[Fever of unknown origin in HIV positive patients]. / Fiebre de origen desconocido en pacientes VIH positivos.

OBJECTIVES: To describe the clinical presentation of FUO in patients infected with HIV and to asses the diagnostic usefulness in this population of several test usually recommended in the study of FUO. PATIENTS AND METHODS: We studied the clinical charts of all patients with HIV that required admission to our Hospital during a 23-month period. FUO was defined according to Petersdorf's modified criteria. Fifty-four patients fulfilled study criteria during the entry period. RESULTS: A cause of fever was identified for 48 patients (89%). Tuberculosis, disseminated atypical mycobacteriosis and Leishmaniasis can explain 68% of them. Examination of bone marrow aspirates, lymph node aspirates and biopsy, and culture of clinical specimens for mycobacteria were the procedures with the highest diagnostic yield. CONCLUSIONS: Mycobacterial infection should be considered as a first-line diagnosis in HIV-patients with FUO. It is possible to predict the diagnosis of tuberculosis infection with a high level of confidence (90.5%) through a logistic regression model based on easily obtainable parameters.

Fiebre de origen desconocido en pacientes HIV positivos / Fever on unknown origin in patients with HIV

Objetivos: Describir la presentación clínica y la utilidad de los de tests diagnósticos habitualmente recomendados en el estudio de la fiebre de origen desconocido (FOD) en los pacientes VIH positivos.Pacientes y métodos: Incluimos en el estudio a los 54 pacientes con infección por el VIH que ingresaron en nuestro Hospital por FOD durante un periodo de 23 meses. La FOD fue definida de acuerdo con los criterios modificados de Petersdorf´s. Resultados: La causa de la fiebre se identificó en 48 casos (89 por ciento). La tuberculosis, la micobacteriosis atípica y la leishmaniasis pueden explicar el 68 por ciento de los casos. El aspirado de médula ósea, la punción aspiración o la biopsia de los ganglios linfáticos y los cultivos para micobacterias fueron las pruebas diagnósticas más rentables. Conclusiones: La infección por micobacterias debe ser el primer diagnóstico de sospecha en los pacientes VIH positivos con FOD. Es posible precedir el diagnóstico de tuberculosis con una alta precisión (90,5 por ciento) con un modelo de regresión logística basado en datos clínicos y analíticos fácilmente obtenibles. (AU)

Auxiliary liver by transplanted frozen-thawed hepatocytes.

Among the therapeutic alternatives to orthotopic liver transplantation, hepatocyte transplantation (HT) offers the best potential in a number of liver diseases, mainly inborn errors of metabolism. Nevertheless, HT presents several inconveniences such as the scarce knowledge of the functionality of the transplanted hepatocytes, which has given rise to controversy about the specificity or unspecificity of the transplant, and the lack of a suitable system for preserving the cells. This study was designed to test a system for cryopreserving hepatocytes and to assess their functionality over prolonged periods after their ectopic transplantation. A medium and a freezing schedule which are reproducible and yield elevated viability have been used, and a number of hepatospecific parameters have been assessed: the activity of ornithine carbamoyltransferase--an enzyme of primary importance in the urea cycle--lipogenesis, gluconeogenesis, glucose-6-phosphatase and cytochrome oxidase activities, the presence of albumin--as an index of plasma protein synthesis--and IDA uptake and metabolism, showing the UDP-glucuronyl transferase activity. As dedifferentiation markers, gamma-glutamyl transpeptidase and alpha-fetoprotein have been studied. From the results, it can be deduced that hepatocytes can be cryopreserved and transplanted and that under these conditions they maintain hepatic features for a long time. Following transplantation, several specific liver functions appear or are enhanced in the spleen. Freshly isolated and cryopreserved transplanted hepatocytes have similar behaviors, although a difference in the expression of the function can be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cryopreservation and transplantation of hepatocytes: an approach for culture and clinical application.

The development of a reproducible, effective system of cryopreservation of hepatocytes would create new possibilities for metabolic studies, as well as the clinical application of hepatocellular transplants in diverse hepatic disorders. For the purpose of dealing with both questions, we have studied different media and procedures of freezing, and have chosen that combination which afforded the best results for long-term studies of function. A series of intrasplenic transplants were performed with freshly isolated hepatocytes as well as cryopreserved ones, and several hepatospecific parameters (Alanine aminotransferase, ornithine carbamoyl transferase, lipogenesis, uptake of 99mTc-N-(p-butylphenylcarbamylmethyl)iminodiacetic acid, G6Pase, albumin, and gamma-glutamyl transpeptidase (gamma-GT) were quantified for 9 months. The histological study of the cells reveals that they acquired an architecture characteristic of the liver. All of the parameters indicative of hepatic function were detected throughout the 9-month period in the transplanted spleens. All the spleens, controls and transplanted, were found negative for the presence of the dedifferentiation marker gamma-GT. These results clearly indicate the possibility of recovering hepatocytes which maintain their specific functions after being subjected to a freezing-thawing process, with the corresponding implications for future clinical application as well as for hepatic biochemistry.

Time-related efficacy of liver cell isografts in fulminant hepatic failure.

We and others have reported that dispersed liver cells transplanted into the spleen parenchyma of syngeneic rats remained functional and viable for a long time. This report describes our results with hepatocellular transplantation as a therapeutic method in a model of fulminant hepatic failure (FHF) in the rat. 60 male Sprague-Dawley rats weighing 200-250 g were used. The FHF was reached through an Eck's fistula with 2/3 hepatectomy at the same time. This model produced lethal hepatic failure in a highly reproducible manner. Liver cells were isolated by the collagenase method. 40 X 10(6) hepatocytes suspended in Hanks' balanced salt solution were transplanted into the spleen parenchyma 24 hr before (group 1), at the same time as (group 2), and 24 hr after (group 3) FHF was achieved. Additional sham-operated animals (groups 4 and 5) and a control group (group 6) were used. The hepatocellular transplantation markedly increased the survival of the animals with induced FHF to 80% (group 1) and 60% (group 2)--but not in group 3 (20%),--compared with 10% in the control group. This study shows that dispersed liver cells transplanted into the spleen can provide sufficient support to allow animals with lethal hepatic failure to survive and recover. Nevertheless the efficacy of transplantation is a time-related phenomenon with the FHF induction.