[Significance of 3D-ultrasonic examinations of the musculoskeletal system]. / Stellenwert von 3D-Ultraschall in der Orthopädie.

UNLABELLED: 3D-ultrasonic is gaining more and more significance in many medical disciplines, e. g., in angiology and prenatal diagnostics. AIM: The aim of this study was to make a comparison between the informative ability of conventional 2D-ultrasound with that of 3D-ultrasound for investigations of joints and to determinate whether 3D-ultrasound can reveal additional diagnostic information. METHOD: During a defined period of time all clinically necessary ultrasonic investigations of joints were done with a 3D-sonograph. However, all data recorded need a manual post-processing stage for visualisation in a 3D-mode. Due to the small impedance differences between the tissue layers, an automated tissue differentiation was not possible. RESULTS: The substantial advantage is that all the DEGUM standard levels can be derived from the scanning volume without conversion of the ultrasound head. CONCLUSION: At the current time the benefit of 3D-visualisation in the diagnostics of joints is small. The introduction of this technique to daily routine is not yet justified.

[Evaluation of potential risks of abrasive water jet osteotomy in-vivo]. / Evaluation verfahrensspezifischer Risikopotentiale der Wasserabrasivstrahl--Osteotomie in-vivo.

Since the 80's the water jet scalpel is an established tool in some surgical fields. It is used in particular in visceral surgery for preparation of parenchymatous organs. By the addition of biocompatible abrasives, this technique is able to effectively machine hard biological tissues. Free defined cutting geometries can be realised in a non contact process. Therewith this method has crucial advantages compared to conventional osteotomy techniques and gives new impulses to the development in endoprosthetics and correction osteotomies of hollow bones. In the presented work the new developed abrasive water injection jet (AWIJ) was used the first time for in-vivo osteotomies. Aim of this study was the detection of potential thrombembolic effects and wash in effects of the cutting fluid. Hollow bones of the fore and hind leg of 20 house pigs were treated with the new cutting technique. Intraoperative documentation of relevant vital parameters was performed by a multi monitoring system. Thrombembolic effects during the osteotomy were detected by transthoracic Doppler ultrasonography and transesophagale echocardiography. The hollow bones were prepared in consideration of the vascularisation's protection especially in respect to the venous flow. Thrombembolic effects with temporary haemodynamic respectively respiratory consequences could be detected exclusively by using the so called "3-component jet", which consists of 90 vol % of air. The usage of an abrasive suspension enables the airfree dosing of dry soluable abrasives. Thrombembolic effects could not be monitored in this case. Intramedullary fluid in-wash effects as well as resulting electrolytic disorders could not be proven. For abrasive waterjet osteotomies with 3 component jet a relevant risk of thrombembolic effects could be shown. This knowledge has also to be considered for abdominal and neurosurgical applications in the future. Due to the usage of an abrasive suspension this risk can fully be avoided.

Trapezius transfer in brachial plexus palsy. Correlation of the outcome with muscle power and operative technique.

Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha's technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique. The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6 degrees (0 to 45) to 34 degrees (5 to 90) at the last review. The mean forward flexion increased from 12 degrees (0 to 85) to 30 degrees (5 to 90). Abduction (41 degrees) and especially forward flexion (43 degrees) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42 degrees of abduction and 56 degrees of forward flexion. Active abduction (28 degrees) and forward flexion (19 degrees) were much less in completely flail shoulders (n = 34). Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished. The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.

[Shoulder arthrodesis. Indications, techniques, results, complications]. / Schulterarthrodese. Indikation, Technik, Ergebnisse, Komplikationen.

Besides the paralysis of shoulder muscles, large rotator cuff tears beyond repair, persistent shoulder instability with repeat dislocations and resection cases are recent indications for shoulder arthrodesis. The fusion of the shoulder is particularly useful since, despite immobilization of the glenohumeral and acromiohumeral joints, no loss of function is experienced; on the contrary, in many cases an increase of active total mobility may occur. According to the functional outcome, the majority of reports vary between 30 degrees and 90 degrees of active abduction and forward flexion with a mean value of about 60 degrees The most generally accepted arthrodesis position is 20 degrees -40 degrees abduction, forward flexion and internal rotation in relation to the trunk. This position results in a maximum development of muscle power and ensures that the arm will rest comfortably at the side, and that the scapula will not protrude. This also allows the hand to reach the head and facial region. The literature is not confined to any uniform type of arthrodesis and it would appear that the techniques and configurations of material vary considerably. A general advantage of any one particular form of arthrodesis, and the use of plates, screws or external fixators, cannot be deduced. Pseudarthrosis appears to be less frequent in cases of plate arthrodesis compared to screw arthrodesis. However, the application of plates more often results in infections, postoperative fractures of the humerus and the necessary removal of material. Screw arthrodesis is more beneficial in that the exposed area to be operated is smaller than in plate arthrodesis. Postoperative immobilization is more time consuming and, therefore, constitutes one of the disadvantages of screw fixation.

[Temperature measurements during abrasive water jet osteotomy]. / Wärmeentwicklung bei der Wasser-Abrasivstrahl-Osteotomie.

Working on bone is a major aspect of orthopaedic surgery. Despite its well-known appreciable thermal effects on the edges of the bone cut, the oscillating bone saw blade the oscillating saw remains the standard instrument both for cutting long bones and creating a bed for an endoprosthesis. The application of abrasive water jets offers the possibility of achieving an extremely precise curved cut in bone with no accompanying thermal effect. The thermographically measured absolute temperature increase at the cut edges seen with the water jet was 13 K maximum. The small process forces permit the application in automated handling systems.

[The brachial plexus lesion. Management, consequences of palsy and reconstructive operations]. / Der Armplexusschaden. Management, Lähmungsfolgen und funktionsverbessernde Operationen.

The treatment of traumatic brachial plexus lesions follows sequential steps. After acute therapy (phase I), neurological diagnostics (phase II), neurosurgery and postoperative treatment (phase III/IV), reconstructive operations (phase V) can be indicated and performed. In most cases an insufficient grade of muscle power remains. Within 6 months after injury, neurosurgery must be performed in patients with brachial plexus palsy. After malfunction of the muscles, taking into account the individual neuromuscular defects, passive joint function and bony deformities, different procedures such as muscle transposition, arthrodesis and corrective osteotomy can be performed to improve the function of the upper extremity. The treatment of patients suffering from brachial plexus lesion requires interdisciplinary teamwork.

[Open versus arthroscopic shoulder stabilization. An analysis of the treatment costs]. / Offene vs. arthroskopische anteriore Schulterstabilisierung. Eine Kostenvergleichsanalyse.

In this study the total costs of clinical open and arthroscopic anterior shoulder stabilization were evaluated, analyzed and compared. From 1988 to 1998 147 patients underwent open (Bankart) or arthroscopic (ASK) anterior shoulder stabilization. We randomized two groups of 30 patients for each method (Bankart: 25 male, 5 female, 29 years of age; ASK: 25 male, 5 female, 26 years of age) and evaluated the costs of their clinical treatment. The total cost was significantly ( p<0.05, Mann-Whitney U-Test) higher for the open (5639 euro) than for the arthroscopic (4601 euro) therapy. There was a significant difference between the groups for the average cost of surgery (Bankart: 2741 euro; ASK: 2315 euro, p<0.05) and the average postoperative treatment cost (Bankart: 2202 euro; ASK: 1630 euro, p<0.05) whereas the average preoperative treatment cost was not significantly different (Bankart: 669 euro, ASK: 657 euro). The staff costs for the surgical procedure (Bankart: 1800 euro (32%), ASK: 1319 euro (29%)) and the postoperative staff costs of the nurses (Bankart: 1271 euro (23%), ASK: 997 euro (22%)) represented the greatest parts of the total costs. The average duration of the clinical treatment was 15.8 days for the open- and 12,4 days for the arthroscopic group.

Effect of group size on performance of growing-finishing pigs.

Six hundred forty growing-finishing pigs (initial BW = 23.2 +/- 4.8 kg) were used in a 12-wk study (final BW = 95.5 +/- 10.2 kg) to quantify the effects of group size (10, 20, 40, and 80 pigs/pen) on performance, tail biting, and use of widely distributed feed resources. One single-space wet/dry feeder was provided for every 10 pigs, and floor allowance was 0.76 m2/pig in all treatment groups. Weight gain and feed intake were measured every 2 wk. At weighing, a tail-biting injury score was given to each pig. Blood samples were collected and analyzed for neutrophil:lymphocyte ratio before regrouping at the beginning of the experiment, 24 to 48 h after regrouping, and on the last day of each trial. The use of feeders by individual pigs was assessed by behavioral observations. Average daily gain for the entire 12-wk trial did not differ among group sizes (861, 873, 854, and 845 g/d for groups of 10, 20, 40, and 80, respectively; P > 0.10). During the first 2 wk, ADG was lower for pigs in groups of 40 (554 g/d) than pigs in groups of 10 (632 g/d; P < 0.05), but not pigs in groups of 20 or 80 (602 and 605 g/d, respectively). Average daily feed intake, feed efficiency, and variability in final BW within a pen also did not differ among group sizes. Tail-biting injury scores increased throughout the study, but did not differ among group sizes. Similar proportions of pigs were removed from the trial for health reasons, primarily due to tail biting, in all treatments. Individual pigs in each group size ate from most, if not all, of the feeders in the pen. There was no evidence of spatial subgrouping within the larger groups. The results suggest that housing growing-finishing pigs in groups of up to 80 pigs is not detrimental to productivity and health if space allowance is adequate and feed resources are evenly distributed.

[Arthroscopic anterior shoulder stabilization combined with laser-assisted capsular shrinkage (LACS) compared to other procedures]. / Die arthroskopische anteriore Schulterstabilisierung durch Kombination von laserassistiertem Kapsel-Shrinkage und Nahttechnik im Vergleich mit anderen Operationsverfahren.

INTRODUCTION: Does additional laser assisted capsular shrinkage (LACS) help to reduce the recurrence rate in arthroscopic anterior shoulder stabilization? METHODS: In a prospective study from 7/97 to 4/99 at 22 nonselected patients a combined Caspari + LACS-technique was performed. We could follow-up 152 (80%) of a total 191 anterior shoulder stabilizations between 4/88 and 4/99 (124 male, 28 female, average age 33 years) (80(52%) Bankart, 30(20%) Du Toit/Roux, 20(13%) Caspari, 22(15%) Caspari + -LACS. RESULTS: The rate of dislocation was 7% (11/152) for all patients (Bankart 5% 4/80), Du Toit/Roux 4% (1/30), Caspari 25%(5/20), Caspari + LACS 5%(1/22)). Using the score of Rowe et al. [34] 113 patients (75%) rated excellent or good (Bankart 77%, Du Toit/Roux 83%, Caspari 60%, Caspari + LACS 86%). CONCLUSIONS: An additional laser capsular shrinkage helps to reduce the high rates of dislocation in arthroscopic anterior shoulder stabilization with results similar to standard open procedures.

[Shoulder arthrodesis with plate fixation. Special features in cases of resection and defects]. / Plattenarthrodese der Schulter. Besonderheiten bei Defekt- und Resektionszuständen.

AIM: Shoulder arthrodesis following prosthesis explantation or resection of the acromion has not often been described in the literature. The presented article analyses the special features and problems of these preoperative circumstances in 4 cases and discusses them within the entire group. PATIENTS AND METHOD: Between 06/1987 and 02/2001, a total of 30 shoulder arthrodeses using plate fixation were performed in our clinic and then analysed after an average of 2.7 (0.5 - 8.7) years. Surgery was carried out on 5 (17 %) females and 25 (83 %) males with a mean age of 37 (17 - 82) years. Two patients underwent shoulder arthrodesis as a salvage operation following unsatisfactory arthroplasty, or after trapezius transfer with corresponding reduced bony conditions, respectively. RESULTS: The active extent of movement following arthrodesis was 56 degrees (20 degrees - 90 degrees ) abduction, and 60 degrees (20 degrees - 105 degrees ) anteversion. The most frequent complications following arthrodesis included pseudarthroses (3/10 %), infections (4/13 %), and fractures of the humerus (4/13 %). The rate of complications was especially high in the cases after explantation of a shoulder prosthesis and resection of the acromion. In two of the four patients, three or five revision operations, respectively, were necessary. Two of the three pseudarthroses of the entire group occurred in these two cases. CONCLUSION: Complications of shoulder arthrodesis after resection of the acromion or the proximal humerus are especially frequent. To avoid pseudarthrosis in such cases, primary spongioplasty is advantageous. A fixation with plates is superior to a simple screw arthrodesis. For postoperative immobilization a plaster cast instead of an orthotic device should be taken into consideration.

[Pattern of paralysis and reconstructive operations after traumatic brachial plexus lesions]. / Lähmungsmuster und funktionsverbessernde Operationen nach traumatischen Arm-Plexus-Läsionen.

The aim of this study was to evaluate persistent patterns of paralysis after traumatic brachial plexus lesions. As a result, consecutive reconstructive operations according to our differential therapy concept are presented. Between 04/1994 and 12/2000 in 104 patients with brachial plexus palsy, the grade of muscle power of the affected upper extremities was evaluated prospectively. The neuromuscular patterns of defect showed, in most cases, insufficient muscle power grades of 0-2 for the deltoid muscle (90%), supraspinatus muscle (82%), infraspinatus muscle (93%), elbow flexors (67% to 77%), hand and finger extensors (69% to 71%), and the abductor and extensors of the thumb (67% to 70%). In corresponding frequency, the following operations were performed between 04/1994 and 06/2002: shoulder arthrodesis (n 26), trapezius transfer (n 80), rotation osteotomy of humerus (n 10), triceps to biceps transposition (n 11), transposition of forearm flexors or extensors/Steindler operation (n 12), latissimus transfer (n 7), pectoralis transfer (n 1), teres major transfer (n 1), transposition of forearm flexors to the tendons of extensor digitorum (n 19) and of the extensor pollicis longus (n 9), and wrist arthrodesis (n 5). On malfunction of muscles following brachial plexus lesions, taking into account the individual neuromuscular defect, passive joint function, and bony deformities, different procedures such as muscle transposition, arthrodesis, and corrective osteotomy can be performed to improve function of the upper extremity.

Characterization of elemental pollution and its variations in sediments and suspended particulate matter from the River Elbe via multi-element analysis combined with chemometric data evaluation.

Sediments and suspended particulate matter taken from about 100 sampling sites along the River Elbe from the source to the mouth during the period 1992 and 1998 have been analyzed for the concentrations of more than 60 elements in each sample. The analytical data were subsequently processed by means of multivariate statistics in order to characterize the charge of the River Elbe with inorganic pollutants to elucidate pollution trends. Using factor analysis 18 elements were found to be enriched by human activities. By means of cluster analysis--using the 18 anthropogenically influenced elements as variables--the sampling sites were aggregated into groups having similar element distributions. Thus, the entire stretch of the River Elbe was divided into three sections of characteristic elemental pollution. Finally, the trends in anthropogenic pollution within the characteristic regions since the early nineties were assessed. It turned out that most of the anthropogenically influenced elements showed a decrease in the upper and middle parts of the river, whereas no decrease could be verified in the estuary region.

[Surgical treatment and rehabilitation for improving function of shoulder muscle impairment]. / Operative Behandlung und Rehabilitation zur Funktionsverbesserung bei Ausfall der Schultermuskulatur.

INTRODUCTION: The results of our integrated conservative and operative concept of therapy to compensate insufficient shoulder muscles following brachial plexus palsy or other nerve damages are presented. PATIENTS/METHODS: To improve stability and function of the shoulder in case of deltoid and supraspinatus paralysis 19 patients (3 female; 16 male; average age 37 years, range 17 to 61 years) underwent a shoulder arthrodesis. In 69 patients (12 female; 57 male; average age 31 years, range 19 to 69 years) a trapezius transfer was performed. The indication for a rotation osteotomy of the humerus to improve loss of external rotation due to paralytic infraspinatus muscle was determined in 5 male patients (average age 30 years, range 15 to 42 years). Our results are based upon an average follow-up of 21 (6-70) months after shoulder fusion, 21 (2-68) months after trapezius transfer and 28 (3-62) months after rotation osteotomy of the humerus. RESULTS: The trapezius transfer resulted in increased function of abduction of 6.6 degrees to 35.9 degrees (10 degrees-90 degrees) and forward flexion of 12.6 degrees to 30.9 degrees (5 degrees-85 degrees). A more stable condition of multidirectional shoulder instability was experienced by 64 patients (92.8%), and 65 patients (94.2%) were subjectively satisfied with the outcome of the operation. The strength and extent of functional improvement was, on average, greater following shoulder arthrodesis: abduction 10.3 degrees to 57.4 degrees (20 degrees-80 degrees), forward flexion of 12.6 degrees to 57.1 degrees (20 degrees-105 degrees). 17 patients (89.5%) were subjectively satisfied with the outcome. Patients who had undergone external rotation osteotomy showed an average deficiency of external rotation of 30 degrees before operation. After osteotomy an improvement of 29 degrees to 3 degrees external rotation was achieved. All patients were satisfied with the increase of function. CONCLUSIONS: In patients with failed shoulder muscles, particularly after brachial plexus palsy, secondary operations according to the individual pattern of muscle failure result in an improvement of shoulder function and stability, as well as patients' satisfaction. Therefore, adequate conservative treatment before and after reconstructive operations is of great importance.

Measurements of atmospheric mercury with high time resolution: recent applications in environmental research and monitoring.

In the past five years automated high time-resolution measurements of mercury species in ambient air have promoted remarkable progress in the understanding of the spatial distribution, short-term variability, and fate of this priority pollutant in the lower troposphere. Examples show the wide range of possible applications of these techniques in environmental research and monitoring. Presented applications of measurement methods for total gaseous mercury (TGM) include long-term monitoring of atmospheric mercury at a coastal station, simultaneous measurements during a south-to-north transect measurement campaign covering a distance of approximately 800 km, the operation on board of a research aircraft, and the quantification of mercury emissions from naturally enriched surface soils. First results obtained with a new method for the determination of reactive gaseous mercury (RGM) are presented. Typical background concentrations of TGM are between 1.5 and 2 ng m(-3) in the lower troposphere. Concentrations of RGM have been determined at a rural site in Germany between 2 and 35 pg m(-3). Flux measurements over naturally enriched surface soils in the Western U.S.A. have revealed emission fluxes of up to 200 ng Hg m(-1) h(-1) under dry conditions.

Ultrasound examination of neonatal hip: correlation of twin pregnancy and congenital dysplasia.

Twin pregnancy is considered to be a risk factor for congenital dysplasia of the hip. From 1987 until 1996, the hips of 4476 (2260 male, 2216 female) newborn babies were examined by ultrasound according to Graf's technique and classification in our hospital. In this study, we compare the results of twins and singletons for this risk factor. Of the newborns, 97 (2.2%) were twins (40 male, 57 female); 39 pairs of twins (10 male/male, 19 female/female, 10 male/female) and 19 individual twins (6 male, 13 female) were investigated. Hips of type Ia, Ib and IIa (alpha > or = 55 degrees) are not pathologic; hips of type IIa (alpha <55 degrees ) need an early control examination; and hips of type IIc, D, IIIa, IIIb and IV require therapy. Types Ia, Ib, and IIa (alpha > or =55 degrees ) were found in 4207 (94.0%) of all newborns, in 4112 (93.9%) of the singletons, and in 95 (97.9%) of the twins. Early control examination and/or therapy (indicated for types IIa (alpha <55 degrees ), IIc, D, IIIa, IIIb, and IV) were necessary in 269 (6.0%) of all cases, in 267 (6.1%) of singletons and two (2.1%) of twins. Twins with additional factors such as breech position birth, hip dysplasia in the family or premature birth did not show the types of hip IIa (alpha <55 degrees ), IIc, D, IIIa, IIIb, IV. We did find these hips in two (3.5%) of the female twins, but not at all in the male twins. Statistically, twins with or without other risk factors that are known before birth did not show significantly more of type hip IIa (alpha <55 degrees ), IIc, D, IIIa, IIIb, IV (P>0.05).

Reconstructive operations for the paralyzed shoulder in brachial plexus palsy: concept of treatment.

Sixty-three patients with persistent brachial plexus palsy underwent a transfer of the trapezius muscle and 14 patients a shoulder arthrodesis. Thirteen female and 64 male patients were treated with a mean age of 31 yr (17-69 yr). The average follow-up period was 14 months (6-50 months). In all cases, the trapezius transfer resulted in increased abduction from 6.1 degrees to an average of 36.4 degrees (20-80 degrees) and forward flexion from 13.8 degrees to an average of 31.9 degrees (10-90 degrees). The multidirectional shoulder instability was improved in 60 patients. Strength and functional improvement was, on average, greater following shoulder arthrodesis (abduction from 9.6 to 59.3 degrees (40-90 degrees), forward flexion from 11.4 to 50.7 degrees (30-90 degrees)). In patients with brachial plexus palsy, trapezius transfer resulted in an improvement of shoulder function and stability as well as subjectively. The increase in function was, however, less pronounced in comparison with shoulder arthrodesis. The advantages of the transfer are the regaining of normal passive function and the shorter duration of surgery. Shoulder fusion is more suitable for those patients who require the best possible extent of function and strength in the shoulder.

Significance of antibodies to the recombinant E2 protein of hepatitis G virus in haemodialysis patients.

Patients on maintenance haemodialysis represent a high-risk group for parenterally transmitted viral infections, such as hepatitis B, C and G. In addition to hepatitis G virus (HGV) (GBV-C) RNA, analysed in previous studies, we characterized the seroprevalence rates of antibodies to the putative E2 protein (anti-E2) of HGV in a German cohort of patients on maintenance dialysis (n = 72) in comparison to healthy blood donors (n = 100). The presence of anti-E2 and/or HGV RNA as indicators of present or past HGV infection could be demonstrated in 34.7% of patients and in 16% of the blood donors (P < 0.01). The infection rates with HGV seem to increase only during the first 6 years of haemodialysis. The simultaneous presence of viraemia and anti-E2 was found very rarely in patients and controls. Therefore, the emergence of anti-E2 indicates clearance of HGV viraemia. In conclusion, patients on haemodialysis are at high risk of acquiring HGV infection, but a chronic carrier state with viraemia is rare. The risk of infection is not strictly correlated with the duration of dialysis.

Evolution of hepatitis G virus infection and antibody response to envelope protein in patients with transfusion-associated non-A, non-B hepatitis.

The clinical significance and course of acute hepatitis G virus (HGV) infection were studied by measuring HGV RNA and antibody to HGV envelope protein E2 (HGV-E2 antibody). A total of 59 patients with transfusion-associated non-A, non-B hepatitis, who were followed-up for more than 1 year, were selected retrospectively. HGV RNA was measured by reverse transcriptase (RT) and nested polymerase chain reaction (PCR) was performed, using primer sets, in the 5'-non-coding region of the HGV genome. HGV-E2 antibody was measured by enzyme-linked immunosorbent assay (ELISA) using recombinant E2 protein. Of the 59 patients, 51 (86%) were infected with hepatitis C virus (HCV) and 12 (20%) were infected with HGV; 11 of the 12 with HGV infection were also infected with HCV. HGV viraemia was cleared during the follow-up period in seven of the 12 patients with HGV infection. All these seven patients seroconverted for HGV-E2 antibody just before or just after the clearance of HGV viraemia. In contrast, all five patients without clearance of HGV viraemia were negative for HGV-E2 antibody (P = 0.0013). Of seven patients with continuous HGV viraemia at 1 year from the onset of acute hepatitis, four with HCV RNA showed chronic elevation of alanine aminotransferase (ALT) but three without HCV RNA did not. The severity of acute hepatitis was similar between patients with both HGV and HCV infections and in those with HCV infection alone. The majority of patients with HGV infection cleared the virus during long-term follow-up. Appearance of HGV-E2 antibody was associated with the clearance of HGV viraemia. An abnormal ALT level was noted to depend on HCV infection but not on HGV infection in both the acute and chronic phases of transfusion-associated hepatitis.

Identification of hepatitis G virus particles in human serum by E2-specific monoclonal antibodies generated by DNA immunization.

In order to elucidate the structure and morphology of hepatitis G virus (HGV), a recently isolated flavivirus, we generated a panel of eight monoclonal antibodies (MAbs) against the putative second envelope protein (E2) following DNA immunization. The MAbs were shown to be specific for four different epitopes on recombinant E2. MAb Mc6 was the only antibody able to detect the linear epitope LTGGFYEPL. In addition, Mc6 was able to immunoprecipitate viral particles in human blood samples as detected by reverse transcription-PCR amplification of HGV RNA. This precipitation could be competed by addition of saturating amounts of the linear peptide or abolished by addition of Nonidet P-40. We conclude that, albeit lacking the N-terminal sequence of a functional core protein, HGV builds classical viral particles displaying E2 envelope protein on their outer surfaces.

Distinct prevalence of antibodies to the E2 protein of GB virus C/hepatitis G virus in different parts of the world.

Since the identification of the new human virus, GB virus C (GBV-C)/hepatitis G-virus (HGV), in 1995/1996, reverse transcription polymerase chain reaction remained the sole available diagnostic tool for GBV-C/HGV infection. Recently, a serologic test based on the detection of antibodies to the putative envelope protein 2 (anti-E2) has been introduced. We used this assay for a seroepidemiological survey including 3,314 healthy individuals from different parts of the world, 123 patients from Germany who were suspected to have an increased risk of acquiring GBV-C/HGV infection, 128 multiple organ donors, and 90 GBV-C/HGV RNA positive persons. In European countries, anti-E2 seropositivity ranged from 10.9% (Germany) to 15.3% (Austria). In South Africa (20.3%) and Brazil (19.5%), even higher anti-E2 prevalence rates were recorded. In Asian countries like Bhutan (3.9%), Malaysia (6.3%), and the Philippines (2.7%), anti-E2 positivity was significantly lower. GBV-C/HGV anti-E2 prevalence in potential "risk groups," i.e., patients on hemodialysis and renal transplant recipients, did not vary significantly from anti-E2 seroprevalence in German blood donors. Anti-E2 and GBV-C/HGV RNA were found to be mutually exclusive, confirming the notion that anti-E2 has to be considered as a marker of past infection.