Persistence of e antigen as prognostic marker in acute hepatitis B

Summary Serial determinations of HBeAg and anti-HBe were made in sera of 155 selected patients with acute hepatitis B who were followed up for one to four years. In the early phase of hepatitis, HBeAg was present in 43 cases (27.7%) and anti-HBe in 12 cases (7.7%). Evaluation of the outcome of hepatitis showed that development of chronic hepatitis occurred in 11 out of 43 HBeAg positive patients, in 10 out of 100 HBeAg negative patients (P=<0.05) and in 2 out of 12 patients carrying anti-HBe. Nine out of 11 HBeAg positive chronic subjects showed persistent HBe antigenemia over two months, while the remaining 32 patients, who recovered completely, lost HBeAg within two to three weeks from the onset of the disease. These data suggest that the prognostic value of HBeAg in acute hepatitis patients may be taken into account when HBeAg persists in the serum and that anti-HBe does not invariably protect from the development of chronic hepatitis.

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Persistenz des e-Antigens als prognostischer Marker bei akuter Hepatitis B

Zusammenfassung Seren von 155 ausgewählten Patienten mit akuter Hepatitis B wurden innerhalb einer ein- bis vierjährigen Beobachtungszeit wiederholt auf HBeAg und anti-HBe untersucht. In der frühen Phase der Hepatitis wurde HBeAg bei 43 Fällen (27,7%) und anti-HBe bei 12 Fällen (7,7%) nachgewiesen. Die Auswertung der Krankheitsverläufe zeigte, daß sich eine chronische Hepatitis bei 11 von 43 HBeAg positiven und bei 10 von 100 HBeAg negativen Patienten (p=<0,05) und bei 2 von 12 Patienten, die anti-HBe aufwiesen, entwickelte. Neun von 11 HBeAg-positiven Patienten mit chronischem Verlauf zeigten eine über zwei Monate anhaltende Antigenämie, während die übrigen 32 Patienten, bei denen die Hepatitis vollkommen ausheilte, innerhalb von zwei bis drei Wochen nach Beginn der Erkrankung HBeAg negativ wurden. Aus diesen Daten ist zu schließen, daß der prognostische Wert des HBeAg bei akuter Hepatitis bei Persistenz des HBeAg zu berücksichtigen ist, und daß das anti-HBe nicht unbedingt vor Entwicklung einer chronischen Hepatitis schützt.

     

Chronic Viral Hepatitis in Thalassemic Liver Disease: A Long-Term Study in Patients with Acute Hepatitis with Nontransfusion-Dependent Thalassemia Minor

To evaluate the effective role of hepatitis viruses in thalassemic (Th) liver disease, we carried out a long-term study in 42 subjects with nontransfusion-dependent Th minor hospitalized for an episode of acute viral hepatitis. 10 patients had serologic evidence of hepatitis A, 23 of hepatitis B and 9 of hepatitis non-A, non-B. In the follow-up chronic hepatitis was detected histologically in 5/23 patients with hepatitis B and 5/9 with hepatitis non-A, non-B. All hepatitis A patients recovered completely. The prevalence in 7 out of 10 patients with chronic hepatitis of piecemeal necrosis and of inflammatory changes over hepatic siderosis and fibrosis evidenced a determinant role of chronic viral infection in the development of liver damage in these patients. Thus, heterozygous nontransfusion-dependent Th patients seem to have a high risk of developing a chronic inflammatory liver disease especially after an episode of non-A, non-B hepatitis. Therefore, in our geographical area, chronic hepatitis of viral origin should be taken into account, among other pathogenetic factors, in many cases of cryptogenic thalassemic liver disease.     

Laparoscopic management of intra-abdominal infections: Systematic review of the literature

AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controlling the source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.     

Late assessment of quality of life in patients with rectal carcinoma: comparison between sphincter preservation and definitive colostomy

Purpose

Patients with cancer of the lower and middle rectum who are candidates for curative surgery often have negative opinions on definitive colostomy. The purpose of this study is to compare the quality of life (QoL) of patients who undergo standard treatment for rectal cancer with sphincter preservation or definitive colostomy.

Methods

A total of 125 patients with adenocarcinoma of the lower or middle rectum who underwent radical surgery with curative intent with a follow-up ≥?1 year were recruited: 83 patients (group 1) were subjected to low anterior resection and low colorectal or coloanal anastomosis—thus preserving their sphincter—and 42 (group 2) were treated with abdominoperineal resection, followed by terminal definitive colostomy. QoL was assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires.

Results

Health and global quality of life were similar between groups; however, patients who underwent definitive colostomy had higher scores on the emotional (p value?=?0.016) and cognitive function scales (p value?=?0.017). Patients with sphincter preservation presented with more symptoms that were related to stool frequency (p value <?0.001), intestinal constipation (p value?=?0.005), fecal incontinence (p value?=?0.001), buttock pain (p value?=?0.023), and nausea and vomiting (p value?=?0.036), whereas patients with permanent colostomy had higher scores for dysuria (p value?=?0.033).

Conclusion

Although global QoL scores did not differ between groups, patients who underwent definitive colostomy had significantly better functional and symptom scale scores, reflecting greater function with fewer symptoms.

     

Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases: Between conventional and mini-invasive approaches

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate. Staged approach, with initial colorectal resection followed by liver resection (LR), or even the reverse, liver-first approach in specific situations, is traditionally preferred. Simultaneous resections, however, represent an appealing strategy, because may have perioperative risks comparable to staged resections in appropriately selected patients, while avoiding a second surgical procedure. In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases, simultaneous major hepatectomies may determine worse perioperative outcomes, so that parenchymal-sparing LR should represent the most appropriate option whenever feasible. Mini-invasive colorectal surgery has experienced rapid spread in the last decades, while laparoscopic LR has progressed much slower, and is usually reserved for limited tumours in favourable locations. Moreover, mini-invasive parenchymal-sparing LR is more complex, especially for larger or multiple tumours in difficult locations. It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise, at least for more complex procedures. This review aims to critically analyze the current status and future perspectives of simultaneous resections, and the present role of the available mini-invasive techniques.     

Body weight impact on puberty: effects of high-calorie diet on puberty onset in female rhesus monkeys

Secular trends toward a declining age at puberty onset with correlated changes in body weight have been reported in economically advanced countries. This has been attributed to excess calorie intake along with reduced physical activity in children. However, because the timing of puberty in humans is also influenced by other factors, such as genetic traits, living conditions, geographical location, and environmental chemicals, it is difficult to distinguish the effect of diet and body size from other factors in a human population. Here we report that feeding juvenile female rhesus monkeys born and raised at the Wisconsin National Primate Research Center with a high-calorie diet results in acceleration of body growth and precocious menarche. The monkeys fed a high-calorie diet also had an elevated body mass index. The most significant treatment effects on circulating hormones were increased leptin and IGF-I levels throughout the experiment. The findings of this study suggest the importance of close monitoring of juvenile feeding behaviors as an important intervention to reduce the prevalence of precocious development and metabolic diseases in adulthood.     

Electrocardiographic manifestation of the middle fibers/septal fascicle block: a consensus report

There are fibers in the left ventricle (LV) (LV middle network) that in around one third of cases may be considered a true septal fascicle that arises from the common left bundle. Its presence and the evidence that there are 3 points of activation onset in the LV favor the quadrifascicular theory of the intraventricular activation of both ventricles. Since the 70s, different authors have suggested that the block of the left middle fibers (MS)/left septal fascicle may explain different electrocardiographic (ECG) patterns. The 2 hypothetically based criteria that are in some sense contradictory include: a) the lack of septal "q" wave due to first left and later posteriorly shifting of the horizontal plane loop and b) the presence of RS in lead V(2) (V(1)-V(2)) due to some anterior shifting of the horizontal plane vectorcardiogram loop. However, there are many evidence that the lack of septal q waves can be also explained by predivisional first-degree left bundle-branch block and that the RS pattern in the right precordial leads may be also explained by first-degree right bundle-branch block. The transient nature of these patterns favor the concept that some type of intraventricular conduction disturbance exists but a doubt remains about its location. Furthermore, the RS pattern could be explained by many different normal variants. To improve our understanding whether these patterns are due to MF/left septal fascicle block or other ventricular conduction disturbances (or both), it would be advisable: 1) To perform more histologic studies (heart transplant and necropsy) of the ventricular conduction system; 2) To repeat prior experimental studies using new methodology/technology to isolate the MF; and 3) To change the paradigm: do not try to demonstrate if the block of the fibers produces an ECG change but to study with new electroanatomical imaging techniques, if these ECG criteria previously described correlate or not with a delay of activation in the zone of the LV that receives the activation through these fibers or in other zones.