Congenital Obliteration of Bile Ducts and Icterus Gravis Neonatorum

Skelton, M. O.; Tovey, Geoffrey H.

doi:10.1136/bmj.2.4434.914

Cited by 18 publications

(6 citation statements)

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“…Other investigators-for instance, Wiener and Wexler (1943), Wiener (1944), Wiener, Wexler, and Gamrin (1944), and Langley and Stratton (1944)have also observed jaundice, hepatomegaly, and splenomegaly in newborn infants affected with haemolytic disease. The relationship between neonatal jaundice and liver damage and the Rh factor has recently been dealt with by Skelton and Tovey (1945).…”

Section: Discussionmentioning

confidence: 99%

The Rh Factor and Hepatomegaly and Splenomegaly in the Young

Drummond¹,

Watkins²

1946

BMJ

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Rh FACTOR: THEORY AND NOMENCLATURE BgRITISH MEDICAL JOURNAXL also states that the relative frequency of gene R" to gene R2 as compared with R' to R' indicates that his mythical, gene locus c lies between d and e. However, these statements are based entirely on the findings in England and disregard the findings in other countries. In America, for example, the relative frequency of R' to R" is reversed, while in negroes the frequency of r°(42.1%) is quite different from the sum of R' (2.7%) and R" (none found).'7 As a result Fisher's theory leads to a contradiction. In my opinion a much more plausible explanation is that the genes ro, R', and R" arose by mutation. Thus the high frequency of gene -ro and of the intermediate R genes, as well as the intermediate gene A1, 2, suggests that the peculiar distribution among negroes is due to a higher mutation rate in this race.The argument that the discovery of the so-called cw factor"8 supports Fisher's theory does not seem correct, because this factor appears to have the characteristic predicted by me'2 for factor Rh"'.In this connexion I should like to point to a recent attempt'9 to develop an elaborate theory of inheritance of the four blood groups by means of four gene couplets. On the basis of this theory, Myslivec derives formulae for the gene frequencies involving the square root of the difference 0-2 AB. Since populations exist in this world where the frequency of group O is less than twice the frequency of group AB, the theory leads to an obvious contradiction.In conclusion I should like to take this opportunity to answer the rather academic attack20 on my use2' of the term " conglutination" in connexion with the Rh antibody reactions. Recent findings22 have all sought to justify my use of this term. The term " co-agglutination," used by other workers, applies to a phenomenon obviously identical with mixed agglutination, and one would expect this to occur in conglutination where the second stage is non-specific.23 In agglutination, involving bivalent antibodies, where the second stage is specific, coagglutination or mixed agglutination does not occur. My new ideas and findings concerning univalent (blocking antibodies or glutinins) and bivalent antibodies (agglutinins) have led me to the theory2"25 that erythroblastosis foetalis actually comprises three separate entities instead of a single disease. According to my proposed nomenclature, these three entities are as follows: (1) Congenital haemolytic disease (with anaemia and hydrops), usually due to univalent Rh antibodies; (2) icterus gravis with kernicterus, usually due to bivalent Rh antibodies; and (3) icterus praecox (formerly confused with " physiologic" icterus, usually due to A-B sensitization. Further details will be given in papers now in the press and in preparation. REFERENCES Fisher, R. A., and Race, R. R. (1946). Nature, 157, 48.2 Wiener, A. S. (1941). Arch. Path., 32, 227. 3-(1942). Amer. J. clin. Path., 12, 302. 4 (1945)

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Section: Discussionmentioning

confidence: 99%

The Rh Factor and Hepatomegaly and Splenomegaly in the Young

Drummond¹,

Watkins²

1946

BMJ

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“…None required operative intervention. But if an obstruction occurs-for example, in the common bile duct-and is due to pigment stones, as in Lightwood and Bodian's Case 3, or to inspissated bile, as in Case " Hi " recorded by Skelton and Tovey (1945), this may be relieved surgically. Two cases of haemolytic disease of the newborn associated with obliteration of the common bile ducts have also been recorded (Pasachoff, 1935;Skelton and Tovey, 1945), but no comparable case has been seen at this hospital.…”

Section: Discussionmentioning

confidence: 99%

Icterus Gravis and Cirrhosis of the Liver

Gerrard¹

1952

BMJ

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BRTsHNm 1385MEDICAL JOUxN& tion I would use the anterior vaginal wall approach and would cut through that band. A further operation was not done in this case because the woman had secondaries from a carcinoma of the larynx.The other failure was in a case of moderate cystocele in which mobilization was again done through the Millin II approach. This woman has not yet had the cystocele repaired, but I feel confident that, when it is, the stress will be finally relieved. In this connexion Mulvany (1951) states: "The writer used to confine the suprapubic route to those cases of stress incontinence requiring also an abdominal operation and the vaginal one for those in need of repair, but these excellent results have prompted its employment also in the early to moderate prolapse, especially if there is a likelihood of future child-bearing, as in most cases it is the stress incontinence and not the prolapse which is the most prominent and troublesome feature." I cannot agree with this, and my results show that support from below is as important as mobilization.Latterly, therefore, nearly all my cases have been done through an anterior vaginal wall incision, whether prolapse was present or not. The procedure when this approach is used consists of: (1) dissection of urethra and bladder-neck; (2) rupture of pudendal diaphragm by index finger or blunt scissors on either side of urethra; (3) pushing the bladder off the back of the symphysis pubis; (4) removal of redundant vaginal mucosa, if any; (5) re-uniting vaginal mucosa and pa'ra-urethral tissues. This operation now constitutes part of any prolapse operation when stress incontinence is present.Many of my cases, but not all, had had several previous operations for prolapse and stress incontinence. One case had also had an Aldridge sling operation by another surgeon, but had not been improved. During operation on that case (suprapubic approach) no evidence could be found of the fascial sling inserted one year before. An immediate postoperative urinary infection tended to obscure the successful result, but one important point made by the patient (and since asked of other patients) was that she could now feel urine passing through the urethra. When the urinary infection was overcome the incontinence was completely relieved. ConclusionsIt would be wrong of me to make statistical deductions with so few cases. But my experience, gained in the study of many other procedures besides the present series, leads me to the following conclusions.1. That cases of stress incontinence require careful radiographic and cystoscopic investigation, apart from clinical neurological examination, before operations are performed. There is nothing new in this, as has been repeatedly pointed out by Millin (1950) and WinsburyWhite (1948). Measured cystography has shown that there is often a slight increase in descent of the bladderneck after mobilization, although the stress is cured.2. That Mulvany has introduced a new aetiological concept and an operation which has formed part of many sling proc...

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“…diffuse degeneration, focal necroses, and in case 1 an early cirrhosis. The latter resembles early human toxic cirrhosis and there is no evidence that obstruction in the biliary passages by inspissatedt bile was a factor in its causation, as has been suggested in some human cases (Lightwood, 1943;Skelton & Tovey, 1945;Hawksley & Lightwood, 1934). The jaundice was probably partly toxic in origin as bile thrombi in canaliculi are not a feature ofhaemolytic jaundice uncomplicated bydamage to liver cells (Gilmour, 1944).…”

Section: Serologymentioning

confidence: 93%

Haemolytic disease of newborn foals due to iso-immunization of pregnancy

et al. 1948

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1. Six cases of haemolytic disease in newborn foals apparently due to iso-immunization of pregnancy are described from their clinical, serological, haematological and pathological aspects. The findings agree closely with those seen in the same disease in newborn mules.2. The disease may be diagnosed serologically by demonstrating the in vivo iso-sensitization of the foal's red cells by means of the direct antiglobulin-sensitization test. It is quite possible that after further investigation a modification of Diamond's albumin tube test may also be of value. Immune anti-red cell iso-antibodies of more than one specificity may be demonstrated in the dams' sera.3. Despite the acute haemolytic process, very few reticulocytes and no erythroblasts are seen in the peripheral blood.4. The morbid histology of the tissues of foals dying with the disease exhibits various points of interest which are discussed.5. The clinical aspect is not described in this paper in any detail. However, a programme is suggested which would enable a successful exsanguino-transfusion of compatible blood to be carried out at very short notice. At present this seems to be the logical and most practical method of specific treatment.

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Congenital Obliteration of Bile Ducts and Icterus Gravis Neonatorum

Cited by 18 publications

References 1 publication

The Rh Factor and Hepatomegaly and Splenomegaly in the Young

The Rh Factor and Hepatomegaly and Splenomegaly in the Young

Icterus Gravis and Cirrhosis of the Liver

Haemolytic disease of newborn foals due to iso-immunization of pregnancy

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