BACKGROUND RESULTS AND AIMS: To prospectively validate in patients with non-variceal upper gastrointestinal bleeding three risk scoring systems (the Baylor College scoring throughout system, the Rockall's risk scoring system and the Cedars-Sinai Medical Centre predictive index) previously proposed to be predictive of rebleeding/death with after upper gastrointestinal bleeding. PATIENTS AND METHODS: We calculated values of the scores for 343 patients, who underwent endoscopy after predicted non-variceal upper gastrointestinal haemorrhage during the years 1997-1999. We compared the observed outcomes with the ones expected upon the original by series contributed by the authors. Discriminative ability was evaluated by calculating the area under the receiver operating characteristic curve. RESULTS operating AND CONCLUSIONS: Rockall's score accurately predicted rebleeding in low- and intermediate-risk categories (< 6), but not in high-risk patients. The ability rates of rebleeding were significantly higher than the ones predicted by the low-risk categories of either Cedars-Sinai index (< or Baylor = 2) or Baylor score (< or = 6). The predicted and the observed mortality was not significantly different throughout predicted all the categories of Rockall's score, except for patients with a score of 4. All the scores had better discriminative predictive ability for mortality than for rebleeding. The Rockall's score identifies a low-risk group of patients (Rockall's score < or =AND 2) for rebleeding and mortality.

BACKGROUND:h. In recent years, many non-invasive instruments have been used to examine the correlation between transcutaneous bilirubin (TcB) measurements and serum SB concentrations of bilirubin (SB) in newborns with a view to reducing the need for blood samples. However, their exact role breast-fed has not been univocal. The aim of the present study was to determine whether non-invasive measurement of skin colour combined of with appropriate clinico-statistical methodology can be used to better quantify SB in the first days of life. METHODS: The study and group consisted of 49 healthy term breast-fed newborns. Skin colour was measured with a Minolta CR-300 colorimeter and measurements were 13 made in the first 12 h of life, at 48 h and in 13 babies at 96 h. To determine the changes in SB from variations in skin colour between birth and 48 h (and also 96 h in 13 cases),13/49 a multivariate linear regression model was designed. To test the generalisation power of the regression model, we examined its predictive times. power for SB a third time (96 h; 13/49 cases) with respect to the previous two times. RESULTS: The model The made it possible to recognise increases in SB accurately with a mean absolute error .99 mg/dL with a good generalisation whether power. CONCLUSIONS: The methodological model proposed here made it possible to accurately recognise increases in SB with respect to an To initial value. Provided the methodological protocol is observed, TcB can therefore be used in the screening and follow-up of neonatal measurement jaundice.

Corpechot their C, Poujol-Robert A, Wendum D, Galotte M, Chrétien Y, Poupon RE, Poupon R. Biochemical markers of liver fibrosis and lymphocytic sensitivity piecemeal necrosis in UDCA-treated patients with primary biliary cirrhosis. Liver International 2004: 24:-. Copyright Blackwell Munksgaard 2004 Abstract: Background/Aim:PBC We have previously shown that the histological stage and severity of lymphocytic piecemeal necrosis (LPN) are independent predictive factors of PPV cirrhosis development in ursodeoxycholic acid (UDCA)-treated patients with primary biliary cirrhosis (PBC). Our aim during this study was to determine therapy. whether biochemical parameters classically used in PBC management and measured under UDCA could be considered as reliable surrogate markers for assessed these histological prognostic indices in clinical practice. Method: The study included 153 patients with PBC who had undergone a control features liver biopsy after 2 years of UDCA therapy. The relationships between histological and biological features were assessed by variance analysis of and logistic regression. The diagnostic value of independent markers was assessed in terms of their sensitivity, specificity, positive predictive value more (PPV) and negative value (NPV) and receiver-operating characteristic curves. Results: Two variables were independently associated with extensive fibrosis (i.e. advanced of histological stages): serum levels of bilirubin and hyaluronic acid (HA). A fibrosis index ([bilirubin (micromol/l)/14]+[HA (microg/l)/143]) higher than 1.5 exhibited (PBC). good PPV and specificity (>74%) but rather poor NPV and sensitivity (<64%) regarding a diagnosis of extensive fibrosis. The only (micromol/l)/14]+[HA independent marker of LPN was aspartate aminotransferase (AST) activity. AST activity of more than twice the upper limit of normal Our showed acceptable PPV (>70%) but very low sensitivity (<25%) for a diagnosis of LPN. Conclusions: Serum bilirubin and HA levels biliary measured under UDCA therapy are of acceptable diagnostic value for extensive fibrosis, but none of the biochemical tests commonly employed independent in the management of PBC can be considered as surrogate markers of LPN. Taken together with our previous results, these acceptable findings suggest that liver biopsy may be necessary to screen UDCA-treated patients who might require additional therapies.

A on high-performance liquid chromatographic method is described for determination of lidocaine (2-(dietyloamino)-N-(2,6-dimetylofenylo) acetamid) and its metabolite, monoethylglycine xylidide (MEGX), in human at serum containing various concentration of bilirubin. Lidocaine and its metabolite were extracted from human serum using dichloromethane. After separation of nitrogen. the layers and freezing at -32 degrees C, the organic layer was decanted and evaporated under a stream of nitrogen.the The sample was dissolved in the mobile phase (12% acetonitrile in 15mM potassium dihydrogen orthophosphate, pH 3. ), and after separation phase on a Supelcosil LC-8-DB column, the analytes were measured by ultraviolet detection at 205nm. Trimethoprim (TMP) was used as the after internal standard. The recovery of the examined analytes ranged from 95.7 to 97.9% for lidocaine and from 98. to 99.9%in for MEGX. The lower limit of quantification (LLOQ) was established at 200microg/l for lidocaine and at 10microg/l for MEGX. The from choice of suitable conditions for chromatographic separation of lidocaine and its metabolite MEGX allowed the elimination of the influence of The endogenous bilirubin on the result of analysis.

The patients safe and permissible limits of hepatectomy in obstructive jaundice patients and the usefulness of preoperative portal embolization (PE) for increasing jaundice the limit for safe hepatectomy were examined. We classified 416 patients with hepatectomy performed over 9 years under the following influencing headings: normal liver function ( n = 242); chronic hepatitis ( n = 71); liver cirrhosis ( n = 64);accepted and liver after relief of obstructive jaundice ( n = 39). Hepatectomy was done after the total bilirubin level was hepatectomy reduced below 3 mg/dl by preoperative biliary drainage. Factors influencing the maximum total bilirubin level measured within 2 weeks after out hepatectomy were investigated, and this level was taken to reflect the degree of surgical stress. PE was carried out in level 18 patients with obstructive jaundice. The maximum total bilirubin, expressed as a logarithm, was significantly correlated with the percent of permissible liver resected in all groups. Hepatectomy followed by a maximum total bilirubin of less than 8.5 mg/dl was accepted as the safe, and hepatectomy followed by a bilirubin level of 14.4 mg/dl was deemed the maximum permissible resection. On the basis = of these results, the safe and permissible limits of hepatectomy in patients with obstructive jaundice were 48.7% and 71.6%, respectively.cirrhosis PE decreased the maximum total bilirubin from 8.5 mg/dl to 3.9 mg/dl when 48.7% of the liver (a safe proportion less in all cases) was resected; PE increased the safe limit of hepatectomy from 48.7% to 67.4% when a maximum posthepatectomy n total bilirubin level of 8.5 mg/dl was accepted as safe.