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Jaundice icterus [keywords]
- [A retrospective analysis of ultrasonic diagnosis for 360 cases of extrahepatic obstructive jaundice.] [JOURNAL ARTICLE]
- Zhonghua Yi Xue Za Zhi 2014 Aug; 94(32):2522-2524.
To retrospectively analyze the ultrasonic diagnosis of extrahepatic obstructive jaundice, discuss their ultrasonographic characteristics, technical procedures and misdiagnostic reasons and improve the diagnostic proficiency and qualitative accuracy of extrahepatic obstructive jaundice.Retrospective analyses were conducted for the causes, obstructive sites and ultrasonic characteristics of 360 cases of extrahepatic obstructive jaundice confirmed by surgical pathology during 10 years, including choledocholithiasis (n = 205), cholangiocarcinoma (n = 30), pancreatic head carcinoma (n = 44), gall bladder (n = 27), ampullary carcinoma (n = 24), cholangitis (n = 24) and biliary tract roundworm (n = 6).For locating extrahepatic obsrtructive jaundice, the accuracy of ultrasonic diagnosis was 93.6% and that of qualitative diagnosis 87.5%.As an economic, rapid, safe and noninvasive tool, ultrasound is valuable in the diagnosis of extrahepatic obstructive jaundice. It may be applied frequently in non-contraindicated and complication-free patients. However, the diagnostic accuracy is closely correlated with inspector experiences, operative techniques and patient conditions.
- [A clinical series of 80 patients with adenosquamous carcinoma of pancreas.] [JOURNAL ARTICLE]
- Zhonghua Wai Ke Za Zhi 2014 Sep; 52(9):658-661.
To raise the awareness of adenosquamous carcinoma of pancreas and discuss the treatment of it.Clinical data of 80 cases of pancreas adenosquamous carcinoma patients in the Department of Pancreas Surgery of Changhai Hospital of Second Military Medical University from December 2003 to October 2011 were analyzed. The diagnose and treatment methods were discussed. There were 61 male cases and 19 female cases who aged from 28 to 81 years, with an average age of 60 years. The primary symptoms included 46 cases (57.5%) of abdominal malaise, 6 cases (7.5%) of low back pain, 4 cases (5.0%) of abdominal swelling pain with low back pain, 15 cases (18.8%) of abdominal swelling pain with jaundice, 5 cases (6.3%) of painless jaundice, 3 cases (3.8%) of significantly decreased body-weight and 1 case (1.3%) of no symptom. All the patients had been identified as pancreas tumor suffers by ultrasound, enhanced CT scan or MRI. Totally there were 43 cases of head/unciform process tumors, 15 cases of pancreas body tumors and 22 pancreas tail cases.Health situation of all cases were follow-up observed in the outpatient department or telephoned every 3 months till 24 months after the surgery.Among the 80 patients, 19 patients underwent pancreaticoduodenectomy (PD) , 19 patients received pylorus-preserving PD, with 4 cases of palliative resection and 1 case of total pancreatectomy. The volume of bleeding during the surgery varied from 50 to 3 500 ml with a blood transfusion volume varied from 0 to 4 000 ml. Consumed time for PD procedures was 90 to 260 min with 60 to 150 min for body and (or) tail resection with or without lienectomy. The mean diameter of tumor was (4.9 ± 2.2) cm. Pathological tests showed 35 cases of positive lymph nodes, adjacent organ invasion happened in 35 patients, however, nerve invasion were found in 68 cases.Eighteen cases occurred postoperative complications, including bleeding, pancreatic fistula, gastric emptying, incision fat liquefaction and infection, pleural effusion, ascites and nervous diarrhea. There were only 48 effective follow-up patients, with a loss ratio of follow-up by 40.0%, reasons for the loss includes change of contact information, refuse or unable to provide useful information by the relatives of the patients.Sixteen patients received chemotherapy, and 8 patients received radiotherapy after operation. All patients were dead in the effective follow-ups. The postoperative median survival time was 6 months (0.1 to 23.0 months).Adenosquamous carcinoma of pancreas is a rare kind of malignant tumor, nerve invasion can be found in almost all the cases. Patients with adenosquamous carcinoma of pancreas have an unfavorable prognosis. The principle treatments are surgery, radiotherapy and chemotherapy.
- Haemophagocytic lymphohistiocytosis: a cause of unresponsive malaria in a 5-year-old girl. [JOURNAL ARTICLE]
- Paediatr Int Child Health 2014 Nov 19.:2046905514Y0000000163.
A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum). Fever was persistent despite antimalarials in the absence of any coexisting bacterial or viral infection. Laboratory findings included cytopaenia, hyperbilirubinaemia, hyperferritinaemia, hypertriglyceridaemia, hyponatraemia, deranged partial thromboplastin time, decreasing ESR and megaloblastic changes on bone marrow aspiration. A final diagnosis of haemophagocytic lymphohistiocytosis (HLH) with megaloblastic anaemia associated with severe mixed malaria was made. There was a dramatic response to corticosteroid treatment with improvement in her clinical condition. This report endorses the use of corticosteroids in malaria-associated HLH whenever there is no clinical improvement with antimalarials alone.
- [Research progress on the relationship between SLCO1B1 gene and neonatal jaundice.] [JOURNAL ARTICLE]
- Zhongguo Dang Dai Er Ke Za Zhi 2014 Nov; 16(11):1183-1187.
Organic anion transporter 2 (OATP2) is an uptake transporter located on the basolateral membrane of human hepatocytes. It mediates the transportation of various organic solutes including bilirubin and impacts bilirubin metabolism. It is encoded by the gene of solute carrier organic anion transporter family member 1B1 and the gene variants that inhibit hepatic bilirubin uptake function may reduce the normal functional level of bilirubin elimination and result in neonatal hyperbilirubinemia. In recent years, some studies have indicated that variants of SLCO1B1 are associated with neonatal jaundice. This article reviews the research advance in SLCO1B1 with respect to the structure and function and the relationship between SLCO1B1 mutations and neonatal jaundice.
- Evaluating eosin-5-maleimide binding as a diagnostic test for hereditary spherocytosis in newborn infants. [JOURNAL ARTICLE]
- J Perinatol 2014 Nov 6.
Objective:Neonates with undiagnosed hereditary spherocytosis (HS) are at risk for developing hazardous hyperbilirubinemia and anemia. Making an early diagnosis of HS in a neonate can prompt anticipatory guidance to prevent these adverse outcomes. A recent comparison study showed that a relatively new diagnostic test for HS, eosin-5-maleimide (EMA)-flow cytometry, performs better than other available tests in confirming HS. However, reports have not specifically examined the performance of this test among neonates.Study design:We compared EMA-flow cytometry from blood samples of healthy control neonates vs samples from neonates suspected of having HS on the basis of severe Coombs-negative jaundice and spherocytes on blood film. The diagnosis of HS was later either confirmed or excluded based on clinical findings and next generation sequencing (NGS) after which we correlated the EMA-flow results with the diagnosis.Result:EMA-flow was performed on the blood of 31 neonates; 20 healthy term newborns and 11 who were suspected of having HS. Eight of the 11 were later confirmed positive for HS and one was confirmed positive for hereditary elliptocytosis (HE). All nine had persistently abnormal erythroid morphology, reticulocytosis and anemia, and eight of the nine had relevant mutations discovered using NGS. The other was confirmed positive for HS on the basis that a parent had HS, and the neonate's spherocytosis, reticulocytosis and anemia persisted. The 20 healthy controls and the 2 in whom HS was initially suspected but later excluded all had EMA-flow results in the range reported in healthy children and adults. In contrast, all nine in whom HS or HE was confirmed had abnormal EMA-flow results consistent with previous reports in older children and adults with HS.Conclusion:Although our sample size is small, our findings are consistent with the literature in older children and adults suggesting that EMA-flow cytometric testing performs well in supporting the diagnosis of HS/HE during the early neonatal period.Journal of Perinatology advance online publication, 6 November 2014; doi:10.1038/jp.2014.202.
- Severe neonatal hyperbilirubinemia leading to exchange transfusion. [Journal Article]
- Med J Islam Repub Iran 2014.:64.
Severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. This study was conducted to investigate the causes of severe hyperbilirubinemia leading to Exchange Transfusion (ET) from March 2009 to March 2011 in Bahrami children hospital, Tehran, Iran in order to establish guidelines to prevent profound jaundice & ET.94 neonates underwent ET for severe hyperbilirubinemia data for demographic data, and onset of jaundice, history of severe hyperbilirubinemia in siblings, blood group of both mother and neonate, G6PD activity, hemoglobin, hematocrite, reticulocyte count, peripheral blood smear, total and direct bilirubin before and after ET, direct and indirect Coombs, times of transfusion and the cause of hyperbilirubinemia were all recorded for analysis.Ninety four neonates (56.4% boys and 43.6% girls) underwent ET with a mean birth weight of 1950±40 g and a mean gestational age of 35.2±1.4 weeks. Premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD with the frequency of 59(63%), 33(35%), 25(24/5%) and 12(12.8%) were of major causes of ET.Predisposing factors for severe hyperbilirubinemia in this study were premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD. The authors recommend prevention of premature labor, reevaluation of successful breastfeeding education for mothers and screening infants for blood group and G6PD In the first of life. Arranging earlier and continuous visits in neonates with these risk factors during the first four days of life is also recommended.
- Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. [Journal Article]
- Evid Based Child Health 2014 Jun; 9(2):303-97.
Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord more than one minute after the birth or when cord pulsation has ceased. The benefits and potential harms of each policy are debated.To determine the effects of early cord clamping compared with late cord clamping after birth on maternal and neonatal outcomesWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 February 2013).Randomised controlled trials comparing early and late cord clamping.Two review authors independently assessed trial eligibility and quality and extracted data.We included 15 trials involving a total of 3911 women and infant pairs. We judged the trials to have an overall moderate risk of bias. Maternal outcomes: No studies in this review reported on maternal death or on severe maternal morbidity. There were no significant differences between early versus late cord clamping groups for the primary outcome of severe postpartum haemorrhage (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.65 to 1.65; five trials with data for 2066 women with a late clamping event rate (LCER) of ˜3.5%, I(2) 0%) or for postpartum haemorrhage of 500 mL or more (RR 1.17 95% CI 0.94 to 1.44; five trials, 2260 women with a LCER of ˜12%, I(2) 0%). There were no significant differences between subgroups depending on the use of uterotonic drugs. Mean blood loss was reported in only two trials with data for 1345 women, with no significant differences seen between groups; or for maternal haemoglobin values (mean difference (MD) -0.12 g/dL; 95% CI -0.30 to 0.06, I(2) 0%) at 24 to 72 hours after the birth in three trials. Neonatal outcomes: There were no significant differences between early and late clamping for the primary outcome of neonatal mortality (RR 0.37, 95% CI 0.04 to 3.41, two trials, 381 infants with a LCER of ˜1%), or for most other neonatal morbidity outcomes, such as Apgar score less than seven at five minutes or admission to the special care nursery or neonatal intensive care unit. Mean birthweight was significantly higher in the late, compared with early, cord clamping (101 g increase 95% CI 45 to 157, random-effects model, 12 trials, 3139 infants, I(2) 62%). Fewer infants in the early cord clamping group required phototherapy for jaundice than in the late cord clamping group (RR 0.62, 95% CI 0.41 to 0.96, data from seven trials, 2324 infants with a LCER of 4.36%, I(2) 0%). Haemoglobin concentration in infants at 24 to 48 hours was significantly lower in the early cord clamping group (MD -1.49 g/dL, 95% CI -1.78 to -1.21; 884 infants, I(2) 59%). This difference in haemoglobin concentration was not seen at subsequent assessments. However, improvement in iron stores appeared to persist, with infants in the early cord clamping over twice as likely to be iron deficient at three to six months compared with infants whose cord clamping was delayed (RR 2.65 95% CI 1.04 to 6.73, five trials, 1152 infants, I(2) 82%). In the only trial to report longer-term neurodevelopmental outcomes so far, no overall differences between early and late clamping were seen for Ages and Stages Questionnaire scores.A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants. Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.Effect of timing of umbilical cord clamping of term infants on mother and baby outcomes At the time of birth, the infant is still attached to the mother via the umbilical cord, which is part of the placenta. The infant is usually separated from the placenta by clamping the cord. This clamping is one part of the third stage of labour (the time from birth of the baby until delivery of the placenta) and the timing can vary according to clinical policy and practice. Although early cord clamping has been thought to reduce the risk of bleeding after birth (postpartum haemorrhage), this review of 15 randomised trials involving a total of 3911 women and infant pairs showed no significant difference in postpartum haemorrhage rates when early and late cord clamping (generally between one and three minutes) were compared. There were, however, some potentially important advantages of delayed cord clamping in healthy term infants, such as higher birthweight, early haemoglobin concentration, and increased iron reserves up to six months after birth. These need to be balanced against a small additional risk of jaundice in newborns that requires phototherapy.
- Choledochal cyst - a different disease in newborns and infants. [Journal Article]
- J Coll Physicians Surg Pak 2014 Nov; 24(11):868-70.
We report experience of managing Choledochal Cyst (CC) in different paediatric ages. Eleven neonates and infants (aged 0-8 months) and 24 paediatric cases (aged 2.5 - 18 years) were managed over 24 years (1988 to 2012). Neonates and infants presented with jaundice, acholic stools and abdominal mass whereas most of the paediatric cases presented with intermittent non-specific abdominal pain. Morphology of CC was mostly cystic in neonates whereas it was fusiform in majority (62%) of paediatric cases. Biliary amylase was high and correlated with the presence of abnormal pancreaticobiliary junction (PBJ) in 20 /24 paediatric patients. Obstruction at the lower end of bile duct, liver fibrosis and cirrhosis were common in neonates. In conclusion, CC in newborns and infants is different and mimic correctable Biliary Atresia (BA). Early excision of CC and biliary reconstruction is promising in neonates, infants and children and it can be performed with minimal morbidity.
- Full length migration of plastic biliary stent into the left lobe of liver and its endoscopic retrieval. [Journal Article]
- J Coll Physicians Surg Pak 2014 Nov; 24(11):861-2.
An elderly female was admitted with obstructive jaundice, secondary to an impacted 1.7 cm size stone in distal CBD. Cholangiogram obtained during ERCP revealed dilated biliary system with large, immobile stone at the lower end of CBD. A large size sphincterotomy was performed and stone extraction using biliary balloon / dormia basket attempted which was unsuccessful as the stone was impacted in distal CBD. Therefore, a plastic biliary stent of 9 cm/8.5 french size was inserted successfully to secure the biliary drainage. Patient improved clinically and discharged home on ursodeoxycholic acid. Four weeks later, she presented to emergency department with signs of cholangitis. An emergency ERCP was performed. The stent had migrated up completely into the left intra hepatic duct. In this session, the stone was extracted and biliary drainage secured. Migrated stent was removed later on by another ERCP procedure.
- Pseudoaneurysm of anomalous cystic artery due to calculous cholecystitis. [Journal Article]
- BMJ Case Rep 2014.
Pseudoaneurysm of the cystic artery is a rare cause of haemobilia resulting from either an inflammatory process in the abdomen or abdominal trauma. We report a case of a patient with chronic calculous cholecystitis associated with a pseudoaneurysm arising from an anomalous cystic artery who presented with haemobilia. The patient was managed successfully with multimodality treatment that included angioembolisation of the pseudoaneurysm and stenting of the common bile duct to relieve jaundice followed by elective open cholecystectomy.