Treatment of severe, nonfulminant acute hepatitis B with lamivudine vs placebo: a prospective randomized double-blinded multicentre trial.

Acute hepatitis B virus (aHBV) infection can lead to fulminant liver failure, which likely is prevented by early lamivudine therapy. Even nonfulminant but severe acute hepatitis B can lead to significant morbidity and impaired quality of life. Therefore, lamivudine was evaluated in patients with severe aHBV in a placebo-controlled trial. Patients with severe aHBV infection (ALT >10× ULN, bilirubin >85 µm, prothrombin time >50%) were prospectively treated with lamivudine 100 mg/day or with placebo within 8 days after the diagnosis. The primary end point was time to bilirubin <34.2 µm. Secondary end points were time to clear HBsAg and HBV-DNA, development of anti-HBs and normalization of ALT. Eighteen cases were randomized to lamivudine, 17 to placebo. 94% of patients were hospitalized. No individual progressed to hepatic failure; all but one patient achieved the primary end point. Due to smaller than expected patient numbers, all study end points did not become statistically significant between treatment arms. Median time end points [in days] were bilirubin <34.2 µm (26.5 vs 32), ALT normalization (35 vs 48) and HBsAg clearance (48 vs 67) referring to earlier recovery under lamivudine, in contrast to loss of HBV-DNA (62 vs 54) and development of anti-HBs (119 vs 109). In all but two patients (one in every group), HBsAg clearance was reached in the study. Adverse events occurred more frequently during lamivudine therapy, but did not reach statistical significance. Lamivudine may ameliorate severe aHBV infection, but limited patient numbers prevented definite conclusions.

[Acalculous cholecystitis in hantavirus infections]. / Akalkulöse Cholezystitis bei Hantavirusinfektionen.

HISTORY AND ADMISSION FINDINGS: Three men, aged 32, 56 and 41 years, respectively, were hospitalized within two weeks because of flu-like symptoms, limb pain and abdominal pain. Being in a febrile, impaired general condition, pressure pains in the upper abdomen and flank pains were particularly noteworthy. INVESTIGATIONS: The results of the examinations, indicating acute renal insufficiency, thrombocytopenia and elevated lactate dehydrogenase were typical of a hantavirus infection, and positive serology for the puumala virus confirmed this suspicion. Ultrasonography indicated nephritic changes in all cases. Striking and unusual, however, was the finding of an acalculous cholecystitis. TREATMENT AND COURSE: In one of the three cases, antibiotic therapy with ceftriaxone was performed, in the other two cases symptomatic therapy. The cholecystitis was closely monitored sonographically and healed without complications in all cases. CONCLUSIONS: Hantavirus infections are common in an endemic area such as the Swabian Alb in Southern Germany, but an acalculous cholecystitis was rarely described in such a context. This accumulation is very remarkable, and the knowledge about it can both help to detect complications at an early stage and prevent unnecessary cases of cholecystectomy.

[Injection therapy of bleeding peptic ulcer with fibrin or polidocanol]. / Injektionstherapie des blutenden Ulcus pepticum mit Fibrin oder Polidocanol.

The effectiveness of injecting fibrin (group 1; with adrenalin: n = 11; without adrenalin: n = 29) or polidocanol (with [n = 17] or without adrenalin [n = 8]) or adrenalin alone (n = 15) (group 2) in the arrest of bleeding from peptic ulcers was compared in a prospective randomized study of 80 patients (61 males, 19 females; mean age 66.7 [28-92] years). Both groups were comparable regarding age, sex distribution, ulcer site and haemoglobin concentration. The amount of fibrin injected per patient at the first session averaged 2.9 +/- 1.8 ml, that of polidocanol 3.1 +/- 1.9 ml. The initial injection was successful in all but one patients (40 and 39, respectively). Primary definitive haemostasis was achieved in 59 patients (73.8%), with recurrence of bleeding in 20 (9 and 11: 25%). Recurrent bleeding was always treated with fibrin injection. Definitive haemostasis was achieved by a second application of fibrin in eight patients (10%), so that the definitive haemostasis rate was 83.8%. A second recurrence of bleeding was noted in eight patients, requiring surgical treatment. Four patients died during the second recurrence. It is concluded that injection of fibrin is an effective method of treatment of bleeding ulcer. There was no evidence that fibrin was better than polidocanol with or without adrenaline.

Conspicuous enterocytic binding pattern for peanut lectin and malignant histiocytosis of the intestine.

We present a case of a 33 year old male with a history of early childhood diarrhoea and more recently diagnosed gluten sensitive enteropathy, who died with active disease, ulcerative proctosigmoiditis and desquamative erythrodermia associated with toxin induced shock. Autopsy revealed a tumour restricted to lymph nodes of the mesentery and the retroperitoneum. This is considered to be malignant histiocytosis of the intestine (MIH). Immunohistological examination of the diagnostic jejunal biopsy showed a pathological binding pattern for peanut lectin (PNL) within the enterocytes. This may be an expression of disturbed production or secretion of a product rich in non-reducing terminal D-galactosyl residues.

[Long-term tissue culture of normal and atherosclerotic human arterial explants (author's transl)]. / Langfristige Gewebekultur von menschlichen normalen und atherosclerotischen Arterienexplantaten.

A method for longterm tissue culture of human arterial explants is described. The explants of normal and atherosclerotic femoral arteries, removed immediately post mortem, were kept in culture for up to 14 days in a biochemically active state. Viability was checked by glucose uptake and lactate production, with daily changes of incubation media and sterility controls. Compared to the well established short term incubation systems where metabolic activity decreases progressively after 6 h, glucose uptake, lactate production and uptake of 3H-oleic acid are linear within 4-14 h. The highest incorporation of 3H-oleic acid is found in phospholipids, the lowest in cholesterol ester. But whilst activity, after the pulse label of 24 h, progressively decreases in phospholipids, it constantly increases in the cholesterol ester fraction as a consequence of the persistant cholesterol esterification.