Studies on the Me­chanism of Bile Pigment Formation in Vivo. Part Ⅰ. On the Cor­relation between the Production of Bile Pigments and Functions of the Parenchymal Cells of the Liver.

1. In normal adults and in patients of non-hepatic diseases a transient hyperbilirubinemia occurs after peroral administration of hemolysed blood. 2. In cases of severe anchylostomiasis the serum bilirubin displays a remarkable decrease, and on imposition of hemolysed blood, no hyperbilirubinemia occurs but a relative one may be seen. 3. In patients with highly impaired functions of the parenchymal cells of the liver, neither absolute nor relative hyperbilirubinemia occurs on similar imposition of hemolysed blood. 4. Imposed blood or hemoglobin seems primarily to be phagocytosed by the reticulo-endothelial system. 5. A similar transient hyperbilirubinemia is also seen in rabbits after peroral imposition of hemohsed blood. 6. When the functions of the reticulo-endothelial system are accelerated by administration of &#34;Koha&#34;, even incases of nonimposition of blood a hyperbilirubinemia occurs, but when hemolysed blood is imposed an additional transient increase in the hyperbilirubinemia may be detected. 7. In cases of blockage of the reticulo- endothelial system, this degree in the occurrence of hyperbilirubinemia is somewhat lower. 8. In cases of impaired liver cells by carbon tetrachloride, this decline is especially remarkable, and only a tendency of occurence can be dected. Since it is very difficult to explain this fact only by the co-existing impairment in the reticulo-endothelial system, the decline in the functions of the parenchymal cells of the liver must be placed under consideration. 9. By absorption tests of the intestines and by serological procedures, it is apparent that the perorally administerred hemoglobin may be readily absorbed from the jejunum, under any of these conditions. 10. Consequently, as for the cause of the hyperbilirubinemia occurring after peroral administration of hemolysed blood, most naturaly the reticulo-endothelial system participates, but it is impossible to neglect the part payed by the parenchymal cells of the liver.</p

Clinical features and treatment strategies of febrile urinary tract infection caused by extended-spectrum beta-lactamase–producing Enterobacteriaceae in children: a multicenter retrospective observational study in Japan

Objectives: The incidence of infections caused by extended-spectrum beta-lactamase (ESBL)–producing bacteria has increased. This study aimed to clarify the risk factors and treatment strategies for febrile urinary tract infection (fUTI) caused by ESBL-producing bacteria in Japanese children. Methods: A retrospective observational study was conducted in 21 hospitals among children aged <16 years diagnosed with an fUTI between 2008 and 2017. Clinical data of children with fUTI caused by ESBL-producing and non-ESBL–producing bacteria were compared. Results: Of the 2049 cases of fUTI, 147 (7.2%) were caused by ESBL-producing bacteria. Children in the ESBL group were more likely to have a history of recent antibiotic use or prophylactic antibiotic use, and experience recurrent UTIs (P <0.001) compared with those in the non-ESBL group. Of the 124 cases of fUTI due to ESBL-producing bacteria that were reviewed, 20 and 100 had concordant and discordant antibiotic use, respectively, and four had unknown antibiotic susceptibility. The median time from the start of treatment to fever resolution was 24 hours and did not differ significantly by therapy group (P = 0.39). Conclusion: ESBL-producing bacteria should be considered in children with recurrent UTIs and recent antibiotic use. Most children with fUTI experience clinical improvement regardless of the choice of antibiotic