Safety and efficacy of subcutaneous hepatitis B immunoglobulin after liver transplantation: an open single-arm prospective study.

Life-long hepatitis B immunoglobulin (HBIG) administration is a main component of prophylactic strategy to prevent hepatitis B virus (HBV) reinfection after liver transplantation (LT). Long-term effects of HBIG treatment are known only for intravenous (IV) and intramuscular formulations. To evaluate safety and efficacy of self-administered SC HBIG, 135 LT patients receiving a 48-week treatment were analyzed. The dose of HBIG was 500 IU or 1000 IU if body weight was <75 kg or ≥75 kg, respectively. Patients were switched from the monthly IV HBIG treatment to weekly SC HBIG 2-3 weeks after the last IV dosage. All patients were able to SC self-injection after a single training. The treatment was effective in maintaining trough anti-HBs levels >100 IU/L. No severe drug-related side effects occurred. Fifteen injection-site small hematomas and four cases of mild itch occurred. At the end of the study, anti-HBs median titer was 232 IU/L (115-566 IU/L) and 97.8% of patients had an anti-HBs level >150 IU/L. Due to high mean level of anti-HBs titers observed during this study, individualized treatment schedules should be further investigated. In conclusion, SC HBIG for long-term prophylaxis of post-LT HBV reinfection resulted safe, well accepted, and effective in maintaining adequate anti-HBs levels.

Polyamine-dependent post-translational modification of proteins in differentiating mouse epidermal cells.

In order to get a better understanding of the role played by polyamines in calcium-induced epidermal cell differentiation, the time course of their metabolism was investigated. Results demonstrate that differentiating epidermal cells are characterized by time-dependent changes in polyamine concentrations. An early polyamine catabolic phase, characterized by increased total putrescine concentration and drastic reduction of both spermidine and spermine levels, is followed by active spermidine biosynthesis. The differences in putrescine and, in particular, spermidine metabolism are reflected in a time-dependent modulation of protein-bound polyamine derivatives. In fact, upon addition of calcium to the culture medium, hypusine N epsilon-(4-amino-2-hydroxybutyllysine) is rapidly reduced to undetectable levels. The very low hypusine level is paralleled by an increase in gamma-glutamyl putrescine derivatives and followed by a large increase in gamma-glutamyl spermidine derivatives; in addition, there is a remarkable concomitant biosynthesis of transglutaminase-catalyzed mono and bis gamma-glutamyl spermidine derivatives and epsilon(gamma-glutamyl)lysine cross-links. The effect of TPA and RA on hypusine formation is also reported.

Portal vein pulsatility ratio provides a measure of right heart function in chronic heart failure.

Portal vein flow was recorded by color Doppler sonography in 31 patients with chronic heart failure and 18 control subjects. Compared with patients showing a forward flow (Group A), those with reversed portal vein flow (Group B) had higher prevalence of tricuspid regurgitation (75% vs. 43%), hepatic congestion (100% vs. 30%) and ascites (50% vs. 18%), and showed higher right atrial pressure (25.3 +/- 3.01 mmHg vs. 11.8 +/- 5.75 mmHg, p < 0.01). In controls, portal vein pulsatility ratio was 0.66 +/- 0.08, in Group A it was 0.46 +/- 0.28 (p < 0.01), in Group B -0.60 +/- 0.19 (p < 0.01). Portal vein pulsatility ratio negatively correlated with right atrial pressure (r = -0.87; p < 0.01). In Group A, hepatic congestion, ascites and tricuspid regurgitation were associated with a higher portal vein pulsatility. This study indicates that portal vein pulsatility ratio reflects the level of impairment of the right heart.

[A case of splenic torsion in a child]. / Di un caso di torsione splenica in età pediatrica.

A case of torsion of the spleen complicated by bowel occlusion occurred in a 3 1/2-yr-old boy is reviewed. Pathogenesis, symptoms and diagnostics are discussed. The rarity of the lesion in childhood is underlined together with the utility, in diagnostics, of plain films of the abdomen taken some hours one from the others.

[Incidentally discovered masses: diagnostic and therapeutic features]. / Gli incidentalomi: aspetti diagnostici e terapeutici.

The term "incidentaloma", which was first used to indicate a mass discovered by chance at an adrenal level, is currently used to indicate any lesion identified accidentally, namely in the absence of specific symptomatology, during echographic or tomographic examination. The authors report their experience of just over one year and, through a review of the literature, draw attention to the fact that these incidentalomas raise unresolved problems both from a diagnostic and therapeutic point of view. They hope that routine abdominal echography will be extended at least to a selected hospital population given that these lesions, diagnosed by chance, may be malignant or even if benign may have a potential evolution. Obviously surgery in these cases would lead to a marked prognostic improvement.

[The rational use of drains in surgery]. / Uso razionale dei drenaggi in chirurgia.

The authors report their clinical experience in 100 cases in which various kinds of drainage were used. They outline the best present techniques, when it is wished to apply this free drainage in the abdominal cavity, at the end of the operation.

[Double hydatid cyst of the liver, one of them with a fistula and causing stenosis of the pyloric canal associated with calculous cholecystitis]. / Cisti di echinococco duplice del fegato, una fistolizzata e provocante stenosi del canale pilorico ed associazione di colecistite calcolosa.

A case of double hydatid cyst of the liver (one fistulised into the pyloric canal where it had caused stenosis) and its association with calculous cholecystitis is reported. The therapy chosen to treat this rare phenomenon had a very satisfactory outcome in view of the complexity of the case given the need to perform several operations in contemporary (enucleation of the cyst, gastric resection and cholecystectomy) and the age of the patient.

[Diverticulitis of the right colon. Description of our experience]. / Diverticolite del colon destro. Descrizione delle nostre esperienze.

Two cases of diverticultis of the right colon are described which received surgical treatment. These lesions often simulate acute appendicitis and thus represent a intraoperative surprise Differential diagnosis using a neoblastic mass is often impossible. The paper stresses the importance of surgical treatment which in general terms is the same as the treatment of the diverticular mass of the left colon. In cases where it is difficult to decide between a phlogostic and neoblastic pathology, it is advised that a right hemicolectomy should be performed in line with criteria for oncological requirements.

[Compared progression of visual-evoked potentials in preterm and term newborns]. / Evolution comparée des potentiels évoqués visuels chez des enfants nés à terme et prématurément.

PURPOSE: To compare the development of the visual pathway in healthy preterm and full-term newborns using flash and patterned (both transient and steady-state) visual-evoked potentials (fVEP, pVEP-t, pVEP-ss). PATIENTS AND METHODS: Twenty-nine preterm newborns (28-35 weeks gestational age) were evaluated at four different times: at 3 months postnatal and corrected age, at 8 months postnatal and corrected age. They were matched with 92 term newborns tested at 3 and 8 months of life. RESULTS: The maximal perceived spatial frequencies in the groups were: 2 C/d at 3 months postnatal age, >2 C/d at 3 months corrected age and at 3 months at term, between 3 and 5C/d, >=5C/d at 8 months corrected age and at 8 months of life, respectively. The latencies of the P1 and P100 waves for the flash and the transient stimulation were, respectively, 192 ms and 207.9 ms at 3 months postnatal age, 144 ms and 137.7 ms at 3 months corrected age, 126.3 ms and 124.1 ms at 8 months postnatal age, 112.7 ms and 112.5 ms at 8 months corrected age, 137.3 and 110.1 ms at 3 months of life; and 122.3 and 100.5 ms at 8 months of life. DISCUSSION: In the preterm infants of 3 gestational months, the latencies of the fVEP are comparable to those of the 3-month-old full-term infants, although the pVEP-t latencies are still delayed at 8 months. In the fVEP; however, we noted a shorter latency in the preterm infants at 8 months corrected age compared to those of the full-term infants. This tendency inversion was also evidenced at the steady-state stimulation. CONCLUSIONS: As evidenced by our results, at 8 months of corrected age the preterm infants recovered the fVEP and pVEP-ss, but not the pVEP-t. Different results obtained with different visual-evoked stimulations suggest that similar neural pools are developed in not completely equal amounts of time.

Exposure to HAV infection in patients with chronic liver disease in Italy, a multicentre study.

We carried out a multicentre study on 2830 patients with chronic liver disease from 79 liver units (25 in northern, 24 in central and 30 in southern Italy) to evaluate naturally acquired immunity against hepatitis A virus (HAV) in relation to age, sex, geographical area of origin and entity of liver disease, and to define the strategy for specific vaccination. Antibody to HAV (anti-HAV) was detected in 1514 (53.5%) of the 2830 patients tested; the prevalence was 50.4% in males and 59.1% in females. Both in central and southern Italy the prevalence of anti-HAV positive subjects increased with increasing age from 43.3 and 44.7%, respectively, in the 0-30-year-old subjects to 80.1 and 68.3%, respectively, in those aged over 60 years. The overall prevalence was much lower in northern Italy, as were the variations from one age group to another, from 28.4% in the 0-30-year-old subjects to 38% in those aged over 60 years. 40.6% of patients with cirrhosis lacked naturally acquired protection against HAV; this percentage was higher in northern (60.5%) than in central (34.9%, P < 0.0001) and southern Italy (27.6%, P < 0.0001). The high prevalence of patients in Italy with chronic hepatitis or cirrhosis who lack naturally acquired immunity to HAV warrants the implementation of vaccination programmes against hepatitis A in such patients.