Initial immunosuppression with or without basiliximab: a comparative study.

BACKGROUND: Following liver transplantation, acute kidney injury (AKI) and chronic kidney disease occur in 20%-50% and 30%-90% of patients, respectively. Basiliximab, a chimeric monoclonal antibody, is highly effective to prevent rejection in organ transplant recipients, particularly among patients with renal dysfunction who benefit from delayed introduction of calcineurin inhibitors. OBJECTIVE: The objective of this study was to measure the immunosuppressive effect of basiliximab and its impact on renal failure, lengths of hospital and intensive care unit (ICU) stays and prevalence of infection. METHODS: From January 2010 through December 2011, we performed a controlled, nonrandomized study comparing two different immunosuppressive regimens: Group I, 36 transplantation on 34 patients, tacrolimus and corticosteroids de novo with mycophenolate mofetil in cases of renal failure; and Group II, 33 transplantation in 33 patients, corticosteriods and mycophenolate mofetil de novo with basiliximab on day 0 and day 4, and inception of tacrolimus on day 3. RESULTS: Basiliximab patients (Group II) showed a significantly lower incidence of renal failure requiring replacement therapy (3.03% vs 25%; P = .014). The incidence of acute cellular rejection episodes treated with corticosteriod boluses was also significantly lower (3.03% vs 25%; P = .014). Bacterial, fungal, and cytomegalovirus infection rates were lower in Group II, although the differences were not significant. Similarly, Group II patients had an insignificantly shorter average stay in the hospital (25.9 vs 40.06 days) and the ICU (5.9 vs 8.17 days). CONCLUSIONS: Basiliximab administration with delayed introduction of calcineurin inhibitors may be an effective strategy to reduce post-liver transplantation AKI requiring renal replacement therapy.

Encefalopatía hepática secundaria a la existencia de un shunt portosistémico tratada satisfactoriamente mediante radiología intervencionista / Hepatic encephalopathy secondary to porto-systemic shunt satisfactorily treated with interventionist radiology

La encefalopatía hepática es un estado reversible de alteraciónen la función cognitiva, que puede ocurrir en pacientes con enfermedadhepática aguda o crónica o shunts porto-sistémicos, en elque puede aparecer cualquiera de los signos neurológicos o psiquiátricosconocidos. Las sustancias nitrogenadas procedentes dela digestión intestinal alcanzan el cerebro sin la depuración que suponesu paso por el hígado, debido a las derivaciones porto-sistémicas,y dan lugar a los signos característicos de la encefalopatíahepática. A continuación presentamos dos casos clínicos de pacientescon shunt porto-sistémicos, diagnosticados de encefalopatíahepática crónica recurrente refractaria al tratamiento médicoconvencional, tratados satisfactoriamente con embolización de dichoshunt mediante técnicas de radiología intervencionista

Hepatic encephalopathy is a reversible state of altered cognitionthat may occur in patients with acute or chronic liver diseaseor porto-systemic shunt, and in which known neurological or psychiatricsigns may develop. Nitrogenated substances from intestinaldigestion reach the brain without being cleared by their passagethrough the liver due to the presence of porto-systemicshunt. We report two cases of patients with porto-systemic shuntdiagnosed with recurrent chronic hepatic encephalopathy refractoryto conventional medical treatment. They were satisfactorilytreated with shunt embolization using interventionist radiologytechniques

[Hepatic encephalopathy secondary to porto-systemic shunt satisfactorily treated with interventionist radiology]. / Encefalopatía hepática secundaria a la existencia de un shunt portosistémico tratada satisfactoriamente mediante radiología intervencionista.

Hepatic encephalopathy is a reversible state of altered cognition that may occur in patients with acute or chronic liver disease or porto-systemic shunt, and in which known neurological or psychiatric signs may develop. Nitrogenated substances from intestinal digestion reach the brain without being cleared by their passage through the liver due to the presence of porto-systemic shunt. We report two cases of patients with porto-systemic shunt diagnosed with recurrent chronic hepatic encephalopathy refractory to conventional medical treatment. They were satisfactorily treated with shunt embolization using interventionist radiology techniques.

El genotipo 4 del virus C presenta una respuesta similar al genotipo 1 en el tratamiento combinado interferón+ribavirina de la hepatitis crónica / Similar poor results in genotype 4 chronic hepatitis C treatment with interferon and ribavirin compared with genotype 1 treatment

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Síndrome de Schwachman-Diamond como causa de diarrea crónica / Schwachman-Diamond syndrome as chronic diarrhea etiology

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Cardiac rehabilitation and the changing cardiac rehabilitation directions in Hoensbroeck rehabilitation centre.

Hoensbroeck Rehabilitation Centre has been providing inpatient and outpatient cardiac rehabilitation services since 1980. In these twenty years the patient population has changed considerably. Rehabilitation is currently focussing on the complex and often old patient. The programme that has been developed during this period consists of standard activities that are mainly group oriented. However, certain activities are provided on an individual basis. Based upon this variety of activities, a tailor-made programme can be composed for every individual patient. If the Hoensbroeck programme is compared with the directions given by the Dutch Society of Cardiology and the Netherlands Heart Foundation, the main difference is the use of an integrated approach instead of separate modules. In our view, this is a must for complex cardiac rehabilitation.

Dominant T cell receptor rearrangements in interleukin 2 expanded lymphocytes from rheumatoid nodules suggest antigen driven T cell activation in situ.

OBJECTIVE: To study at a molecular level the clonality of interleukin 2 (IL-2) expanded T cell lines derived from rheumatoid nodules. Such cell lines were reported in earlier studies with flow cytometry and antiidiotypic monoclonal antibodies (MAb) to be obligoclonal. METHODS: T cell lines were derived from rheumatoid nodules in 2 patients with rheumatoid arthritis (RA) and expanded in medium containing IL-2. Clonality was assessed by flow cytometry and T cell receptor (TCR) idiotype specific Mab and by polymerase chain reaction with primers for V alpha and V beta gene families. Sequence analysis was performed in selected cell lines. RESULTS: In one patient, one cell line was identified with marked overexpression of V alpha 2 cells. Eleven V alpha 2 CDR3 sequences were derived from this cell line: 8 of these clones had an identical CDR3 sequence and one other clone showed a related sequence. Five cell lines derived from a second patient displayed a marked clonal bias to V beta 8 cells. One cell line with strong V beta 8 expression was chosen for further sequence analysis. Twelve V beta 8 sequences were obtained; 11 showed identical CDR3 sequences. CONCLUSION: Molecular analysis of TCR rearrangements in IL-2 expanded T cell lines from rheumatoid nodules strongly suggests that in situ T cell activation is related to classical antigen induced immune activation.

Prevalence of antibodies to hepatitis C virus after blood transfusion in heart surgery.

We studied the frequency and time of appearance of antibodies to the hepatitis C virus (HCV) retrospectively in the sera of 127 patients who underwent heart surgery between 1983 and 1986. They received blood from volunteer donors hepatitis B surface antigen (HBsAg) negative with normal serum alanine-aminotransferase levels. A prospective follow-up was carried out every 15 days for at least 6 months from the moment of the transfusion. Of the ten patients who developed biochemical criteria of post-transfusional non-A non-B hepatitis, six seroconverted to anti-HCV (60%). Of the other 117, two were already positive before transfusion (1.51%), one patient showed antibodies only in the first post-transfusional serum (passive transfer), and another two patients with no evidence of post-transfusional hepatitis developed HCV antibodies on the 90th day, remaining indefinitely (afterwards seroconversion without hepatitis); both patients' earlier sera were anti-HCV negative. Four (40%) of the ten patients with post-transfusional hepatitis did not develop any serum markers to known hepatotropic agents. Although these findings do not exclude a viral infection by these viruses, they are consistent with the involvement of an unidentified non-A, non-B, non-C agent.

[Prevalence of hepatitis C virus antibody in chronic HBsAg-negative non alcoholic hepatopathy]. / Prevalencia del anticuerpo al virus de hepatitis C en la hepatopatía crónica no alcohólica HBsAg negativa.

The presence of antibody to hepatitis C virus was determined in 316 HBsAg-negative patients with non-alcoholic chronic hepatitis who did not receive any blood transfusion once the diagnosis was made. A titre of antinuclear antibodies of 1/40 or lower was found in 18 patients. Persistent chronic hepatitis was present in 21 patients, active chronic hepatitis in 145, hepatic cirrhosis in 128, and hepatocarcinoma in 22 patients. One hundred and three patients had previously received blood transfusion, 76 had undergone previous surgery without transfusion, a clinical episode of hepatitis could be traced in 14, 13 patients were drug addicts (all of them HIV negative), 1 patient had received multiples injections, another had been treated with acupuncture, and 108 patients were free of any of the above. Anti-HCV was present in 76.6% of patients; a significantly higher proportion (87.4%) was found among patients who had received blood transfusion than in patients with previous surgery (72.4%) (p = 0.012), clinical hepatitis (57.1%), or without previous hepatic disease (70.3%) (p = 0.003). The incidence of anti-HCV was lower among cirrhotics (70.3%) than in patients with active chronic hepatitis (84.1%) (p = 0.006); in contrast, previous blood transfusion was significantly higher (p = 0.001) among the latter (40.7%) than in cirrhotics (21.9%). The incidence of anti-HCV was similar among patients with (78.6%) and without (75.8%) type B infection. Our results suggest that infection with virus C may account for a high proportion of non-alcoholic non-B chronic hepatitis.

[The value of endoscopic biopsy in the diagnosis of carcinoma of Vater's ampulla]. / Valor de la biopsia endoscópica en el diagnóstico del carcinoma de la ampolla de Vater.

In a series of 23 ampullary carcinomas, confirmed by the pathological examination of the duodenopancreatectomy specimens, 17 were biopsied during the previous ERCP examination. Biopsies were diagnostic of carcinoma in 12 (70.5%). Among 11 exophytic tumours biopsy was positive in 8 (72.7%) while in 6 tumours growing inside the papilla biopsies were positive in 4 (66.6%) (NS). It is concluded that endoscopic biopsy may be diagnostic in two-thirds of ampullary carcinomas.

[Spontaneous motility and contractile response of the sheep omasum (author's transl)]. / Motilidad espontánea y respuesta contráctil de la capa muscular del omaso de oveja.

Spontaneous motility of the sheep omasum longitudinal muscular layer its responses to the periarterial and transmural electric stimulus have been studied in vitro. Three parts of the organ were chosen: a) the greater curvatura; b) omasum lateral wall, and c) omasum canal. The preparations always showed a great spontaneous motility with elevated contractions followed by relaxations. The electric stimulation caused contractile responses followed by relaxation. The lesser the spontaneous motility, the greater becomes the response, which disappears when the spontaneous motility is very high.