Bilirubin, combination with serum

The effect of ethinylestradiol 50 pg daily on liver function tests was examined in five women with PBC. These patients had been previously exposed to various HRT preparations (oestrogen or an oestrogen-progestogen combination). Three of the women, who had normal or near-normal serum bilirubin before treatment, tolerated HRT well. However, the remaining two, who were profoundly jaundiced (with serum bilirubins of 193 pmol/L and 365 pmol/L, respectively) before treatment, experienced a further increase in serum bilirubin levels two to three months after starting treatment. A decrease in bilirubin levels occurred in both patients upon withdrawal of ethinylestradiol [18]. 

Intestinal transplantation is combined with liver transplantation in 46% of cases, because of terminal liver failure (93). Of 78 patients who had received parenteral nutrition for more than 2 years n — 66) and/ or had short bowel syndrome and could not be weaned from parenteral nutrition (n = 12), 58 developed chronic cholestasis and 37 developed one or more severe liver complication (serum bilirubin concentration 60 pmol/l, factor V (proaccelerin) 50%, portal hypertension, encephalopathy, ascites, bleeding from the gastrointestinal tract, or histological findings consisting of extensive fibrosis and cirrhosis) after 6 (3-132) months and 17 (2-155) months respectively. Liver disease was responsible for deaths in 6.5% of the patients (22% of deaths). 

It is still too early to tell whether serum bile acid determinations will be added to the currently available combination of liver function tests or replace individual tests, such as the measurement of bilirubin (H19). In correctly diagnosing patients with histologically defined liver disease, serum bile acids appear to slightly improve the results from conventional liver tests, if used in combination with these tests (F3). Perhaps when sensitive analytical methods such as bioluminescence, which can be applied to serum bile acid analysis, become available and established in diagnostic laboratories, serious consideration will be given to routine measurement of serum bile acid levels to... 

Reticulose. Reticulose is a peptide-nucleic acid solution in which ribonucleic acid is combined with short-chain peptides. Recently, reticulose has been described as an immune system modulator, and early clinical studies have shown that reticulose has an ability to rapidly inhibit the course of a variety of viral diseases, particularly in the acute stage. However, it has also been reported to be effective in sub-acute and chronic phases of certain infections and has exhibited no reported side effects in over 20 years of use. Retieulose appears to act by alteration of the host cell response to viral replication. It seems to stimulate the immune system via increases in endogenous interferon and increases in lymphocyte production. In clinical trials with patients infected with hepatitis A or B viruses, treatment with reticulose demonstrated positive results in that serum bilirubin levels reached normal levels and white blood eell count showed significant increases, indicating stimulation of the immune system (190). 

In addition to the hematologic indications that it shares with vincristine, vinblastine sulfate (Fig. 42.35) has found utility in the treatment of advanced testicular carcinoma (often in combination with bleomycin), advanced mycosis fungoides, Kaposi s sarcoma, and histiocytosis X. Leukopenia is the dose-limiting side effect, and dose reductions are warranted in patients with serum bilirubin levels greater than 3 mg/dL. The drug-related impact on erythrocyte and thrombocyte levels usually is insignificant. Like vincristine, it is administered as an IV bolus or infusion. The initial elimination half-life of 3.7 minutes is similar to vincristine, but the 24.8-hour terminal half-life is significantly shorter. 

In general, transaminases are only mildly increased, and deep jaundice combined with mild elevation of liver enzymes should raise the suspicion for fulminant Wilson disease. However, increases of transaminases may be indistinguishable from findings seen in acute hepatitis. Sometimes alkaline phosphatase activities are relatively low in patients with Wilson disease. A ratio of total serum bilirubin concentration and alkaline phosphatase activity (>2) may differentiate fulminant Wilson disease from other forms of fulminant hepatic failure. However, the usefulness of this test was not confirmed in larger series. 

Hepatotoxicity- Duloxetine increases the risk of elevation of serum transaminase levels. The combination of transaminase elevations and elevated bilirubin, without evidence of obstruction, is generally recognized as an important predictor of severe liver injury. Because it is possible that duloxetine and alcohol may interact to cause liver injury, duloxetine should ordinarily not be prescribed to patients with substantial alcohol use. 

Acute reversible ciclosporin toxicity occurred in a renal transplant patient a few days after colchicine was administered for an acute attack of gout (SEDA-16, 115). Other potential adverse effects of combining colchicine with ciclosporin include diarrhea, increases in serum liver enzymes, bilirubin, and creatinine, and less often severe myalgia (SEDA-19, 101). Acute myopathy, associated with neuropathy in one case, has been observed in two young renal transplant recipients (SEDA-22, 119). 

Derivative spectrophotometry was applied in different than pharmaceutical analysis areas of analysis. This method was utilised for the determination of amphothericin in various biological samples like plasma, serum, urine and brain tissue [40]. The combination of ratio spectra with their derivatisation allowed to remove spectral interferences caused by a presence of bilirubin in plasma [40]. 

On the other hand, functional liver damage with elevation of serum transaminases and bilirubin levels during therapy with the combination of isoniazid and rifampicin is observed more often in slow inactivators, in whom rifampicin activates the enzyme system, which disintegrates the drugs. Therefore in these cases there is an elevated hepatotoxicity of isoniazid due to the increased appearance of reactive intermediates (voN Oldershausen et al. 1978 Smith 1979 Smith et al. 1972 Pessayre et al. 1977 von Oldershausen 1976 Dengler and Eichelbaum 1977 Musch et al. 1982). Admittedly, some of these studies were carried out with relatively high doses of isoniazid (10 mg/kg/day). 

Kintzel and co-workers [465] achieved lowered levels of bilirubin using 300 mg orotic acid per day. The premature infants subjected to therapy had from the 3rd to the 6th day consistently 25-30% of the earlier serum bilirubin levels. A number of studies related to the effect of orotic acid on bilirubin level in premature infants was carried out under different conditions [472-480]. Recently, the combination of orotic acid with phenobarbital and adenine was tested [481] as a prophylactic preparation against premature hyperbilirubinaemia. 

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