On three occasions, a 63 year old housewife with hyperthyroidism developed a reaction which included fever, pruritus, malaise, and, on one occasion, jaundice one to 17 days after taking carbimazole. Challenge with carbimazole was followed within 12 hours by abdominal pain, pruritus, and increased serum transaminase levels. Light microscopy of a liver biopsy showed increase of portal zone cellularity over the control and the electron microscopy revealed fine structural changes compatible with drug-related liver injury. (+info)
Bile system morphogenesis defects and liver dysfunction upon targeted deletion of HNF1beta.
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The inactivation of the Hnf1beta gene identified an essential role in epithelial differentiation of the visceral endoderm and resulted in early embryonic death. In the present study, we have specifically inactivated this gene in hepatocytes and bile duct cells using the Cre/loxP system. Mutant animals exhibited severe jaundice caused by abnormalities of the gallbladder and intrahepatic bile ducts (IHBD). The paucity of small IHBD was linked to a failure in the organization of duct structures during liver organogenesis, suggesting an essential function of Hnf1b in bile duct morphogenesis. Mutant mice also lacked interlobular arteries. As HNF1beta is not expressed in these cells, it further emphasizes the link between arterial and biliary formation. Hepatocyte metabolism was also affected and we identified hepatocyte-specific HNF1beta target genes involved in bile acids sensing and in fatty acid oxidation. (+info)
Binding of bilirubin with albumin-coupled liposomes: implications in the treatment of jaundice.
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In the present study, we demonstrated the suitability of liposomes as a method of removing plasma bilirubin in hyperbilirubinemic rats. The liposomes have innate tendency to bind with bilirubin through hydrophobic interaction. Among different types of liposomes, the positively charged liposomes were found to have maximum affinity to free bilirubin. However, the entrapment or coupling of serum albumin on the surface of egg phosphatidylcholine liposomes can render a several-fold increase in their bilirubin binding capacity. The proteoliposomes were able to preferentially bind with bilirubin even in the presence of erythrocytes. Interestingly, these liposomes were found to displace bilirubin bound on the surface of erythrocytes as well. The results of the present study further demonstrate that albumin-bearing liposomes were equally effective in removing plasma bilirubin in experimental jaundiced animals. These observations indicate that liposome-mediated selective homing of excess plasma bilirubin to the liver cells (cf. hepatocytes) may help in the development of safer strategy for the treatment of hyperbilirubinemic conditions in the model animals. (+info)
The "jaundice hotline" for the rapid assessment of patients with jaundice.
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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. (+info)
A comparison of transcutaneous bilirubinometers: SpectRx BiliCheck versus Minolta AirShields.
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BACKGROUND: Two devices are available for making transcutaneous estimates of serum bilirubin (SBR): the Minolta AirShields JM102 and the new SpectRx BiliCheck. OBJECTIVES: (a) To measure how well the readings produced by these devices agree with SBR measured in the laboratory; (b) to estimate for each device, the proportion of infants with clinical jaundice who would require blood sampling if the device was used as a screening tool to detect infants with SBR > or = 250 micromol/l. DESIGN: Prospective cohort study of jaundiced infants who required SBR at < or = 20 days of postnatal age. Those who had received phototherapy or exchange transfusion were excluded. SETTING: Tertiary neonatal service in South-East Scotland. INTERVENTIONS: Within 30 minutes of SBR sampling, transcutaneous bilirubinometry was performed using one Minolta and two SpectRx devices (designated A and B). RESULTS: Sixty-four neonates were enrolled, 19 of which were preterm (31-35 weeks). The 95% confidence intervals of a device reading corresponding to SBR were +/- 66.7, +/- 67.9, and +/- 66.4 micromol/l respectively. Using the devices to identify all SBR > or = 250 micromol/l would reduce SBR sampling by 23%, 16%, and 20% respectively. CONCLUSIONS: Given that SBR levels range from 50 to 400 micromol/l in jaundiced infants, the 95% confidence intervals of the devices are wide at +/- 67 micromol/l. The SpectRx can be used as a screening tool for hyperbilirubinaemia but there is no advantage in using it over the Minolta. (+info)
Repeated jaundice due to YMDD mutant in a patient with prolonged lamivudine therapy for chronic hepatitis B under prednisolone treatment for Still's disease.
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A 50-year-old woman patient began receiving lamivudine because of acute exacerbation of chronic hepatitis B. She also suffered from adult-onset Still's disease and had received prednisolone for 5 years. Lamivudine was effective for treatment of the first flare. Fifteen months after lamivudine treatment was started, a breakthrough due to lamivudine-resistant strain M5521 occurred. Between 10 and 12 months after the breakthrough, flare with jaundice occurred 3 times. We decided interferon would not be suitable, because it could induce activation of Still's disease. Prolonged lamivudine therapy is only recommended in cases of hepatitis B in which there is no alternative treatment. (+info)
Common issues in the care of sick neonates.
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Newborn infants may be transferred to a special care nursery because of conditions such as prematurity (gestation less than 37 weeks), prolonged resuscitation, respiratory distress, cyanosis, and jaundice, and for evaluation of neonatal sepsis. Newborn infants' core temperature should be kept above 36.4 degrees C (97.5 degrees F). Nutritional requirements are usually 100 to 120 kcal per kg per day to achieve an average weight gain of 150 to 200 g (5 to 7 oz) per week. Standard infant formulas containing 20 kcal per mL and maternal breast milk may be inadequate for premature infants, who require special formulas or fortifiers that provide a higher calorie content (up to 24 kcal per mL). Intravenous fluids should be given when infants are not being fed enterally, such as those with tachypnea greater than 60 breaths per minute. Hypoglycemia can be asymptomatic in large-for-gestational-age infants and infants of mothers who have diabetes. A hyperoxia test can be used to differentiate between pulmonary and cardiac causes of hypoxemia. The potential for neonatal sepsis increases with the presence of risk factors such as prolonged rupture of membranes and maternal colonization with group B streptococcus. Jaundice, especially on the first day of life, should be evaluated and treated. If the infant does not progressively improve in the special care nursery, transfer to a tertiary care unit may be necessary. (+info)
Effects of hyperthermia therapy on the liver. II. Morphological observations.
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Liver biopsy specimens obtained from three patients during treatment of advanced malignant disease by exogenous hyperthermia were studied by light and electron microscopy. In two patients the parenchymal cells showed either slight swelling or nuclear alterations by light microscopy and, at the fine structural level, large numbers of autophagic vacuoles, dilatation of Golgi elements and endoplasmic reticulum, and large cytoplasmic vacuoles. Similar changes, but in much more severe form together with parenchymal cell necrosis and cholestasis, were seen in the liver of case 3, who developed jaundice 24 hours after hyperthermia. The findings are discussed in relation to earlier accounts of liver changes following hyperthermia, and the functional implications are considered. (+info)