Alex F. Robertson

Lack of association of supernumerary nipples with renal anomalies in black infants

determination in most cases. However, the use of lyophilized stools may be more appropriate for FA-1-AT assessment on watery specimens or when subtle variations in FA-1-AT excretion must be determined. Our data suggest that random FA-I-AT determination is reliable when performing on untreated samples. This should facilitate the routine application of this valuable test for the evaluation of intestinal protein loss.

Effect of lactate, pyruvate, acetone, acetoacetate, and β-hydroxybutyrate on albumin binding of bilirubin

Lactate, pyruvate, acetone, acetoacetate, and beta-hydroxybutyrate were tested for their bilirubin-displacing effect on human serum albumin. Only lactate had a significant effect at levels found in asphyxiated infants (up to 20 mM). The reserve albumin equivalent for binding bilirubin was determined, using the deputy ligand monoacetyldiaminodiphenyl sulfone (MADDS), in adult human serum albumin solution, neonatal serum, and neonatal albumin solution. Twenty mM lactate caused a 23% decrease of reserve albumin when adult albumin was used, but did not cause any change of binding when neonatal serum or neonatal albumin solution was used. It is unlikely that endogenous substances, acting as competitive ligands, cause the low binding affinity of albumin for bilirubin in sick, premature infants.

Tryptophan metabolism in acrodermatitis enteropathica

Tryptophan-loading tests were performed on two normal subjects before and after diiodohydroxyquin treatment and on three acrodermatitis enteropathica patients being treated with diiodohydroxyquin. Patients who received a loading dose of tryptophan had higher urinary levels of kynurenine, kynurenic acid, and acetylkynurenine in comparison with normal subjects; 3-hydroxykynurenine and N-methylnicotinamide values were lower in patients than in control subjects. A possible explanation for these results would be a decreased activity of kynurenine hydroxylase in the patients.

Drugs Affecting Bilirubin Uptake by Human Erythrocyte Ghosts

Drugs known to affect the red blood cell membrane and used clinically in neonates were tested for their ability to cause increased 14C-bilirubin uptake by erythrocyte ghosts. The additional uptake of bilirubin by ghosts in the presence of penicillin G, phenobarbital, furosemide and theophylline may be explained by the effect of these drugs on free bilirubin levels as measured with a horseradish peroxidase assay. In contrast, the effect of chlorpromazine in causing increased bilirubin uptake by ghosts could not be totally explained by either ghost lysis or increased free bilirubin levels, as measured by light scattering, and was due to a direct effect of chlorpromazine on the ghost membrane. Our results demonstrate that drugs may act through different mechanisms in causing increased bilirubin uptake by erythrocytes.

Human Placental Amino Acid Oxidation

Uniformly labeled L -alanine, L -aspartic acid, L -glutamic acid, and glycine were incubated with placental ‘mitochondria’ from normal pregnancies

Predicting the Need for Exchange Transfusion in Newborn Infants A Comparison of Five Methods

The need for exchange transfusion was analyzed retrospectively using several different meth ods (total bilirubin binding capacity, birth weight, plasma protein level, and two published charts). These predictive methods were applied to 175 jaundiced infants for whom all the data were available and to 19 infants who were actually exchanged. Most of the patients were sick, premature infants. This study demonstrates the lack of agreement among the predictive methods.

Effect of pancuronium on bilirubin-albumin binding

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Hematin and Bilirubin Binding to Human Serum Albumin and Newborn Serum

ABSTRACT. In jaundiced newborn infants, hemolytic disease is considered a risk factor for kernicterus due to the suspected competition between bilirubin and other hemoglobin breakdown products for albumin binding. We have studied the effect of hematin on bilirubin‐albumin binding using the peroxidase assay and a light‐scattering technique for measuring unbound bilirubin. Our results show that hematin does not affect bilirubin‐albumin binding. To determine if other albumin binding functions are affected by hematin, we used a microdialysis rate technique employing two ligands, diazepam and monoacetyldiaminodiphenyl sulfone (MADDS). Hematin does not utilize the diazepam binding function of albumin, but does decrease the albumin binding of MADDS. The results of this study indicate that the MADDS and bilirubin binding functions are not identical. The clinical usefulness of reserve albumin equivalent determination using MADDS is discussed.

Digital swelling following long-term administration of prostaglandin E1 in an infant

A premature infant with hypoplasia of the right heart and pulmonary arteries required treatment with prostaglandin E1 (PGEI) for 107 days prior to surgical intervention. Digital swelling was noted at 40 days of age. Swelling was measured by determining the ratio of the distal phalangeal depth to interphalangeal depth. The ratio declined from 1.16 to 0.94 in the first 64 days after treatment. We believe digital swelling is a reversible complication of PG therapy.

Decreased bilirubin binding by albumin in late pregnancy

It is known that the albumin concentration of maternal plasma is reduced at term and that the binding of certain drugs and bilirubin’ in plasma is likewise reduced. This decreased plasma binding of bilirubin may be due to decreased albumin concentrations alone or a decrease in the ability of albumin to bind bilirubin. It is possible that the same factor(s) which causes decreased binding ability in cord blood may decrease the binding ability in maternal blood. We undertook this study to determine if the quantitative binding of bilirubin to albumin (binding fraction) was changed in pregnant women at term. We collected heparinized venous plasma from 19 normal pregnant subjects at term (38+ gestational weeks) and 19 normal, nonpregnant control subjects. Informed consent was obtained from all subjects in this study. Apparent total bilirubin binding capacity was measured by the peroxidase method with pooled human bilirubin-enriched plasma used as a control. Albumin was determined by the bromcresol green method. All assays have been described in detail elsewhere.’ The binding fraction was expressed as the total bilirubin binding capacity/albumin molar ratio. Statistical analysis of the data included calculations of Pearson’s product-moment correlation coefficients and multiple regression analysis. Correlation coefficients were tested for significance with the use of one-tailed t tests. The total bilirubin binding capacity in the pregnant subjects was 20.9? 2.7 (mean? SD) compared to 30.5 2 3.4 in our nonpregnant sample. The albumin concentration was 3.6 * 0.26 compared to 4.6 -C 0.29 and the binding fraction was 0.66 ‘0.11 versus 0.78 * 0.10 for the nonpregnant sample. Fig. 1 shows the relationship of total bilirubin binding capacity to binding fraction in the two groups, along with the respective linear regression equations. We found that the relationship between total bilirubin binding capacities and binding fraction was stronger in nonpregnant women (r = 0.87, p < 0.001) than in pregnant women (r = 0.76, p < O.OOl), probably because there was less spread in the total bilirubin binding capacity in the former group. The binding fraction of the pregnant group was about 15% lower than the binding fraction of the nonpregnant group, whereas