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BILIRUBIN CONJUGATION IN A 28-WEEK FŒTUS
471 BILIRUBIN IN FŒTAL LIVER IN ERYTHROBLASTOSIS SIR,-It is commonly accepted that in the human newborn bilirubin conjugation in the liver starts only a few days after birth. It has been shown1 that an active bilirubin-glucuronyltransferase is present at birth in the liver of newborn Wistar rats if the bilirubinxmia during intrauterine life is increased during at least 24 hours before delivery. It was concluded that the accumulation of unconjugated bilirubin acts as a trigger for the conjugating system. A similar mechanism was proposed2 to explain the finding of conjugated bilirubin immediately after birth in the cord-blood of children severely affected by erythroblastosis foetalis. This raises the question of how early in intrauterine life the conjugating system can be activated by bilirubin overload in the immature foetal liver. During a histochemical study of post-mortem foetal liver specimens, we found a much higher incidence of microscopically visible bile accumulation in the liver tissue of cases with erythroblastosis than in the non-erythroblastotic control series. The incidence was 80% in erythroblastosis (4 cases out of 5) and 13% in the control series (4 cases out of 31). The degree of cholestasis was usually slight; the bile pigment accumulated extracellularly in the form of coarse thrombi, usually in the lumen of smaller bile-ducts in the portal tracts, or in the lumen of hepatic-cell cords with tubular arrangement. Total and conjugated bilirubin was selectively demonstrated in all cases by examining serial frozen section, stained for total bilirubin with Fouchet’s reagent,3 for conjugated bilirubin with the diazonium salt of ethylanthranilate,4and again for total bilirubin with the accelerator diazo reagent of Raia.5 In all cases with erythroblastosis the bile thrombi showed the histochemical staining characteristics of conjugated bilirubin. The age of the foetuses included in this study ranged from 28 weeks to 33 weeks. The presence of bile pigment in the form of extracellular thrombi in this liver tissue suggests immaturity or secretory disturbance at a level beyond the hepatocyte, either canaliculi or ductules.
CONJUGATED
Laboratorium en
voor
Histochemie
Cytochemie,
Dienst voor Pathologische, Ontleedkunde B, en Kliniek voor Gynæcologie en
Verloskunde,
Academisch Ziekenhuis St. Rafaël,
Leuven, Belgium,
BILIRUBIN
INTEGRATING COMMONWEALTH DOCTORS SIR,-It has been recognised for some time, and particularly in the north of the United Kingdom, that the junior echelons of the hospitals are largely staffed by Commonwealth doctors. The recent controversy that has arisen in the National press in regard to their ability does very scant justice to a body of hardworking, loyal, and intelligent doctors. I can only assume that those regional hospital boards and hospital management committees which are dissatisfied with Commonwealth doctors are entirely at fault because of their inadequate arrangements for the selection of suitable candidates. I am currently assessing such Commonwealth doctors before their integration in the National Health Service. This procedure will not only permit an adequate assessment of their linguistic capabilities, but also facilitate arrangements for vocational training of these doctors under the aegis of the National Health Service. PETER O. 0. LEGGAT. Newcastle upon Tyne NE4
CONJUGATION
DE WOLF-PEETERS M. MOENS-BULLENS VAN ASSCHE J. DESMET.
IN A 28-WEEK
Sip,ňThe physiological hyperbilirubinaemia in the newborn activates the conjugating process which is a necessary step in bilirubin excretion.1 Heavily immunised cases of erythroblastosis fcetalis are jaundiced even before delivery and, contrary to normals, they are able to conjugate bilirubin in the foetal stage.2 Bilirubin conjugates have been observed in the amniotic fluid in the 32nd week.In this fluid, we have found conjugated bilirubin as early as the 28th week of gestation. A 51-year-old pregnant, anicteric woman, immunised by a blood-transfusion in 1955, had an indirect Coombs anti-D titre of 2048 (October, 1968). She had abortions in 1957, 1960, and 1963, and a foetus which died 2 weeks before term in 1959. Amniocentesis was performed in the 28th week (November 1968) of her last pregnancy. The amniotic fluid had a Liley optical density (O.D.) of 0-8 7; it contained 1-05 Bakken, A. F., Fog, J. Lancet, 1967, ii, 309. Bakken, A. F., Fog, J. ibid. 1967, i, 1280. Hall, M. J. Am. J. clin. Path. 1960, 34, 313. Desmet, V. J., Bullens, A. M., De Groote, J., Heirwegh, K. P. M., J. Histochem. Cytochem. 1968, 16, 499. 5. Raia, S. in Bilirubin Metabolism (edited by I. A. D. Bouchier and B. H. Billing); p. 285. Oxford, 1967. 6. Bakken, A. F., Billing B., Liley, A. W. Personal communication. 7. Liley, A. W. Am. J. Obstet. Gynec. 1961, 81, 1359.
J. Scand. J. clin. Lab. Invest. 1958, 10, 241. J., Bratlid, D., Winsnes, A., Bakken, A. F. III Meeting European Association for the Study of the Liver; p. 59. Modena, 1968. Schmid, R., Buckinham, S., Vendilla, G. A., Hammaker, L. Nature, Lond. 1959, 183, 1823.
8. Fog, 9. Fog, 10.
C. A. A. V.
FŒTUS
1. 2. 3. 4.
mg. per 100 ml. of total bilirubin,8 and 0-70 mg. per 100 ml. of bilirubin extractable into chloroform when it is calculated from the O.D. at 454 mlL.9 In the chloroform extract 0-54 mg. per 100 ml. of the bilirubin formed a blue acid azopigment.9 Unconjugated bilirubin and some non-bilirubin pigments, only, are extractable into chloroform by this technique.9 Consequently, in this case, nearly half of the total bilirubin could be classified as bilirubin conjugates. The conjugated bilirubin present in the amniotic fluid must have been formed in the 28-week-old foetus because the placenta barrier is impermeable to conjugated bilirubin. 10 Unfortunately, a second amniocentesis was excluded by the death of the foetus, which was hydropic and heavily macerated when delivered. J. FOG Pædiatric Research Institute, D. BRATLID University of Oslo, W. BLYSTAD. Rikshospitalet, Oslo.
Parliament Disabled Denied
a
Fresh Charter
UNDOUBTEDLY all disabled people need a satisfactory pension, but Mr. J. M. L. PRIOR’S private member’s Bill, which aims to provide a pension for all the disabled who do not qualify for benefit under the national insurance, industrial injuries, or war disability schemes, was not accorded a second reading in the House of Commons on Feb. 21. Mr. NORMAN PENTLAND, under-secretary of State for the Department of Health and Social Security, said that the Government could not support the Bill because its provisions were arbitrary and would inevitably be unsatisfactory in practice. Introducing the Bill, Mr. PRIOR was particularly concerned with the fate of the disabled housewife whose husband could not afford to pay someone to run the house and care for the children. He claimed that the twin stresses of poverty and sickness might well lead to the break-up of the family, and the children being taken into care. The first clause of the Bill provided for a pension for the chronically disabled housewife who could not receive help from either the Insurance Fund or the Supplementary Benefits Commission, and also for those permanently and badly handicapped since childhood. The Bill also sought to extend the constant-attendance allowance, at present only available to those qualifying for disablement benefit under the National Insurance (Industrial Injuries) Act, and to empower the Minister of Housing and Local Government to ensure that a proportion of new council houses were
CONJUGATED
Laboratorium en
voor
Histochemie
Cytochemie,
Dienst voor Pathologische, Ontleedkunde B, en Kliniek voor Gynæcologie en
Verloskunde,
Academisch Ziekenhuis St. Rafaël,
Leuven, Belgium,
BILIRUBIN
INTEGRATING COMMONWEALTH DOCTORS SIR,-It has been recognised for some time, and particularly in the north of the United Kingdom, that the junior echelons of the hospitals are largely staffed by Commonwealth doctors. The recent controversy that has arisen in the National press in regard to their ability does very scant justice to a body of hardworking, loyal, and intelligent doctors. I can only assume that those regional hospital boards and hospital management committees which are dissatisfied with Commonwealth doctors are entirely at fault because of their inadequate arrangements for the selection of suitable candidates. I am currently assessing such Commonwealth doctors before their integration in the National Health Service. This procedure will not only permit an adequate assessment of their linguistic capabilities, but also facilitate arrangements for vocational training of these doctors under the aegis of the National Health Service. PETER O. 0. LEGGAT. Newcastle upon Tyne NE4
CONJUGATION
DE WOLF-PEETERS M. MOENS-BULLENS VAN ASSCHE J. DESMET.
IN A 28-WEEK
Sip,ňThe physiological hyperbilirubinaemia in the newborn activates the conjugating process which is a necessary step in bilirubin excretion.1 Heavily immunised cases of erythroblastosis fcetalis are jaundiced even before delivery and, contrary to normals, they are able to conjugate bilirubin in the foetal stage.2 Bilirubin conjugates have been observed in the amniotic fluid in the 32nd week.In this fluid, we have found conjugated bilirubin as early as the 28th week of gestation. A 51-year-old pregnant, anicteric woman, immunised by a blood-transfusion in 1955, had an indirect Coombs anti-D titre of 2048 (October, 1968). She had abortions in 1957, 1960, and 1963, and a foetus which died 2 weeks before term in 1959. Amniocentesis was performed in the 28th week (November 1968) of her last pregnancy. The amniotic fluid had a Liley optical density (O.D.) of 0-8 7; it contained 1-05 Bakken, A. F., Fog, J. Lancet, 1967, ii, 309. Bakken, A. F., Fog, J. ibid. 1967, i, 1280. Hall, M. J. Am. J. clin. Path. 1960, 34, 313. Desmet, V. J., Bullens, A. M., De Groote, J., Heirwegh, K. P. M., J. Histochem. Cytochem. 1968, 16, 499. 5. Raia, S. in Bilirubin Metabolism (edited by I. A. D. Bouchier and B. H. Billing); p. 285. Oxford, 1967. 6. Bakken, A. F., Billing B., Liley, A. W. Personal communication. 7. Liley, A. W. Am. J. Obstet. Gynec. 1961, 81, 1359.
J. Scand. J. clin. Lab. Invest. 1958, 10, 241. J., Bratlid, D., Winsnes, A., Bakken, A. F. III Meeting European Association for the Study of the Liver; p. 59. Modena, 1968. Schmid, R., Buckinham, S., Vendilla, G. A., Hammaker, L. Nature, Lond. 1959, 183, 1823.
8. Fog, 9. Fog, 10.
C. A. A. V.
FŒTUS
1. 2. 3. 4.
mg. per 100 ml. of total bilirubin,8 and 0-70 mg. per 100 ml. of bilirubin extractable into chloroform when it is calculated from the O.D. at 454 mlL.9 In the chloroform extract 0-54 mg. per 100 ml. of the bilirubin formed a blue acid azopigment.9 Unconjugated bilirubin and some non-bilirubin pigments, only, are extractable into chloroform by this technique.9 Consequently, in this case, nearly half of the total bilirubin could be classified as bilirubin conjugates. The conjugated bilirubin present in the amniotic fluid must have been formed in the 28-week-old foetus because the placenta barrier is impermeable to conjugated bilirubin. 10 Unfortunately, a second amniocentesis was excluded by the death of the foetus, which was hydropic and heavily macerated when delivered. J. FOG Pædiatric Research Institute, D. BRATLID University of Oslo, W. BLYSTAD. Rikshospitalet, Oslo.
Parliament Disabled Denied
a
Fresh Charter
UNDOUBTEDLY all disabled people need a satisfactory pension, but Mr. J. M. L. PRIOR’S private member’s Bill, which aims to provide a pension for all the disabled who do not qualify for benefit under the national insurance, industrial injuries, or war disability schemes, was not accorded a second reading in the House of Commons on Feb. 21. Mr. NORMAN PENTLAND, under-secretary of State for the Department of Health and Social Security, said that the Government could not support the Bill because its provisions were arbitrary and would inevitably be unsatisfactory in practice. Introducing the Bill, Mr. PRIOR was particularly concerned with the fate of the disabled housewife whose husband could not afford to pay someone to run the house and care for the children. He claimed that the twin stresses of poverty and sickness might well lead to the break-up of the family, and the children being taken into care. The first clause of the Bill provided for a pension for the chronically disabled housewife who could not receive help from either the Insurance Fund or the Supplementary Benefits Commission, and also for those permanently and badly handicapped since childhood. The Bill also sought to extend the constant-attendance allowance, at present only available to those qualifying for disablement benefit under the National Insurance (Industrial Injuries) Act, and to empower the Minister of Housing and Local Government to ensure that a proportion of new council houses were