Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients

In 2007, a previously uninfected kidney transplant recipient tested positive for human immunodeficiency virus type 1 (HIV) and hepatitis C virus (HCV) infection. Clinical information of the organ donor and the recipients was collected by medical record review. Sera from recipients and donor were tested for serologic and nucleic acid-based markers of HIV and HCV infection, and isolates were compared for genetic relatedness. Routine donor serologic screening for HIV and HCV infection was negative; the donor's only known risk factor for HIV was having sex with another man. Four organs (two kidneys, liver and heart) were transplanted to four recipients. Nucleic acid testing (NAT) of donor sera and posttransplant sera from all recipients were positive for HIV and HCV. HIV nucleotide sequences were indistinguishable between the donor and four recipients, and HCV subgenomic sequences clustered closely together. Two patients subsequently died and the transplanted organs failed in the other two patients. This is the first recognized cotransmission of HIV and HCV from an organ donor to transplant recipients. Routine posttransplant HIV and HCV serological testing and NAT of recipients of organs from donors with suspected risk factors should be considered as routine practice.

Herpes simplex virus hepatitis: expanding the spectrum of disease

We describe 2 transplant patients with herpes simplex virus (HSV) hepatitis who were minimally symptomatic throughout their illness. The spectrum of disease caused by HSV hepatitis is more variable than previously reported in this population. HSV hepatitis should be considered in immunocompromised hosts with elevated transaminases without evidence of fulminant hepatic necrosis.

Repair of aneurysmal aortic coarctation in an octogenarian

An 80-year-old man presented with a descending thoracic aortic aneurysm. Computed tomography and aortography revealed a large aneurysm and tight aortic coarctation. This was successfully repaired with an interposition prosthesis.

Infectious complications of solid organ transplantations

The rate of infectious complications in SOT recipients has declined dramatically. As improvements in immunosuppressive therapy, surgical techniques, and diagnostics and antimicrobial treatment continue, further declines in infectious complications are expected. Refinements to preemptive therapy for high-risk patients are likely to contribute further to this decrease. Further investigation is required to define what role various infectious agents play in chronic allograft injury and rejection.

Acquired neurologic deficits in young children: a diagnostic journey with Dora

Young children with limited communication abilities are often difficult to diagnose. When a neurologic insult occurs prior to language development, the communication effects tend to be less predictable than when the same event occurs in an older child or in an adult with a history of "normal" language use. Information in the medical chart regarding status during prelinguistic periods for cognition, motor, and verbal function should be helpful in predicting outcomes in some instances, but a series of decisions, over time, are likely to be necessary to reach a definitive communication diagnosis. As children become more verbal, the characteristics of the motor speech system can lead to new or changing diagnoses.

Fatty acid composition of commercially manufactured omega-3 enriched pork products, haddock, and mackerel

This study was conducted to determine the commercial feasibility of feeding a 15% ground flaxseed diet to finishing hogs for up to 42 d before slaughter and to compare the fatty acid composition of the resulting pork products with commercially produced haddock and mackerel. Eighty-seven pigs were fed a control diet (predominantly corn, soybean meal-based) and then a similar diet containing 15% flaxseed for the last 28 (FS28) or 42 d (FS42) before slaughter. Control pigs were continued on the control diet (CO28 and CO42). Percentages of saturated and monounsaturated fatty acids were decreased (P < .0001), and percentages of polyunsaturated fatty acids, most prominently alpha-linolenic acid [18:3(n-3)] and the sum of all (sigma) measured (n-3) fatty acids, were increased (P < .0001) in all pork tissues (backfat, liver, and longissimus thoracis) and products (lard, muffins, Braunschweiger, and bacon) due to dietary flaxseed. The percentage of arachidonic acid [20:4(n-6)] decreased in FS28 compared to CO28 liver (P < .0001) and in longissimus thoracis polar fraction FS42 compared to CO42. The percentage of 18:3(n-3) was similar in mackerel, CO bacon, and CO longissimus thoracis, and the percentage of 18:3(n-3) and sigma(n-3) in haddock was similar to that in FS bacon and FS longissimus thoracis. The percentage of 20:5 in FS42 longissimus thoracis, polar fraction, approached the level in haddock, but the percentages of 20:5 and 22:6 were greater (P < .0001) in mackerel than in haddock. The percentage of sigma(n-3) was greater (P < .0001) in mackerel than in haddock and sigma(n-6) was greater (P < .0001) in haddock than in mackerel. Commercial production of omega-3 enriched pork products can provide consumers a feasible alternative to a diet higher in fish than that normally consumed.

Treatment of chronic hepatitis C with interferon alfa-n3: a multicenter, randomized, open-label trial

We studied the antiviral effectiveness and safety of interferon alfa-n3, a natural alpha interferon which contains multiple interferon species, in the treatment of previously untreated patients with chronic hepatitis C. Seventy-seven patients were randomized to receive either 1.0, 2.5, 5.0, or 10.0 million units (MU) of interferon alfa-n3 three times a week for 24 weeks and were then followed for an additional 24 weeks. At the end of therapy, 67% of patients in the 10 MU group normalized serum alanine transaminase (ALT) levels and 59% had no hepatitis C virus (HCV) RNA detected by polymerase chain reaction. At the end of the follow-up period, 44% of patients in the 10 MU group maintained normal ALT, and 24% had nondetectable HCV RNA. Lower doses were much less effective. Interferon alfa-n3 was well tolerated and no patient developed neutralizing anti-interferon antibodies during or after the treatment period. Interferon alfa-n3 appears to be effective against hepatitis C virus and deserves further study in larger randomized controlled trials.

Gastric vascular ectases

Gastric vascular ectases are being increasingly recognized as a significant source of acute and chronic upper gastrointestinal bleeding. Upper gastrointestinal endoscopy has not only facilitated the identification of gastric vascular ectases but has also revolutionized their therapy. This article reviews recent developments with reference to the epidemiology, diagnosis, pathogenesis, and therapy of gastric vascular ectases.

Multicenter trial of octreotide in patients with refractory acquired immunodeficiency syndrome-associated diarrhea

BACKGROUND/AIMS

Diarrhea is a significant problem in patients with acquired immunodeficiency syndrome (AIDS). The aim of this study was to determine octreotide effectiveness in refractory AIDS-associated diarrhea.

METHODS

In a 3-week protocol, 129 patients with a stool weight of > 500 g/day despite standard antidiarrheal therapy were randomized to receive octreotide or placebo (3:2 ratio). Octreotide dose was increased 100 micrograms weekly to a maximum of 300 micrograms three times a day based on weekly 72-hour stool collections. Subsequently, patients received open-label octreotide at doses of up to 500 micrograms three times a day.

RESULTS

A 30% decrease in stool weight defined response. After 3 weeks, 48% of octreotide- and 39% of placebo-treated patients had responded (P = 0.43). At 300 micrograms three times a day, 50% of octreotide- and 30.1% of placebo-treated patients responded (P = 0.12). At a baseline stool weight of 1000-2000 g/day, 57% of octreotide- and 25% of placebo-treated patients responded (P = 0.06). Response rates based on CD4 counts, diarrhea duration, body weight, human immunodeficiency virus risk factor, and presence or absence of pathogens showed no benefit of octreotide. Adverse events were more frequent in the octreotide-treated group.

CONCLUSION

In the doses studied, octreotide was not more effective than placebo in patients with refractory AIDS-associated diarrhea. This lack of effectiveness may be attributable to inadequate sample size, doses, and duration of study treatment.

Clostridium difficile-associated diarrhea in patients with HIV positivity and AIDS: a prospective controlled study

OBJECTIVE

To compare the clinical manifestations and therapeutic responses of Clostridium difficile infection in HIV-infected and noninfected individuals.

METHODS

Patients were identified for this study if they had C. difficile toxin in the stool. The patients were then followed prospectively by the investigators. All patients were treated with a standard regimen, and clinical and laboratory findings were recorded. Persistence and resolution or recurrence of symptoms and complications were recorded.

RESULTS

A total of 87 patients were studied, of which 12 were HIV positive, 20 had AIDS, and 55 had no known HIV infection. The AIDS group was younger and had a lower total leukocyte count than the controls. There were no statistically significant differences in temperature, leukocytosis, clinical symptoms, therapeutic response, or recurrence or persistent of symptoms.

CONCLUSIONS

Despite the immunosuppression of HIV infection, C. difficile infection behaves no differently in HIV/AIDS patients than it does in controls.

Differences in release of tumor necrosis factor from THP-1 cells stimulated by filtrates of antibiotic-killed Escherichia coli

Bacterial products, such as endotoxin, activate mononuclear cells to produce tumor necrosis factor (TNF) and other monokines capable of producing host cell injury. THP-1 cell TNF release in response to bacterial products generated during antibiotic killing of Escherichia coli (ATCC 12014) was evaluated. THP-1 is a mature monocytic leukemia cell line that produces TNF in a dose-dependent fashion in response to purified endotoxin. E. coli were incubated in the presence of amikacin, ciprofloxacin, ceftazidime, cefotaxime, aztreonam, or imipenem at concentrations that killed greater than 99.9% of the organisms. Aliquots of these antibiotic-bacterial cultures were added to THP-1 cells, and TNF concentrations were determined by specific immunoassay. Amikacin and imipenem produced rapid bacterial killing and were associated with low TNF levels. Ceftazidime, aztreonam, and cefotaxime killed E. coli at a slower rate and were associated with significant increases in mononuclear cell TNF responses. Ciprofloxacin produced intermediate TNF levels. Differences exist among bactericidal antibodies in their ability to generate products capable of stimulating mononuclear cell TNF release.

Endoscopic sphincterotomy: a reappraisal

Endoscopic sphincterotomy is the procedure of choice for choleducolithiasis post-cholecystectomy, and in poor-surgical-risk patients with the gallbladder still present. Sphincterotomy indications have been expanded to include acute biliary pancreatitis, acute cholangitis, and choleducolithiasis removal prior to definitive surgery. This paper will review the available literature and make recommendations on these new indications.

The antigastrolesive activity of rioprostil, a 16-methyl prostaglandin-E1 analogue in healthy volunteers

The antigastrolesive activity of rioprostil, an orally effective synthetic 16-methyl analogue of prostaglandin-E1, with potent antisecretory and antigastrolesive properties in animals, is evaluated in a series of studies involving 166 healthy male volunteers. Three double-blind, randomized, parallel, placebo-controlled studies are conducted independently at three study centres. In two studies the protective effect of rioprostil against endoscopically-demonstrated mucosal changes caused by concurrent administration of aspirin is examined. The third study evaluates the inhibitory effect of rioprostil on faecal blood loss produced by co-administration of aspirin. Oral doses of rioprostil give significant dose-dependent protection against aspirin-induced mucosal changes. The total mucosal scores at day 3 and day 11 are significantly lower in each of the rioprostil + aspirin groups compared with the aspirin treated group. The total mucosal scores generally decrease with increasing rioprostil dose. Daily faecal blood loss is significantly lower in each of the groups of subjects treated with rioprostil + aspirin, compared with those treated with aspirin + placebo. This study shows that rioprostil provides significant protection against mucosal damage caused by high doses of concomitantly administered aspirin.

Peliosis hepatis in a patient with marasmus

Peliosis hepatitis is a rare disorder previously seen in tuberculosis and malignant disorders and now seen with anabolic steroid use or after renal transplantation. We report the first case of peliosis hepatis in a patient with marasmus and no previously reported predisposing condition. Of interest, the peliosis hepatis resolved rapidly (over 2-3 wk) as determined by computed tomography scan and the patient presented with a cholestatic enzyme pattern that resolved with development of the lesion.

Effects of therapeutic paracentesis on systemic and hepatic hemodynamics and on renal and hormonal function

Thirteen patients with cirrhosis and tense ascites (six with and seven without peripheral edema) underwent 4- to 15-liter paracentesis without intravenous "colloid" replacement. Cardiac output increased from 6.6 +/- 0.7 liters per min at baseline to 8.2 +/- 0.7 liters per min (p less than 0.003) 1 hr after large-volume paracentesis completion and fell to 7.5 +/- 0.69 liters per min (p less than 0.05 vs. baseline, p less than 0.02 vs. 1 hr) 24 hr after large-volume paracentesis completion. There was no change in mean arterial pressure or mean pulmonary artery pressure. Central venous pressure fell from 9.1 +/- 0.8 mm Hg at baseline to 8.6 +/- 1.4 mm Hg 1 hr post-large-volume paracentesis to 6.8 +/- 1.0 mm Hg (p less than 0.005 vs. baseline, p less than 0.02 vs. 1 hr value) at 24 hr, and pulmonary capillary wedge pressure fell from 13.1 +/- 0.9 to 11.1 +/- 1.3 mm Hg 1 hr after large-volume paracentesis and to 9.89 +/- 1.2 (p less than 0.01 vs. baseline, p less than 0.03 vs. 1 hr after large-volume paracentesis) at 24 hr. Heart rate fell from 90 +/- 3.0 to 85 +/- 2.9 beats per min (p less than 0.01) 1 hr after large-volume paracentesis completion, but increased to 89 +/- 2.5 beats per min (p less than 0.02 vs. 1 hr after large-volume paracentesis) at 24 hr.(ABSTRACT TRUNCATED AT 250 WORDS)