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- The diagnostic value of a panel of serological markers in acute appendicitis. [JOURNAL ARTICLE]
- Scand J Surg 2014 Apr 15.
Appendicitis is a frequent reason for hospital admissions. Elevated C-reactive protein, white blood cell count, and serum bilirubin have been suggested as individual markers for appendicitis and appendiceal perforation. The aim of this study was to analyze if a combination of serologic markers could increase the prognostic accuracy of diagnosing non-perforated and perforated appendicitis.Demographic data, histological findings, blood tests, and clinical symptoms were collected on all patients who underwent a diagnostic laparoscopy, a laparoscopic appendectomy, or conventional (open) appendectomy between May 2009 and May 2012 from a surgical department. The patients were grouped into those with either perforated appendicitis, non-perforated appendicitis, or differential diagnosis. Univariate and multivariate models were used to identify which markers were useful in predicting acute and perforated appendicitis, and receiving operating characteristics curves were used to find the specificity, sensitivity, and the negative and positive predictive values.A total of 1008 patients were operated under suspicion of appendicitis. From these, 700 patients had a pathologically verified inflamed appendix and 190 had a perforated appendix. Patients with acute appendicitis had significantly higher blood levels of white blood cell, bilirubin, C-reactive protein, and alanine transaminase than patients without appendicitis. Patients with perforated appendicitis had significantly higher levels of white blood cell, bilirubin, and C-reactive protein than patients with non-perforated appendicitis. The highest positive predictive value to discriminate between acute appendicitis and non-appendicitis was of a linear regression model combining white blood cell count, bilirubin, and alanine transaminase. C-reactive protein levels and a linear regression model, including white blood cell count, bilirubin, and C-reactive protein levels as variables, had the highest negative predictive values when discriminating between perforated and non-perforated appendicitis.Combining blood markers was useful in predicting appendicitis and perforated appendicitis. In addition to C-reactive protein and white cell count, blood levels of bilirubin, and alanine transaminase may be useful.
- Differences in clinical chemistry values according to the use of two laxatives for colonoscopy. [JOURNAL ARTICLE]
- Clin Biochem 2014 Apr 12.
Polyethylene glycol-electrolyte lavage solutions (PEG-ELSs) and sodium phosphate formulations (NaPs) are two major colon cleansing laxatives used in preparation for endoscopic examinations of the gastrointestinal tract. PEG-ELSs are osmotically balanced preparations, whereas NaPs are hyperosmotic purgatives. This study aimed to evaluate the effects of these two laxatives on routine chemistry tests.We retrospectively reviewed 9,366 clinical records of patients who had health checkups with or without colonoscopy from July 2010 to June 2011. We compared the values of 19 clinical chemistry parameters in the NaPs group (n=3,239) and the PEG-ELSs group (n=1,279) with those of controls (without colonoscopy, n=4,848).Compared with controls, the NaPs group had higher mean values of inorganic phosphate, sodium, chloride, creatinine, total protein, AST, and ALT, and lower mean values of calcium and potassium, exceeding acceptable biases. Notably, inorganic phosphate showed the largest % bias (51.14%). In the PEG-ELSs laxative group, higher mean values of inorganic phosphorus, creatinine, uric acid, AST, and total bilirubin and a lower mean value of potassium were observed compared with controls, exceeding acceptable biases. The effects of NaPs on inorganic phosphate, calcium, and electrolyte levels exceeded those of PEG-ELSs.PEG-ELSs rather than NaPs are recommended as the first choice for bowel preparation, taking safety concerns and the reliability of laboratory values into account. Blood chemistry data from blood samples drawn after the ingestion of laxatives for colonoscopy should be interpreted with caution.
- Screening and management of major bile leak after blunt liver trauma: a retrospective single center study. [JOURNAL ARTICLE]
- Scand J Trauma Resusc Emerg Med 2014 Apr 15; 22(1):26.
Major bile leak after blunt liver trauma is rare but challenging. It usually requires endoscopic retrograde cholangiography (ERC) for management. However, there is still lack of specific indications. The aim of this study is to elucidate risk factors for major bile leak and indications for early ERC after blunt liver trauma.The trauma registry of a level I trauma center in Taiwan was queried, and all blunt liver trauma patients from June, 2008 to June, 2011 were selected for retrospective review. Data collected included demographic data, laboratory data, Injury Severity Score (ISS), liver injury grade and location, management of liver trauma, length of ICU, hospital stay and treatment result. ERC was used to confirm major bile leak.288 blunt liver trauma patients were selected from 2,475 torso trauma patients. There were 214 (74.5%) male and 74 (25.7%) female patients. The mean ISS was 24.2. Most patients received conservative treatment. Transcatheter artery embolization (TAE) and operation were 15.6% and 10.8% respectively. Major bile leak occurred in 14 (4.9%) patients. Risk factors for bile leak include high-grade liver injury, centrally-located liver trauma and use of TAE. A bilirubin level greater than 43.6 mumol/L provides a sensitivity of 100% and specificity of 85.1% for predicting major bile leak.High injury grade; centrally-located liver trauma; and use of TAE are risk factors for major bile leak after blunt liver trauma. ERC should be arranged early if the patient has risk factors and their plasma bilirubin level is greater than 43.6mumol/L during admission.
- Prognostic factors for survival of patients with ampullary carcinoma after local resection. [JOURNAL ARTICLE]
- ANZ J Surg 2014 Apr 16.
Local resection (LR) is a potentially effective alternative to pancreaticoduodenectomy for treatment of ampullary cancer, but the prognostic factors remain undefined. The purpose of this study was to identify the prognostic factors for ampullary cancer patients who had undergone LR.We retrospectively reviewed the clinical, pathological data and surgical approach of 34 ampullary cancer patients who had undergone LR during 1996-2009 at People's Liberation Army General Hospital. Prognostic factors for survival and recurrence were analysed.The 1-, 3- and 5-year survival rates of the patients were 97.1, 69.5 and 53.7%, respectively. The gender, age, preoperative bilirubin levels, CA19-9 levels and preoperative biopsy did not correlate with the survival rates. The survival rates of patient with T1 and T2 tumours were superior to that of patients with T3 tumours (P = 0.000). Tumour size, surgical margin status and the extent of differentiation had no effect on survival rates (P = 0.464, P = 0.601 and P = 0.121, respectively). The survival rate of patients who had extraduodenal LR (12 cases) was superior to that of patients who had transduodenal LR (22 cases) (P = 0.026). Tumour recurrence occurred in 14 (41.2%) patients. Tumour infiltration (P = 0.014) correlated with the recurrence.The degree of tumour infiltration is the pathological factor that most affects the survival of ampullary cancer patients who undergo LR. Extraduodenal LR is a promising surgical procedure, the efficacy of which is superior to that of transduodenal LR. The depth of tumour invasion correlated with the recurrence.
- [In Process Citation]. [English Abstract, Journal Article]
- G Ital Med Lav Ergon 2013 Jul-Sep; 35(3):163-7.
In health care the contact with body fluids, such as saliva or blood is frequent. The aim of our study was to analyze whether the exposure to biological risks in health care, in particular exposure to HBV and HCV, could cause alterations of some liver parameters.Our study analyzes of 254 health care workers of a big hospital in Rome. The subjects exposed to biological risks were divided into two groups, one exposed to a high biological risk and the other one exposed to a low biological risk, according to individual duties and/or the departments where they carry out their work. We checked the markers for hepatitis B and C in order to highlight a possible infection, the possible vaccine coverage and the control of the antibody titer by previous infection. We measured the values of transaminases, GGT, alkaline phosphatase, total bilirubin and fractional proteinaemia total and electrophoresis.In health care workers exposed to high risk the average values of transaminases, total protein, alkaline phosphatase, gamma GT, total bilirubin were not significant compared to the some values formed in workers exposed to low risk (p > 0.05). Subjects positive for hepatitis B and C were 4% in the group of workers exposed to high risk (class 1) while in the group of workers exposed to low risk (class 2) the percentage of exposed individuals was 0.01% for the hepatitis B and 2.6% for hepatitis C.We found a small numbers of positive cases of hepatitis B and C in people exposed to biological agents. We did not find alterations of the average values of transaminases, total protein, alkaline phosphatase, gamma GT, total bilirubin and albumin in positive cases, so that we can say that the proper use of personal protective equipment, training and information of workers and the observance of universal precautions are effective in protecting workers.
- Value of twelfth hour bilirubin level in predicting significant hyperbilirubinemia in preterm infants. [Journal Article]
- J Clin Med Res 2014 Jun; 6(3):190-6.
As hyperbilirubinemia is a significant cause of brain injury, it is important to predict the cases who are at risk. Data for preterm infants are scarce. The aim of this study is to predict significant hyperbilirubinemia in preterm infants by measuring capillary bilirubin at 12th hour of life.One hundred and fifty neonates born ≤ 35 weeks were included in the study. They were categorized into two groups according to their birth weights (group 1: 1,000 - 1,499 g; group 2: 1,500 - 2,000 g). Their bilirubin levels were measured at 12th hour and daily thereafter for 5 days. Risk nomograms were generated based on their bilirubin measurements and postnatal ages. On the age-specific percentile-based nomogram, the zone above the 90th percentile was determined as high risk and those below the fifth percentile as low risk. Infants who had bilirubin levels over the limits defined according to their postnatal ages and birth weights were accepted to have significant hyperbilirubinemia and received phototherapy and predictive value of the 12th hour bilirubin was asssessed.Fifty-four of 57 infants (94.7%) in group 1 and 75/93 infants (80.7%) in group 2 received phototherapy. Capillary bilirubin levels of 3.55 mg/dL and 4.55 mg/dL for group 1 and group 2 measured at the 12th hour of life had the highest sensitivity, negative and positive predictive value to predict the neonates who will develop significant hyperbilirubinemia.Bilirubin levels of preterm infants should be monitored closely. More attention should be paid to the ones who had 12th hour bilirubin level above the cutoff values.
- Liraglutide-Induced Autoimmune Hepatitis. [JOURNAL ARTICLE]
- JAMA Intern Med 2014 Apr 14.
IMPORTANCE Use of incretin-based hypoglycemic agents is increasing, but safety data remain limited. We treated a woman with marker-negative autoimmune hepatitis associated with the glucagon-like peptide 1 agonist liraglutide. OBSERVATIONS A young woman with type 2 diabetes mellitus and vitiligo presented with a 10-day history of acute hepatitis. Other than starting liraglutide therapy 4 months prior, she reported no changes in medication therapy and no use of supplements. At admission, aspartate aminotransferase level was 991 U/L; alanine aminotransferase level, 1123 U/L; total bilirubin level, 9.5 mg/dL; and international normalized ratio, 1.3. Results of a liver biopsy demonstrated interface hepatitis with prominent eosinophils and rare plasma cells. The patient's liraglutide therapy was withheld at discharge but her symptoms worsened. A second biopsy specimen revealed massive hepatic necrosis. She started oral prednisone therapy for presumed liraglutide-induced marker-negative autoimmune hepatitis. CONCLUSIONS AND RELEVANCE This case represents, to our knowledge, the first report of liraglutide-induced autoimmune hepatitis. Hepatotoxicity may be an incretin analogue class effect with a long latency period. This case raises prescriber awareness about the potential adverse effects of glucagon-like peptide 1 agonists. Postmarketing studies are needed to define the hepatotoxic potential of these agents.
- Potential first trimester metabolomic biomarkers of abnormal birth weight in healthy pregnancies. [JOURNAL ARTICLE]
- Prenat Diagn 2014 Apr 14.
Macrosomia and low birth weight (LBW) can be associated with pregnancy complications and may affect the long term health of the child. The aim of this study was to evaluate the metabolomic serum profiles of healthy pregnant women to identify early biomarkers of macrosomia and LBW, and to understand mechanisms leading to abnormal fetal growth not related to mother's body mass index (BMI) or presence of gestational diabetes (GDM).Serum samples from 770 women were collected between the 12(th) -14(th) gestational week. After delivery samples were divided into three groups according to the infant birth weight: low <2500 grams; normal 2500-4000 grams; and high >4000 grams. Samples from women with any complications of pregnancy were excluded. Serum fingerprinting was performed by LC-QTOF-MS.Lower levels of phospholipids, lysophospholipids and monoacylglycerols; low vitamin D3 metabolites, and increased bilirubin level were associated to macrosomia. Because most changes involved lipids, as a concept of validation, adipocyte fatty acid binding protein (A-FABP) levels were measured and found correlated with the studied lipids and birth weight.Serum fingerprinting in early pregnancy can predict the risk of macrosomia. Serum levels of A-FABP and several lipids are promising prognostic markers for macrosomia in healthy pregnancies. This article is protected by copyright. All rights reserved.
- Selected ABCB1, ABCB4 and ABCC2 Polymorphisms Do Not Enhance the Risk of Drug-Induced Hepatotoxicity in a Spanish Cohort. [Journal Article]
- PLoS One 2014; 9(4):e94675.
Flawed ABC transporter functions may contribute to increased risk of drug-induced liver injury (DILI). We aimed to analyse the influence of genetic variations in ABC transporters on the risk of DILI development and clinical presentations in a large Spanish DILI cohort.A total of ten polymorphisms in ABCB1 (1236T>C, 2677G>T,A, 3435T>C), ABCB4 (1954A>G) and ABCC2 (-1774G>del, -1549A>G, -24C>T, 1249G>A, 3972C>T and 4544G>A) were genotyped using Taqman 5' allelic discrimination assays or sequencing in 141 Spanish DILI patients and 161 controls. The influence of specific genotypes, alleles and haplotypes on the risk of DILI development and clinical presentations was analysed.None of the individual polymorphisms or haplotypes was found to be associated with DILI development. Carriers homozygous for the ABCC2 -1774del allele were however only found in DILI patients. Hence, this genotype could potentially be associated with increased risk, though its low frequency in our Spanish cohort prevented a final conclusion. Furthermore, carriers homozygous for the ABCC2 -1774G/-1549A/-24T/1249G/3972T/4544G haplotype were found to have a higher propensity for total bilirubin elevations when developing DILI.Our findings do not support a role for the analysed polymorphisms in the ABCB1, ABCB4 and ABCC2 transporter genes in DILI development in Spanish patients. The ABCC2 -1774deldel genotype was however restricted to DILI cases and could potentially contribute to enhanced DILI susceptibility.
- Neonatal total bilirubin measurements: Still room for harmonization. [JOURNAL ARTICLE]
- Clin Biochem 2014 Apr 11.
Universal screening of total bilirubin in neonates is endorsed by experts from the American Academy of Pediatrics and is increasingly common. Methodological differences between diazo-based quantitation ("wet" chemistry) and reflectance spectrophotometric quantitation ("dry" chemistry) can lead to unnecessary treatment. A recent recalibration of the only commercially available "dry" chemistry assay was issued to reduce these differences. This study evaluated the post-recalibration bias between the two assay types.Method comparison of neonatal total bilirubin (Beckman AU680 vs Ortho-Clinical-Diagnostics Vitros) was achieved using freshly-drawn neonatal samples (n=239).The Vitros produced neonatal bilirubin results with a 12.4% average positive bias compared to the AU680 total bilirubin results. The AU680 direct bilirubin reaction had 5.6% cross reactivity with unconjugated bilirubin.Neonatal or total bilirubin quantitation remains unharmonized between platforms. Care should be taken to understand the bias of specific platforms.