions improving survival. Insidious onset and slow progression halter research successes in developing disease-modifying therapies. In part, the difficulty in finding new therapies is because of the extreme heterogeneity within recognized COPD phenotypes. Novel biomarkers are necessary to help understand the natural history and pathogenesis of the different COPD subtypes. A more accurate phenotyping and the ability to assess the therapeutic response to new interventions and pharmaceutical agents may improve the statistical power of longitudinal clinical studies. In this study, we will review known candidate biomarkers for COPD, proposed pathways of pathogenesis, and future directions in the field.

  16. Obstructive sleep apnea in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aliye Tosun

    2008-01-01

    Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.

  17. URETERO PELVIC JUNCTION OBSTRUCTION IN THE NEWBORN

    Directory of Open Access Journals (Sweden)

    J. Kouranloo

    2006-06-01

    Full Text Available Uretero pelvic junction (UPJ obstruction is a common cause of hydronephrosis in infants. The frequent use of fetal ultrasound is allowing early (prenatal diagnosis of numerous uropathies previously delayed until the child either became symptomatic or had a palpable mass. Newborn with severe obstruction often has marked improvement following correction, therefore, early diagnosis and operation are important. From 1993 to 2002, 21 patients were operated on for severe UPJ obstruction who were diagnosed before 6 weeks of age. Only 10 patients (63% had antenatal ultrasonographic diagnosis, the remaining were diagnosed by postnatal ultrasound and IVP or radionuclide scan for palpable renal enlargement or for associated anomalies. Eighteen of them had unilateral and three had bilateral obstruction. Twenty-four pyeloplasties were done; all pyeloplasties were dismembered with tailoring of the dilatated renal pelvis. Postoperative renal function was followed with laboratory blood test, urine test or radionuclide scan or IVP. Postoperative complications included urinary tract infection in three patients and postoperative stenosis in one patient were seen. No mortality occurred on infants in unilateral but one occurred in bilateral obstruction. Also, there was one unrelated late death. We report documented functional improvement with minimal complications in unilateral or bilateral pyeloplasty in newborns with UPJ obstruction. We recommend that if the initial scan shows substantially reduced function in the obstructed kidney, a pyeloplasty (rather than nephrectomy generally should be performed, because the newborn kidney has tremendous capacity for improvement in renal function following decompression.

  18. Risk factors of intestinal obstruction in pregnancy

    Directory of Open Access Journals (Sweden)

    Khvorostukhina N.F.

    2012-09-01

    Full Text Available

    Objective: to study risk factors and options for clinical course of acute intestinal obstruction in pregnancy. Materials and methods. A detailed study of history, clinical course, diagnosis and treatment characteristics of acute intestinal obstruction in 79 pregnant women was undertaken. Results: It was determined that a combination of intestinal obstruction, and pregnancy is more common for II and III trimester of gestation (88,5%, with more likely to develop mechanical obstruction caused by the adhesive process (77,2%. Risk factors for intestinal obstruction in pregnancy are: chronic diseases of gastrointestinal tract, surgery of abdominal cavity and pelvis, burdened obstetric and gynecological history and long-term use of progestogens during pregnancy. Difficulties in diagnosis are associated with absence of classical symptoms of disease that is caused by changes in topographical relations of abdominal cavity, increasing size of uterus, as well as lack of immune response to the emergence of a pathological process. Conclusion. Formation of pregnant women at risk for development of intestinal obstruction and preventive measures to address violations of intestinal motor function can reduce the risk of disease. Algorithm of medical tactics for suspected acute intestinal obstruction in pregnancy, allowing to reduce time of diagnosis and provision of medical care.

  19. Adult large bowel obstruction: A review of clinical experience

    African Journals Online (AJOL)

    Background: Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. Materials and Methods: This is a prospective study of adult ...

  20. Adult large bowel obstruction: A review of clinical experience | Sule ...

    African Journals Online (AJOL)

    Background: Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. Materials and Methods: This is a prospective study of adult ...