ABSTRACT
Hepatitis B virus (HBV) is a high risk factor in the frequently found liver involvement of renal transplant recipients. As in other immunosuppressed patients, these often follow a course of slight jaundice, with a progressive tendency and great replicative and infectious power. Also, in addition to an increased incidence of chronic hepatitis (CH) in transplanted when compared with hemodialized patients, specially when HBsAg is present, it is surprising the poor correlation between enzyme levels and the grade of activity of the hepatic lesion. In a retro and prospective study, we present 52 patients of the 73 transplant reviewed. There are 32 men and 20 females, with and average age of 34 years, minimum time on dialysis of 2 months and maximum of 7 years, time of renal transplant from 6 moth to 15 years (average 4.9 years). There were 31 cadaver transplants and 21 live donors. The HBsAg was + in 20 (9 seroconverted), HBeAg was + in 4 (with 2 seroconvertions), hyperbilirrubinemia in 5, hyperalkaline phosphatasemia (2 or more times) in 11 and elevated serum transaminases (SGPT) (3 times or more) in 20 cases. Positive HBsAg plus SGPT x 3 was found on 9 occasions and positive HBsAg with SGPT x 3 in 3 cases. liver biopsy (LB), in those with enzymatic changes and/or positive antigenemia, was performed in 15 instances and there were 5 autopsies. The most important histological findings were: 5 acute viral hepatitis, 2 active chronic hepatitis (CAH), 2 persistent chronic hepatitis (CPH), 5 with fat infiltration and 4 with colestasis.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Hepatitis B Surface Antigens/analysis , Hepatitis B virus/immunology , Kidney Transplantation , Female , Hepatitis B e Antigens/analysis , Humans , Male , Prospective Studies , Retrospective Studies , Transaminases/bloodABSTRACT
El VBH es un factor de alto riesgo en el frecuente compromiso hepático del trasplantado renal. Como en otros inmunosuprimidos, estos suelen cursar con ictericias leves, tendencia progresiva, gran poder replicativo e infectivo. También, además de una alta incidencia de HC en los trasplantados en relación a los dializados y en particular cuando el HBsAg se halla presente, sorprende la pobre correlación entre los niveles enzimásticos y el grado de actividad de la lesión hepática. En un estudio retro y prospectivo se presentan 52 pacientes sobre 73 trasplantados revisados. Hubo 32 hombres y 20 mujeres, con un promedio de edad de 34 años, tiempo mínimo de diálisis de 2 meses y máximo de 7 años, tiempo de injerto desde 6 meses hasta 15 años 94,9 años de promedio). Se trasplantaron 31 riñones cadavéricos y 21 vivos. El HBsAg resultó + en 20 (9 seroconviertieron), el HBeAg fue + en 4 (con 2 seroconversiones), hiperbilirrubinemia en 5 hiperfosfatasemia alcalina 9 x 2 veces o más) en 11, transaminasas elevadas (ALAT) (x 3 veces o más) en 20 casos. Se comprobó HBsAg + con ALAT x 3 en 9 ocasiones y HBeAg + con ALAT x 3 en 3 casos. Se realizó una PBH por alteraciones enzimáticas y/o antigenemia + en 15 enfermos y hubo 5 autopsias. Los hallazgos histológicos más improtantes consistieron en: 5 hepatitis virales agudas, 2 HCA, 2 HCP, 5 con infiltración grasa y 4 con colestasis. El grupo más afectado fue el de los 5 pacientes con HBsAg + (2 de ellos además con el HBeAg +) y ALAT elevada al menos x 3...
Subject(s)
Humans , Male , Female , Hepatitis B Surface Antigens/analysis , Kidney Transplantation , Liver Diseases/etiology , Liver Diseases/pathology , Prospective Studies , Retrospective Studies , Transaminases/blood , Hepatitis B virus/pathogenicityABSTRACT
Hepatitis B virus (HBV) is a high risk factor in the frequently found liver involvement of renal transplant recipients. As in other immunosuppressed patients, these often follow a course of slight jaundice, with a progressive tendency and great replicative and infectious power. Also, in addition to an increased incidence of chronic hepatitis (CH) in transplanted when compared with hemodialized patients, specially when HBsAg is present, it is surprising the poor correlation between enzyme levels and the grade of activity of the hepatic lesion. In a retro and prospective study, we present 52 patients of the 73 transplant reviewed. There are 32 men and 20 females, with and average age of 34 years, minimum time on dialysis of 2 months and maximum of 7 years, time of renal transplant from 6 moth to 15 years (average 4.9 years). There were 31 cadaver transplants and 21 live donors. The HBsAg was + in 20 (9 seroconverted), HBeAg was + in 4 (with 2 seroconvertions), hyperbilirrubinemia in 5, hyperalkaline phosphatasemia (2 or more times) in 11 and elevated serum transaminases (SGPT) (3 times or more) in 20 cases. Positive HBsAg plus SGPT x 3 was found on 9 occasions and positive HBsAg with SGPT x 3 in 3 cases. liver biopsy (LB), in those with enzymatic changes and/or positive antigenemia, was performed in 15 instances and there were 5 autopsies. The most important histological findings were: 5 acute viral hepatitis, 2 active chronic hepatitis (CAH), 2 persistent chronic hepatitis (CPH), 5 with fat infiltration and 4 with colestasis.(ABSTRACT TRUNCATED AT 250 WORDS)
ABSTRACT
El VBH es un factor de alto riesgo en el frecuente compromiso hepático del trasplantado renal. Como en otros inmunosuprimidos, estos suelen cursar con ictericias leves, tendencia progresiva, gran poder replicativo e infectivo. También, además de una alta incidencia de HC en los trasplantados en relación a los dializados y en particular cuando el HBsAg se halla presente, sorprende la pobre correlación entre los niveles enzimásticos y el grado de actividad de la lesión hepática. En un estudio retro y prospectivo se presentan 52 pacientes sobre 73 trasplantados revisados. Hubo 32 hombres y 20 mujeres, con un promedio de edad de 34 años, tiempo mínimo de diálisis de 2 meses y máximo de 7 años, tiempo de injerto desde 6 meses hasta 15 años 94,9 años de promedio). Se trasplantaron 31 riñones cadavéricos y 21 vivos. El HBsAg resultó + en 20 (9 seroconviertieron), el HBeAg fue + en 4 (con 2 seroconversiones), hiperbilirrubinemia en 5 hiperfosfatasemia alcalina 9 x 2 veces o más) en 11, transaminasas elevadas (ALAT) (x 3 veces o más) en 20 casos. Se comprobó HBsAg + con ALAT x 3 en 9 ocasiones y HBeAg + con ALAT x 3 en 3 casos. Se realizó una PBH por alteraciones enzimáticas y/o antigenemia + en 15 enfermos y hubo 5 autopsias. Los hallazgos histológicos más improtantes consistieron en: 5 hepatitis virales agudas, 2 HCA, 2 HCP, 5 con infiltración grasa y 4 con colestasis. El grupo más afectado fue el de los 5 pacientes con HBsAg + (2 de ellos además con el HBeAg +) y ALAT elevada al menos x 3... (AU)
Subject(s)
Humans , Male , Female , Kidney Transplantation , Hepatitis B Surface Antigens/analysis , Liver Diseases/etiology , Transaminases/blood , Liver Diseases/pathology , Hepatitis B virus/pathogenicity , Retrospective Studies , Prospective StudiesSubject(s)
Cardiac Surgical Procedures , Drainage/instrumentation , Intubation/methods , Postoperative Care/methods , Thorax , Adult , Aged , Drainage/methods , Humans , Male , Middle AgedABSTRACT
Malignant tumors occur with greater frequency in patients with kidney transplants. Kaposi's sarcoma (KS), a rare vascular neoformation, represents approximately 3% of them. Its uncertain etiology appears to respond to: a chronic antigen stimulation by the transplanted tissue, to a depression of immune responsiveness, to the direct oncogenic action of the immunosuppressive agents, to the activation of oncogenic viruses or to a genetic predisposition of other possible factors. The clinical evolution is presented in two immunosuppressed kidney transplant patients with this pathology in the digestive tract. One had remission of the lesion following the suspension of the immunosuppressive agent. The relationship of this tumor with acquired immunodeficiency syndrome which occurred primarily (75%) in homosexuals shows a mortality rate of 30% due to KS. The first case showed signs of digestive hemorrhage and the typical nodule of KS was found in the esophagus on endoscopy. She also suffered a severe mixed infection due to Streptococcus faecalis and Cryptococcus neoformans with neurological complications and a new endoscopy 4 months after suspension of azathioprine showed the disappearance of the esophageal as well as the skin lesions. In the second patient, the suspicion of the digestive tract involvement could only be proved at autopsy. We insist on the importance of immunosuppression as a predisposing factor for the appearance of KS and infections in transplanted patients. It should also be remembered in cases with mucocutaneous lesions, that any digestive hemorrhage must primarily be attributed to KS and that the suspension of the immunosuppressive therapy constitutes the most effective treatment for the tumor.
Subject(s)
Digestive System Neoplasms/etiology , Immunosuppressive Agents/adverse effects , Kidney Transplantation , Sarcoma, Kaposi/etiology , Adult , Digestive System Neoplasms/pathology , Female , Graft Rejection , Humans , Male , Sarcoma, Kaposi/pathologyABSTRACT
Three cases of acute cholestatic viral hepatitis are presented. A discussion is made regarding the difficulties encountered and the methods used for certifying this not always easy diagnosis: one patient with virus A and two presumed cases of non-A, non-B virus. The most noteworthy laboratory findings are observed in the very slight transaminase changes or their abrupt descent over a short period whereas bilirubin and cholestatic parameters increase. Due to the particular characteristics observed in the first case, a doubt still exists regarding the possibility of an occult systemic disease existing even though 17 months have passed since the onset of symptoms. The possibility of Hodgkin's disease has been virtually ruled out since it seldom presents such long term hyperbilirubinemia and such high alkaline phosphatase levels.
Subject(s)
Cholestasis/etiology , Hepatitis A/diagnosis , Hepatitis C/diagnosis , Hepatitis, Viral, Human/diagnosis , Adult , Bilirubin/blood , Cholesterol/blood , Female , Hepatitis A/complications , Hepatitis C/complications , Humans , Male , Middle Aged , Transaminases/bloodABSTRACT
Malignant tumors occur with greater frequency in patients with kidney transplants. Kaposis sarcoma (KS), a rare vascular neoformation, represents approximately 3
of them. Its uncertain etiology appears to respond to: a chronic antigen stimulation by the transplanted tissue, to a depression of immune responsiveness, to the direct oncogenic action of the immunosuppressive agents, to the activation of oncogenic viruses or to a genetic predisposition of other possible factors. The clinical evolution is presented in two immunosuppressed kidney transplant patients with this pathology in the digestive tract. One had remission of the lesion following the suspension of the immunosuppressive agent. The relationship of this tumor with acquired immunodeficiency syndrome which occurred primarily (75
) in homosexuals shows a mortality rate of 30
due to KS. The first case showed signs of digestive hemorrhage and the typical nodule of KS was found in the esophagus on endoscopy. She also suffered a severe mixed infection due to Streptococcus faecalis and Cryptococcus neoformans with neurological complications and a new endoscopy 4 months after suspension of azathioprine showed the disappearance of the esophageal as well as the skin lesions. In the second patient, the suspicion of the digestive tract involvement could only be proved at autopsy. We insist on the importance of immunosuppression as a predisposing factor for the appearance of KS and infections in transplanted patients. It should also be remembered in cases with mucocutaneous lesions, that any digestive hemorrhage must primarily be attributed to KS and that the suspension of the immunosuppressive therapy constitutes the most effective treatment for the tumor.
ABSTRACT
Three cases of acute cholestatic viral hepatitis are presented. A discussion is made regarding the difficulties encountered and the methods used for certifying this not always easy diagnosis: one patient with virus A and two presumed cases of non-A, non-B virus. The most noteworthy laboratory findings are observed in the very slight transaminase changes or their abrupt descent over a short period whereas bilirubin and cholestatic parameters increase. Due to the particular characteristics observed in the first case, a doubt still exists regarding the possibility of an occult systemic disease existing even though 17 months have passed since the onset of symptoms. The possibility of Hodgkins disease has been virtually ruled out since it seldom presents such long term hyperbilirubinemia and such high alkaline phosphatase levels.
ABSTRACT
A study of 50 liver biopsies (LB) is presented from a series of 45 patients with Hodgkin's disease as diagnosed by node biopsy in 40, by laparoscopic liver biopsy (LLB) or surgery in 5, with a simultaneous positive bone marrow study in one case. A total of 34 LLB and 16 blind liver biopsies were carried out For diagnosis of the disease the LB was positive in 2/7 or 28.5%. In order to establish the clinical status as a pre-treatment staging procedure in 30 cases, the biopsy was useful in 10% of the cases; whereas during the evolution of the disease in order to establish restaging in 13 patients, positivity was observed in 1 case (7.6%). In 7/34 with laparoscopic changes of the hepatic surface, invasion was later determined by LLB, surgery or autopsy in 71%, whereas with a normal surface infiltration was only established in 18.5% In 12 patients with liver invasion as demonstrated by LLB, laparotomy or autopsy, alkaline phosphatase was increased in 91.6%. We consider that the elevated number of false negatives (58.3%) is due fundamentally to the single biopsy technique performed some years ago with the Vim-Silverman needle instead of the procedure in use at present o repeated biopsies in both lobes when possible. Our experience of 50 LB in these 45 patients has been most useful in arriving at a diagnosis in 2, determining a change in stage on 3 occasions, demonstrating peritoneal and spleen involvement in 2 cases in addition to revealing other hepatic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Hodgkin Disease/pathology , Liver Neoplasms/pathology , Liver/pathology , Adolescent , Adult , Aged , Alkaline Phosphatase/analysis , Biopsy , False Negative Reactions , Female , Humans , Laparoscopy , Liver/enzymology , Male , Middle Aged , Neoplasm StagingABSTRACT
A study of 50 liver biopsies (LB) is presented from a series of 45 patients with Hodgkins disease as diagnosed by node biopsy in 40, by laparoscopic liver biopsy (LLB) or surgery in 5, with a simultaneous positive bone marrow study in one case. A total of 34 LLB and 16 blind liver biopsies were carried out For diagnosis of the disease the LB was positive in 2/7 or 28.5
. In order to establish the clinical status as a pre-treatment staging procedure in 30 cases, the biopsy was useful in 10
of the cases; whereas during the evolution of the disease in order to establish restaging in 13 patients, positivity was observed in 1 case (7.6
). In 7/34 with laparoscopic changes of the hepatic surface, invasion was later determined by LLB, surgery or autopsy in 71
, whereas with a normal surface infiltration was only established in 18.5
In 12 patients with liver invasion as demonstrated by LLB, laparotomy or autopsy, alkaline phosphatase was increased in 91.6
. We consider that the elevated number of false negatives (58.3
) is due fundamentally to the single biopsy technique performed some years ago with the Vim-Silverman needle instead of the procedure in use at present o repeated biopsies in both lobes when possible. Our experience of 50 LB in these 45 patients has been most useful in arriving at a diagnosis in 2, determining a change in stage on 3 occasions, demonstrating peritoneal and spleen involvement in 2 cases in addition to revealing other hepatic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)
ABSTRACT
From 1973 to 1976, 23 public health laboratories performed cost accounting studies with the assistance of the Laboratory Management Consultation Office, Center for Disease Control. Cose data obtained in 16 of these laboratories were used as the basis of a discussion on the identification of indirect expenses and the method of reapportioning these costs to the diagnostic testing sections of the laboratories. Calculations of cost-per-weighted units and cost-per-test of some laboratory diagnostic sections are presented. A laboratory administrator can gain some insight into the effectiveness of resource utilization within his own laboratory by identifying cost center expenditures and considering differences in cost-per-weighted unit among the various revenue-producing sections. With the currently available data, no significant relationship between indirect costs and overall laboratory cost-per-weighted unit was demonstrated. It is hoped that additional data can be gathered and other indices developed which will help laboratory management to more precisely identify and then control indirect costs.
