Prevalence of hepatitis E virus IgG antibodies in patients from a referral unit of liver diseases in Salvador, Bahia, Brazil.

Hepatitis E virus (HEV) is prevalent in Asia and Africa. Recently, it was also described in Mexico, but epidemiologic data from other Latin American countries are scarce. The seroprevalence of anti-HEV in a referral hepatology unit in northern Brazil was determined by testing for anti-HEV IgG in 701 serum samples from our serum bank. Specimens analyzed were from 200 blood donors, 79 patients with acute viral hepatitis (AVH), 392 hemodialyzed patients, and 30 carriers of schistosomiasis. Duplicate test results for anti-HEV were positive in four (2%) of 200 of the blood donors, three (10%) of the 30 carriers of schistosomiasis, and in none of the 392 hemodialyzed patients. Fourteen (17.7%) of the AVH patients were positive, as were six (25%) of 24 with hepatitis A virus, three (11%) of 26 with hepatitis B virus, 0 (0%) of 12 with hepatitis C virus, and five (29%) of 17 with non-A, non-B, non-C hepatitis viruses. Among AVH cases, those with hepatitis A virus had a higher frequency of anti-HEV positivity compared with all other hepatotropic viruses (P < 0.0003). We conclude that HEV is prevalent in northern Brazil. The higher prevalence in patients compared with blood donors could be explained by the lower social condition of patients who sought public health service in this area, in contrast with the heterogeneous socioeconomic distribution of blood donors. Patients with AVH due to hepatitis A had a greater frequency of anti-HEV, probably because of similar routes of transmission for both hepatitis A and E viruses. Finally, the absence of anti-HEV in the hemodialyzed group could be explained by a lower immunologic response found in patients with chronic renal failure.

[What is to be done in the absence of a superficial venous network compatible with the creation of an arteriovenous shunt?]. / Que faire en l'absence de réseau veineux superficiel compatible avec la création d'une FAV?

When the utilization of a simple arteriovenous fistula is out of the question, or no longer practicable, several alternative solutions have been advocated. Our own experience of surgery rests on 3000 vascular operations on dialysis patients since 1968. The solutions we have come to favour are saphenous vein homografts or heterografts with PTFE. The respective results seem to us equivalent so that either option can be held justified.

[Coronary surgery in patients aged 70 years and older. 65 cases]. / Chirurgie coronaire chez le sujet âgé de 70 ans et plus. 65 cas.

Out of 428 patients operated upon for coronary disease between December 1984 and November 1989, sixty-five (15.18 percent) were 70 to 80 years' old. All were suffering from a more or less invalidating stage II, III or IV angina. Coronary arteriography showed severe lesions of two or three main vessels (24.6 and 60 percent respectively). Each patient underwent 2.06 bypasses on average. Perioperative mortality was 7.7 percent, and late mortality 1.53 percent. The postoperative myocardial infarction rate was 4.61 percent, and 83 percent of these patients became asymptomatic. There was no deterioration. These satisfactory results are the consequences of numerous technical advances in cardiovascular surgery, anaesthesia and intensive care. As more and more elderly patients undergo coronary surgery, the desire of other elderly patients to be operated upon and their comfort after coronary surgery, the desire of other elderly patients to be operated upon and their comfort after coronary bypass are two additional reasons to opt for surgery. In spite of new vascular recanalization techniques, coronary surgery remains of considerable value. Close cooperation between surgical and medical teams should clarify the respective indications for coronary angioplasty and direct coronary bypass, thereby making these two procedures complementary and no longer competitive.

Results following surgical correction of renovascular hypertension.

During a 12 year period, 110 patients were submitted to surgery for correction of renovascular hypertension. The pathologic process was atherosclerosis in 65, fibrodysplasia in 28, aneurysms in 6 abdominal coarctation in 5, aortoarteritis in 2 and 3 miscellaneous lesions. Operative procedures used on 148 renal arteries have been: nephrectomy (12), reconstructive surgery (133). Among them: endarterectomy (89), aorto-renal grafts (20) venous, dacron or arterial autografts, resection and anastomosis (10), direct reimplantation (8), angioplasty (5), arterial spleno-renal anastomosis (1). Postoperative arteriograms have been obtained in 98% of the patients, 4 occlusions occurred in aorto renal grafts, no thrombosis in endarterectomy. Progression of dysplasia and atherosclerosis was observed in 5 patients. The overall clinical results show: cure 55%, improvement 34% and no change 11%. With a difference between atherosclerosis (45% cured, 40% improved, 15% no change) and fibrodysplasia (63% cured, 29% improved and 8% no change). Several parameters are studied correlated with the surgical result. This series support interest to treat operatively renovascular hypertension: 89% of patients benefited from surgery.