Is hepatitis B immunoglobulin prophylaxis needed for liver transplantation in the era of new antivirals?

Chronic infection with hepatitis B virus (HBV) is one of the most common causes of cirrhosis of the liver and hepatocellular carcinoma worldwide, frequently requiring liver transplantation. Other nonliver organ transplants get infected de novo or through reactivation from previous active or inactive infections. With significant improvements in the surgical techniques and immunosuppressive regimens over the last 20 years, organ transplantation has become the most effective and lifesaving therapy for patients with chronic renal failure, cirrhosis, hepatocarcinoma, and heart failure. Until recently chronic HBV infection was considered a formal contraindication for liver transplantation, since recurrence of infection without prophylaxis occurs in 75% to 90% of the patients, with significant morbidity and mortality and few therapeutic alternatives. However, the introduction of hepatitis B immunoglobulin (HBIG) a decade ago to reduce the risk of reinfection of liver grafts, and more recently the availability of nucleoside analogues with few side effects and easy administration, have led to a dramatic improvement in patient outcomes with a risk of long-term HBV reinfection of less than 10% with combined HBIG and lamivudine prophylaxis. Chronic HBV infection in kidney, heart, and other organs has become a serious long-term problem and one of the most frequent and important comorbidities affecting graft and patient survival. Fortunately the introduction of nucleoside analogues allows significant control of viral replication and prevents progression of liver disease and other organ damage. In the present article we discuss the current indications for HBV prophylaxis and treatment prior to and after organ transplantation, as well as the most cost-effective way to apply different regimens to reduce side effects and improve survival and quality of life after transplantation.     

Neue Beobachtungen über den Zusammenhang der Verringerung des Seh- und Hörvermögens an Patienten mit Degeneratio pigmentosa retinae

Zusammenfassung Unsere Ergebnisse in ihrer Gesamtheit überblickend stellen wir fest, daß wir bei allen 26 Untersuchten eine nervöse Schwerhörigkeit verschiedenen Grades gefunden haben, welche bei höheren Frequenzen stärker ausgeprägt war. Wir könnten weder zwischen Sehschärfe und Schwerhörigkeit, noch zwischen Gesichtsfeldeinengung und der Letzterwähnten einen Zusammenhang finden. Unentschieden blieb auch die Frage der Lateralisierung. Nach unseren Befunden progrediiert die Schwerhörigkeit mit zunehmendem Alter—im Gegensatz zur Abnahme der Sehschärfe—nicht; es scheint vielmehr, als ob die Hörverminderung ein mit der D.p.r. zusammenhängenderZustand wäre.Die Frage blieb auch nach unseren Regressionsuntersuchungen offen, ob die Schwerhörigkeit bei D.p.r. labyrinthären oder retrolabyrinthären Ursprunges ist.Mit 2 Textabbildungen     

Experimentelle Transplantation vom lyophilisierten Glaskörper

Zusammenfassung Nach kurzer Übersicht der Literatur über Glaskörperersatz und-transplantation wird über die eigenen Versuche berichtet. Bei 8 Kaninchen wurde an Stelle des abgesaugten Glaskörpers lyophilisierter arteigener Glaskörper transplantiert. Nach 24 Std ist die Tension am operierten Auge gleich wie am Kontrollauge. Alle 8 Glaskörper sind durchsichtig geworden. In 2 Fällen trat eine Netzhautablösung ein.Mit 1 Textabbildung     

Detecting location-specific neuronal firing rate increases in the hippocampus of freely-moving monkeys

The spatial properties of the firing of hippocampal neurons have mainly been studied in (a) freely moving rodents, (b) non-human primates seated in a moveable primate chair with head fixed, and (c) epileptic patients subjected to virtual navigation. Although these studies have all revealed the ability of hippocampal neurons to generate spatially selective discharges, the detected firing patterns have been found to be considerably different, even conflicting, in many respects. The present cellular electrophysiological study employed squirrel monkeys (Saimiri sciureus), which moved freely on the walls and floor of a large test chamber. This permitted the examination of the spatial firing of hippocampal neurons in nearly ideal conditions, similar to those used in rodents, yet in a species that belongs to the primate Suborder Anthropoidea. The major findings were that: (1) a group of slow-firing complex-spike cells increased their basal, awake firing rate more than 20-fold, often above 30 spikes/s, when the monkey was in a particular location in the chamber, (2) these location-specific discharges occurred consistently, forming 4-25 s action potential volleys, and (3) fast-firing cells displayed no such electrical activity. Thus, during free movement in three dimensions, primate hippocampal complex-spike cells do generate high-frequency, location-specific action potential volleys. Since these cells are components of the medial temporal lobe memory system, their uncovered firing pattern may well be involved in the formation of declarative memories on places.     

Pancreaticoduodenectomy in the treatment of congenital fibrosarcoma of the duodenum.

A 2-mo-old female with congenital fibrosarcoma causing duodenal obstruction had a pancreaticoduodenectomy. She is doing well with the aid of oral pancreatic enzyme supplements 14 mo after her pancreaticoduodenectomy with no evidence of tumor recurrence or pancreatic endocrine dysfunction.