Comparación clínica y laboratorial de la fiebre amarilla severa versus dengue grave en Perú / Clinical and laboratory differences between severe yellow fever and severe dengue in emergency patients

En los centros de Emergencia con poco apoyo de laboratorio, es difícil diferenciar a los pacientes con dengue grave y fiebre amarilla severa. El objetivo fue comparar el perfil clínico y de laboratorio de los pacientes con dengue grave y fiebre amarilla severa en Urgencias. Se realizó un estudio observacional retrospectivo de pacientes con diagnóstico confirmado de dengue y fiebre amarilla en el período 2018 a 2020 atendidos en la Unidad de Emergencia del Hospital Carrión, Huancayo-Perú. Se evaluaron un total de 35 pacientes, 11 pacientes (31,4%) fueron diagnosticados con fiebre amarilla severa y 24 pacientes (68,5%) con dengue grave. La media de los resultados de laboratorio con fiebre amarilla severa fueron bilirrubina indirecta 4,7 ml/dL, aspartato transaminasa 4463 UI/L, transaminasa aminotransferasa 4329 UI/L, creatinina 4,9 mg/dl. En pacientes con dengue grave el hematocrito promedio fue 51,8, hemoglobina 17,6 g/dl, plaquetas 24 × 103/mm. En pacientes con síndrome ictérico-febril la presencia de bradicardia, bilirrubina indirecta elevada y transaminasas muy elevadas debe hacer sospechar de fiebre amarilla; mientras que los pacientes que acuden por ascitis, derrame pleural, aumento de hematocrito y deficiencia de plaquetas, se debe tratar como dengue grave sobre todo en Unidades de Emergencia con poco apoyo de laboratorio(AU)

In Emergency centers with little laboratory support, differentiating patients with dengue and yellow fever is difficult. The Aim was to compare the clinical and laboratory profile of patients with severe dengue and severe yellow fever in the Emergency unit. We conducted a retrospective observational study of patients with a confirmed diagnosis of dengue and yellow fever in the period 2018 to 2020 treated in the Emergency Unit of the Carrión hospital, Huancayo-Peru. A total of 35 patients were evaluated, 11 patients (31.4%) were diagnosed with severe yellow fever and 24 patients (68.5%) with severe dengue. The mean laboratory results in patients with severe yellow fever were indirect bilirubin 4.7 ml/dL, aspartate transaminase 4463 IU/L, transaminase aminotransferase 4329 IU/L, creatinine 4.9 mg / dl. In patients with severe dengue were hematocrit 51.8, hemoglobin 17.6 g / dl, platelets 24 × 103 / mm. In patients with syndrome jaundice and fever the presence of bradycardia, elevated indirect bilirubin, and very elevated transaminases should be suspicious for yellow fever; while in patients who come for ascites, pleural effusion, increased hematocrit and platelet deficiency, it should be treated as severe dengue especially in Emergency Units with little laboratory support(AU)

Epidemiological profile, referral routes and diagnostic accuracy of cases of acute cholangitis among individuals with obstructive jaundice admitted to a tertiary-level university hospital: a cross-sectional study

ABSTRACT BACKGROUND: Obstructive jaundice may lead to ominous complications and requires complex diagnostic evaluations and therapies that are not widely available. OBJECTIVE: To analyze the epidemiological profile, referral routes and diagnostic accuracy at admittance of cases of acute cholangitis among patients with obstructive jaundice treated at a referral unit. DESIGN AND SETTING: Cross-sectional study at a tertiary-level university hospital. METHODS: Patients with obstructive jaundice who were treated by means of endoscopic retrograde cholangiopancreatography, resection and/or surgical biliary drainage were evaluated. The main variables analyzed were epidemiological data, referral route, bilirubin levels and time elapsed between symptom onset and admittance and diagnosing of acute cholangitis at the referral unit. The accuracy of the clinical diagnosis of acute cholangitis was compared with a retrospective analysis on the medical records in accordance with the Tokyo criteria. RESULTS: Female patients predominated (58%), with an average age of 56 years. Acute cholangitis was detected in 9.9% of the individuals; application of the Tokyo criteria showed that the real prevalence was approximately 43%. The main referral route was direct contact (31.8%) and emergency care (29.7%); routing via official referral through the public healthcare system accounted for 17.6%, and internal referral from other specialties, 20%. The direct route with unofficial referral was the most important route for cases of neoplastic etiology (P < 0.01) and was the fastest route (P < 0.01). CONCLUSIONS: There is a deficiency in the official referral routes for patients with obstructive jaundice. The accuracy of the clinical diagnosis of acute cholangitis was poor. Wider dissemination of the Tokyo criteria is essential.

The application of Compont gel in chronic obstructive jaundice rats model

Abstract Purpose: To establish a new rat model, the pathogenesis of which is closer to the clinical occurrence of chronic obstructive jaundice with liver fibrosis. Methods: 90 SD rats were randomly divided into 3 groups. Group A common bile duct ligation, group B common bile duct injection compont and group C injection saline. The serum of three groups was extracted, and the liver function was detected by ELISA. HE staining, Masson staining and immunohistochemistry were used to detect liver pathology. Results: Group B showed a fluctuant development of jaundice, obstructive degree reached a peak at 2 weeks, and decreased from 3 weeks. HA, LA and PCIII were significantly higher than control group. 3 weeks after surgery, liver tissue fibrosis occurred in group B, and a wide range of fiber spacing was formed at 5 weeks. Immunohistochemistry showed that hepatic stellate cells were more active than the control group. Conclusion: Intra-biliary injection of Compont gel is different from the classic obstructive jaundice animal model caused by classic bile duct ligation, which can provide an ideal rat model of chronic obstructive jaundice with liver fibrosis.

A Korean patient with Guillain-Barré syndrome following acute hepatitis E whose cholestasis resolved with steroid therapy

Autochthonous hepatitis E virus (HEV) is an emerging pathogen in developed countries, and several cases of acute HEV infection have been reported in South Korea. However, there have been no reports on HEV-associated Guillain-Barré syndrome (GBS) in Korea. We recently experienced the case of a 58-year-old Korean male with acute HEV infection after ingesting raw deer meat. Persistent cholestasis was resolved by the administration of prednisolone. At 2.5 months after the clinical presentation of HEV infection, the patient developed weakness of the lower limbs, and was diagnosed with GBS associated with acute hepatitis E. To our knowledge, this is the second report on supportive steroid therapy for persistent cholestasis due to hepatitis E, and the first report of GBS in a Korean patient with acute HEV infection.

Clinical Significance of Biliary Dilatation and Cholelithiasis after Subtotal Gastrectomy / 대한소화기학회지

BACKGROUND/AIMS: The well-organized study to support that increased cholelithiasis and bile duct dilatation can occur after gastrectomy has not been reported. The aim of this study was to determine the incidence of cholelithiasis and the degree of common bile duct (CBD) dilatation in patients undergoing subtotal gastrectomy, compared to those undergoing endoscopic treatment for gastric cancer. METHODS: Patients who diagnosed with gastric cancer and received treatment at six academic referral centers were investigated for the incidence and time of cholelithiasis and the degree of CBD dilatation after treatment by analysis of 5-year follow-up CTs. The operation group underwent subtotal gastrectomy without vagotomy, while in the control group endoscopic treatment was administered for gastric cancer. RESULTS: A total of 802 patients were enrolled in 5-year analysis (735 patients in the operation group and 67 patients in the control group). Cholelithiasis occurred in 47 patients (6.39%) in the operation group and 3 patients (4.48%) in the control group (p=0.7909). The incidences of cholelithiasis were 4.28% in Billoth-I and 7.89% in Billoth-II (p=0.0487). The diameter of proximal CBD and distal CBD increased by 1.11 mm and 1.41 mm, respectively, in the operation group, compared to 0.4 mm and 0.38 mm, respectively, in the control group (p<0.05). Patients with increased CBD dilatation more than 5 mm showed statistically significant increases in alkaline phosphatase and gamma-glutamyltransferase. CONCLUSIONS: The incidence of cholelithiasis was not increased due to subtotal gastrectomy without vagotomy, but the incidence was higher after Billoth-II compared to Billoth-I. In addition, significant change in the CBD diameter was observed after subtotal gastrectomy.

Influence of assessment site in measuring transcutaneous bilirubin / Influência do local de avaliação na mensuração da bilirrubina transcutânea / Influência do local de avaliação na mensuração da bilirrubina transcutânea

Objective : To investigate the influence of the site of measurement of transcutaneous bilirubin (forehead or sternum) in reproducibility of results as compared to plasma bilirubin. Methods : A cohort study including 58 term newborns with no hemolytic disease. Transcutaneous measurements were performed on the forehead (halfway between the headline and the glabella, from the left toward the right side, making consecutive determinations, one-centimeter apart) and the sternum (five measurements, from the suprasternal notch to the xiphoid process with consecutive determinations, one-centimeter apart) using Bilicheck® (SpectRx Inc, Norcross, Georgia, USA). The correlation and agreement between both methods and plasma bilirubin were calculated. Results : There was a strong linear correlation between both determinations of serum bilirubin at the forehead and sternum (r=0.704; p<0.01 and r=0.653; p<0.01, respectively). There was correspondence of the mean values of transcutaneous bilirubin measured on the sternum (9.9±2.2mg/dL) compared to plasma levels (10.2±1.7mg/dL), but both differ from the values measured on the forehead (8.6±2.0mg/dL), p<0.05. Conclusion : In newborn term infants with no hemolytic disease, measuring of transcutaneous bilirubin on the sternum had higher accuracy as compared to serum bilirubin measurement on the forehead. .

Objetivo : Verificar a influência do local da mensuração da bilirrubina transcutânea (fronte ou esterno) na reprodutibilidade dos resultados, quando comparada à bilirrubina plasmática. Métodos : Estudo tipo coorte incluindo 58 recém-nascidos a termo sem doença hemolítica. Foram realizadas determinações transcutâneas na fronte (a meia distância entre a raiz do couro cabeludo e a glabela, iniciando do lado esquerdo em direção ao direito, realizando determinações consecutivas, separadas por 1cm) e no esterno (cinco mensurações iniciando da fúrcula até o apêndice xifoide, com determinações consecutivas, separadas por 1cm), utilizando o equipamento Bilicheck® (SpectRx Inc, Norcross, Geórgia, Estados Unidos). Foram calculadas as correlações e a concordância entre ambos os métodos, e a bilirrubina plasmática. Resultados : Foi encontrada forte correlação linear tanto entre a determinação na fronte quanto no esterno, com nível sérico de bilirrubina (r=0,704; p<0,01 e r=0,653; p<0,01, respectivamente). Houve correspondência dos valores médios de bilirrubina transcutânea aferidos no esterno (9,9±2,2mg/dL) com os valores plasmáticos (10,2±1,7mg/dL), porém ambos diferiram dos valores medidos na fronte (8,6±2,0mg/dL), com p<0,05. Conclusão : Em recém-nascidos a termo sem doença hemolítica, a mensuração da bilirrubina transcutânea realizada no esterno apresenta maior acurácia em relação à mensuração na fronte, quando comparada à bilirrubina sérica. .

Massive Bleeding Hemobilia Occurred in Patient with Hepatocellular Carcinoma / 대한소화기학회지

Massive bleeding hemobilia occurs rarely in patients with hepatocellular carcinoma (HCC) without any invasive procedure. Upper gastrointestinal bleeding in patient with cirrhosis and abdominal pain with progressive jaundice in patient with HCC were usually thought as variceal bleeding and HCC progression respectively. We experienced recently massive bleeding hemobilia in patient with HCC who was a 73-year old man and showed sudden abdominal pain, jaundice and hematochezia. He had alcoholic cirrhosis and history of variceal bleeding. One year ago, he was diagnosed as HCC and treated with transarterial chemoembolization periodically. Sudden right upper abdominal pain occurred then subsided with onset of hemotochezia. Computed tomography showed bile duct thrombosis spreading in the intrahepatic and extrahepatic ducts, while an ampulla of vater bleeding was observed during duodenoscopy. Hemobilia could be one of the causes of massive bleeding in patients with cirrhosis and HCC especially when they had sudden abdominal pain and abrupt elevation of bilirubin.

Association between Total Bilirubin and Hemoglobin A1c in Korean Type 2 Diabetic Patients

Recent studies have shown that bilirubin is negatively associated with hemoglobin A1c (HbA1c) in the general population. The association between bilirubin and HbA1c in serum of diabetes patients has not yet been studied. The aim of the present study was to evaluate the association between total bilirubin and HbA1c in Korean patients with type 2 diabetes. A total of 690 of the 1,275 type 2 diabetes patients registered with the public health centers in Seo-gu, Gwangju and Gokseong-gun, Jeollanam-do participated in this study. Following an overnight fast, venous blood and urine samples were collected and analyzed. The mean HbA1c values differed significantly according to total bilirubin ( or = 0.8 mg/dL, 7.1%; P for trend = 0.016) after we adjusted for other confounding factors. When the odds ratio (OR) was adjusted for other confounding factors, there was a significant association between total bilirubin and HbA1c (OR, 0.4 [95% confidence interval, 0.2-0.8] for total bilirubin > or = 0.8 mg/dL versus < or = 0.4 mg/dL. In conclusion, total bilirubin concentrations in serum are negatively associated with HbA1c levels after adjustment for sex, age, and other confounding factors in type 2 diabetes patients.

Níveis aumentados de bilirrubina estão associados com risco reduzido de doença pulmonar e mortalidade / Increased bilirubin levels are associated with reduced risk of lung disease and mortality

Níveis aumentados de bilirrubina (acima de 2,34 mg/dL para homens e 1,75 mg/dL para mulheres) estão associados com uma redução de risco de doença respiratória e mortalidade geral por todas as causas.

Lipotoxicidade na leptospirose humana: aspectos prognósticos e potencial efeito benéfico da administração de albumina / Lipotoxicity in human leptospirosis: prognostics aspects and potential beneficial effect of albumin administration

A leptospirose humana é uma doença infecciosa aguda de amplo espectro clínico e que cursa com alterações metabólicas e dislipidêmicas envolvendo colesterol total e frações, triglicerídeos e ácidos graxos não esterificados (AGNEs). Dentre os mecanismos celulares envolvidos na sua fisiopatologia encontram-se a inibição da enzima Na, K ATPase pela endotoxina GLP e a lipotoxicidade, ambos agravados pela redução dos níveis circulantes da albumina, molécula que exerce um papel fundamental na adsorção de moléculas lipídicas. Neste estudo observacional, determinamos as concentrações séricas de bilirrubina, creatinina e albumina e, pela técnica de cromatografia líquida de alta performance, a concentração sérica dos AGNEs de cadeia longa (C16: C18) de 27 pacientes com síndrome de Weil durante o período de internação hospitalar, dos quais cinco vieram a falecer. Verificamos correlações significantes (p<0,05) ao longo da internação hospitalar, nas concentrações séricas de marcadores bioquímicos de gravidade da doença (bilirrubina, creatinina e albumina), AGNEs, ácido oléico e ácido linoléico, e relação molar ácido oléico/albumina, com r (Pearson) de -0,7981, -0,7699, 0,9014, -0,8795 -0,9816, -0,9694, -0,9821, respectivamente. A relação molar ácido oléico/albumina e ácido oléico+linoléico/albumina foi significantemente mais elevada nos pacientes que faleceram (p<0,001), retornando aos valores semelhantes aos do grupo controle nos pacientes que evoluíram para a cura. Na análise por Curva Roc, a relação molar ácido oléico/albumina se mostrou um bom teste preditivo, com valor de corte 0,705 associado com maior especificidade e sensibilidade prognóstica. Nossos resultados sugerem que a utilização parenteral da albumina humana em pacientes com leptospirose pode ser uma potente ferramenta terapêutica nos casos mais graves ao interferir positivamente no resgate do equilíbrio bioquímico das relações molares ácido oléico/algumina e ácido oléico+linoléico/algumina.

Human leptospirosis is an acute infectious disease with a broad clinical spectrum. It courses with metabolic and dyslipidemic alterations, involving total cholesterol and fractions, triglycerides and nonesterified fatty acids (NEFAs). The cellular mechanisms involved in its pathogenesis include the inhibition of the enzyme sodium-potassium adenosine triphosphatase and lipotoxicity. Both mechanisms are aggravated by the reduction of serum levels of albumin, a molecule that plays a fundamental role in the absorption of lipid molecules. In this observational study, we determined the serum concentrations of bilirubin, creatinine and albumin, and, by High Performance Liquid Chromatography, the serum concentrations of long chain NEFAs (C16: C18) during the period of hospitalization of 27 patients with Weil's syndrome, five of whom progressed to death. Significant correlations were found between the length of hospitalization and serum concentrations of biochemical markers of severity (bilirubin, creatinine, albumin), NEFAs, oleic acid and linoleic acid, and the oleic acid: albumin molar ratio, with r (Pearson) of de -0,7981, -0,7699, 0,09014, -0,8795 -0,9816, -0,9694, -09821 respectively. The oleic acid: albumin molar ratio and oleic-plus-linoleic acid: albumin molar ratio were significantly higher in the patients who progressed to death, whereas in the cured patients this ratio decreased to levels that were similar to those found in the control group. Roc Curve analysis for the acid oleic: albumin molar ratio proved a good predictive test, with value of cutting 0.705 associated with greater specificity and prognostic sensitivity. Our results suggest that parenteral administration of human albumine may interfere positively in the rescue of biochemical balance of oleic acid: albumin molar ratio and oleic-plus-linoleic acid: albumin molar ratio and be a therapeutic tool for severe cases of leptospirosis.

Enfermedad hemolítica perinatal: manejo de la embarazada RhD negativo / Perinatal hemolytic disease: management of RhD immunization in pregnancy

En solo 50 años la enfermedad hemolítica perinatal por isoinmunización anti D pasó de ser una enfermedad sin etiología conocida, incurable y no prevenible, a la situación actual en que por las técnicas de prevención, diagnóstico oportuno y tratamiento especializado tiene baja incidencia y altas expectativas de sobrevida, incluso en los casos más severos. Se describe la historia, las técnicas de prevención, diagnóstico, manejo y tratamiento de la enfermedad.

In just 50 years the perinatal hemolytic disease due to RhD isoimmunization went from being a disease without known etiology, untreatable and not preventable to the current situation in which the prevention techniques, opportune diagnosis and specialized treatment has low its incidence and has an expected high survival even in the more severe cases. This article describes the history, prevention techniques, diagnosis, management and treatment of the disease.

Clinical Characteristics of Intrahepatic Cholangiocarcinoma and Prognostic Factors in Patients Who Received Non-surgical Treatment / 대한소화기학회지

BACKGROUND/AIMS: This study was conducted to analyze the prognostic factors in patients with intrahepatic cholangiocarcinoma (ICC) who did not receive surgery. METHODS: Between August 1997 and November 2007, the medical records of 175 patients (mean age; 66 years, male/female 126/49), who were diagnosed as ICC, were reviewed retrospectively. RESULTS: Clonorchiasis and hepatolithiasis was found in 14.9%, and 6.3% of all patients, and no risk factors were identified in 77.8% of them. Surgical resection was performed in 29.1% (51 patients), chemotherapy +/- radiotherapy in 12.6% (22 patients), and palliative therapy in 58.3% (102 patients). The proportion of patients with stage I was 23.4% (41 patients). The prognostic factors in patients who did not receive surgery were alkaline phosphatase (ALP) and bilirubin levels by univariate and multivariate analysis. The median survival of patients with normal ALP and bilirubin levels was six months, whereas only one month in patients with elevated ALP and bilirubin levels (p<0.001). Tumor characteristics of patients with elevated bilirubin and ALP levels were infiltrative tumor, bile duct involvement, and very huge tumor. CONCLUSIONS: The prognostic factors of ICC in patients who did not receive surgery were ALP and bilirubin levels, but not lymph node metastasis.

Changes in Liver Stiffness after Acute or Chronic Liver Injury due to Viral Hepatitis - Does Fibrosis Exist after Recovery from Acute Viral Hepatitis? / 대한소화기학회지

BACKGROUND/AIMS: Liver stiffness (LS) measurement by transient elastography can estimate the degrees of liver fibrosis in patients with chronic liver disease. However, longitudinal data of LS after recovery of acute viral hepatitis are still lacking. In the present study, we aimed to evaluate among LS of patients at various stages of viral hepatitis and normal control. METHODS: Patients who had admitted at Korea University Ansan Hospital between January 2006 and January 2007 due to acute viral hepatitis and recovered were recruited (group A, n=22). We compared the liver biochmistry and LS of group A with those of healthy control group (group B, n=23), current acute viral hepatitis group (group C, n=49), and chronic viral hepatitis group (group D, n=66). RESULTS: Mean ALT, total bilirubin, and LS level of group A were not different from group B (p=0.318, p=0.116, p=0.125, respectively). However, group A had lower ALT, total bilirubin, and LS values compared to group C (all p<0.001), and lower ALT and LS values compared to group D (p=0.007, p<0.001). The mean total bilirubin was not significantly different from group D (p=0.117). CONCLUSIONS: Our data suggest that liver fibrosis is a long-term sequela of chronic hepatitis, and not developed in patients who recovered from acute viral hepatitis.

Associação da concentração de bilirrubina sérica com a carga aterosclerótica em pacientes com doença arterial coronariana estabelecida / Association of serum bilirubin concentration with atherosclerotic burden in patients with established coronary artery disease

Fundamentos: As doenças cardiovasculares são um importante problema de saúde pública, e as respostas adaptativas e protetoras da vasculatura contra o estresse oxidativo são importantes na prevenção da aterosclerose. A bilirrubina tem sido considerada um antioxidante, com capacidade de remover espécies reativas de oxigênio. Estudos têm demonstrado que a concentração de bilirrubina sérica aumentada promove proteção contra aterosclerose. Objetivo: Avaliar a possível existência de relação entre a carga aterosclerótica de pacientes com doença arterial coronariana e a concentração de bilirrubina. Método: Estudo transversal composto por 81 pacientes com diagnóstico angiográfico estabelecido de doença arterial coronariana, submetidos a revascularização miocárdica. Foram avaliados os fatores de risco clássicos e a dosagem de bilirrubina. Foram utilizados os testes do qui-quadrado, teste t de Student ou Mann-Whitney, sendo considerado p < 0,05 estatisticamente significativo. Resultados: A amostra foi composta predominantemente por homens, com média de idade de 59,32 ± 9,28 anos no grupo com lesão mínima/moderada e 61,79 ± 7,55 anos no grupo com lesão grave. A mediana da bilirrubina total no grupo com lesão mínima/moderada foi de 0,34 mg/dL, enquanto no grupo com lesão grave foi de 0,43 mg/dL, diferente do esperado. A concentração de bilirrubina total foi maior no grupo com carga aterosclerótica grave que no grupo com carga mínima/moderada, embora sem significância estatística (p = 0,241). Conclusão: Níveis séricos de bilirrubina não se mostraram úteis na detecção ou predição da gravidade da lesão aterosclerótica dos pacientes com doença arterial coronariana.

Background: Cardiovascular diseases are an important public health problem. Adaptive and protective responses of the vascular system against oxidative stress are important in the prevention of atherosclerosis. Bilirubin has been considered an antioxidant, with the capacity to remove reactive species of oxygen. Previous studies have demonstrated that increased serum bilirubin concentrations promote protection against atherosclerosis. Purpose: To evaluate the relationship between the atherosclerotic burden and the bilirubin concentration of patients with coronary artery disease. Method: Transversal study composed of 81 patients with established angiographic diagnosis of coronary artery disease, submitted to myocardial revascularization. Classical risk factors and bilirubin levels were assessed. The chisquare, the t Student test or the Mann-Whitney test were used with p value significant at < 0.05. Results: The sample was composed predominantly of men, with a mean age of 59.32 ± 9.28 years in the minimum/moderate atherosclerotic burden group and 61.79 ± 7.55 years in the severe burden group. The median of total bilirubin in the minimum/moderate atherosclerosis burden group was 0.34 mg/dL and 0.43 mg/dL in the severe burden group. Differently than expected, the concentration of total bilirubin was higher in the group with severe atherosclerotic burden than in the group with minimum/moderate burden, although without statistical significance (p = 0.241). Conclusion: Serum bilirubin levels were not useful in the detection or prediction of the severity of atherosclerotic lesions in patients with coronary artery disease.

Jaundice in the newborns.

Hyperbilirubinemia is the commonest morbidity in the neonatal period and 5-10% of all newborns require intervention for pathological jaundice. Neonates on exclusive breast-feeding have a different pattern and degree of jaundice as compared to artificially fed babies. Latest guidelines from the American Academy of Pediatrics (AAP) for management of jaundice in a normal term newborn have been included in the protocol. Separate guidelines have been provided for the management of jaundice in sick term babies, preterm and low birth weight babies, for hemolytic jaundice and prolonged hyperbilirubinemia.

Clinical Significance of White Bile (Bilirubin-Free Bile) in Malignant Bile Duct Obstruction / 대한소화기학회지

BACKGROUND/AIMS: White bile is colorless, translucent fluid found occasionally in malignant bile duct obstruction (MBO). Little information is available on the cause and effect of white bile. The aim of this study was to determine the frequency and clinical significance of white bile in MBO. METHODS: Bile was aspirated during endoscopic retrograde cholangiopancreatography in consecutive patients with MBO. White bile was defined as bile bilirubin or=1.5 mg/dL in the bile. Two groups were compared prospectively for the duration of jaundice, itching, cholangitis, level of obstruction, and decremental rate of bilirubin after the insertion of 7 Fr endoscopic nasobiliary drainage until the insertion of metal stent or 10 Fr plastic stent. RESULTS: Among 60 patients with MBO, 16 (26.7%) had white bile. WBC count in blood was higher (9,456/mm3 vs. 7,400/mm3, p=0.029) and cholangitis was more common (11/16 vs. 7/44, p=0.000) in white than yellow bile group. Proximal portion of MBO had no communication with GB in 9/16 patients with white bile group and 17/44 patients with yellow bile group (p>0.05). Mean survival of the inoperable 35 patients was 242 days in yellow bile and 227 days in white bile group (p>0.05). CONCLUSIONS: White bile in MBO was not rare and was associated with cholangitis. Gallbladder did not seem to play a role in the formation of white bile. Further study for the pathogenesis and prognosis of white bile in MBO will be necessary.

Correlación entre bilirrubina sérica y bilirrubinometría transcutánea en neonatos estratificados por edad gestacional / Correlation between serum bilirubin and transcutaneus bilirubinometry in newborns stratified by gestation age

La ictericia neonatal es un dilema diagnóstico y terapéutico muy común. Las decisiones basadas en mediciones seriadas de bilirrubina sérica se asocian con dolor en el niño, tiempo de espera y ansiedad por los resultados. La bilirrubinometría transcutánea puede ser una alternativa confiable si se demuestra su validez para poblaciones e instituciones particulares. Establecer el grado de correlación entre bilirrubina sérica total (BST) y bilirrubina transcutánea (BTC) en neonatos estratificados por edad gestacional. Estudio de diseño transversal. Cien recién nacidos ictéricos, 50 de término y 50 pretérmino, fueron analizados. A cada niño se le realizó una medición simultánea de BST y BTC. Luego se calcularon los coeficientes de variación de las medias, las diferencias de las medidas, la sensibilidad y el valor predictivo positivo de la BTC, los coeficientes de correlación, la ecuación de la línea de regresión, y la equivalencia de ambas mediciones para predecir el riesgo de hiperbilirrubinemia. El coeficiente de variación de las medias fue similar para ambas mediciones (BST: 3,09 por ciento; BTC: 3,24 por ciento). Las mediciones de BST y BTC fueron diferentes en 95 niños, e iguales en 5 de ellos. En los 95 neonatos con lecturas divergentes, la BTC subestimó la BST en 59 y la sobreestimó en 36, con una diferencia promedio de 1,39 mg/dl (DE 0,58 mg/dl). La sensibilidad de la BTC para identificar una BST >12 mg/dl fue 87 por ciento, con un valor predictivo positivo de 94 por ciento. El coeficiente de correlación de toda la muestra fue 0,88; en los neonatos de término fue 0,92 y en los pretérmino fue 0,84. El 82 por ciento de los neonatos fueron correctamente clasificados por la BTC en los percentiles de riesgo para hiperbilirrubinemia significativa. La precisión de las medidas de BST y BTC es similar en nuestra institución. Aunque hay una correlación aceptable entre ambos métodos de valoración, independientemente de la edad gestacional, la técnica de la BTC...

Newborn jaundice with its potential for producing brain damage remains a continuing problem for pediatricians. Therapeutic decisions based on serial measurements of serum bilirubin (TSB) are time-consuming and associated with stress for the child, parents and practitioners. Transcutaneous bilirubinometry (TCB) may be an alternative method if its reliability is proven for a particular institution and population. To establish the degree of correlation between TSB and TCB in newborn infants classified by gestational age. Cross-sectional study. 100 jaundiced infants, stratified into two groups of 50 preterm and 50 full-term newborns, were analyzed by simultaneous samples of TSB and TCB. Statistical analysis included estimates of differences between the two measurements, coefficients of variation of means, correlation coefficients, sensitivity and positive predictive value of TCB, and accuracy of TCB to predict significant hyperbilirubinemia. The coefficient of variation of means was similar for both methods (TSB: 3.09 percent; TCB: 3.24 percent). Measurements of TSB and TCB were different in 95 infants and equivalent in 5. TCB underestimated TSB in 59 measurements and overestimated it in 36 of them, with a mean difference of 1.39 mg/dl (SD 0.58 mg/dl). Sensitivity of TCB to identify a TSB >12 mg/dl was 87 percent, with a positive predictive value of 94 percent. The global correlation coefficient was 0.88 (term infants: 0.92; preterm infants: 0.84). 82 percent of the infants were correctly classified by the TCB within the percentiles of risk for significant hyperbilirubinemia. Precision of measurements of TSB and TCB is similar in our institution. Despite a good correlation between the two methods, regardless the gestational age, TCB tends to underestimate TSB when bilirubin values go beyond 12 mg/dl. The TCB technique can accurately predict the risk of extreme hyperbilirubinemia, so it can be cautiously used prior to dischange to reduce this risk and to avoid...