Renal graft outcome in combined heart-kidney transplantation compared to kidney transplantation alone: a single-center, matched-control study.

BACKGROUND: Renal allograft outcome in heart-kidney transplantation (HKTx) might be affected by hemodynamic instability and high levels of calcineurin inhibitor-dependent immunosuppression. METHODS: From November 1999 to March 2008, 13 patients who received HKTx were compared with a matched control group of 13 kidney transplantation (KTx) recipients with similar cardiovascular risk factors. Graft function, rejection periods, and patient survival were analyzed. RESULTS: Renal allograft rejection was noted in three patients (23%) after HKTx and in four patients (31%) after KTx. Serum creatinine levels were comparable at 1 week, 1 month, 1, 2, and 3 years after transplantation. Patient survival rates at 1, 2, and 3 years were 100% for HKTx recipients and 100, 92, and 92% for isolated KTx patients. Graft survival was 92% at 1, 2, and 3 years after HKTx and 100% at 1 year and 92% at 2 and 3 years after isolated KTx. CONCLUSIONS: Our results with excellent long-term graft function and survival after combined HKTx indicate that this procedure is a valuable option for a growing number of patients suffering from coexistent cardiac and renal failure.

[Donor liver histology : Joint recommendations of the DGP, DTG and DSO]. / Histologische Diagnostik bei Spenderlebern : Gemeinsame Empfehlungen von DGP, DTG und DSO.

BACKGROUND: The indications, implementation and reporting of liver biopsies for deceased organ donation are not mandatory or regulated. Reliable data on outcome quality and prognostic relevance are therefore not available. Defined standards are thus required to enable meaningful studies and to ensure high data quality of a national transplantation registry. OBJECTIVE: Presentation of a synopsis of available studies and literature-based recommendations. RESULTS AND CONCLUSION: Against the background of an organ shortage and a growing number of older donors, pretransplantation liver histology is of significant relevance to guide clinical decision making. With the joint recommendations of the German Transplantation Society (DTG), the German Society of Pathology (DGP) and the German Organ Transplantation Foundation (DSO) standardized procedures are defined for the first time.

Chemotherapy in metastatic malignant triton tumor: report on two cases.

Malignant triton tumor (MTT) is a rare, highly malignant nerve sheath tumor with rhabdomyoblastic differentiation. Initial debulking surgery followed by adjuvant therapy is the current treatment of choice, but has very limited efficacy when optimal cytoreduction is not achieved by surgical procedure. Neoadjuvant therapy for MTT, to potentially facilitate subsequent surgery, eradicate micrometastatic lesions and, therefore, improve the therapeutical outcome, has never before been presented in literature. Here, we report on the multimodal management of two cases of advanced and metastatic MTT. Treatment modalities involved neoadjuvant and adjuvant chemotherapy, surgical resection, and radiation. In both cases, integrated Positron Emission Tomography/Computed Tomography (PET/CT) emerged as an important diagnostic tool for the reliable assessment of MTT response and metabolic remission.

Influence of porcine circovirus type 2 vaccination on the level of antimicrobial consumption on 65 Austrian pig farms.

The administration of antibiotics to farm animals is an important contemporary topic. Veterinarians, pig producers, politicians, retailers and consumers all have a vested interest in reducing antimicrobial use on farm, while ensuring adequate health and welfare of food-producing animals. Vaccination programmes may be used to reduce the overall level of clinical disease in a population, subsequently leading to a decline in antimicrobial use. In 2008, a vaccination programme against porcine circovirus type 2 (PCV-2) was initiated in Austria. In the retrospective observational study presented here, farm medication records (2008-2011) from 65 conventional pig farms were evaluated. As PCV-2 has been shown to lead to generalised immunosuppression, enabling secondary bacterial infections to occur, the authors hypothesised that PCV-2 vaccination would decrease antimicrobial consumption at farm level. Firstly, we focused on the annual antimicrobial consumption expressed as the number of administered animal daily doses per kg liveweight (nADDkg/kg/year). Secondly, a linear mixed effects model was applied to evaluate the influence of PCV-2 vaccination on the antimicrobial consumption at farm level. The interaction between farm type and PCV-2 vaccination was found to be a highly significant factor (P=0.0002) influencing antimicrobial use at farm level. The estimated impact of PCV-2 vaccination revealed a highly significant (P<0.001) decline in total antimicrobial drug use from 1.72 ADDkg/kg/year to 0.56 ADDkg/kg/year on finishing farms, whereas only a negligible decline was detectable on farrow-to-finish farms.

Influence of porcine circovirus type 2 vaccination on the probability and severity of pneumonia detected postmortem.

To evaluate the influence of porcine circovirus type 2 vaccination (PCV-2) on the probability and severity of pneumonia, postmortem findings of 247,505 pigs slaughtered between 2008 and 2011 were analysed by applying a cumulative link mixed model. Three major effects could be observed: (1) PCV-2 vaccination significantly (P<0.01) reduced the odds (coefficient: -0.05) of postmortem findings of mild, moderate and severe pneumonia for vaccinated pigs. (2) Pigs from fattening farms were less likely (coefficient: -0.44; P<0.05) to exhibit signs of pneumonia at slaughter than pigs from farrow-to-finish farms. (3) When vaccinated, the odds of detecting postmortem signs showed an even more pronounced reduction (coefficient: -0.19; P<0.001) for pigs from fattening farms. Combining PCV-2 vaccination, farm type and interaction effects between these two factors, a pig vaccinated against PCV-2 from a fattening farm had only half the chance (OR 0.51) of pneumonia being detected at postmortem than a non-vaccinated pig from a farrow-to-finish farm. The study demonstrates the benefit of a vaccination programme against PCV-2 as an important tool to reduce the risk of postmortem pneumonia findings and the severity of pneumonia in pigs at slaughter.

[Correlation between antibodies against porcine reproductive and respiratory syndrome virus and pathological-anatomical organ findings in slaughter pigs at farm level]. / Zusammenhang zwischen dem Betriebsstatus für das Virus des Porzinen Reproduktiven und Respiratorischen Syndroms und Organbefunden an Schlachtkörpern.

OBJECTIVE: The porcine reproductive and respiratory syndrome (PRRS) worldwide causes important economic losses in pig production. Its causative agent, the PRRS virus (PRRSV), is one of the most frequently detected infectious agents in relation to respiratory diseases in pigs in Austria. We investigated the correlation between the PRRSV status of pig farms, determined by detection of PRRSV antibodies in the serum of slaughter pigs, and the prevalence of pathological-anatomical lung lesions in slaughter pigs of the respective farms. MATERIAL AND METHODS: Between December 1, 2011 and April 16, 2012, a total of 1056 serum samples of slaughter pigs from 66 pig farms were collected at an Austrian abattoir. The presence of PRRSV antibodies was tested by enzyme-linked immunosorbent assay in each sample and the PRRSV status of the respective farms was determined. No PRRSV vaccination was performed on any of the farms. In addition, the pathological-anatomical lung lesions of all slaughter pigs of the 66 farms that were slaughtered between September 1, 2011 and December 11, 2012 were recorded by authorized veterinarians at the abattoir. The prevalence of lung lesions and pleuritis in PRRSV-positive and unsuspected farms was compared and statistically interpreted. RESULTS: Slaughter pigs of PRRSV positive farms had a significantly higher prevalence of severe lung lesions and pleuritis visceralis and parietalis than slaughter pigs of PRRSV unsuspected farms. Pigs of combined farms (nursery and fattening unit at the same location) displayed a tendency for more moderate and severe lung lesions than pigs of exclusive fattening farms. CONCLUSIONS AND CLINICAL RELEVANCE: In the present study, the PRRSV status of pig farms displayed a significant influence on the prevalence of lung lesions in the slaughter pigs. Findings untypical for PRRS, including pleuritis, were also found significantly more often on those farms. This leads to the conclusion that other primary and/or secondary infections are involved, which can be exacerbated by the immunosuppressive effect of the PRRSV. There was a tendency for combined farms to be more severely affected than fattening farms.

Complex assembly of calgranulins A and B, two S100-like calcium-binding proteins from pig granulocytes.

Calgranulin A (CAGA) and calgranulin B (CAGB) are two S100-like calcium-binding proteins that in human, bovine and mouse granulocytes are associated into a heterocomplex. We have previously identified in pig granulocytes the porcine homologue of CAGA and a novel S100-like protein which was named calgranulin C (CAGC). As pig CAGA is not associated with CAGC, we herein investigate its possible association with other proteins. CAGA was purified from pig granulocytes by gel filtration followed by Mono Q chromatography. The purified fractions were analysed by SDS-polyacrylamide gel electrophoresis, isoelectric focusing, mass spectrometry, chemical cross-linking and hydrophobic interaction chromatography. The CAGA-associated protein was further characterized by amino acid sequencing. Two CAGA-containing fractions were isolated. One of them was identified as a CAGA homodimer. The other fraction consists of a heterocomplex containing CAGA and a pI 7.0 calcium-binding protein; this protein has a molecular mass of 15,877.9 +/- 3.8 Da (mean +/- SD) whereas it migrates on 10 and 16% polyacrylamide gels as a 24- and 20-kDa protein, respectively. The pI 7.0 protein was identified by internal amino acid sequencing as the porcine homologue of CAGB. The stoichiometry of the heterocomplex was estimated to be 1:1. Both the CAGA homodimer and CAGA/CAGB were found to be non-covalently associated. Unlike the homodimer, CAGA/CAGB was bound to a Phenyl Superose column in a calcium-dependent manner. Our results suggest that pig granulocytes contain, in addition to CAGC, a CAGA homodimer and a CAGA/CAGB heterodimer. It is proposed that CAGB/CAGB and the CAGA homodimer may play different roles in vivo.

Purification and structural characterization of a fatty acid-binding protein from the liver of the catfish Rhamdia sapo.

We report here the isolation of a fatty acid-binding protein (FABP) from the liver of the catfish Rhamdia sapo. The purification procedure involves gel filtration, anion-exchange chromatography and reverse-phase high-performance liquid chromatography. The purified protein is basic (pI > 8.7) and migrates on sodium dodecyl sulfate-gel electrophoresis as a single entity of about 15 kDa. Its amino acid composition resembles those of FABPs isolated from other animals. Unlike mammalian liver FABPs, catfish liver FABP contains at least one tryptophan residue per molecule. No significant cross-reactivity was observed between the purified protein and polyclonal antibodies against either rat liver FABP or rat heart FABP. Amino acid sequencing of peptides obtained by digestion with Lys-C revealed that the catfish protein is structurally more similar to chicken liver FABP (69% identity in a 67-residue overlap) than to human liver FABPs (36%), nurse shark (Ginglymostoma cirratum) liver FABP (30%) and human heart FABP (31%). Taken together, these results suggest that catfish liver FABP is far more closely related to chicken liver FABP than to the FABPs isolated from the liver of mammals or elasmobranchs.

[Radiation exposure of the ocular lens and thyroid gland in digital subtraction angiography of brain-supplying arteries]. / Strahlenexposition der Augenlinse und der Schilddrüse bei der Digitalen Subtraktionsangiographie der hirnversorgenden Arterien.

PURPOSE: To find out the individual level of radiation exposure of the ocular lens and thyroid gland during DSA of arteries supplying the brain, considering the indication. MATERIAL AND METHOD: The study was conducted on 72 patients during aortic arch and cerebral artery angiographies using thermoluminescent dosimetry. RESULTS: During 20 aortic arch angiographies the measured values were within non-critical limits, whereas during carotid, vertebral or cerebral four-vessel angiography of the left ocular lens exposure values of more than 500 mGy (max. 782 mGy) were stated in two of 52 cases. The highest measured exposure relating to the right ocular lens was 126 mGy, to the thyroid gland 88 mGy. However, in 51 of 52 cases thyroid gland doses of below 51 mGy were measured. In 71 of 72 cases there was a lateral difference between right and left lens exposure up to twice the measured dose for the right ocular lens during aortic arch angiographies and up to sixteen-fold in respect of the left lens during cerebral angiographies. CONCLUSION: In addition to the fluoroscopic time, number of images, fade-in and zoom some other dose-influencing factors, radiation geometry is especially decisive for organ exposure. The risk of cataracts or thyroid gland carcinomas/hypothyrosis can be neglected with median values of 40 and 70 mGy relating to the ocular lens and 17 mGy for the thyroid gland during cerebral angiographies.

[The observed and chance-corrected agreement of the computed tomographic and histological staging results in renal-cell carcinoma]. / Beobachtete und zufallskorrigierte Ubereinstimmung computertomographischer und histologischer Stagingergebnisse beim Nierenzellkarzinom.

PURPOSE: To assess the diagnostic value of abdominal computed tomography in the preoperative staging of renal cell carcinoma. METHODS: Computed tomograms of 87 renal cell carcinomas were classified according to the TNM-System. The results were correlated with the histopathological categories. The usual parameters for diagnostic tests were calculated and chance correction of the observed agreement was performed using Cohen's Kappa (kappa) test. RESULTS: T-category staging showed an overall accuracy of 60% (kappa = 0.44). The pT1 category was correctly predicted in all cases. For perirenal invasion, an accuracy of 60% (kappa = 0.27), a sensitivity of 90.5%, and a specificity of 51% were found. For venous involvement, accuracy was 92% (kappa = 0.59), sensitivity 86%, and specificity 92%. All inconspicuous adrenals on CT were histologically normal as well. An accuracy of 80% for lymphadenopathy staging was attributable to chance (kappa = 0.04). 7 distant metastases were detected in the scanned volume. CONCLUSIONS: Good CT staging results are obtained with discrimination between T1 tumors and higher categories, the assessment of venous invasion, the exclusion of adrenal involvement, and the detection of metastatic spread to abdominal organs. Insufficient results are seen with lymphadenopathy staging and the distinction of organ-confined and invasive tumors.

Analysis of the variation in meat inspection of pigs using variance partitioning.

According to legal regulations, all slaughtered pigs in the European Union are subject to routine meat inspection at the slaughterhouses. The resulting post-mortem findings are valuable indicators that help improve slaughterhouse and farm management and can be used to establish a feedback system regarding animal health. A sufficiently high quality of meat inspection is therefore imperative, which implies that the results of the inspection must not depend on the person carrying out the examination. The objective of the study at hand is the estimation of the amount of variation in these post-mortem findings that can be attributed to the official meat inspectors. In order to reduce the influence of the heterogeneity in the health state of the pigs, the variation due to the farms of origin was considered in the statistical model as well. The analyzed meat inspection data were recorded by 12 official meat inspectors under real working conditions at an Austrian slaughterhouse. Logistic Multilevel Models with cross-classified random effects were applied to 20 post-mortem findings. On the basis of these models, variance partitioning coefficients (VPCs) were used to estimate the amount of variation in the probabilities of these findings due to meat inspector and farm levels. The estimated VPCs suggest that especially meat inspection of blood aspiration, scalding water lungs, skin lesions and hepatitis can be deemed as not sufficiently standardized. Hardly any variation in meat inspection could be identified for other post-mortem findings, such as pericarditis, peritonitis, arthritis and milkspots.

Rapid monitoring of Campylobacter in high-shedding flocks for targeted disease control.

Broilers excreting Campylobacter spp. at high levels (>7 log CFU/g of feces) were described in the Dutch Campylobacter Risk Management and Assessment project as an important source of carcass contamination. The researchers concluded that the risk of infection to humans could be economically and efficiently minimized by eliminating these flocks from fresh poultry meat chains. In the present study, we evaluated a simple and rapid gold-labeled immunosorbent assay (GLISA) for the identification of Campylobacter spp. in flocks shedding high levels of the pathogen. Results were obtained within 2 h. Pooled samples from 102 of the 114 Campylobacter-positive flocks produced positive results, resulting in a test sensitivity of 89.5% (95% confidence interval, 82.6 to 94.2%) and a test specificity of 94.5% (86.7 to 98.2%). Given a GLISA detection limit of 7.3 log CFU/g of feces, nearly all Campylobacter-positive flocks were identified as "high shedders." Therefore, reduction of the incidence of Campylobacter infections by elimination of high-shedding flocks from fresh meat production is an unrealistic approach. Under the constraints given, a reduction in the incidence of Campylobacter spp. in Austria will require either improved hygiene or an intensive carcass decontamination strategy in fresh meat production facilities.

[Stoma prolapse and stoma retraction]. / Stomaprolaps und Stomaretraktion.

Prolapse and retraction of an intestinal stoma are postoperative complications which severely decrease the quality of life of patients and in some cases lead to an operative revision. Both entities should be treated with sophisticated care by specialized stoma therapists in the early phase in order to prevent secondary problems such as dermal ulceration. However, in case of additional problems, such as ileus, bleeding, incarceration or impossibility of adequate stoma care, an operative revision is indicated. It remains an individual decision whether a local or a transabdominal revision of the stoma is necessary.At present the level of information and the number of well designed studies dealing with prolapse or retraction of a stoma are unsatisfactory and there are merely studies which report on prolapse and retraction as an incidental finding rather than primarily focusing on these problems. In addition there is a lack of clear cut definitions for both entities which would allow a comparison of data obtained in different studies.There is clearly a demand for a structured scientific clarification as the occurrence of stomal retraction or prolapse may present psychological and medical problems for the patients and therefore needs to be treated, conservatively and/or operatively, by both stoma specialists and surgeons.

Timing of conversion to mammalian target of rapamycin inhibitors is crucial in liver transplant recipients with impaired renal function at transplantation.

BACKGROUND: Renal dysfunction, primarily related to long-term use of calcineurin inhibitor-based immunosuppression, is the most common complication after liver transplantation. OBJECTIVE: To evaluate whether liver transplant recipients with impaired kidney function at transplantation can benefit from early conversion to mammalian target of rapamycin inhibitor therapy (mTORi) compared with patients with late induction of mTORi-based therapy. MATERIALS AND METHODS: Between 2003 and 2008, therapy was changed to an mTORi-based regimen in 57 patients. Patients were divided into 4 groups: group 1, early conversion (≤3 months after orthotopic liver transplantation) to mTORi therapy, and with impaired perioperative renal function; group 2, early conversion to mTORi therapy, and with normal perioperative renal function; group 3, late conversion to mTORi therapy, and with impaired perioperative renal function; and group 4, late conversion to mTORi therapy, and with normal perioperative renal function. RESULTS: One month after conversion, the mean (SD) increase in calculated glomerular filtration rate in groups 1 (early conversion) and 3 (late conversion) was comparable: 8 (9) mL/min vs 7 (10) mL/min. At month 3, the increase in calculated glomerular filtration rate between groups 1 and 3 was significant (15 [11] mL/min vs 9 [15] mL/min; P = .04), an effect that persisted at month 6 (16 [12] mL/min vs 10 [12] mL/min; P = .05) and month 12 (22 [14] mL/min vs 12 [15] mL/min; P = .04). CONCLUSION: In liver transplant recipients with perioperatively impaired renal function, early conversion to mTORi therapy should be performed because this approach seems to be more effective in improving long-term renal function.

Endosonographic and histopathological staging of extrahepatic bile duct cancer: time to leave the present TNM-classification?

OBJECTIVES: The discrepancy between high rates of sensitivity, specificity, and accuracy for intraductal ultrasonography (IDUS) in extrahepatic bile duct carcinoma and the failure to depict different wall layers as defined by the TNM classification have not yet been elucidated sufficiently. METHODS: In a prospective study, endosonographic images were correlated with histomorphology including immunohistochemistry. Using IDUS, we examined fresh resection specimens of patients who had undergone pancreato-duodenectomy. For histological analysis, the formalin-fixed and paraffin-embedded specimens were stained by hematoxylin-eosin, elastica-van-Gieson, and immunohistochemically by smooth muscle-actin. To confirm our hypothesis, further cases from the archives were analyzed histopathologically and immunohistochemically. RESULTS: The various wall layers of the extrahepatic bile duct as described by the International Union Against Cancer are neither histomorphologically nor immunohistochemically consistently demonstrable. Especially, a clear differentiation between tumor invasion beyond the wall of the bile duct (T2) and invasion of the pancreas (T3) by histopathological means is often not possible. Endosonographic images using high-resolution miniprobes similarly confirm the difficulty in imaging various layers in the bile duct wall. CONCLUSIONS: Most adaptations made by the sixth edition of the TNM classification accommodate to the endosonographic and most of the histopathological findings as demonstrated in our study. In contrast to the new edition, however, our findings suggest to combine T2- and T3-staged tumors into one single class leading to clarification, and improved reproducibility of histopathological staging.

[Roentgenologic and endoscopic findings after papillotomy]. / Röntgenologische und endoskopische Befunde nach Papillotomien.

During 1977--1980 36 papillotomies were performed; indications for the latter were: papillary stenosis, incarcerated stones or stones which could not be removed which certainty and suspicion of a papillocarcinoma. The indications were evaluated as to whether endoscopic or surgical papillotomy should be performed. The results of the papilloplasties were considered satisfactory. In 40% of the cases a duodenobiliary reflux was observed, which however did not give troubles.