Nineteenth-Century Homeopathic Repertories Predict Increased Urinary Excretion of Bile in Cholestasis but Not in Non-Cholestatic Infant Jaundice.

INTRODUCTION: There are two types of bilirubin: conjugated bilirubin, prevalent in cholestatic jaundice, and unconjugated bilirubin, prevalent in hematologic jaundice. Conjugated bilirubin is water soluble and is excreted in urine, whereas unconjugated bilirubin is neither water soluble nor excreted in urine. Homeopathic repertories published prior to the discovery of the two types of bilirubin in 1913 present an opportunity to test the reliability of homeopathic repertories and associated materia medica. If procedures involved in the collecting of homeopathic observations are reliable, then in repertories published prior to 1913, medicines listed for cholestatic jaundice should exhibit a stronger association with urine bile than medicines listed for hematologic jaundice. MATERIALS AND METHODS: In three repertories published prior to 1913, medicines associated with jaundice were further classified into groups labeled "Cholestatic" or "Infant, mostly hematologic". Medicines were identified as "Cholestatic" if associated with both white/clay-colored stool and liver/gallbladder symptoms. Medicines were identified as "Infant, mostly hematologic" if associated with infant jaundice without meeting criteria for the "Cholestatic" group. Controls were medicines appearing in Hahnemann's Materia Medica Pura. Each category was assessed for green urine-usually reflective of bile in urine. RESULTS: In Knerr's repertory, the "Cholestatic" group demonstrated a significantly greater association with green urine than controls (p < 0.05, Fisher's exact test), whereas the "Infant, mostly hematologic" group did not differ significantly from controls. For Lippe's and Boenninghausen's repertories, statistical significance was not demonstrated. Across repertories, the overall weighted pooled odds ratio (OR) demonstrated significance in the association between the "Cholestatic" group and green urine (OR, 2.384; 95% confidence interval, 1.234 to 4.607), whereas the "Infant, mostly hematologic" group was similar to that of controls (OR, 0.754; 95% confidence interval, 0.226 to 2.514). CONCLUSIONS: Based on the presence or absence of bile in the urine, homeopathic repertories from the 19th century can distinguish between disease processes involving conjugated bilirubin and disease processes involving unconjugated bilirubin.

Evaluation of an automated hemostasis testing analyzer, the Trombolyzer Combi.

We evaluated the Trombolyzer Combi (Behnk Elektronik, Norderstedt, Germany), an automated hemostasis analyzer, in a clinical setting. Determination of prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (FIB) and antithrombin (AT) were performed using Organon Teknika reagents. Determination of PT, APTT and FIB on a KC4 (Amelung, Germany) using Dade reagent (Dade Behring, The Netherlands) and determination of AT on a Hitachi 912 using Chromogenix reagent (Nodia, The Netherlands) were used as reference methods. Within-run and total precision of the tests were determined by measuring pooled plasma samples at various levels in duplicate twice daily for twenty days. For all tests the within-run and total precision of the Trombolyzer Combi was comparable or superior to the reference methods. Methods comparison was performed with 100 patient samples for PT, APTT and FIB and with 50 patient samples for AT. The correlation coefficients between the Trombolyzer Combi values and the results from the reference methods were between 0.87 and 0.98. No effect of hemolysis on the determination of the studied parameters was detected. However, bilirubinemia above 260 micromol/L and triglycerides above 9 mmol/L resulted in erroneous test results. In conclusion, it is shown that the Trombolyzer Combi performs equivalently or better than the reference methods and can be used as a state-of-the-art hemostasis analyzer in a clinical laboratory.

Clinical rounds in the well-baby nursery: treating jaundiced newborns.

Ten pearls (and pitfalls) in the management of the jaundiced newborn: Remember to take a history. Ask about jaundice in previous siblings and check family ethnicity. Don't ignore jaundice in the first 24 hours--it is considered pathologic until proven otherwise. Some normal infants may appear jaundiced and have a bilirubin level of 5 mg/dL at 23 hours and 59 minutes. On the other hand, a bilirubin level of 5 mg/dL at 10 hours is almost certainly pathologic. Use your judgment. Don't treat 35 to 37 week gestation infants as if they were full-term infants. Although these babies are cared for in well-baby nurseries and are generally treated like full-term infants, they are not full term. They are not as vigorous and do not nurse as well as full-term infants. Infants at 37 weeks gestation are four times more likely to have a serum bilirubin level greater than 13 mg/dL than those at 40 weeks gestation. Don't send 35-week gestation infants home before 48 hours. Document your assessment, particularly if the infant is being discharged early. Document the presence or absence of jaundice and its severity. A late rising bilirubin is typical of G6PD deficiency. Think about the ethnic background: G6PD deficiency is much more likely to occur in families from Greece, Turkey, Sardinia, and Nigeria, and particularly in Sephardic Jews from Iraq, Iran, Syria, and Kurdistan. Your practice may not contain many such families but remember in today's world of travel and intermarriage, etc, these genes are ubiquitous and the diagnosis of G6PD deficiency should always be considered in a newborn child with a significant elevation of bilirubin, particularly if it is a male and the rise in bilirubin is of late onset. Don't use homeopathic doses of phototherapy. As with any drug, phototherapy should be provided in a therapeutic dose (see above), but with the light sources commonly used, it is impossible to overdose the patient. Don't ignore a failure of response to phototherapy. If the bilirubin rises despite adequate phototherapy, there must be a reason. Consider the possibility of an unrecognized hemolytic process. Provide timely follow-up. Infants discharged (as most are) before 48 hours should be seen by a health-care professional within 2 to 3 days of discharge. Don't ignore prolonged jaundice. About one in three normal breast-fed infants still will be clinically jaundiced when they are 2 weeks old (two thirds will be biochemically jaundiced). These infants all have indirect hyperbilirubinemia. Occasionally, however, an infant with prolonged jaundice has direct hyperbilirubinemia. In these infants, the diagnosis of biliary atresia or some other cause of cholestatic jaundice must be considered. If the infant is clinically jaundiced beyond age 2 weeks, you should: 1) check the newborn record to make sure that the metabolic screen for hypothyroidism is normal (congenital hypothyroidism is a cause of indirect hyperbilirubinemia), and 2) ask the mother about the color of the urine and stool. If the baby's stools are pale or the urine is dark yellow, you must get a direct bilirubin to rule out cholestasis. If there is direct hyperbilirubinemia, a urine dipstick will identify the presence of bile (bilirubin). If the color of the urine and stool are normal (by history), it is reasonable to follow the child for another week. However, any infant who is still jaundiced beyond age 3 weeks must have a measurement of direct bilirubin. Don't ignore severe jaundice. If the bilirubin is sufficiently elevated, kernicterus can occur in a healthy, breast-fed infant.

[Photodecomposition of artificial calculus bovis].

Artificial calculus bovis (ACB) is widely used in dispensing Chinese Traditional Patent Medicine as a substitute for Calculus bovis. Photodecomposition rule of ACB sample irradiated with three different light sources was studied by diffuse reflectance spectrophotometry (DRS) in this paper. The results show that, the photodecomposition rate curves of the ACB sample irradiated by all three light sources are composed of two straight lines of different slopes, indicating that they are of two-step apparent first order reaction, the apparent photodecomposition constants in the first steps are about twice as high as those in the second steps. The ACB sample has the fastest photodecomposition rate when irradiated with the UV mercury-arc lamp and the second with the fluorescent mercury-arc lamp and slowest with the iodine-tungsten lamp. In these three light sources apparent photodecomposition constants of ACB sample are respectively: K1, 2.7629 x 10(-5), 4.4132 x 10(-6); k2, 1.2176 x 10(-5), 2.0684 x 10(-6), 1.4357 x 10(-6) (lx-1.h-1). The apparent constants are independent of the product of the radiation intensity and the irradiation time, but the irradiation time is in inverse ratio of the radiation intensity to get the same proportion of the sample photodecomposition. The fading time of the ACB sample under different radiation intensity can be predicted with the kinetic equations reported. The fading time of ACB sample if directly exposed to light in bright room is 1.6 days.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assay of bilirubin of ox gallstone in Chinese patent medicines by differential spectrophotometry].

This paper describes that the absorption spectrum of bilirubin solution was changed obviously by photo-oxidation. The absorbance was measured at 453 nm before and after light irradiation. The contents of bilirubin of ox gallstone in Liuying pills, Liushen pills and Niuhuang Xiaoyan pills were determined by differential absorbance (delta A). Calibration graph was linear in the range of 1.6-8.0 micrograms/ml for delta A. The average recoveries for three Chinese patent medicines were over 93%. Determinations of bilirubin in Chinese patent medicines were not affected by other components.

[Clinical study on effect of jinshisan on dissolution of extra-/ intrahepatic biliary stones].

In order to evaluate the role and mechanism of Jinshisan (JSS) in bile stone dissolution, 164 cases of extra-/ intrahepatic biliary stone patients were treated by a collaborated group, the therapeutic effect was observed by B-ultrasonography before and after treatment. Results showed: (1) Among the 164 cases, 26 cases (15.85%) were cured clinically; 73 (44.51%) were effective and 65 (39.63%) ineffective. (2) After treatment, in 84 patients of right hepatolith, the stone were diappeared in 10 cases, the size or number of stone decreased in 44 casess. In 34 patients with left hepatolith, the figure were 5 and 13 respectively. In 10 cases of choledocholith they were 10 and 10 respectively. While in 21 cases of multiple gallstone, only one case with stones of both sides disappeared, except 3 ineffective cases, others with stone decreased in size or number or disappeared unilaterally. (3) Gallston diappeared in 7 of 10 patients with size of stone 6 months. (5) Analysis of bile showed that JSS could increase the amount of bile acid, decrease the bilirubin, mucous and bicarbonate radical in bile.

[Quantitative analysis of calcium bilirubin in calculus bovis by infrared spectrometry].

This paper reports the method of quantitative analysis of calcium bilirubin in calculus bovis by infrared spectrometry. This method is simple and quick, requiring no separation and only small amount of sample, not destroying the sample and having few interferences.

[Studies on calculus bovis by FTIR-PAS].

This article reports the characteristics of different colour layers of Calculus Bovis by FTIR-PAS. It is unnecessary to treat the sample before analysis, and the sample can be reused after analysis. The method is fast accurate and easy to operate.

[Content analysis of bilirubin in niuhuang compound suppository by HPLC].

OBJECTIVE: To establish a method of determinating content of bilirubin in Niuhuang Compound Suppository by HPLC. METHOD: C18 column was used. The mobile phase was consisted of dimethylsulfoxide: acetonitrile: 0.5% acetic ammonium (1:1.4:1). Detector wavelength was 456 nm. The extraction solution for bilirubin was consisted of dlimethylsulfoxide: acetonitrile = 9:4. RESULTS: The linearity was obtained over the range of 0.107 - 2.14 microg. The mean recovery was 101.0%, RSD = 0.518% (n = 5). CONCLUSION: The method was sensitive, simple and accurate.

Ictericia y hepatopatía en el paciente con malaria / Jaundice and hepatopathy in patients with malaria

La ictericia es un hallazgo frecuente en el paciente con malaria. Según la Organización Mundial de la Salud, se considera un signo de peligro cuando se acompaña de aumento importante de las bilirrubinas y comúnmente se relaciona con disfunción hepática y lesión de otros sistemas. La lesión hepática en estos pacientes es frecuente, está asociada a otras complicaciones, y es reversible si se identifica y se trata a tiempo. Con este trabajo se pretende revisar el valor semiológico de la ictericia como indicador de malaria complicada, explicar su patogénesis y los mecanismos de daño hepático; además, hacer un enfoque del paciente con hepatopatía palúdica, diferenciando la disfunción hepática de la falla y la encefalopatía hepáticas.

Jaundice is a common finding in malaria patients. According to the World Health Organization, it is considered a sign of danger when accompanied by an important increase of bilirubin and it is frequently related to hepatic dysfunction and injury to other organs. Liver injury in these patients is common and it is associated with other complications. If it is identified and treated early, it is reversible. This paper reviews the semiological value of jaundice as an indicator of complicated malaria; it explains its pathogenesis and the mechanisms of liver damage. It also focuses on the patient with hepathopathy, distinguishing hepatic dysfunction, hepatic failure and hepatic encephalopathy.

Hyperbilirubinemia following exposure to pancuronium bromide in newborns.

We investigated the risk of hyperbilirubinemia in relation to the administration of pancuronium bromide among newborn infants requiring mechanical ventilation. One hundred and twenty-nine infants treated with pancuronium were compared to 129 infants who were never exposed, matched on ventilatory status, hospital, birthweight, initial total serum bilirubin, and date of hospital discharge. Overall, the adjusted summary relative risk (RR) for hyperbilirubinemia among pancuronium-exposed infants compared to nonexposed infants was 1.2 (95% confidence interval 1.1-1.4). The risk was greatest among exposed infants during the 4 days following the last dose of pancuronium (RR = 1.4; 1.0-1.8). These data suggest that the use of pancuronium in sick newborns may be associated with an increased risk of clinically important hyperbilirubinemia.

Câncer primário da vesícula biliar: consideraçöes clínicas e laboratoriais / Primary gallbladder cancer: clinical and laboratory considerations

Foram estudados 50 casos de câncer primário da vesícula biliar, dos quais 47 em mulheres (94,0 por cento) e três em homens (seis por cento), com uma idade média de 60,5 anos. Os sintomas e sinais foram múltiplos, variados e inespecíficos. A tríade sintomatológica mais frequente foi dor abdominal no hipocôndrio direito (42 casos - 84 por cento), perda de peso (37 casos - 74 por cento) e icterícia (25 casos - 50 por cento). A dosagem de bilirrubina sérica foi determinada em 39 casos (78 por cento), com confirmaçäo de icterícia em 23 (59 por cento). O aumento da bilirrubina direta predominou na maioria dos casos, constatando-se icterícia do tipo obstrutivo. O autor advoga que se deva obter um diagnóstico precoce empregando-se os modernos métodos diagnósticos por imagem (ultra-sonografia e tomografia computadorizada) pois, clinicam,ente, o diagnóstico precoce é impossível