[Studies on the behavior of serum enzymes in newborn infants with jaundice. Physiological jaundice, jaundice due to blood incompatibility].
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Alcohol Oxidoreductases↗
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Differential maternal retrieval of jaundiced versus non-jaundiced Gunn rat pups.
Gunn rat dams were tested for differential retrieval of their jaundiced versus non-jaundiced offspring in 2 experiments. In Experiment 1, in which testing took place every day from Day 1 to Day 8 postpartum, non-jaundiced pups were retrieved significantly faster than jaundiced pups. In Experiment 2, in which testing took place every other day from Day 1 to Day 15 and the pups were weighed each test day, the order of retrieval of the 4 gender/genotype (jaundiced vs non-jaundiced) classifications as found in the 1st experiment was replicated and the non-jaundiced pups tended to be retrieved faster. Heavier pups were retrieved significantly faster than lighter pups, indicating that weight or size may be a cue to differential retrieval.
Age Factors↗
Metabolic alterations in obstructive jaundice: effect of duration of jaundice and bile-duct decompression.
We examined the effect of prolonged bile duct obstruction, and subsequent biliary decompression, on biochemical and metabolic parameters, using a reversible jaundice model in male Fischer 344 rats. The animals were studied after biliary obstruction for varying periods (4 days, one week, and two weeks) and following decompression. They were sacrificed one or two weeks following decompression. All the rats were compared to sham operated, pair-fed, controls. Obstructive jaundice rapidly increased bilirubin, liver enzymes, serum free fatty acid, and triglyceride levels. Glucose levels were significantly decreased in the jaundice rats compared to their pair-fed controls. Only after two weeks of jaundice was significant hypoalbuminemia observed. Following decompression, all biochemical and metabolic values gradually returned to normal levels, except for albumin. Hypoalbuminemia was not reversed within the two-week post-decompression period. The rats jaundiced for two weeks had significantly higher mortality, compared to the other groups. We conclude that prolonged jaundice adversely affects the metabolic capacity of the rats, with albumin concentration being markedly decreased, and that biliary decompression could not reverse completely all the alterations seen with cholestasis, especially following two weeks of bile duct obstruction.
Animals↗
[Experimental study on the interruption of hepatic blood flow in obstructive jaundice, with special reference to the causes of death and prolonged jaundice after biliary decompression].
The purpose of this investigation was to elucidate the influence of interruption of the hepatic blood flow on survival and on prolonged jaundice after biliary decompression in dogs with obstructive jaundice. There were three experimental groups. Two or three weeks after inducing obstructive jaundice by ligation of the common bile duct with cholecystectomy, the hepatic artery (group A), portal vein (group B) or both (group C) were interrupted for various intervals, with antibiotics administration. Biliary decompression was simultaneously performed with choledochoduodenostomy. The one week survival rate after the interruption of hepatic blood flow was more than 60% at 2 and 1 hours in group A, 20 and 10 minutes in group B, 10 and 5 minutes in group C at two and three weeks after biliary obstruction, respectively. Necrosis more than 50% of the liver was observed in early death cases. Edema and stasis in the bile canaliculi were markedly observed histologically in survivors in groups A and C, accompanied with significant elevations of serum T. Bil and GPT. The changes were greater in cases with longer periods of jaundice. In obstructive jaundice, hepatic artery occlusion causes hepatic necrosis, in spite of antibiotics administration, and may induce prolonged jaundice after biliary decompression. As an indicator of the prognosis, the serum total bile acid value was useful.
Animals↗
A lipoprotein characterizing obstructive jaundice. I. Method for quantitative separation and identification of lipoproteins in jaundiced subjects.
Three immunochemically and electrophoretically distinct lipoproteins, LP-A, LP-B, and LP-X,(1) were isolated from the low density lipoprotein fraction (1.006-1.063 g/ml) in plasma from patients with biliary obstruction by a separation procedure which combines ultracentrifugation, heparin precipitation, and ethanol fractionation. This method, here described, permits the quantitative determination of individual plasma lipoprotein families on the basis of their protein moieties, rather than on the basis of their lipid moieties or density. The chemical composition of the unique lipoprotein, LP-X, was similar to that of an abnormal lipoprotein, OLP, isolated by Russ et al. (29) and by Switzer (30). In obstructive jaundice plasma, the combined LP-X and LP-B accounted for 98% and the LP-A for only 2% of the total protein content of the LDL fraction. This study indicates that the plasma lipoprotein pattern in obstructive jaundice is characterized by (a) a decreased concentration of HDL, (b) an increased concentration of LDL, and (c) the presence in the LDL fraction of varying amounts of a specific lipoprotein, LP-X, immunochemically and chemically distinct from LP-A and LP-B. LP-X, with its characteristically high content of unesterified cholesterol and phospholipids, is primarily responsible for the unusual protein and lipid content of the LDL fraction. Screening tests in 61 patients with various forms of jaundice indicated that a characteristic immunoelectrophoretic precipitin are between plasma samples and purified antibodies to LP-X was observed only in patients with obstructive jaundice. This simple immunochemical test may represent a valuable new tool in the differential diagnosis of obstructive and nonobstructive jaundice.
Animals↗
[Effects of obstructive jaundice on immunocompetence in jaundiced patients].
Using CD series monoclonal antibody indirect immune fluorescent assay and LDH enzyme-release assay, we investigated lymphocyte subsets and natural killer cells (NKC) activity in the peripheral blood of 30 patients with obstructive jaundice. The results showed that the percentage of CD3+, CD4+, B cells and that of CD8+ was high. The ratio of CD4/CD8 was low at the first 10 days of jaundice when the serum bilirubin level was less than 171 mumol/L. Our studies suggested that obstructive jaundice might cause depression and impairment of host cellular and humoral immunity. Further studies showed that impaired immune function of jaundiced patients returned to normal 30 days after the disappearance of the jaundice by external or internal biliary drainage. Immune function recovered 30 days after relief of biliary obstruction and external or internal biliary drainage. External or internal biliary drainage was useful in improving host immunity.
Adult↗
Transcutaneous bilirubin measurements in Saudi infants: the use of the jaundice meter to identify significant jaundice.
A total of 155 transcutaneous bilirubin (TcB) measurements were performed on 155 healthy full-term Saudi newborns with neonatal jaundice using the Minolta/Airshield Jaundice Meter applied to the forehead. The TcB measurements correlated well with the serum bilirubin determinations (r = 0.817). The regression equation for our population was y = 13.24 + 0.69x. At a cut-off TcB index of 21 the machine could identify infants with serum bilirubin levels of 12.5 mg/dl or more with a sensitivity of 74% and a specificity of 90%. The positive and negative predictive values were 78% and 88%, respectively. We think at that action line the machine is a useful screening tool that can identify children with significant jaundice who will need serum bilirubin determination.
Bilirubin↗
The "jaundice hotline" for the rapid assessment of patients with jaundice.
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 OF 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.
Adolescent↗
Measurement of operative plasma endotoxin levels in jaundiced and non-jaundiced patients.
A study of portal plasma endotoxin levels was performed using a chromogenic limulus amoebocyte lysate (LAL) assay. The assay proved sensitive and reproducible. In only 1 of 25 healthy subjects was the systemic plasma endotoxin level above 100 pg/ml (equivalent Escherichia coli 0111B4). In 30 non-jaundiced patients undergoing surgery the mean (+SEM) portal plasma endotoxin level (60 + 9 pg/ml) was significantly higher (p less than 0.05) than the mean level in the systemic blood (46 + 6 pg/ml), supporting the concept of endotoxin absorption from the intestine into the portal blood. In 20 patients with obstructive jaundice undergoing surgery 42% of portal, 45% of inferior mesenteric and 35% of systemic venous plasma endotoxin levels were above 100 pg/ml. There were significantly higher levels in the portal (p less than 0.05) and inferior mesenteric (p less than 0.05) compared with the systemic blood. Neither the presence of malignancy nor the duration of surgery appeared to influence endotoxin absorption. The significance of raised plasma endotoxin levels in obstructive jaundice is discussed.
Adult↗
Obstructive jaundice blunts myocardial contractile response to isoprenaline in the dog: a clue to the susceptibility of jaundiced patients to shock?
Patients with obstructive jaundice are susceptible to postoperative shock. To clarify the mechanism of this phenomenon, we compared the contractile response to isoprenaline of isolated ventricular preparations from three groups of dogs: (a) dogs with chronic bile-duct ligation (CBDL), (b) dogs with choledochocaval anastomosis (CDCA) and (c) sham-operated dogs (SO). Isolated ventricular muscles from CBDL and CDCA dogs showed a depressed contractile response to isoprenaline as compared with SO dogs. Mechanical performance was spared in the CBDL and CDCA dogs. There were no differences in the contractile responses of SO and CBDL dogs, either to ouabain or to changes in the rates of stimulation (force-frequency relationships). These data demonstrate that, in the dog, obstructive jaundice and/or cholaemia are associated with blunted contractile response to beta-adrenoreceptor stimulation in the face of intact basic mechanical performance. Similar inotropic refractoriness to beta-adrenoreceptor stimulation could contribute to the susceptibility to postoperative shock in patients with obstructive jaundice.
Alanine Transaminase↗
[A case of prolonged jaundice after surgical treatment of obstructive jaundice caused by a carcinoma of the head of the pancreas relieved with dibutyryl cyclic AMP].
Recently, we experienced a case of obstructive jaundice caused by a carcinoma of the head of the pancreas which could not be relieved by reduction surgery. The operation performed was a cholecystectomy and supraduodenal choledochotomy with T-tube insertion. Glucagon and insulin were, therefore, administered with the aim towards the recovery of the liver function to be induced by the enhancement of the liver regeneration. The treatment, however, was not effective. Then, dibutyryl cyclic AMP was administered to the case by intravenous drip infusions at the rate of 5 micrograms/kg/min. Thereafter, the value of serum total bilirubin was reduced remarkably. A prolonged and intense obstructive jaundice is generally accompanied by damage to the liver function, and the condition carries a high risk of postoperative complication. In this paper, the effectiveness of dibutyryl cyclic AMP on liver cell damage caused by prolonged obstructive jaundice are reported.
Aged↗
[Effect of li dan ling in decreasing jaundice and improving liver function in patients with obstructive jaundice].
A total of 89 cases with extrahepatic jaundice were studied clinically. All patients were divided into two groups at random: control group and Li Dan Ling treatment group. It was found that: (1) liver functions in the patients with obstructive jaundice were injured severely; bilirubin, R15ICG, m-GOT, and gamma-GT were increased significantly; (2) in patients with incomplete biliary obstruction or after the relief of obstruction, liver functions could be improved gradually. They were improved more quickly in patients of the Li Dan Ling treatment group; (3) for the patients suffering from complete biliary tract obstruction, until the obstruction was relieved liver function could not be improved. After the herbal medicine, all the indicators would be further worsened before the relief of the obstruction, and the value of "b" would be positive. The increase in m-GOT and gamma-GT was higher than in the control group, indicating the liver functions were further injured. Therefore, the herbal cholegogue was not suitable for the patients before the obstruction was relieved. The further investigations showed that excretion of bilirubin from the bile could be accelerated by Li Dan Ling, and after herbal administration, the cholesterol level in bile was lowered significantly; the liver blood flow in normal and jaundiced rats would be increased 30 to 90 min. after administering the herbs.
Adult↗
The "jaundiced heart": a possible explanation for postoperative shock in obstructive jaundice.
Patients with obstructive jaundice are susceptible to postoperative shock and kidney failure. The cause of these potentially fatal complications has not been fully clarified. The present study was designed to assess the role of myocardial dysfunction in the hemodynamic disturbance of obstructive jaundice. We studied the effect of isolated cholemia on left ventricular performance in five conscious dogs before and 2 weeks after choledochocaval anastomosis by using measurements of systolic time intervals (STIs) and maximal dp/dt. Mean left ventricular ejection tiem (LVET) decreased after cholemia from 159 +/- 2.8 msec to 139 +/- 2.6 msec (p less than 0.005), while mean preejection period (PEP) and mean PEP/LVET were increased from 41 +/- 8.5 msec to 87 +/- 14 msec (p less than 0.05) and from 0.39 +/- 0.06 to 0.62 +/- 0.1 (p less than 0.01), respectively. During cholemia, STIs were unchanged after intravenous administration of ouabain, whereas in the control period, there was shortening of mean PEP from 71 +/- 8.8 msec to 58 +/- 7.6 msec (p less than 0.05) and of Q-S2 from 257 +/- 12 msec to 235 +/- 14 msec (p less than 0.005) in response to ouabain. Maximal dp/dt decreased after choledochocaval anastomosis from 4543 +/- 593 mm Hg/sec to 3666 +/- 648 mm Hg/sec (p less than 0.025). We conclude that cholemia in the dog is clearly associated with impaired left ventricular performance. The present data also support a previously published in vitro study from our laboratory showing that cholemia blunts the myocardial contractile response to sympathomimetic agents. The cardiodepressor effect of cholemia may explain the increased tendency of patients with obstructive jaundice to postoperative shock and renal failure.
Animals↗
Obstructive jaundice. Nonsurgical options for 'surgical' jaundice.
The development of nonoperative methods of biliary drainage has altered traditional concepts regarding management of medical and surgical jaundice. Patients with newly diagnosed obstructive jaundice typically are elderly and have an unresectable neoplasm. Because surgical cure is often impossible and operation is usually risky in such patients, decompression of the biliary tree by endoscopic retrograde cholangiopancreatography and endoscopically inserted biliary stents has become an increasingly popular means of palliation. Percutaneous transhepatic cholangiography and surgical bilidigestive bypass remain important alternatives. Selection of optimal management for the individual patient requires an in-depth evaluation by a skilled team consisting of the primary care physician, endoscopist, interventional radiologist, and surgeon.
Aged↗
Comparative quantitative evaluation of hepatic clearance of diethyl-IDA and para-butyl-IDA in jaundiced and non-jaundiced patients.
A method for comparative measurement of hepatic clearance of different hepatobiliary agents is described and the clinical use of diethyl-IDA and parabutyl-IDA is discussed. The study was performed with both radiopharmaceuticals in 13 patients with hepatobiliary disease with serum bilirubin ranging from 0.3 to 16.4 mg/100 ml. Diethyl-IDA is preferable for a qualitative evaluation of hepatobiliary disease because of its higher hepatic clearance and faster biliary excretion rate. Parabutyl-IDA is superior for measuring the hepatocytic uptake function, due to the low urinary excretion and the absence of an apparent re-entry from liver to plasma, even in patients with obstructive jaundice. In contrast, an appreciable re-entry can be demonstrated for diethyl-IDA.
Adult↗
Benign cholestatic jaundice of pregnancy and benign cholestatic jaundice from oral contraceptives.
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Cholestasis↗
Reconstructive analysis of the cholangiolar area in surgical jaundice with reference to intractable jaundice after biliary drainage.
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Adult↗
The response of jaundiced and non-jaundiced weanling rats to thirsting.
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Age Factors↗