Living donor liver transplantation and management of portal venous pressure.

Small-for-size syndrome occurs in the presence of a reduced mass of liver that is insufficient to maintain normal liver function. It has been speculated that this dysfunction is principally associated with graft exposure to excessive portal perfusion. The aim of these cases was to evaluate the efficacy of octreotide, a splanchnic vasoconstrictor, and esmolol, a selective beta-blocker, to modify the portal perfusion in the postoperative phase after left living related liver transplantation (LRLT). Four patients who underwent left LRLT with graft-to-recipient weight ratios of 0.60 +/- 0.24 were studied with a catheter placed in a jejunal vein. We observed high basal values of hepatic venous pressure gradient (HVPG) and portal vein flow (PVF). Octreotide infusion decreased HVPG, an effect that was more pronounced when it was combined with esmolol. The administration of both drugs was also associated with an improvement in portal vein oxygen saturation. Despite variation in PVF, the plasma disappearance rate of indocyanin green did not change during the infusion of the two drugs. In conclusion, octreotide and esmolol infusion allowed a manipulation of portal vein pressure that should be measured in left LRLT using a small-for-size graft.

Genetic prediction of type 1 diabetes in a population with low frequency of HLA risk genotypes and low incidence of the disease (the DIABFIN study).

BACKGROUND: To develop a sensitive, specific screening strategy for predicting genetic risk for type 1 diabetes mellitus (T1DM) in the low-incidence continental Italian population, and to define with this tool, a cohort of high-to-moderate risk infants for an immunological follow-up study aimed at identifying environmental risk factors for T1DM. METHODS: 4855 newborns in three regions of continental Italy were screened for T1DM HLA-DRB1-DQB1 risk genotypes using a reverse line blot typing method. Risk classification was based on odds ratios (OR) found in a preliminary case-control study (356 T1DM patients, 412 controls). Screening efficiency was optimized by allele subtyping. RESULTS: Screening for well-known T1DM susceptibility genotypes [DRB1*03/*04-DQB1*0302; DRB1*03/*03; DRB1*04/*04-DQB1*0302; DRB1*04-DQB1*0302/X where X is not equal to DRB1*03, DRB1*04-DQB1*0302, DQB1*0602 or DQB1*0603] was associated with <60% sensitivity due to their low frequencies in the general Italian population. Inclusion of an additional genotype from which protective DRB1 and DQB1 alleles had been excluded [DRB1*03/X degrees where DQB1 is not equal to *0301, *0503, *0602, or *0603 and X degrees not equal DRB1*03, DRB1*04-DQB1*0302 or DRB1*07] increased screening sensitivity to 75% (specificity: 85%). Among 4855 newborns, we have found the high-risk genotype [DRB1*03/*04-DQB1*0302; estimated absolute risk (AR) 1/23] to be present in only 0.9%. The moderate-risk genotypes were found in 13.8% of newborns (estimated AR 1/177). CONCLUSIONS: Risk classification must be tailored to the characteristics of the individual population, in particular, the allelic frequencies in the background population and T1DM prevalence. We have developed a screening strategy with good levels of sensitivity that should prove effective for use throughout the Italian peninsula.

[Age-related loss of maternal antibodies against measles in children in La Plata]. / Pérdida con la edad de los anticuerpos maternos contra el sarampión en niños de la ciudad de La Plata.

Measles outbreaks every 3-4 years have occurred in Argentina. The vaccine was introduced in 1978 as part of a regular program, and the age for the first vaccination was changed to one year old. The optimal age for first measles vaccination is defined as that age with the highest proportion of infants responding to the vaccine. It is dependent on the presence of maternal antibodies against measles virus and the maturation of the immune system. This paper reports the loss of maternal antibodies in infants from vaccinated mothers, attending at the Hospital I.A.E.P. Superiora Sor María Ludovica, La Piata, Argentina. To determine the IgG antibodies against measles virus, an ELISA test was used in a longitudinal follow up of 48 patients (4, 6 and 9 month-old infants). Only 18.7% of 4 month-old infants showed detectable levels of IgG antibodies against measles virus; this value declined to 4.2% in 6 month-old infants (p < 0.01) and measles virus antibodies were undetectable in 9 month-old infants. The extension of this study to a broader population is suggested, in order to reconsider the optimal age of the first measles vaccination.

Pérdida con la edad de los anticuerpos maternos contra el sarampión en niños de la ciudad de La Plata / [Age-related loss of maternal antibodies against measles in children in La Plata]

Measles outbreaks every 3-4 years have occurred in Argentina. The vaccine was introduced in 1978 as part of a regular program, and the age for the first vaccination was changed to one year old. The optimal age for first measles vaccination is defined as that age with the highest proportion of infants responding to the vaccine. It is dependent on the presence of maternal antibodies against measles virus and the maturation of the immune system. This paper reports the loss of maternal antibodies in infants from vaccinated mothers, attending at the Hospital I.A.E.P. Superiora Sor María Ludovica, La Piata, Argentina. To determine the IgG antibodies against measles virus, an ELISA test was used in a longitudinal follow up of 48 patients (4, 6 and 9 month-old infants). Only 18.7

of 4 month-old infants showed detectable levels of IgG antibodies against measles virus; this value declined to 4.2

in 6 month-old infants (p < 0.01) and measles virus antibodies were undetectable in 9 month-old infants. The extension of this study to a broader population is suggested, in order to reconsider the optimal age of the first measles vaccination.

Pérdida con la edad de los anticuerpos maternos contra el sarampión en niños de la ciudad de La Plata. / [Age-related loss of maternal antibodies against measles in children in La Plata]

Measles outbreaks every 3-4 years have occurred in Argentina. The vaccine was introduced in 1978 as part of a regular program, and the age for the first vaccination was changed to one year old. The optimal age for first measles vaccination is defined as that age with the highest proportion of infants responding to the vaccine. It is dependent on the presence of maternal antibodies against measles virus and the maturation of the immune system. This paper reports the loss of maternal antibodies in infants from vaccinated mothers, attending at the Hospital I.A.E.P. Superiora Sor María Ludovica, La Piata, Argentina. To determine the IgG antibodies against measles virus, an ELISA test was used in a longitudinal follow up of 48 patients (4, 6 and 9 month-old infants). Only 18.7

of 4 month-old infants showed detectable levels of IgG antibodies against measles virus; this value declined to 4.2

in 6 month-old infants (p < 0.01) and measles virus antibodies were undetectable in 9 month-old infants. The extension of this study to a broader population is suggested, in order to reconsider the optimal age of the first measles vaccination.

Literature overview on artificial liver support in fulminant hepatic failure: a methodological approach.

Artificial liver support is a therapeutic option for subjects with fulminant hepatic failure. Results of these studies suggest a possible favourable effect on this condition. The aim of the present review is to evaluate not the results of the different artificial systems available but the methodology used to achieve these results. A computer and manual search of the literature was performed; 832 pertinent references were retrieved. Seventy-seven were full papers reporting the application of artificial liver support in animals or humans (15 RCTs (3 in humans, 12 in animals), 53 uncontrolled phase I trials, 9 case reports). The results of this review indicate that, although the rationale of artificial liver support as shown by animal studies is acceptable, the widespread use in clinical practice is not justified and a controlled design for the studies on artificial liver support systems is mandatory.

Natural history of inoperable hepatocellular carcinoma: estrogen receptors' status in the tumor is the strongest prognostic factor for survival.

Clinical course in hepatocellular carcinoma may be very different. We prospectively evaluated 96 patients with hepatocellular carcinoma unsuitable for radical therapy to investigate factors that could influence survival. Clinical, pathologic, and molecular data of patients were analyzed by univariate and multivariate analysis. The overall actuarial probability of survival at year 1, 2, 3, 4, 5, and 6 was 72%, 41%, 38%, 24%, 20%, and 9%. At univariate analysis, alpha-fetoprotein (AFP) (P =.0082); alkaline phosphatase (P =.0281); bilirubin (P =.0076); etiology (P =.0001); increment of tumor mass at month 3 (P =.0051); type of estrogen receptor (ER) in the tumor (P =.0000); prothrombin time (P =.0003); and portal vein thrombosis (P =.0000) had prognostic significance. At multivariate analysis, only type of ER (P =.0000) and bilirubin (P =.0030) showed independent predictive value for mortality. Survival was significantly longer in patients with wild-type estrogen receptors (P =.0000). Cumulative probability of survival at year 1, 2, 3, 4, 5, and 6 was 94%, 66%, 52%, 43%, 35%, and 18% for wild-type and 51%, 21%, 16%, and 9% for variant estrogen receptors (no patients alive after 4 years). Hepatitis B surface antigen (HBsAg)-positive patients with variant ERs had a median survival of 8 months versus 45 months in anti-hepatitis C virus-positive patients with wild-type ERs (P =.0001). In conclusion, (1) the presence of variant liver ER transcripts in the tumor was the strongest negative predictor of survival in inoperable hepatocellular carcinoma; (2) their presence was associated with spontaneous survival significantly worse than in patients with wild-type estrogen receptors; and (3) HBsAg-positive patients with variant receptors were characterized by the worst survival.