[Conception and course of eight pregnancies in five women on TNF blocker etanercept treatment]. / Konzeption und Verlauf von acht Schwangerschaften bei fünf Patientinnen unter TNF-α-Blockade mit Etanercept.

The introduction of tumor necrosis factor (TNF)-α inhibitors s in the late 1990s considerably broadened the treatment options for, and essentially contributed to the successful management of, rheumatoid arthritis (RA) and other immune-mediated inflammatory diseases. Nevertheless, their use during pregnancy is still controversially discussed since it remains unclear whether the benefits of treatment might be outweighed by potential teratogenicity or adverse effects on the course of pregnancy. In this case series report we describe the course and outcome of eight pregnancies in five women (four with RA and one with ankylosing spondylitis) at our private clinical practice treated with the TNF-α inhibitor etanercept at the time of conception and during pregnancy. The course was inconspicuous in six of the eight pregnancies; in one case a megacolon congenitum was diagnosed 2 weeks after birth, while one spontaneous abortion occurred in the 10th week of pregnancy after a disease flare following treatment discontinuation with etanercept in the 5th week of pregnancy. Based on our experience to date and the currently available literature data, we believe that continuation of treatment with TNF-α blockers is justified in pregnant patients with otherwise high disease activity and disease progression.

The significance of serologic, histologic, and immunohistologic findings in the prognosis of 88 asymptomatic carriers of hepatitis B surface antigen.

Eighty-eight asymptomatic carriers of hepatitis B surface antigen (HBsAg) were followed with biochemical, serologic, histologic, and immunohistologic studies over a period of four years. None of the 78 HBsAg carriers with normal or minimally changed liver tissue, antibody to hepatitis B e antigen (HBeAg) in serum, and no intranuclear hepatitis B core antigen (HBcAg) developed a chronic inflammatory liver disease. Four individuals lost circulatory HBsAg, and at least two individuals terminated their HBsAg carrier state. Seven asymptomatic HBsAg carriers with chronic hepatitis were characterized by HBeAg in serum and intranuclear HBcAg. However, three HBsAg carriers with chronic hepatitis and an absence of intrahepatocellular HBcAg were positive for antibody to HBeAg over the observation period. The mechanism that leads to chronic hepatitis in these patients remains to be determined.

Follow-up of anti-HBc titers in healthy HBsAg carriers and patients with chronic inflammatory liver diseases.

Sera of 85 asymptomatic HBsAg carriers found among blood donors were tested for anti-HBc titers and were retested 4 years later. The results were correlated with the histological findings of first and final biopsy. None of 75 HBsAg carriers with normal or minimally changed liver tissue, 71 of them anti-HBe positive, developed chronic inflammatory liver disease. 4 HBsAg carriers eliminated HBsAg from the serum after a 1-to 3-year HBsAg-carrier state and 2 developed antibody against HBsAg in the sequel. In 65 of 75 cases we found unchanged anti-HBc titers. The geometrical mean titer (GMT) was 1:7,800 in the first and 1:7,000 in the final examination with a range of 1:400 and 1:25,600 in the group of HBsAg carriers with normal liver, and was 1:14,200 and 1:10,300, respectively, with a range of 1:800 and 1:51,200 in HBsAg carriers with minimal changes. In both groups the decrease of anti-HBc concentration within 4 years was not significant. The group of 10 HBsAg carriers with chronic hepatitis did not differ from healthy HBsAg carriers in respect to anti-HBc titers. Anti-HBc titers varied between 1:6,400 and 1:25,600, the GMT was 1:13,700 and 1:12,800, respectively. It is speculated that in healthy HBsAg carriers shedding of serologically undetectable quantities of complete and/or defective HBcAg from liver cell nuclei which contain HBcAg not detectable by immunofluorescence maintain the production of anti-HBc.

Failure to detect naturally occurring serum inhibitors of hepatitis B virus deoxyribonucleic acid polymerase.

Sera of patients with past or ongoing hepatitis -B virus infection were tested for the presence of inhibitors of hepatitis -B virus-specific deoxyribonucleic acid (DNA) polymerase activity. None of the sera tested, which included those from anti-hepatitis B surface- and anti-hepatitis B core antigen-positive hemophiliacs, anti-hepatitis Bc antigen-positive hepatitis B surface antigen carriers, patients with hepatitis B surface antigen-positive chronic active hepatitis, hepatitis B surface antigen-positive hemodialysis patients, tumor patients with minimal hepatitis, patients with acute type B, type A, and type non-A, non-B hepatitis and individuals with autoimmune phenomena, contained inhibitors of DNA polymerase activity. This implies that the DNA polymerase test is not affected when utilized to quantitate DNA-containing Dane particles. In addition, there is no evidence that inhibitors of DNA polymerase activity play some pathogenic role in the course of hepatitis B virus infection.

[Spread of hepatitis B virus infection among family contacts of asymptomatic HBsAg carriers (author's transl)]. / Die Ausbreitung von Hepatitis-B-Infektionen in Familien HBsAg-positiver Träger.

Family members of 34 asymptomatic HBsAg carriers were tested for different hepatitis B virus (HBV) markers. Among 67 family members tested 24 (36%) presented signs of a past or ongoing HBV-infection. Spread of HBV-infection was particularly high in those families in which the HBsAg carrier was positive for HBeAg and Dane particle-associated DNA polymerase activity. Non-parenteral "horizontal" transmission of HBV among spouses and brothers and sisters and probably parenteral vertical transmission of HBV from carrier mothers to their infants occurred in approximately the same frequency. Fathers transmitted HBV unfrequently to their offsprings. The results show that the risk to acquire a HBV-infection from an asymptomatic HBsAg carrier is closely linked to the serological findings in the HBe/anti-HBe-system of the index HBsAg carrier and not to the family relationship to the HBsAg carrier.

[Long-term results after operative treatment of acute haemorrhagic necrotising pancreatitis (author's transl)]. / Langzeitergebnisse nach operativer Therapie der akuten hämorrhagisch-nekrotisierenden Pankreatitis. Unter besonderer Berücksichtigung der endokrinen und exokrinen Pankreasfunktion.

A follow-up investigation of 20 patients, surgically treated for acute haemorrhagic necrotising pancreatitis, was performed in an average of 2 3/4 years after the operation. Twelve patients showed manifest diabetes mellitus, four further cases had a suspicious oral glucose tolerance test. Only one patient was insulin dependent. A secretin-pancreozymin test performed in 15 patients showed a dissociated or global pancreatic insufficiency in 13 cases. The extent of the endocrine and exocrine functional disturbance did not correlate with the extent of surgery. Postoperative functional defects were readily improved therapeutically in most cases. Only in patients who continued to consume alcohol were there digestive disturbances. The results indicate that the functional state of the remaining pancreas does not only depend on the extent of surgery but also on the extent of already existing or persisting toxic inflammatory damage and on the regenerative capacity of the remaining parenchyma.

[Radioimmunological determination of HBeAg/anti-HBe in HBsAg-positive liver diseases and in "healthy" HBsAg carriers]. / Radioimmunologischer Nachweis von HBeAg/anti-HBe bei HBsAg-positiven Leberekrankungen und "gesunden" HBsAg-Trägern.

This paper describes a "solid-phase"-radioimmunoassay for the demonstration of HBeAg and anti-HBe. The investigations revealed the following results: 1. HBeAg is positive in all patients with acute type B-hepatitis during the acute phase of illness. During the normal course of the disease HBeAg turns to negative followed by an anti-HBe lasting for several months. 2. Cases with a persistent virus B-replication as HBsAg-positive CPH, CAH or patients on hemodialysis are positive for HBeAg in their serum. By means of the fluorescent antibody technique these patients have demonstrable HBcAg and HBeAg in their liver biopsies. 3. Healthy HBsAg carriers are anti-HBe-positive in their serum. In their liver biopsies there are no signs of an on-going virus B-replication (HBsAg and HBeAg negative). 4. The radioimmunological determination of HBeAg and anti-HBe enables us to differentiate between the groups with HBsAg positive acute or chronic hepatitis and the group of healthy HBsAg-carriers.

[Muscle blood flow and capillary diffusion capacity in patients with rheumatoid arthritis (author's transl)]. / Das Verhalten von Kapillarer Muskeldurchblutung und von kapillarer Transportkapazität (PS-Produkt) bei Patienten mit chronisch-progredienter Polyarthritis.

Capillary blood flow (Xenon-133) and diffusion capacity for Chrom-51-EDTA (PS-Product of Renkin) of striated muscle tissue were examined by double isotope method in patients with rheumatoid arthritis. Xenon-Clearance and PS-Product were studied under normal conditions and following hyperemisation. There existed no significant difference between rheumatoid patients and normal subjects and there was no evidence of increased capillary permeability. Apparently, derangement of muscle capillaries is rare in rheumatoid arthritis.

[Delayed surgery in acute pancreatitis]. / Verzögerte Operation bei akuter Pankreatitis.

In 32 patients with acute pancreatitis, delayed operation was performed between 13 and 44 days after onset of the illness. The indications for the operation were development of a palpable mass together with clinical deterioation and other complications. In all patients we found a necrotizing pancreatitis and/or abscesses of the pancreas. The surgical procedure consisted of digital removal of necrotic tissue (sequestrotomy) and/or abscess incision in 20 patients, of left-sided resection in 11 patients and partial duodenopancreatectomy in 1 patient. Twenty-three patients survived, 9 died.

[Early operation in acute hemorrhagic necrotizing pancreatitis]. / Intervento precococe nella pancreatite emorragico-necrotizzante acuta

Between 1973 and 1975, the "early" operation was carried out in 15 patients suffering from acute haemorrhagic-necrotizing pancreatitis to eliminate necrotic parts. Partially necrotizing pancreatitis was identified in 10 patients: 7 survived. All patients with total pancreatic necrosis died. Surgery consisted of digital removal of the necrosis (digitoclasia) and in left resection with adequate drainage. Patients with partially necrotizing acute pancreatitis can be saved by "early" surgery while in patients with total necrosis surgery must be undertaken even earlier, namely before fatal complications set in.