Síndrome de Parsonage-Turner durante el tratamiento de la enfermedad de Castleman multicéntrica asociada a VIH y herpes humano 8 / Parsonage-Turner syndrome during the treatment of HIV/HHV8-related multicentric Castleman disease

No disponible

Liver transplantation for bile duct injury after open and laparoscopic cholecystectomy.

BACKGROUND: Bile duct injury (BDI) after cholecystectomy is a serious complication. In a small subset of patients with BDI, failure of surgical or non-surgical management might lead to acute or chronic liver failure. The aim of this study was to review the indications and outcome of liver transplantation (LT) for BDI after open and laparoscopic cholecystectomy. METHODS: Patients with BDI after cholecystectomy who were on the waiting list for LT between January 1987 and December 2010 were identified from LT centres in Spain. A standardized questionnaire was sent to each unit for extraction of data on diagnosis, previous treatments, indication and outcome of LT for BDI. RESULTS: Some 27 patients with BDI after cholecystectomy in whom surgical and non-surgical management for BDI failed were scheduled for LT over the 24-year interval. Emergency LT for acute liver failure was indicated in seven patients, all after laparoscopic cholecystectomy. Two patients died while on the waiting list and only one patient survived more than 30 days after LT. Elective LT for secondary biliary cirrhosis after a failed hepaticojejunostomy was performed in 13 patients after open and seven after laparoscopic cholecystectomy. One patient from the elective transplantation group died within 30 days of LT. The estimated 5-year overall survival rate was 68 per cent. CONCLUSION: Emergency LT for acute liver failure was more common in patients with BDI after laparoscopic cholecystectomy, and associated with a poor outcome.

Terapia celular hepática en el tratamiento de las metabolopatías congénitas en niños / Liver cell therapy in the treatment of inborn errors of metabolism in children

El trasplante hepático (TH) es el único tratamiento efectivo existente para las enfermedades hepáticas en fase terminal. La desproporción entre demanda y oferta de órganos constituye su principal limitación, planteando la necesidad de buscar alternativas de tratamiento. El trasplante de hepatocitos humanos o trasplante celular hepático (TCH) constituye, en el momento actual, la mejor opción terapéutica puente al restablecimiento de la función hepática o al trasplante hepático. Consiste en trasplantar hepatocitos humanos totalmente diferenciados a un órgano receptor, en cantidad suficiente para que estos sobrevivan y restauren la función hepática normal, basándose en la capacidad de regeneración hepática. El TCH consta básicamente de 4 pasos: el aislamiento de los hepatocitos a partir de injertos hepáticos descartados para TH, la preparación de las suspensiones celulares, la criopreservación de los hepatocitos aislados y, finalmente, su implante en el receptor. Esta terapia se ha llevado a cabo en pacientes con insuficiencia hepática aguda de distintas etiologías con intención de sustituir o servir de puente al TH y en el tratamiento de pacientes pediátricos con errores congénitos del metabolismo con objetivo de reemplazar el déficit enzimático causante de la enfermedad. En el Hospital La Fe de Valencia hemos puesto en marcha una Unidad de Terapia Celular Hepática y llevado a cabo el primer TCH en España, abriendo una nueva línea de trabajo dentro del Programa de Trasplante Hepático (AU)

Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant. The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient. This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program (AU)

Design and validation of an augmented reality system for laparoscopic surgery in a real environment.

PURPOSE: This work presents the protocol carried out in the development and validation of an augmented reality system which was installed in an operating theatre to help surgeons with trocar placement during laparoscopic surgery. The purpose of this validation is to demonstrate the improvements that this system can provide to the field of medicine, particularly surgery. METHOD: Two experiments that were noninvasive for both the patient and the surgeon were designed. In one of these experiments the augmented reality system was used, the other one was the control experiment, and the system was not used. The type of operation selected for all cases was a cholecystectomy due to the low degree of complexity and complications before, during, and after the surgery. The technique used in the placement of trocars was the French technique, but the results can be extrapolated to any other technique and operation. RESULTS AND CONCLUSION: Four clinicians and ninety-six measurements obtained of twenty-four patients (randomly assigned in each experiment) were involved in these experiments. The final results show an improvement in accuracy and variability of 33% and 63%, respectively, in comparison to traditional methods, demonstrating that the use of an augmented reality system offers advantages for trocar placement in laparoscopic surgery.

Estimation of the elastic parameters of human liver biomechanical models by means of medical images and evolutionary computation.

This paper presents a method to computationally estimate the elastic parameters of two biomechanical models proposed for the human liver. The method is aimed at avoiding the invasive measurement of its mechanical response. The chosen models are a second order Mooney-Rivlin model and an Ogden model. A novel error function, the geometric similarity function (GSF), is formulated using similarity coefficients widely applied in the field of medical imaging (Jaccard coefficient and Hausdorff coefficient). This function is used to compare two 3D images. One of them corresponds to a reference deformation carried out over a finite element (FE) mesh of a human liver from a computer tomography image, whilst the other one corresponds to the FE simulation of that deformation in which variations in the values of the model parameters are introduced. Several search strategies, based on GSF as cost function, are developed to accurately find the elastics parameters of the models, namely: two evolutionary algorithms (scatter search and genetic algorithm) and an iterative local optimization. The results show that GSF is a very appropriate function to estimate the elastic parameters of the biomechanical models since the mean of the relative mean absolute errors committed by the three algorithms is lower than 4%.

[Liver cell therapy in the treatment of inborn errors of metabolism in children]. / Terapia celular hepática en el tratamiento de las metabolopatías congénitas en niños.

Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant. The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient. This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program.

Human hepatocyte transplantation in patients with hepatic failure awaiting a graft.

BACKGROUND: Hepatocyte transplantation (HT) has the potential to become a promising treatment to temporarily support liver function in patients with liver failure. METHODS: Two patients, who had already received a liver transplant (LT) in the past, with an end-stage liver disease due to recurrent hepatitis C virus cirrhosis, suffering acute-on-chronic liver failure while on the waiting list for an LT, received HT as a bridge to whole-organ retransplantation. After HT and during intensive care unit admission, blood tests and ammonia levels were determined every 12 and 24 h, respectively, before and after each hepatocyte infusion. RESULTS: The present study describes monitoring of analytical and clinical parameters and improvement of liver function following HT. In both patients, we managed to lower the blood ammonia levels and clinically improve the degree of hepatic encephalopathy, thus serving as a bridge to liver retransplantation in 1 patient. CONCLUSIONS: We believe that this therapy may be an alternative treatment in patients with chronic liver disease who suffer episodes of acute decompensation as a bridge to conventional LT.

Exploring mass spectrometry suitability to examine human liver graft metabonomic profiles.

BACKGROUND: Transplant surgeons rely on morphologic aspects of the organ as well as clinical and histologic data to decide whether to use a graft. Metabonomics measures the "downstream" products of proteins and genes; these metabolic profiles are particularly good reporters of tissue physiologic features. Sample preparation and data acquisition are generally considered limiting steps in metabonome analysis because they are important sources of variability. State-of-the-art mass spectrometry and multivariate statistical analysis have been used to explore the suitability of a metabonomic platform as a liver tissue metabonomic profiling method. OBJECTIVE: To develop robust and reliable sample processing and mass spectrometry protocols for studying human liver metabonomic profiles. MATERIALS AND METHODS: Liquid chromatography coupled with mass spectrometry was used to analyze 20 liver tissue samples from 10 discarded and 10 transplanted grafts. Principal component analysis (PCA) and projection to latent structures-discriminant analysis (PLS-DA) were used for data interpretation. RESULTS: Standard operating protocols for sample processing (tissue homogenization) and data acquisition were developed. The quantification of the quality controls present in the test mix demonstrated coefficients of variation less than 15%. The PCA score plot revealed that the sample triplicate cluster was quite close. Furthermore, PLS-DA analysis demonstrated a clear separation (transplanted vs discarded) along the first component. DISCUSSION: Multivariate data analysis (PCA and PLS-DA) indicated that protocols developed in-house for sample processing and mass spectrometry data acquisition were sufficiently sensitive (approximately 1245 features) and reproducible (sample triplicate clusters and test mix quantification) to perform liver tissue metabonomic profiling. In addition, a reduced set of metabolites was selected as potential biomarkers responsible for sample discrimination. These findings encourage ongoing research into the development of a metabonomic model to assess liver graft quality and function before transplantation.

New alternatives to the treatment of acute liver failure.

INTRODUCTION: Acute-on-chronic liver failure (ACLF) is defined as an acute deterioration of a chronic liver disease. The most effective treatment in these patients is orthotopic liver transplantation (OLT), which is highly limited by the donor shortage. The aim of this study was to increase the usefulness of hepatocyte transplantation (HT) as a bridge or alternative to OLT. METHODS: During the last 2 years, we have performed HT in 3 patients with ACLF. The diagnosis was graft cirrhosis due to hepatitis C virus in 2 of them, who were already included on waiting lists for retransplantation, and the third, unknown alcoholic cirrhosis. RESULTS: After the first HT infusion, we observed an improvement in the clinical condition in all patients, hyperammonemia, and a partial correction of the degree of encephalopathy; 1 patient was retransplanted 6 days after the first HT. DISCUSSION: The main indications for HT are inborn errors of metabolism in children. Other indications especially in adults, are acute liver failure, ACLF in patients with end-stage-liver disease who are a waiting OLT, and acute liver failure after an hepatectomy. HT may be a new treatment to improve the clinical condition in patients awaiting OLT.

Vascular complications after orthotopic liver transplantation: hepatic artery thrombosis.

INTRODUCTION: Hepatic artery thrombosis (HAT) is the second main cause of liver graft failure after primary nonfunction. It is the most frequent arterial complication in orthotopic liver transplantation (OLT). The consensus for early HAT definition consists of an arterial thrombosis detected during the first month after OLT. HAT is associated with markedly increased morbidity, being the leading cause of graft loss (53%) and mortality. However, improvements in postoperative care have resulted in a marked reduction of its incidence. METHODS: We performed a review of all patients who underwent liver transplantations from January 1991 to December 2009, involving 1560 subjects who underwent 1674 OLT, excluding children. To analyze the impact of the study period on HAT, we defined 3 periods: the first between January 1991 and April 1993, the second from May 1993 to December 2003, and the last from January 2004 to December 2009. RESULTS: The total number of patients with HAT was 48 (2.8%) including 32 (1.9%) early HAT and 16 (0.9%) late HAT. The incidence of HAT diminished as the surgical team gained experience from 9.3% in the first period to 2.1% in the last. Most patients with early HAT presented acute fulminant hepatic failure (30%) and most were retransplantations (81%). DISCUSSION: In general, there are 3 modalities for HAT: revascularization, retransplantation, and observation. The choice of the treatment depended on the time of diagnosis although retransplantation was the treatment of choice for most groups. Minimizing risk factors, protocols for early detection, and good operative techniques should be the standard in all centers.

Functional characterization of hepatocytes for cell transplantation: customized cell preparation for each receptor.

The first indication of hepatocyte transplantation is inborn liver-based metabolic disorders. Among these, urea cycle disorders leading to the impairment to detoxify ammonia and Crigler-Najjar Syndrome type I, a deficiency in the hepatic UDP-glucuronosyltransferase 1A1 present the highest incidence. Metabolically qualified human hepatocytes are required for clinical infusion. We proposed fast and sensitive procedures to determine their suitability for transplantation. For this purpose, viability, attachment efficiency, and metabolic functionality (ureogenic capability, cytochrome P450, and phase II activities) are assayed prior to clinical cell infusion to determine the quality of hepatocytes. Moreover, the evaluation of urea synthesis from ammonia and UDP-glucuronosyltransferase 1A1 activity, a newly developed assay using beta-estradiol as substrate, allows the possibility of customizing cell preparation for receptors with urea cycle disorders or Crigler-Najjar Syndrome type I. Sources of human liver and factors derived from the procurement of the liver sample (warm and cold ischemia) have also been investigated. The results show that grafts with a cold ischemia time exceeding 15 h and steatosis should not be accepted for hepatocyte transplantation. Finally, livers from non-heart-beating donors are apparently a potential suitable source of hepatocytes, which could enlarge the liver donor pool.

Indications for and results of liver retransplantation.

Liver retransplantation (LReTx) is the therapeutic option for the irreversible failure of a hepatic graft. Our aim was to evaluate the rate of and indications for LReTx and actuarial patient survivals. Among 1260 LTx were 79 LReTx (6.3%). During the first LTx, there were no apparent differences between patients who did or did not required LReTx. The most frequent reasons were hepatic artery thrombosis (31.6%), recurrence of the VHC cirrhosis (30.4%), and primary graft failure (21.5%). The actuarial survivals at 1 and 5 years were 83% and 69% among those without LReTx versus 71% and 61% among early LReTx, and 64% and 34% among late LReTx (P < .001). Although there exists high morbidity and mortality with LReTx, it seems that this therapeutic alternative continues to be valid for patients with early hepatic loss, but not when the graft loss was late. It becomes necessary to define the minimal acceptable results that patient can benefit from LReTx.

Indications for and results of liver retransplantation.

Liver retransplantation (LRT) is the only therapeutic option for the irreversible failure of a hepatic graft. The aim of this study was to evaluate our rate, indications, postoperative morbidity and mortality and patient survival at one and 5 years after LRT. 1,260 liver transplants (LT) were performed between 1991 and 2006, 79 were LRT (6.3%). During the first LT, there were no apparent differences between patients who did or did not require LRT. The most common reasons for LRT were hepatic artery thrombosis (31.6%), recurrence of hepatitis C virus cirrhosis (30.4%) and primary graft non function (21.5%). The actuarial survival rates at one and 5 years were 83% and 69% among those without LRT versus 71% and 61% among those with early LRT, and 64% and 34% among those with late LRT (p < 0.001). Although high morbidity and mortality were associated with LRT, it seems that this therapeutic option is valid for patients with early hepatic loss, although not when the graft loss is late. It becomes necessary to define the minimal acceptable results so that patients can benefit from LRT.

Desarrollo, análisis y optimización de modelos celulares hepáticos para estudios de fármacotoxicología y terapia celular / Development and optimization of hepatic cell models for pharmaco-toxicology and cell therapy research

El hígado juega un papel fundamental en el metabolismo de medicamentos y enel mantenimiento de la homeostasis del organismo y, por tanto los modelos celulareshepáticos desempeñan un papel clave para estudios fármaco-toxicológicos ymás recientemente en el campo de la terapia celular. Sin embargo, la limitada disponibilidadde hepatocitos viables y funcionales, debido a la falta de tejido hepático,es la principal limitación para utilizar estos recursos celulares. El objetivo delpresente trabajo se ha basado en el desarrollo y caracterización de modelos celulareshepáticos que puedan constituir una alternativa a los hepatocitos para estetipo de aplicaciones. Para ello se han abordado tres estrategias diferentes: 1) optimizacióndel proceso de obtención de hepatocitos a partir de hígados enterosdescartados para transplante, determinando las condiciones adecuadas para elaislamiento y cultivo de hepatocitos; 2) caracterización funcional de las células delhepatoblastoma HepG2, y 3) desarrollo de un protocolo para inducir la diferenciaciónhepatogénica de células madre mesenquimales adultas derivadas de tejidoadiposo (ADSC). Para conseguir un buen aprovechamiento de hígados descartadospara transplante resulta necesario optimizar los protocolos de aislamiento y criopreservaciónde hepatocitos. El estudio con células madre adultas se presenta comouna alternativa muy válida para la obtención de hepatocitos-like viables y funcionalmenteactivos, útiles a corto plazo en estudios de fármaco-toxicología y en unfuturo para terapia celular hepática. El uso de células madre abre un gran abanicode posibilidades, facilitando el establecimiento de un modelo celular diferenciadoadulto con características que otros modelos celulares, como son el hepatomahumano HepG2, no presentan. No obstante, es necesario adquirir un mayor conocimientode los mecanismos celulares y moleculares que controlan la transdiferenciacióna hepatocitos

Given the importance of the liver in the metabolism and maintenance of thehomeostasis of the organism, many studies have been conducted in the area oftoxicology and, more recently, in hepatic cellular therapy. However, the maindrawback is the limited availability of viable and functional hepatocytes due tothe scarcity of liver tissue. The purpose of this work was based on the developmentand characterization of hepatic cellular models to become an alternative tohepatocytes in toxicology studies and cellular therapy. To this end, three mainobjectives have been investigated: 1) to adopt a procedure of hepatocyte isolationfrom discarded organs for transplantation which determines the optimal conditions for the isolation and culture of hepatocytes, 2) to characterize the cells from thehepatoblastome HepG2, and 3) to develop a hepatogenic differentiation protocolto induce the hepatic differentiation in adipose-derived stem cells (ADSC). Inparticular, the hepatogenic differentiation of stem cells opens a wide range ofpossibilities to facilitate the establishment of an adult differentiated cellular modeluseful for pharmaco-toxicological studies and for hepatic cellular therapy. The useof adult stem cells may allow the establishment of an adult cellular model withproperties that others cellular models, like HepG2, do not show. However, it isnecessary to optimise the isolation and cryopreservation procedures, as well as thedifferentiation protocols from adult stem cells and try to acquire a wide knowledgeof the cellular and molecular mechanisms that control the transdifferentiation tohepatocytes

Terapia celular hepática: tipos celulares potencialmente útiles para el trasplante / No disponible

No disponible

[Comparative study on the protective effect of two immunization schemes using a hepatitis B recombinant vaccine in vulnerable health science students]. / Estudio comparativo del efecto protector de dos esquemas de inmunización con una vacuna recombinante contra la Hepatitis B en estudiantes del area de ciencias de la salud susceptibles.

OBJECTIVE: Demonstrate the protective effect of hepatitis B in vaccine vulnerable health sciences students, under 30 years with three schemes the vaccination, two of them are conventional three doses and another one with two doses. HYPOTHESIS: Three schedules of vaccination dosage schemes hepatitis B produce antibody response over 10 IU/ml. DESIGN: Analytical, experimental, longitudinal., prospective and concurrent cohort study. MATERIALS AND METHOD: 100 vulnerable female and male students of the Medical Technology Faculty of the UNMSM Medical School were enrolled at first. 89 students completed the final analysis due to the inclusion and exclusion criteria in accordance with the study purpose. A vaccine dosage of 20 ug of surface antigen in 1 mL through three dosage schemes was administered: month 0, 1, 6; month 0, 1, 2; and month 0, 1. Blood samples were taken before and 1, 2, 6, and 7 months after the first dosage administration to determine the anti-HBs level. Anti-HBs approximately 10 mIU/mL was defined as seroprotective value. RESULTS: 89 students under 30 years (average age: 23.5 years). 46 (51.7%) male individuals, and 43 (48.3%) female individuals.12.4% of students reached protection within 30 days from the first dosage; 98.8% reached protection within 30 days from the second dosage; and 100% reached protection 180 days later. After the second dosage, the three groups reached protection values, and at the end of the study, the average antibody levels were between 532.7 mIU/mL and 1237.2 mIU/mL. CONCLUSIONS: This study showed an equivalent protective effect 7 months after the first dosage. An equivalent protective effect for hepatitis B was reached through three different vaccination schemes: conventional three dose scheme (month 0, 1, 6); two dose brief scheme (month 0, 1); and three dose brief scheme (month 0, 1, 2). A two dose scheme is suggested for individuals under 30 years, which would imply a higher compliance rate, lower cost, and a similar protection benefit.

Estudio comparativo del efecto protector de dos esquemas de inmunización con una vacuna recombinante contra la Hepatitis B en estudiantes del área de ciencias de la salud susceptibles / Comparative study on the protective effect of two immunization schemes using a Hepatitis B recombinant vaccine in vulnerable health science students

Objetivo: Demostrar que el efecto protector contra la Hepatitis B en estudiantes menores de 30 años del área de Ciencias de la Salud susceptibles es similar luego de completar los dos esquemas de vacunación (acortado y convencional) en menor tiempo y con menos dosis. Hipotesis: Los 3 esquemas de dosificación de la vacuna contra la hepatitis B generan anticuerpos por encima de 10 ug/100 ml generando igual efecto de protección. Diseño: Analítico, experimental, longitudinal, prospectivo y de cohortes concurrentes. Material y Métodos: Un total de 100 alumnos de ambos sexos de Tecnología Médica de la Facultad de Medicina de la UNMSM susceptibles fueron enrolados, quedando para el análisis final, 89 alumnos tomando en cuenta los criterios de inclusión y exclusión de acuerdo al objetivo del estudio. Se administró la vacuna a la dosis de 20 ug del antigeno de superficie en 1 mL, en tres esquemas de dosificación; 0, 1, 6 y 7 meses de la primera dosis de vacuna para determinación de anti.HBs. Se definió como seroprotección un valor mayor o = a 10 mUI/mL de anti-HBs. Resultados: En base a los 89 alumnos menores de 30 años, cuya edad promedio fue 23.5 años, siendo el 51.7 por ciento (46) del sexo masculino y 48.3 por ciento (43) sexo femenino. A los 30 días de la primera dosis el 12.4 por ciento alcanzó protección, a los 30 días posterior a la segunda dosis el 98.8 por ciento y los 180 días el 100 por ciento de protección. Después de la segunda dosis los tres grupos alcanzaron títulos protectores, y al final del estudio los niveles promedios de anticuerpos estuvieron entre 532.7 mUI/mL y 1237.2 mUI/mL. Conclusiones: En el presente estudio se logró alcanzar hasta los 7 meses después de la primera dosis, igual efecto protector contra la Hepatitis B mediante la administración de la vacuna con tres esquemas de vacunación diferentes: esquema convencional de tres dosis (0,1,6 meses), esquema acortado de dos dosis (0,1 mes) y esquema acortado de tres dosis (0,1,2 meses). Se plantea la posibilidad de un esquema con dos dosis en personas menores de 30 años, el cual tendría un mayor índice de cumplimiento y un menor costo e igual beneficio protector.

Objetive : To prove the protector effect of vaccine against hepatitis B in susceptible health sciences students, younger than 30 years old with three schedule of vaccination, two of them are three conventional doses and another one with two doses. Hypothesis: Three schedules of vaccination against hepatitis B produce antibody response over 10 IU/ml Design: This is a analytical, expetimental, longitudinal., prospective and concurrents cohort study. Subjects and Methods: Overall of 100 susceptible medical technology students both sexs from Medicine Faculty of San Marcos University were enlisted; final analysis were done with 89 students.Vaccine doses administred was a HBsAg 20 ug/mL in three schedules: : 0,1 and 6 months, 0,1 and 2 months and 0,1 month and were taken blood samples before and 1,2,6, and 7 months after first doses of vaccine in order to determine anti HBs levels. Results: Final analysis was done in 89 students with 23.5 years old on average; 51.6% were males and 48.3 per cent females. Thirty days after first doses 12.4 per cent of vaccinated were protected, 98.8 per cent after second doses and 100 per cent at 180 days after first doses: Serum antibody levels at the end of study were betwem 532.7 mIU/mL and 1237.2 mIU/ml Conclusions: The results of our study indicate that seven months after first doses of hepatitis B vaccine has a similarseroprotection levels of anti HBs with any of three schedule used. This results seggest that we could be to recomend atwo doses schedule for persons younger than 30 years old.

Pancreatic function after severe acute biliary pancreatitis: the role of necrosectomy.

OBJECTIVES: To investigate the recovery of pancreatic function after severe acute biliary pancreatitis (ABP), especially the influence of necrosectomy on endocrine and exocrine functions. METHODS: Prospective cohort study including 39 patients with severe ABP. According to need or no need for surgical necrosectomy, patients were further subdivided into 2 groups. Functional pancreatic evaluation was carried out 12 months after the ABP episode. Endocrine function was evaluated by an oral glucose tolerance test and exocrine function by fecal fat excretion, fecal chymotrypsin (FQ), and secretin-cerulein tests (SCT). RESULTS: Most of the patients with necrosectomy had an abnormal exocrine pancreatic function, with steatorrhea in 25%. In the group without surgery, exocrine function was pathologic in only 13.3% and there were no cases of steatorrhea. Endocrine function was pathologic in 75% of patients undergoing necrosectomy versus 26.7% in the nonoperated group. In this latter group, the patients with abnormal endocrine function did not require insulin therapy, while in 33.3% of patient in the necrosectomy group insulin was necessary. CONCLUSIONS: In our homogeneous series of severe ABP, necrosectomy impaired significantly pancreatic endocrine and exocrine function. On the other hand, most patients with the same origin and severity index, but without surgical debridement, maintained normal pancreatic function.