Study on the efficacy and safety of adefovir dipivoxil treatment in post-liver transplant patients with hepatitis B virus infection and lamivudine-resistant hepatitis B virus.

Hepatitis B virus (HBV) recurrence and de novo HBV infection are frequent events in liver transplantation recipients. Treatment with lamivudine is initially efficient in both infections but the incidence of lamivudine-resistant HBV emergence increases over time. Adefovir appears to be promising in post-liver transplantation patients with recurrent HBV infection and lamivudine-resistant HBV. This study analyzed adefovir treatment in 42 post-liver transplantation patients who developed recurrent HBV or de novo HBV infection with lamivudine-resistant HBV (54.8% HCV-coinfected). Patients received 10 mg of oral adefovir once daily for a mean period of time of 21.5 months (range from 12 to 31 months). In 62.9% of patients, ALT levels decreased significantly. Serum HBV-DNA was undetectable in 64% of the cases. Twenty percent of patients lost HBeAg marker and 13.3% of them developed anti-HBe. In 9.5% of recipients, HBsAg became negative. There was no significant change in serum creatinine levels. In only one patient was worsening of the renal function detected, making dose adjustment necessary. No other side effects were reported. Our results confirm the efficacy and safety of adefovir treatment in post-liver transplantation patients with lamivudine-resistant HBV, neither were adefovir-resistant mutations identified in patients after 21 months of therapy, nor were there adverse events, especially renal toxicity.

Sistemas de soporte hepático extracorpóreo: un paso más hacia las técnicas de depuración integral / Extracorporeal liver support: one step nearer the integrated blood purification techniques

Durante los últimos años se ha extendido la utilizaciónde diversas modalidades de terapia extracorpóreaen varias especialidades. La capacidad deestos sistemas en otras enfermedades distintas a lainsuficiencia renal está limitada por su falta de eficaciaen la eliminación de las toxinas precisas. Laexperiencia alcanzada en aspectos técnicos en elcampo de la diálisis1, 2 ha potenciado la investigacióny aplicación de diferentes sistemas de depuraciónextracorpórea en situaciones de ámbito multidisciplinario.Como paradigma de la aplicación deestas medidas terapéuticas hemos evaluado el estadoactual del tratamiento de los pacientes que presentanfracaso hepático

Localized phlegmonous gastritis: endoscopic view.

A case of localized phlegmonous gastritis is reported. Features of this condition and the diagnostic and therapeutic usefulness of endoscopy are briefly considered.