cholecystokinin and Jaundice--Neonatal

Cholecystagogue cholescintigraphy can be employed as a means of (1) confirming the surgeon's and/or gastroenterologist's clinical impression of symptomatic chronic acalculous biliary disease, (2) better understanding the pathophysiology of gallbladder disease, (3) preparing patients for hepatobiliary scintigraphy who have fasted for longer than 24-48 hours and who are suspected of acute cholecystitis, and (4) reducing the time required to confirm the clinical impression of acute cholecystitis. Morphine-augmented cholescintigraphy is also used to decrease the time required to determine cystic duct patency. Phenobarbital-augmented cholescintigraphy is used as a means of increasing the accuracy of hepatobiliary scintigraphy in differentiating neonatal hepatitis from biliary atresia. Nonpharmacological interventions and augmentations have been employed to maintain the high degree of accuracy of cholescintigraphy in confirming the clinical impression of acute cholecystitis. The efficacy of these modalities in detecting acute and chronic disorders of the hepatobiliary tree as well as how and why they are performed comprise the contents of this article.

Topics: Biliary Tract Diseases; Cholecystokinin; Humans; Infant, Newborn; Jaundice, Neonatal; Morphine; Phenobarbital; Radionuclide Imaging

The present study reports the levels of plasma somatostatin and cholecystokinin in 19 preterm infants with asphyxia [n = 10, GA (median; range) 26; 23-30 weeks] and respiratory distress syndrome (n = 14, GA 27; 23-29 weeks) compared with preterm infants without any of these conditions (reference group, n = 59, GA 33; 25-36 weeks). In the reference group 37 infants received phototherapy and their peptide levels were compared with those not receiving phototherapy (n = 22). Plasma somatostatin and cholecystokinin were analysed by specific radioimmunoassays on day 1, day 3-4 and at 6 weeks of life. Plasma somatostatin levels, but not cholecystokinin levels, of reference infants were inversely related to gestational age on day 1 and day 3-4. Asphyxiated infants and infants with respiratory distress syndrome had significantly higher somatostatin levels than reference infants on day 1 and day 3-4. These differences disappeared when the levels were adjusted for gestational age. Plasma cholecystokinin levels were not influenced by respiratory distress syndrome and asphyxia. Phototherapy did not affect plasma somatostatin and cholecystokinin levels.

Topics: Asphyxia Neonatorum; Cholecystokinin; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Jaundice, Neonatal; Male; Phototherapy; Radioimmunoassay; Respiratory Distress Syndrome, Newborn; Somatostatin

Pancreatic function can only be determined exactly via the pancreozymin-secretin test. We conducted this test in two versions: (1) under conditions of continuous perfusion with the possibility of volume correction and (2) as a simple tubing. We compared the results of 86 tubings with the results of 87 examinations under perfusion. For that purpose all patients were classified into four groups: group a) with 46 and 10 examinations, respectively, in patients suffering from cholestasis in early infancy, group b) with 7 and 12 examinations, respectively, in older patients with liver diseases, group c) with 8 and 17 examinations, respectively, in patients suffering from cystic fibrosis or Shwachman's syndrome and group d) with 25 and 48 examinations, respectively, in children with normal pancreatic function. Both examination methods nearly identical mean values of the enzyme activities in all four patient groups. However, mean variations were found to be higher in case of tubing. Therefore the lower limits (x - 2s) of this test were defined at a lower level than those of the tests under perfusion.

Topics: Amylases; Child; Child, Preschool; Cholecystokinin; Cystic Fibrosis; Diagnosis, Differential; Exocrine Pancreatic Insufficiency; Humans; Infant; Infant, Newborn; Intestinal Secretions; Jaundice, Neonatal; Lipase; Liver Diseases; Pancreatic Function Tests; Reference Values; Secretin; Trypsin