Percutaneous liver biopsy: retrospective study over 15 years comparing 287 inpatients with 428 outpatients

Background and Aim:  Liver histology still represents the gold standard for the assessment of liver inflammation, necrosis, and fibrosis. The least cumbersome way of obtaining liver tissue is percutaneous liver biopsy. The aim of this retrospective study was to compare the complications following liver biopsy in in- and outpatients and to evaluate for which patients the benefit from liver biopsy is highest.
Methods:  All patients undergoing percutaneous liver biopsy at a teaching hospital between January 1990 and April 2005 were evaluated for indications, complications and impact of histology.
Results:  Liver biopsy was performed in 287 inpatients and 428 outpatients with a success rate of 99.4%. The total complication rate was 6.3% in inpatients and 11% in outpatients. Only two major complications, but no deaths occurred. Pain was the main complication, especially in young patients with chronic viral hepatitis. Despite normal alanine aminotransferase (ALT) levels advanced liver fibrosis was found in 9.3%, 2.6%, and 5.4% of all patients with HBV-, HCV infection, and non viral liver diseases, respectively. In 3% of all patients evaluated a previously unrecognized second liver disease was found. In 21.4% of the patients alkaline phosphatase (AP) levels were elevated, and in more than 90% of these patients liver biopsy led to the final diagnosis.
Conclusion:  Liver biopsy is safe in in- and outpatients. Biopsy is particularly helpful in patients suspected of having liver disease in spite of normal ALT levels or in patients exhibiting unexplained elevated AP levels.     

Superantigen reactive Vbeta6+ T cells induce perforin/granzyme B mediated caspase-independent apoptosis in tumour cells

The endogenous viral superantigen 7 in DBA/2 mice serves as a target antigen on syngeneic ESb-MP lymphoma cells for allogeneic graft-vs-leukaemia reactive cells. Allogeneic viral superantigen 7 reactive Vbeta6+ T cells are able to transfer graft-vs-leukaemia reactivity and to kill specifically viral superantigen 7+ ESb-MP tumour cells in vitro. Here we elucidate the mechanism of this superantigen specific cell lysis. Already 10 min after co-incubation with in vitro stimulated Vbeta6+ T cells, viral superantigen 7+ ESb-MP tumour cells show an apoptotic phenotype (Annexin V-positivity, DNA-fragmentation). This extremely rapid type of cell death is not mediated by the death inducing ligands CD95L, TRAIL and TNF but by perforin and granzyme B. Surprisingly, neither mitochondria nor any of the known caspases appear to be involved in this type of tumour cell killing. In contrast, nitric oxide, released by activated macrophages and endothelial cells, induces in the same tumour cells another type of apoptosis which is much slower and involves mitochondria and caspase activation. A synergistic effect between the two different effector mechanisms of superantigen reactive donor cytotoxic T lymphocytes and nitric oxide releasing host macrophages and endothelial cells might explain the effective immune rejection of even advanced metastasised cancer in this graft-vs-leukaemia animal model.     

Functional diversity of synaptic AMPA/KA receptors from rat as revealed by subtype‐specific antagonists

Subtype-specific pharmacological compounds represent important tools to identify the molecular components of synaptically activated glutamate receptors in central neurones. Here, we utilized a collection of subtype-specific antagonists and modulators to investigate the functional profile of glutamate receptors in identified synapses in thin slices of the cerebellum, hippocampus and brain stem. During whole-cell patch-clamp recordings α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate/kainate (AMPA/KA) receptor-mediated synaptic currents (EPSCs) in cerebellar Purkinje cells were (i) prolonged by 100 μm cyclothiazide, (ii) not significantly changed after preincubation in 10 μm concanavalin A, (iii) not affected by 1 μm Evans Blue or polyamine toxin analogue N-(4-hydroxyphenylpropanolyl)-spermine (NHPPS), but (iv) significantly reduced by high (≥ 100 μm ) concentrations of Evans Blue. These pharmacological properties were distinct from those observed in hippocampal granule cells and brain stem interneurones and markedly different from those of recombinant glutamate receptor channels GluR1–GluR6 previously investigated in heterologous expression systems.     

Spätergebnisse von 103 operativ behandelten Hüftpfannenbrüchen

This paper describes a long-term follow-up study of 103 operatively treated acetabular fractures. The interval between accident and follow-up examination ranged from 18 months to 12 years, with a mean interval of 4.0 years. The frequency of post-traumatic complications caused by avascular necrosis of the femoral head, coxarthrosis and periarticular calcification is reported. The evaluation of the overall results for each patient was determined using a specially designed evaluation scheme. The long-term results seen in this study demonstrate that operative methods are superior to conservative treatment in severely displaced acetabular fractures. This study emphasizes clearly three demands for the treatment of acetabular fractures: 1. the immediate reduction of the femoral head; this is mandatory in posterior dislocations, 2. a skilled, standardized operative technic and 3. the reduction of the interval between accident and operation to a period of less than two weeks for all transacetabular fractures.     

Die operative Versorgung von Hüftpfannenbrüchen mit standardisiertem Verfahren nach anatomischen und biomechanischen Gesichtspunkten

The conservative treatment of displaced acetabular fractures, with splintering of large fragments out of the main weight bearing zone, generally results in incongruence arthrosis. Better results can only be achieved surgically, through an anatomically and functionally stable reconstruction of the hip socket. As with all osteosyntheses, good results on a large scale are only obtainable when indications for operation and surgical technics both have been largely standardized. This article describes our procedure, used by us for years and now standardized for the various types of fractures. Our experience has shown that the dorsal osteosynthesis, using the narrow dynamic compression plate, in nearly all cases meets the anatomic and biomechanical standards which have been established for treating articular fractures.     

DWI predicts future progression to Alzheimer disease in amnestic mild cognitive impairment

The authors assessed whether measures of hippocampal water diffusivity at baseline can predict future progression to Alzheimer disease (AD) in amnestic mild cognitive impairment (aMCI). Higher baseline hippocampal diffusivity was associated with a greater risk of progression to AD in aMCI (p = 0.002). Magnetic resonance diffusion-weighted imaging may help identify patients with aMCI who will progress to AD as well as or better than structural MRI measures of hippocampal atrophy.     

Anästhesie und Intensivmedizin—eine Standortbestimmung

Ohne Zusammenfassung