Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease. / Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera.

BACKGROUND AND PURPOSE: The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. METHODS: This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). RESULTS: Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). CONCLUSIONS: Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. LEVEL OF EVIDENCE: Level IV.

Perfil epidemiológico da cisticercose bovina e suína em três regiões do estado de Minas Gerais, Brasil / Epidemiological profile of bovine and swine cysticercosis in three regions of Minas Gerais State, Brazil

Com o objetivo de avaliar a situação epidemiológica da cisticercose suína e bovina na zona rural de cinco municípios, distribuídos em três distintas regiões do estado de Minas Gerais, foi determinada a prevalência das cisticercoses bovina e suína nas propriedades rurais e os principais fatores de risco que poderiam favorecer a transmissão e manutenção da doença nas referidas propriedades. A pesquisa abrangeu 388 propriedades, localizadas em 91 diferentes comunidades rurais, sendo coletadas 1.792 amostras de sangue bovino e 554 de suíno. Além da avaliação das referidas amostras laboratoriais (ELISA indireto e imunoblot), também foram analisados os dados obtidos da aplicação de um questionário para cada propriedade, no qual constava as informações sobre as condições socioeconômicas, higiênico-sanitárias e as relacionadas ao sistema de criação animal. A prevalência da cisticercose variou de 0,3 a 5,9% nos bovinos e de 0 a 2,8% nos suínos criados artesanalmente nesses municípios pesquisados. Os principais fatores de risco de transmissão identificados foram a fonte de água consumida, a origem da carne, a natureza do município e da região, para a cisticercose bovina, e o destino do esgoto e o sistema de criação, para a cisticercose suína.(AU)

In order to evaluate the epidemiological situation of porcine and bovine cysticercosis in the rural area of five municipalities, distributed in three different regions of the state of Minas Gerais, Brazil, the prevalence of bovine and porcine cysticercosis was determined in the rural properties as well as the main risk factors that may favor the transmission and maintenance of the disease in these properties. The research covered 388 farms, located in 91 different rural communities, with 1,792 samples of bovine blood and 554 of swine collected. In addition to the evaluation of these laboratory samples (indirect ELISA and Imunoblot), the data obtained from the application of a questionnaire for each property were also analyzed, with information on socioeconomic, hygienic-sanitary and animal-related conditions. The prevalence of cysticercosis ranged from 0.3 to 5.9% in cattle and from 0 to 2.8% in the pigs raised in these municipalities. Among the main risk factors for transmission of bovine cysticercosis were the source of water consumed, the origin of the meat, the nature of the municipality and the region. Regarding the pigs, risk factors were the sewage disposal and animal management system.(AU)

Association between completed suicide and bipolar disorder: A systematic review of the literature.

BACKGROUND: Completed suicide is a major cause of death in bipolar disorder (BD) patients. OBJECTIVE: The aim of this paper is to provide an overall review of the existing literature of completed suicide in BD patients, including clinical and genetic data DATA SOURCES: We performed a systematic review of English and non-English articles published on MEDLINE/PubMed, PsycInfo and Cochrane database (1970-2017). Additional studies were identified by contacting clinical experts, searching bibliographies, major textbooks and website of World Health Organization. Initially we did a broad search for the association of bipolar disorder and suicide and we were narrowing the search in terms included "bipolar disorder" and "completed suicide". STUDY SELECTION: Inclusion criteria were articles about completed suicide in patients with BD. Articles exclusively focusing on suicide attempts and suicidal behaviour have been excluded. We used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) consensus for drafting this systematic review. RESULTS: The initial search generated 2806 articles and a total of 61 meeting our inclusion criteria. We reviewed epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD. Suicide rates in BD vary between studies but our analyses show that they are approximately 20-30-fold greater than in general population. The highest risk of successful suicide was observed in BD-II subjects. The heritability of completed suicide is about 40% and some genes related to major neurotransmitter systems have been associated with suicide. Lithium is the only treatment that has shown anti-suicide potential. LIMITATIONS: The most important limitation of the present review is the limited existing literature on completed suicide in BD. CONCLUSIONS: BD patients are at high risk for suicide. It is possible to identify some factors related to completed suicide, such as early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities and treatment. However it is necessary to promote research on this serious health problem.

Difference in the deactivation of Au catalysts during ethanol transformation when supported on ZnO and on TiO2.

Au nanoparticles of different sizes were supported by the deposition-precipitation method on two metal oxides: ZnO and TiO2. The resulting catalysts were tested in the ethanol catalytic transformation reaction. Both metal oxide support materials exerted a different influence on the achieved Au particle size as well as on the behavior of the subsequent catalyst, with regard to their initial conversion values, product distribution and stability. While TiO2 favors the formation of smaller nanoparticles, ZnO offers larger Au particle sizes when prepared under similar conditions. At the same time, TiO2 produced catalysts which displayed higher initial conversions in comparison with AuZnO catalysts, even when observing catalysts of each series with similar particle sizes. At the same time, catalysts supported on ZnO exhibited higher resistance to deactivation caused by coke formation. These results were evidenced employing different characterization techniques on both used and fresh catalyst samples. The decline in deactivation was generally accompanied by an increase in the carbon content on the catalyst's surface.

DNA Damage in Vicia faba by Exposure to Agricultural Soils from Tlaxcala, Mexico.

The aim of this research was to quantify some POPs, such as p,p' DDT, p,p' DDE, and PCBs in agricultural soils of Tlaxcala, Mexico and evaluate their capacity for eliciting DNA damage, using Vicia faba as bioindicator. The values of ΣDDTs and ΣPCBs ranged from 8-24 to 118-26,983 µg/kg, respectively. The samples T1 (HQ = 9.3) and T2 (HQ = 53.9) showed concentrations of ΣPCBs higher than Canadian guidelines (SQGE = 500 µg/kg). The genotoxicity testing produced percentages of DNA fragmentation higher than negative control and statistically significant (p < 0.05), both in agricultural soils and organic extracts. The soils T2, T3, N4, and N5 showed a DICA from 2.6 to 3.1 times, statistically higher (p < 0.05) than negative control. In general, the agricultural soils have greater genotoxic capacity than the organic extracts, suggesting a potential risk to biota that depends upon this ecosystem.

Relevant peptides of Taenia crassiceps for the diagnosis of bovine cysticercosis by immunoblot / Peptídeos relevantes de Taenia crassiceps para o diagnóstico da cisticercose bovina pelo immunoblot

Given the limited knowledge about the diagnosis of bovine cysticercosis by immunoblot, the aim of this study was to assess the applicability of this test, identifying key peptides with diagnostic value. Immunoblot assays were performed using total larval antigen of Taenia crassiceps and 60 sera of positive bovines for cysticercosis (30 naturally and 30 experimentally infected with T. saginata eggs), 30 sera of negative bovines for cysticercosis and 30 sera of bovines with other diseases (fascioliasis, hydatidosis and tuberculosis). The peptides of greater diagnostic importance, in descending order of accuracy (%), were as follows: 6-8kDa (90.8%), 129-143kDa (74.2%), 99-105kDa (71.7%) and 14-19kDa (71.1%). Cross-reactions, due to fascioliasis and hydatidosis, were observed in the four intervals of peptides highlighted. The results demonstrate that the total antigen of T. crassiceps has peptides with a high diagnostic potential; therefore, the immunoblot is useful in the diagnosis of bovine cysticercosis.

Tendo em vista o conhecimento limitado sobre o diagnóstico da cisticercose bovina pelo immunoblot, o objetivo deste trabalho foi avaliar a aplicabilidade desse teste, identificando os principais peptídeos com valor diagnóstico. Foram realizados ensaios de immunoblot, utilizando antígeno total de larva de Taenia crassiceps e 60 soros de bovinos positivos para a cisticercose (30 naturalmente e 30 experimentalmente infectados com ovos de T. saginata), 30 soros de bovinos negativos para a cisticercose e 30 soros de bovinos com outras patologias (fasciolose, hidatidose e tuberculose). Os peptídeos de maior importância diagnóstica, em ordem decrescente de acurácia (%), foram os seguintes: 6-8 kDa (90,8%), 129-143 kDa (74,2%), 99-105 kDa (71,7%) e 14-19 kDa (71,1%). Reações cruzadas, em decorrência da fasciolose e hidatidose, foram observadas nos quatro intervalos de peptídeos ressaltados. Os resultados demonstram que o antígeno total de T. crassiceps possui peptídeos com alto potencial diagnóstico, sendo, portanto, o immunoblot útil no diagnóstico da cisticercose bovina.

Asenapine prescribing patterns in the treatment of manic in- and outpatients: Results from the MANACOR study.

BACKGROUND: Asenapine is the most recent compound that has been FDA- and EMA-approved for treatment of mania. Its efficacy and safety have been assessed in placebo-controlled trials, but little is known about its performance in routine clinical conditions. In this study, we compared features of patients treated with adjunctive asenapine or other adjunctive antipsychotics and the costs of the treatment. METHODS: A combined prospective and retrospective data collection and analysis was conducted from January 2011 to December 2013 following a clinical interview and assessment of manic and depressive symptoms (YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST), sexual dysfunction (PRSexDQ) and health resource costs associated with treatment with adjunctive asenapine versus other adjunctive antipsychotics. RESULTS: Hundred and fifty-two patients from different university hospitals were included. Fifty-three patients received adjunctive asenapine and 99 received other adjunctive antipsychotics concomitantly to mood stabilizers. Considering inpatients, those treated with adjunctive asenapine presented a significantly less severe manic episode (P=0.001), less psychotic symptoms (P=0.030) and more comorbid personality disorder (P=0.002). Regarding outpatients, those treated with adjunctive asenapine showed significantly less severe manic episode (P=0.046), more previous mixed episodes (P=0.013) and more sexual dysfunction at baseline (P=0.036). No significant differences were found in mean total costs per day. CONCLUSION: Clinicians tended to use adjunctive asenapine in patients with less severe manic symptoms but more complex clinical profile, including more mixed episodes in the past, concomitant personality disorder, and sexual problems. Treatment with adjunctive asenapine was not associated with higher costs when compared to other options.

Feral finfish, and their relationships with sediments and seawater, as a tool for risk assessment of PAHs in chronically polluted environments.

An integrated study has been carried out of the fate and effects of PAHs in fish living in a chronically polluted environment. Total PAH concentrations in different target organs (muscle, liver and gills), have been determined in five species of feral fish and possible histopathological effects and correlations of all these values with concentrations found in sediments and water column have been studied in two of these species. The Potency Equivalent Concentrations and Screening values (SVs), the Biota-to-sediment accumulation factors (BSAFs) and the Toxic Potency Assessment (TEQ) of sediment for fish have been calculated. Results show that levels found in target organs, the TEQs of sediment calculated for fish related to the SVs for fish consumption are of special concern. However, the index of pathologies shows a relatively low impact of PAHs on fish health. The use of feral finfish in risk assessment for PAHs in chronically polluted environments has been proved to be a useful tool to complement environmental diagnoses and improve their accuracy. This approach combines the measurement of total concentrations in different target organs of several appropriate species, the study of histopathological effects, and correlations between all these results and the concentrations found in associated sediments and column water.

Puente adhesivo en paciente con labio leporino y fisura velopalatina: una solución temporal con compromiso estético / Adhesive bridge in a patient with cleft lip and palate: a temporary solution with esthetic commitment

En la actualidad el aumento de la demanda estética y la necesidad de procedimientos mínimamente invasivos ha llevado a un aumento de la técnica adhesiva. Ribbond® es una marca de fibra de polietileno que permite un eficiente traspaso de fuerzas, es virtualmente plegable y se adapta fácilmente a la morfología dentaria y al contorno del arco dentario. Dentro de sus principales características podemos encontrar: Biocompatibilidad, inerte, translúcido y durable. Dentro de la odontología se le han dado distintos usos para esta fibra, ya sea como mantenedor de espacio, puente adhesivo, poste y núcleo endodóntico, ferulización, restauraciones tipo inlay y estabilización postortodóncica. En el caso de los pacientes fisurados se ha hecho relevante el uso de Ribbond® como puente adhesivo ya que permite mejorar la estética y rehabilitar temporalmente los espacios desdentados causados por la ausencia de un incisivo, principalmente una vez terminado el tratamiento de ortodoncia y en espera de una rehabilitación definitiva, aún más cuando el paciente no ha terminado su crecimiento y desarrollo. En este artículo se presenta un caso clínico de un paciente con labio leporino y fisura velopalatina operado demostrativo de la técnica de rehabilitación con Ribbond®.

Today the increasing demand of aesthetic and minimally invasive procedures has led to a boom of the adhesive technique. Ribbond® is a polyethylene fiber that allows an efficient transfer of forces, is virtually foldable and is easily adapted to tooth morphology and dental arch contour. Among its main features we can find: Biocompatibility, inert, translucent and durable. In dentistry, different uses have been given to this fiber, whether as space maintainer, adhesive bridge, endodontic post and core, splinting, inlay type restorations and postorthodontic stabilization. In the case of cleft lip and palate patients the use of Ribbond® as an adhesive bridge has become relevant, as it improves aesthetics and temporarily rehabilitates the edentulous spaces caused by the absence of an incisor. It is used especially after completion of the orthodontic treatment and waiting for a final rehabilitation, even when the patient has not completed their growth and development. This article presents a clinical case of a patient with lip and cleft palate operated with the rehabilitation technique using Ribbond®.

Recreating the seawater mixture composition of HOCs in toxicity tests with Artemia franciscana by passive dosing.

The toxicity testing of hydrophobic organic compounds (HOCs) in aquatic media is generally challenging, and this is even more problematic for mixtures. The hydrophobic properties of these compounds make them difficult to dissolve, and subsequently to maintain constant exposure concentrations. Evaporative and sorptive losses are highly compound-specific, which can alter not only total concentrations, but also the proportions between the compounds in the mixture. Therefore, the general aim of this study was to explore the potential of passive dosing for testing the toxicity of a PAH mixture that recreates the mixture composition found in seawater from a coastal area of Spain, the Bay of Algeciras. First, solvent spiking and passive dosing were compared for their suitability to determine the acute toxicity to Artemia franciscana nauplii of several PAHs at their respective solubility limits. Second, passive dosing was applied to recreate the seawater mixture composition of PAHs measured in a Spanish monitoring program, to test the toxicity of this mixture at different levels. HPLC analysis was used to confirm the reproducibility of the dissolved exposure concentrations for the individual PAHs and mixtures. This study shows that passive dosing has some important benefits in comparison with solvent spiking for testing HOCs in aquatic media. These include maintaining constant exposure concentrations, leading to higher reproducibility and a relative increase in toxicity. Passive dosing is also able to faithfully reproduce real mixtures of HOCs such as PAHs, in toxicity tests, reproducing both the levels and proportions of the different compounds. This provides a useful approach for studying the toxicity of environmental mixtures of HOCs, both with a view to investigating their toxicity but also for determining safety factors before such mixtures result in detrimental effects.

Assessment of dioxin-like soil contamination in Mexico by enzyme-linked immunosorbent assay.

In this work, we describe the results of a preliminary soil assessment program for the detection of dioxins at different sites in Mexico performed by immunoassay. We studied five different sectors considered relevant sources of dioxins: Anaversa and Tekchem industrial areas where organochlorine pesticides were manufactured and released by accidental explosions, secondary smelters, brick kilns, and rural dwellings. In the context of the Agency for Toxic Substances and Disease Registry (ATSDR) guidelines, only the brick kilns sites can be considered as low-risk areas. The dioxin concentrations detected in the vicinity of the Anaversa and Tekchem chemical plants and secondary smelters exceed the screening level of 0.05 ppb set by the ATSDR, and therefore further site-specific studies are needed. The dioxin levels found in all soot samples from indigenous dwellings where wood is used for indoor cooking were above the evaluation level. Considering that the studied areas are representative examples of dioxin sources in less developed countries, our work demonstrates the useful application of dioxin immunoassays as a tool for dioxin screening for environmental assessment programs in developing countries.

Actividad in vitro de 5 antifúngicos contra aislados clínicos y ambientales de pichia anomala / In vitro activity of 5 antifungal against environmental and clinical isolates of pichia anomala

Las infecciones fúngicas han aumentado en el último tiempo, entre ellas, las infecciones por levaduras emergentes, cuyos patrones de sensibilidad no han sido estudiados debido a la inexistencia de patrones de temperatura y medios de cultivo apropiados para realizar test de sensibilidad. El presente trabajo, fue propuesto como un modelo experimental de Pichia anomala, aislada de pacientes con MICs superiores que los aislados ambientales, siendo la anfotericina B el antifúngico con la mejor actividad antifúngica.

Variability of MELD score during the year before liver transplantation.

Model for end-stage liver disease (MELD) score is a good parameter to establish the patient survival before liver transplantation and give priority to the sickest patients. The aim of this study was to evaluate the variability and potential regression of MELD score during the months before liver transplant. From the 350 patients waitlisted for transplantation, we evaluated the 124 patients who had enough blood tests during 12 months before the final event (transplantation, death, removal from list due to improvement or worsening). We considered month 12 as the final event and blood tests from 0, 3, 6, and 12 months were analyzed. MELD score was calculated and compared using ANOVA for repeated measures test. To determine variability of MELD and its components, intraclass correlation coefficient (ICC) was calculated for 0, 3, and 6 months. The degree of constancy was defined by proximity of ICC to 1. Two groups by initial MELD (< or =17 or >17) were considered. Patient data are: mean age, 53 +/- 9 years; sex: 70% men, etiology, 28% hepatitis C, 11% alcohol and hepatitis C, 16% alcohol, 28% hepatocellular carcinoma, 6% hepatitis B, 11% others; Initial Child-score, 8.5 +/- 2.0; Initial MELD score, 15.2 +/- 4.9; mean time on waiting list, 8.1 +/- 5.7 months. MELD score from 6 and 12 months was significantly higher than the initial one. The most constant parameter was creatinine (ICC:0.89); bilirubin (ICC:0.58) and INR (ICC:0.59) were the most variable ones. MELD score ICC was 0.79. In only one patient did MELD score decrease 5 points below the initial one. For initial MELD < or = 17 and >17, variability was lower in the former. In conclusion, MELD became significantly higher 6 months after the basal determination. This score is reliable as it does not tend to decrease in time. In high MELD scores (>17), 3-month survival was lower and variability greater so that more careful follow-up and prioritizing are needed.

[Controversies about the clinical management of Whipple's disease]. / Controversias en el manejo clínico de la enfermedad de Whipple.

BACKGROUND: There are a lot of controversies related to the diagnostic and therapeutic management of Whipple s disease. PATIENTS: We present 4 cases of Whipple's disease, collected from the Gastroenterology Service of the Hospital Ramon y Cajal, from Madrid. RESULTS: The average age was 69. The first symptoms were in order of frequency, arthralgias, loss of weight, arthritis, diarrhoea, fever, epigastric pain and neurologic symptoms. Three were treated with trimethoprim-sulphamethoxazol and one with cefixime. There were no recurrences. CONCLUSIONS: The endoscopic appearance of the duodenum is fundamental for the suspicion of the disease. The initial parenteral treatment may consist of ceftriaxone and try to avoid using streptomycine because of its toxicity, followed by oral trimethoprim-sulphamethoxazol. As an alternative to the latter, cefixime is usually effective. The typical findings of the duodenum biopsy can persist several months or years after finishing the treatment, decreasing the value of endoscopic pursuit after treatment.

HPLC determination of Vitamin D(3) and its metabolite in human plasma with on-line sample cleanup.

A HPLC method with automated column switching and UV-diode array detection is described for the simultaneous determination of Vitamin D(3) and 25-hydroxyvitamin D(3) (25-OH-D(3)) in a sample of human plasma. The system uses a BioTrap precolumn for the on-line sample cleanup. A sample of 1ml of human plasma was treated with 2ml of a mixture of ethanol-acetonitrile (2:1 (v/v)). Following centrifugation, the supernatant was evaporated to dryness under a stream of dry and pure nitrogen. The residue was reconstituted in 250muL of a solution of methanol 5mmoll(-1) phosphate buffer, pH 6.5 (4:1 (v/v)), and a 200mul aliquot of this solution was injected onto the BioTrap precolumn. After washing during 5min with a mobile phase constituted by a solution of 6% acetonitrile in 5mmoll(-1) phosphate buffer, pH 6.5 (extraction mobile phase), the retained analytes were then transferred to the analytical column in the backflush mode. The analytical separation was then performed by reverse-phase chromatography in the gradient elution mode with the solvents A and B (Solvent A: acetonitrile-phosphate buffer 5mmoll(-1), pH 6.5; 20:80 (v/v); solvent B: methanol-acetonitrile-tetrahydrofuran, 65:20:15 (v/v)). The compounds of interest were detected at 265nm. The method was linear in the range 3.0-32.0ngml(-1) with a limit of quantification of 3.0ngml(-1). Quantitative recoveries from spiked plasma samples were between 91.0 and 98.0%. In all cases, the coefficient of variation (CV) of the intra-day and inter-day-assay precision was

Use of semipreparative supercritical fluid chromatography to obtain small quantities of the albendazole sulfoxide enantiomers.

The semipreparative separation of the albendazole sulfoxide enantiomers using chiral supercritical fluid chromatography is presented in this work. For this purpose, a modular SFC chromatograph was adapted to work at semipreparative scale and a Chiralpak AD (250 x 10 mm) column was used. Different injection volumes were evaluated in order to obtain high purities and throughputs. Using the maximum load, it was possible to obtain 37 mg/h of the first eluted enantiomer with a purity of 99.9%, and 36.5 mg/h of the second eluted enantiomer with a purity of 95%.

Use of combined treatment of hepatitis B immune globulin and lamivudine as prevention of hepatitis B virus recurrence in liver allograft.

Antiviral prophylaxis with lamivudine appears to reduce hepatitis B virus (HBV) infection after liver transplantation, although recurrence of infection occurs in at least 20% of the patients because of the development of drug resistance. Treatment for HBV reinfection with lamivudine pretransplantation and posttransplantation together with hepatitis B immunoglobulin could abolish recurrence of HBV infections following liver transplantation. We report the experience at our center in which lamivudine has been used in combination with low doses of immunoglobulin. Lamivudine (100 mg/d) was administered to liver transplant candidates for at least 4 weeks before transplantation and was continued posttransplantation indefinitely. Immunoglobulin was administered intramuscularly (10,000 IU at time of liver transplantation; 1,000 IU for 1 week; 1,000 IU weekly the first month; and 1,000 IU monthly thereafter). Lamivudine and low-dose immunoglobulin administration prevents posttransplantation recurrence of hepatitis B with 100% efficiency; it is well tolerated and is less cost-effective than high-dose immunoglobulin regimens.

Prophylaxis of recurrent hepatitis B virus by vaccination after liver transplant: preliminary results.

Liver transplantation for chronic HBV-induced cirrhosis is associated with a high rate of recurrence and poor long-term survival. Prolonged and combined prophylaxis with hepatitis B immunoglobulin (HBIg) and lamivudine has been demonstrated to prevent HBV recurrence, but its lifelong administration is highly expensive. An alternative strategy may be the use of an HBV vaccine after liver transplantation. Herein we report the results of administration of a reinforced recombinant HBV vaccine to liver transplant recipients. Twelve patients transplanted for HBV-related liver disease and treated with HBIg for at least 24 months were administered HBV vaccine (40 microg administered intramuscularly and repeated 1 and 2 months thereafter) 2 months after beginning the last HBIg dose. The response rate to HBV vaccination was 75% (9/12 patients). Serum titers of anti-HBs were considered to be protective when they reached levels >10 IU/L. Responding patients were followed for a median of 43+/-22.5 months; during this period none of the responders showed evidence of HBV recurrence. These results suggest that vaccine administration after liver transplant may avoid HBV recurrence allowing HBIg withdrawal. However, future studies are necessary to define an optimal schedule.