Arturo J. Aballi

Absorption of vitamin K from the colon in the newborn infant

Summary We have shown that the effects on thecoagulation defects of the newborn of vitamin K administered rectally are comparable to those obtained by intramuscular administration of the same dose. These results provide suggestive evidence that vitamin K which is synthesized by colonic bacteria can be utilized by the host.

Liver damage in rabbits from administration of a single dose of gram-negative endotoxin.

Summary: The present experiments were undertaken to study the effect of a preparatory dose of gram-negative endotoxin on the liver. Sixteen adult male New Zealand rabbits bad initial liver biopsies, blood chemistries, and coagulation studies and were then divided into two groups: group I, consisting of 10 animals, received 50 μg/kg endotoxin from Escherichia coli OlllB4; group 11, consisting of six animals, served as controls and received no endotoxin. In group I all animals developed increased levels of lactic dehydrogenase (LDH) isoenzyme 5 and SGOT and decreased serum albumin levels. A rise in the level of SGPT and 5′-nucleotidase occurred in most rabbits. LDH isoenzyme 5 values increased from 3.6 ± 5.83 mU/ml before to 180.4 ± 142.11 mU/d after endotoxin (P < 0.005). SGOT rose from 28.90 ± 8.87 mU/ml to 241.10 ± 104.76 mU/ml (P < 0.001). Serum albumin levels decreased from 3.78 ± 0.31 g/dl to 3.21 ± 0.32 g/dl (P < 0.001). SGPT initially showed a level of 41.00 ± 6.97 mU/ml and this rose to 94.40 ± 19.60 mU/ml (P < 0.001). 5′-Nucleotidase rose from 1.48 ± 0.69 mU/ml to 6.01 ± 4.51 mU/d (P < 0.01). The animals also had changes in coagulation tests with a decrease in factors I1 and V. Factor I1 was 77.4 ± 11.82% before and decreased to 38.70 ± 7.47% after endotoxin (P < 0.001). Factor V values were 95.00 ± 9.04% before and 50.6 ± 7.5% after endotoxin (P < 0.001). Changes in fibrinogen and factor VIII were not significant. Split products of fibrinogen showed a slight increase. Definite hepatic necrosis consisting of scattered patchy areas of variable size and severity was found in 7 of the 10 animals. In many of these areas of necrosis a polymorphonuclear leukocyte reaction and few small thrombi were detectable. The Liver biopsies performed before endotoxin administration failed to show any evidence of hepatic involvement. Group I1 control animals showed no indications of abnormal liver function and no evidence of hepatic necrosis. These studies indicate that significant hepatic changes occur after the administration of a single dose of endotoxin given in preparation for the Shwartzman reaction.Speculation: In rabbits significant liver damage has been demonstrated after an injection of gram-negative endotoxin. The dose of endotoxin employed was similar to that frequently used to prepare animals for the Shwartzman reaction. This Liver damage was demonstrated to occur at a time when the provocative dose of endotoxin is usually given. In view of the role of the liver in replacing consumed clotting factors and in cleating thrombi, it is suggested that disturbed liver functions plays an important role in predisposing to disseminated intravascular coagulation (DIC), which is an integral part of the Shwartzman reaction.

Radiological changes in 127 patients with sickle cell anemia.

Abstract:The radiological findings in 127 patients with sickle cell anemia are reviewed, and a general overview of the literature is described. The most common findings are cardiac enlargement, skeletal abnormalities involving long bones, and other parts of the osseous structure, gallstones, hepatosplenomegaly, renal disturbances and pneumonia.

GALL BLADDER DISEASE (GBD) IN CHILDREN WITH SICKLE CELL DISEASE (SS)

The present study was carried out to determine the incidence and clinical manifestations of GBD in children with SS. Thirty-two SS patients ranging in age from 2 to 17 years (mean 9.3) had oral cholecystography (OC) performed and in addition 6 of these had sonography. On OC 6 patients aged 17, 16, 16, 13, 6 and 3 years had evidence of GBD. Two had non-opaque and one opaque stones and in 3 there was no visualization after repeat OC with a double dose of telepaque. Of the 6 patients who had sonography 2 were normal and 4 had abnormal gall bladders consistent with chronic choleystitis without demonstrating cholelithiasis. OC on these 6 patients revealed that 2 had normal gall bladders, 3 had non-functioning gall bladders and 1 had non-opaque stones.GBD in these patients did not seem to correlate with the incidence of painful abdominal crises. The incidence of GBD in this series was 18% which is higher than that previously reported in children with SS. Since the incidence of severe symptoms and/or complications of cholelithiasis is about 50

Coagulation changes in the neonatal period and in early infancy.

with an overall mortality of 2.7% within the first five years in unoperated patients (Lund, J.: Ann. Surg. 151:153, 1960) the presence of gallstones in children with SS is an indication for elective cholecystectomy.