Evaluation of blood levels of XXXX as a means of differentiation between @entity99 and @entity2876 : A pilot study.

@entity1 @entity1448 @entity842 @entity2876 @entity99
AIM: The differentiation between @entity99 ( @entity99 ) and @entity2876 ( @entity2876 ) is not always possible despite all the currently available diagnostic modalities. In this study, an attempt has been made to evaluate the role of @entity842 (NO) levels in the peripheral blood to differentiate between the two conditions, one requiring early surgical intervention ( @entity2876 ) and the other amenable to conservative medical management ( @entity99 ). @entity1 AND METHODS: Twenty @entity1 who presented to the pediatric surgical service, over a 2 years period, with features of @entity1448 were enrolled in the study. The diagnostic workup included documentation of history and clinical examination, biochemical liver function tests, ultrasonography, hepatobiliary scintigraphy (HS), and magnetic resonance cholangio-pancreaticography (MRCP). These @entity1 did not show excretion on HS and intrahepatic ducts on MRCP. Hence, they were subjected to mini-laparotomy and operative cholangiography (OC). The @entity2876 @entity1 were treated with the Kasai's portoenterostomy procedure, and the extrahepatic ducts were flushed with normal saline in @entity99 @entity1 . All @entity1 were evaluated preoperatively for levels of NO in the peripheral blood by the Greiss reaction spectrophotometrically at 540 nm. Normal values were determined from a cohort of controls. The median (range) levels of NO in @entity1 with @entity2876 and @entity99 were compared, and the statistical significance of the difference was calculated by applying the Wilcox Rank Sum test. A P = 0.05 was considered as significant. RESULTS: Of the 20 @entity1 enrolled in the study, 17 @entity1 were treated for @entity2876 (Group I) and the remaining 3 @entity1 had patent ducts on OC and were thus diagnosed as @entity99 (Group II). The mean age of the @entity1 in Groups I and II was comparable: 2.79    0.75 and 2.67    0.58 months, respectively (P = 0.866). The median NO levels were significantly elevated in each of the two groups as compared to the controls (5.6  mol/l, range 1.26-11.34  mol/l); when compared among themselves, the NO levels were significantly higher in Group I, 64.05  mol/l (range 24.11-89.43  mol/l), when compared with Group II, 41.72  mol/l (range 23.53-45.63  mol/l) (P = 0.022). CONCLUSION: The serum levels of NO were found to be significantly higher in @entity1 with @entity2876 as compared to those with @entity99 . Hence, this may be a useful biochemical marker for the preoperative differentiation of @entity2876 from @entity99 . However, a larger study is required for establishing the validity of the statistical significance.
