Onset Of Jaundice Research Articles

Epidemiology of type A infections.

Since specific laboratory tests for type A infections do not exist, discussion of their epidemiology is hazardous. Most of the infections are doubtless anicteric and occult. The jaundice itself lacks clinical and biological pathognomonic features. One can imagine what confusion has appeared and remains between type A and type B infections. The epidemiological distinctions attempted under these circumstances need to be reexamined in the light of recent advances in immunology. Krugman and Giles 1 in the Willowbrook State School, New York, an institution for mentally retarded children, showed that hepatitis due to type A viruses is characterized by ( a ) two routes of inoculation: oral and parenteral; ( b ) an incubation period of 29 to 43 days, with an average duration of 35 days, regardless of the route of inoculation, if the incubation period is designated as the time interval between exposure and onset of jaundice or peak of serum glutamic oxaloacetic

Patterns of immunoglobulins in acute viral hepatitis: relation to hepatitis-associated antigen.

The documented association between the hepatitis-associated antigen (HAA) and long-incubation serum hepatitis has inspired a study of immunoglobulin patterns in serum during the course of disease in 65 hepatitis patients with demonstrable HAA and in 40 histopathologically verified cases of hepatitis without demonstrable HAA in acute-phase serum. The HAA-negative patients showed markedly increased levels of IgM that were significantly higher than those of the HAA-positive patients during the first month after onset of jaundice. Both groups had elevated levels of IgG, but normal levels of IgA. These different patterns, which may be of diagnostic help in selected cases of viral hepatitis, support the concept that viral hepatitis associated with HAA has an immunologic nature different from that of viral hepatitis not associated with HAA.

Hepatitis-associated antigen (HAA) in acute viral hepatitis. Serological and clinical studies.

AbstractIn a prospective study serial serum specimens from 291 patients (including 99 intravenous amphetamine abusers) with acute viral hepatitis were tested for presence of hepatitis-associated antigen (HAA) with a diffusioningel method. The antigen was found in high frequency in patients with presumed long-incubation serum hepatitis, but not in patients of a small common-source outbreak of short-incubation infectious hepatitis. The incubation period could be determined in 45 cases and was compatible with the period reported for serum hepatitis in the patients with HAA and with the period reported for infectious hepatitis in the patients without HAA. The antigen was found in 48% of the patients without any known hepatitis exposure, indicating that serum hepatitis is a common cause of sporadic hepatitis in urban adults. HAA tended to disappear within the first few weeks after onset of jaundice and chronic persistence of HAA was not found, indicating that this is unusual in previously healthy patients with...

Chromosomal aberrations in infective hepatitis.

Structural chromosomal aberrations, in the form of breaks, were found in a significantly higher proportion of bone marrow cells in patients with infective hepatitis than in controls. These anomalies were observed during the first and third weeks after the onset of jaundice but had subsided by the sixth week. Chromosomal aberrations did not appear to be related to the severity of infective hepatitis or to the sex or age of the patients.The distribution of chromosomal abnormalities did not appear to be random; they were observed predominantly in the A(2) and B(4-5) series. Since no abnormalities were detected in the G-group chromosomes, no evidence in support of a relationship between infective hepatitis and Down's syndrome was obtained. Numerical chromosomal aberrations were not observed, nor was any evidence obtained that mitotic activity of bone marrow cells is suppressed in patients with infective hepatitis.

Viral hepatitis. New light on an old disease.

Tests for the presence of Australia or hepatitisassociated antigen (HAA) and antibody (anti-HAA) were performed on more than 25,000 serum specimens from more than 700 patients with viral hepatitis. Hepatitisassociated antigen was consistently present in sera from patients with MS-2 strain of serum hepatitis (SH); it was not present in MS-1, infectious hepatitis (IH). Hepatitis-associated antigen was detected earlier after a parenteral exposure to SH than after an oral exposure. Antigen appeared two weeks to two months before onset of jaundice; it was transient in 65% of patients, but persisted for four months to 13 years in 35% of children. The average incubation period of IH (MS-1) was essentially the same following an oral or parenteral exposure (32 to 33 days); in SH (MS-2) it was 65 days after parenteral exposure and 98 days after oral exposure. Gamma-globulin consistently neutralized the infectivity of IH (MS-1) serum; in most cases it did not neutralize the infectivity of SH (MS-2) serum.

IDIOPATHIC, RECURRENT CHOLESTASIS

Idiopathic, recurrent cholestasis is characterized by episodes of obstructive jaundice often preceded by pruritus, steatorrhea, and purpuric rash. Between episodes of jaundice the liver histology is normal. We report a case of idiopathic, recurrent cholestasis occurring in a 14-year-old Caucasian girl who has experienced seven episodes of jaundice since 8 years of age. Serum alkaline phosphatase elevation preceded clinical jaundice. During remission the bromsulphalein excretion was normal. Response to oral steroids occurred when used after 4 weeks of jaundice. Cholestyramine resin and cyproheptadine relieved pruritus and in combination may have prevented progressive jaundice when administered early. Light microscopy during exacerbation showed centrilobular cholestasis with a slight mononuclear infiltration of the portal triad. The electron microscopic examinations demonstrate dilated bile canaliculi with altered microvilli. Serial liver biopsies over 6 years show no fibrosis or cytoplasmic alterations of hepatocytes. Of the 24 reported cases of idiopathic, recurrent cholestasis, two-thirds have been in males and had onset of jaundice under 20 years of age. This younger age of onset merits a greater awareness by the practicing pediatrician. After the diagnosis is established by clinical, biochemical, and morphologic studies, a benign course can be anticipated.

Viral inhibition of the phytohemagglutinin response of human lymphocytes and application to viral hepatitis.

SummaryThe PHA-stimulated leukocyte cultures from healthy donors were inoculated with representatives from picornavirus, picodnavirus, arbovirus, myxovirus, paramyxovirus, rhabdovirus, reovirus, adenovirus and papovavirus groups. Cultures were harvested after 6 days of incubation and assayed for virus multiplication and for DNA synthesis of the leukocytes by uptake of thymidine-3H. Virus replication and inhibition of the PHA response of the lymphocytes by these viruses were limited primarily to viruses which replicated and assembled in the cytoplasm of the cell. Leukocytes from 15 patients with viral hepatitis were studied, and in 8 of them the cells were hyporesponsive to PHA stimulation after 3 days of incubation. This pattern was observed in all samples taken within the first week after onset of jaundice. Sera from patients with viral hepatitis when added to normal leukocyte cultures showed some inhibition of the PHA response, but the effect could not be serially passed to fresh cultures. The same patt...

Maximal acid output and oesophagitis in hiatus hernia.

<b>Singh, H. M., and Baker, J. T. (1974)</b>. <i>Thorax</i>, <b>29</b>, 68-74. <b>Jaundice following open-heart surgery</b>. A study was made into the factors influencing the onset of jaundice in 102 patients undergoing valve replacement during cardiopulmonary bypass. Postoperative jaundice appeared to be correlated with double valve replacement, the co-existence of an uncorrected valvular lesion, length of perfusion and myocardial ischaemia times, and also the age of the patient. Factors appearing not to be correlated with the onset of jaundice included preoperative pulmonary artery pressure, cardiac index, parameters of preoperative renal and hepatic function, and the amount of blood used during bypass. The biochemical features of the jaundice seemed to follow a pattern not previously recognized in this context, with sometimes considerably raised bilirubin levels in association with virtually normal levels of transaminases and alkaline phosphatase.

Serum alcohol dehydrogenase, an indicator of intrahepatic cholestasis.

Abstract The activity of alcohol dehydrogenase, an enzyme present principally in liver tissue, was repetitively determined in the serums of 266 patients with hepatic and nonhepatic diseases. The enzyme was present only in patients with liver-cell necrosis. The level of serum activity reflected the extent of parenchymal necrosis, and in acute hepatitis the enzyme was present for as long as three weeks after onset of jaundice. Disappearance from the serum correlated with relief of intrahepatic cholestasis. In patients with hepatocellular necrosis and prolonged cholestasis persistent serum alcohol dehydrogenase activity was present while serum glutamic oxalacetic transaminase values fell close to normal. Only three of 40 patients with jaundice secondary to extrahepatic biliary obstruction had serum alcohol dehydrogenase elevation. These results indicate that serum activity is a specific reflection of hepatocellular necrosis, a good index of intrahepatic cholestasis and of value in the differential diagnosis ...

An intravenous galactose tolerance test and its use in hepatobiliary diseases.

Abstract The paper describes an intravenous galactose tolerance test performed by a single injection of 350 mg of galactose per kg body weight. Galactose in the blood was determined by a specific galactose oxidase method.The disappearance of the galactose from the blood mainly occurs by hepatic metabolism which is rate‐limited. The course of the elimination curve, however, is also influenced by extrahepatic factors. The curve was found to be most easily described as a straight line in a semilogarithmic system, the T 1/2 value for galactose being found to be 12.0 ± 2.6 min in normal adults. The galactosuria was reasonably small and constant in different clinical conditions and was therefore disregarded.The T 3/2 value was elevated in 84% of cases of liver cirrhosis, and the elevation appeared to be a good measure of the degree of liver damage. Abnormal test results were obtained in 58% of patients with acute infectious hepatitis. Among patients with an abnormal T 1/2 value more than three weeks after the onset of jaundice a long duration of the disease was generally seen, the development of cirrhosis was demonstrated in one isolated case, and one patient died. In patients with cancer metastases of the liver the test result was abnormal in 50%. The T 1/2 value was normal in 93% of cases of biliary obstruction.The galactose test was found to give valuable diagnostic and prognostic information in liver cirrhosis and in hepatitis, and also to be useful in differentiating between obstructive and parenchymatous jaundice.

TWO CASES OF HEPATITIS DUE TO TOXOPLASMA GONDII

Two cases of hepatitis clinically and biologically resembling acute viral hepatitis are reported. In both, Toxoplasma gondii could be demonstrated in the liver, together with a significant, rise in antitoxoplasmic antibodies. The two cases had prolonged prodromal stages with lymphadenopathy, anorexia, and fatigue before the onset of jaundice. It could be that more cases of so-called viral hepatitis are caused by T. gondii.

An assessment of red cell survival in idiopathic unconjugated hyperbilirubinaemia (Gilbert's syndrome) by the use of radioactive diisopropylfluorophosphate and chromium.

SUMMARYRed cell survival was determined in 20 patients with idiopathic unconjugated hyperbilirubinæmia without overt signs of hæmolysis (Gilbert's syndrome) by means of a double isotope technique with the use of diisopropylfluorophosphate (DF32P) and chromium (51Cr) simultaneously. Red cell life span was significantly reduced in 42% of patients. However, the degree of hæmolysis was not sufficient to produce hyperbilirubinæmia in persons with normal hepatic function. The incidence of familial involvement in patients with reduced red cell survival was not significantly different from that in patients with normal red cell survival. Similarly, there was no difference between the groups with respect to symptomatology, age of onset of jaundice, or results of laboratory investigations.It is concluded that the hyperbilirubinæmia in this syndrome is more likely to be due to a defect in hepatic handling of bilirubin than to compensated hæmolysis. This defect appears to occur whether or not there is a reduced red cell survival. It remains to be shown why some patients with this syndrome have a reduced red cell survival while others do not.

Chronic Familial Hyperbilirubinemia

Summary A patient is presented who exhibits Rotor's syndrome of chronic idiopathic jaundice with direct hyperbilirubinemia, Bromsulphalein (BSP) retention, and normal liver histology. He also has a slightly shortened red blood cell survival. The apparent onset of jaundice was coincident with a well documented episode of viral hepatitis. Studies of the patient's bilirubin metabolism and BSP excretion are presented and compared with findings in previously reported cases. Three of the patient's 5 children were found to have slight shortening of red blood cell survival, indirect-reacting hyperbilirubinemia out of proportion to the degree of hemolysis, and elevated BSP retention. It is postulated that the patient's defects in bilirubin and BSP uptake, as well as the low grade hemolytic process, were transmitted to the children, probably as an autosomal dominant. At the present time the children do not show an excretory defect.

Acute renal failure in association with fatty liver of pregnancy: Recovery after fourteen days of complete anuria

A twenty-one year old woman with severe and prolonged renal failure associated with the acute onset of jaundice following delivery is described. The clinical, pathological and biochemical findings were consistent with fatty liver of pregnancy complicated by renal failure. The ultrastructural morphology of the renal lesion is described in detail and the changes in the glomeruli are interpreted as compatible with a lesion produced by intraglomerular fibrin formation. Such an event may have been the cause of the renal failure in this case.

Leiomyosarcoma of the Bile Ducts

Summary The case history of a 62-year-old woman with progressive jaundice is presented. To our knowledge, this is the third patient reported in the literature with a leiomyosarcoma of the common duct. Preoperative diagnostic difficulty arose because of a history of chlorpromazine ingestion 1 week before the onset of jaundice. Other sar comas reported to arise in the bile ducts include melanosarcoma, round cell sarcoma, and sarcoma botryoides, which is a form of embryonal rhabdomyosarcoma occurring predominantly in infants and children.

Benign Recurrent Intrahepatic Cholestasis in Two Brothers

Case Studies1 August 1966Benign Recurrent Intrahepatic Cholestasis in Two BrothersA Clinical, Light, and Electron Microscopy StudyLUIZ CAETANO DA SILVA, M.D., THALES DE BRITO, M.D.LUIZ CAETANO DA SILVA, M.D.Search for more papers by this author, THALES DE BRITO, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-65-2-330 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBenign recurrent intrahepatic cholestasis is a recently described disorder (1) characterized by attacks of jaundice with obstructive features recurring over a number of years. Though the etiology is obscure, the coincidence in two boys, possibly related (2), and in two brothers (3) suggests that this may be a constitutional form of jaundice. In some cases (1, 4-6), inquest or examination of the families were negative, and according to Williams and associates (6), the evidence for an acquired or genetic defect is far from conclusive.Summerskill (7) concluded in 1965 that eight cases had been published so far. But adding 2...

Benign recurrent intrahepatic cholestasis, with response to cholestyramine

A fourteen year old girl who had had recurrent episodes of cholestatic jaundice and itching since the age of nine years is described. Recurrent seasonal pruritus preceded the onset of jaundice by eight years. No evidence of extrahepatic biliary obstruction could be found despite two surgical explorations. A correlation between the patient's serum bile acid levels and pruritus was strongly suggested. It was found that cholestyramine, when given in adequate dosage, decreased the patient's abnormally increased serum bile acid concentration and relieved the pruritus. These changes were accompanied by a decrease in the serum alkaline phosphatase and total bilirubin; bromsulfalein retention was no longer abnormal and there was no histologic evidence of cholestasis. Following discontinuation of cholestyramine therapy for a period of thirty-four days there was a significant increase in only the serum alkaline phosphatase activity, although there was moderate pruritus in the latter part of this period; this was again observed during a second period of discontinuation of cholestyramine therapy.

METHYLTESTOSTERONE, RELATED STEROIDS, AND LIVER FUNCTION.

JAUNDICE due to methyltestosterone was first reported by Werner in 1947. 1 Subsequently 42 cases of jaundice during methyltestosterone therapy have been reported. 2 Foss and Simpson 2 summarized reported cases and noted that the duration of therapy to the onset of jaundice ranges from eight days to ten months. Studies of liver function, in addition to elevation of serum direct and indirect bilirubin levels, showed abnormal sulfobromophthalein (Bromsulphalein) sodium (BSP) retention, and normal or a slight elevation of the alkaline phosphatase concentration. The flocculation tests and total serum albumin and globulin concentrations were not altered. In most cases the illness is mild with anorexia, malaise, nausea, vomiting, and upper abdominal pain. Pruritus and jaundice subsequently develop with acholic stools and dark yellow urine. There is no fever. These symptoms are of varying intensity and duration. Withdrawal of methyltestosterone results in remission of hepatocellular dysfunction within a few days to

NEEDLE BIOPSY IN DIFFERENTIAL DIAGNOSIS OF ACUTE LIVER DISEASE.

A cute liver disease may be defined as any one of several clinicopathological entities that makes itself known by the sudden onset of jaundice in a previously symptomless patient. Fever, hepatomegaly, and liver tenderness are common but not always present. Acute disease in which the patient is anicteric is not often brought to the attention of the surgical pathologist. Patients with chronic liver disease who become acutely jaundiced form another important group and often it is the jaundice that brings them to the clinician for the first time. The problem in differential diagnosis may be most difficult in patients with acute liver disease, and sometimes cannot be solved by a careful history, physical examination, or extensive laboratory tests. Clinicians believe that further valuable information may be obtained in many patients by the use of a needle biopsy of the liver. Even when the correct diagnosis is suspected, a needle biopsy

STUDIES ON POST-TRANSFUSION HEPATITIS

(1) Post-transfusion hepatitis occurred in eleven paients out of eighty-two in-patients received transfusion with whole blood or blood plasma during recent five years.(2) Incidence of the hepatitis was related to the total amount of blood transfused. Posttransfusion hepatitis occurred more frequently among the patients transfused larger amount of bood.(3) There was no significant difference between the incidence of post-transfusion hepatitis in the patients transfused with fresh blood and that with stored blood only.(4) Changes in the results of hepatic function tests were followed during the course of the hepatitis in these patients. Serum GPT level was higher than SGOT at the onset of jaundice and recovery of SGPT level to normal ranges was delayed as compared with that of SGOT. Increase in serum iron level with decrease in UIBC was observed in these cases.