Hypothermic Machine Preservation in Liver Transplantation Revisited: Concepts and Criteria in the New Millennium

To overcome the present shortage of liver donors by expansion of the existing donor pool and possibly lengthening of the storage time, hypothermic machine perfusion of the liver as a dynamic preservation method is revisited. The three most important aspects are defined to be the type of preservation solution, the characteristics of perfusion dynamics, and the oxygen supply. Reviewing hypothermic liver machine perfusion experiments, the University of Wisconsin machine preservation solution is the solution most used. It is also found that nothing conclusive can be said about the optimal perfusion characteristics, since either perfusion pressure or perfusion flow is reported. The best estimation is perfusion of the liver in a physiological manner, i.e. pulsatile arterial perfusion and continuous portal venous perfusion. The applied pressures could be chosen to be somewhat lower than physiological pressures to prevent possible endothelial cell damage. Oxygen supply is necessary to achieve optimal preservation of the liver. The minimal amount of partial oxygen pressure required is inversely related to the normalized flow. Incorporating these features in a system based on existing standard surgical and organ sharing procedures and which is able to work stand-alone for 24 h, weighing less than 23 kg, could successfully implement this technique into every day clinical practise.     

Rare Norovirus GIV Foodborne Outbreak,Wisconsin, USA

We report a norovirus GIV outbreak in the United States, 15 years after the last reported outbreak. During May 2016 in Wisconsin, 53 persons, including 4 food handlers, reported being ill. The outbreak was linked to individually prepared fruit consumed as a fruit salad. The virus was phylogenetically classified as a novel GIV genotype.     

A study of visual and auditory verbal working memory in schizophrenic patients compared to healthy subjects

Impaired working memory (WM) performance is considered as a central feature of schizophrenia. Divided into two components, verbal and spatial, WM has been shown to involve frontal and parietal regions. Verbal WM can be tested either visually or aurally. The present study aimed to test schizophrenic patients in both visual and auditory verbal WM in order to assess a possible distinct pattern of alteration of these two modalities. Twenty-four schizophrenic patients and 24 healthy controls were compared with 2-back continuous visual and auditory verbal WM testing. Both groups were also tested on a neuropsychological battery including Wisconsin Card Sorting Test (WCST). Schizophrenic patients were less efficient in both verbal WM tests. When taking age and educational level as covariates and both WM modalities as dependent variables, there was no differential effect of modalities across groups. In further exploratory analyses, partial correlations brought association between verbal WM and psychosocial adaptation, WCST and length of illness. These results suggest a similar pattern of alteration of both modalities of verbal WM in schizophrenic patients. The implications of this finding are discussed. Received: 16 February 1999 / Accepted: 20 December 1999     

A pathophysiologic approach to diagnosis of malabsorption.

Most patients with malabsorption do not have “textbook” symptoms; they often complain of a variety of more subtle manifestations including excessively large or sticky stools, abdominal discomfort or the consequences of a specific nutritional deficiency. Suspicion of malabsorption demands confirmation by determination of fecal fat content since most diseases affecting intestinal absorption alter lipid assimilation. If steatorrhea is present, an abdominal plain film and barium meal x-ray film, xylose absorption test and a Schilling test with appropriate subsequent administration of intrinsic factor, antibiotics and pancreatic enzymes will suggest whether the defect is in intraluminal digestion of triglyceride or in a mucosal process. An etiologic diagnosis should be approached by a consideration of the possible defects in the intraluminal and mucosal events of lipid absorption and the use of selected tests.Patients with carbohydrate malabsorption usually do not have steatorrhea, but complain of watery diarrhea, cramps and excessive flatus. Although the diagnosis is usually made by the appropriate carbohydrate tolerance test, both the breath hydrogen test and assay of mucosal biopsy material for disaccharidases are more accurate.