Immunodiagnostic tests' predictive values for progression to tuberculosis in transplant recipients. A prospective cohort study

Background: Little is known about the predictive value for progression to tuberculosis (TB) of interferon-γ release assays and how they compare with the tuberculin skin test (TST) in assessing the risk of TB infection in transplant recipients. Methods: We screened 50 liver transplant (LT) and 26 hematopoietic stem cell transplant (HSCT) recipients with both QuantiFERON-TB Gold In-tube (QFT-GT) and TST and prospectively followed them for a median of 47 months without preventive chemoprophylaxis. Results: In the LT cohort, 1 in 22 (4.5%) QFT-GT-positive patients developed posttransplant TB, compared with none of the QFT-GT-negative patients. In the HSCT cohort, none of the 7 QFT-GT-positive patients developed TB, whereas 1 case (5.3%) progressed to active TB among the 19 QFT-GT-negative patients. Comparable results were obtained with the TST: in the LT group, 1 of 23 TST-positive and none of the 27 TST-negative patients developed TB; and in the HSCT group, none of the 8 TST-positive and one of the 18 TST-negative patients progressed to active TB. Conclusions: In this cohort of transplant recipients, the positive predictive value of QFT-GT for progression to active TB was low and comparable to that of TST. Although the risk of developing TB in patients with negative results at baseline is very low, some cases may still occur

Prognostic value and risk stratification of residual disease in patients with incidental gallbladder cancer

Background and aim: given their poor prognosis, patients with residual disease (RD) in the re-resection specimen of an incidental gallbladder carcinoma (IGBC) could benefit from a better selection for surgical treatment. The Gallbladder Cancer Risk Score (GBRS) has been proposed to preoperatively identify RD risk more precisely than T-stage alone. The aim of this study was to assess the prognostic value of RD and to validate the GBRS in a retrospective series of patients. Material and methods: a prospectively collected database including 59 patients with IGBC diagnosed from December 1996 to November 2015 was retrospectively analyzed. Three locations of RD were established: local, regional, and distant. The effect of RD on overall survival (OS) was analyzed with the Kaplan-Meier method. To identify variables associated with the presence of RD, characteristics of patients with and without RD were compared using Fisher's exact test. The relative risk of RD associated with clinical and pathologic factors was studied with a univariate logistic regression analysis. Results: RD was found in 30 patients (50.8%). The presence of RD in any location was associated with worse OS (29% vs. 74.2%, p = 0.0001), even after an R0 resection (37.7% vs 74.2%, p = 0.003). There was no significant difference in survival between patients without RD and with local RD (74.2% vs 64.3%, p = 0.266), nor between patients with regional RD and distant RD (16.1% vs 20%, p = 0.411). After selecting patients in which R0 resection was achieved (n = 44), 5-year survival rate for patients without RD, local RD, and regional RD was, respectively, 74.2%, 75%, and 13.9% (p = 0.0001). The GBRS could be calculated in 25 cases (42.3%), and its usefulness to predict the presence of regional or distant RD (RDRD) was confirmed (80% in high-risk patients and 30% in intermediate risk p = 0.041). Conclusion: RDRD, but not local RD, represents a negative prognostic factor of OS. The GBRS was useful to preoperatively identify patients with high risk of RDRD. An R0 resection did not improve OS of patients with regional RD

Immunodiagnostic tests' predictive values for progression to tuberculosis in transplant recipients. A prospective cohort study

Background: Little is known about the predictive value for progression to tuberculosis (TB) of interferon-γ release assays and how they compare with the tuberculin skin test (TST) in assessing the risk of TB infection in transplant recipients. Methods: We screened 50 liver transplant (LT) and 26 hematopoietic stem cell transplant (HSCT) recipients with both QuantiFERON-TB Gold In-tube (QFT-GT) and TST and prospectively followed them for a median of 47 months without preventive chemoprophylaxis. Results: In the LT cohort, 1 in 22 (4.5%) QFT-GT-positive patients developed posttransplant TB, compared with none of the QFT-GT-negative patients. In the HSCT cohort, none of the 7 QFT-GT-positive patients developed TB, whereas 1 case (5.3%) progressed to active TB among the 19 QFT-GT-negative patients. Comparable results were obtained with the TST: in the LT group, 1 of 23 TST-positive and none of the 27 TST-negative patients developed TB; and in the HSCT group, none of the 8 TST-positive and one of the 18 TST-negative patients progressed to active TB. Conclusions: In this cohort of transplant recipients, the positive predictive value of QFT-GT for progression to active TB was low and comparable to that of TST. Although the risk of developing TB in patients with negative results at baseline is very low, some cases may still occur

Estudio comparativo de la colestasis hepática entre la infusión de triglicéridos de cadena larga y mezcla de triglicéridos de cadena media y larga

Se realiza un estudio prospectivo, randomizado, doble ciego en pacientes quirúrgicos que requieren nutrición parenteral durante un período de diez días y estén en ayuno completo. Los pacientes deben tener una función hepática normal medida por gamma-GT, fosfatasa alcalina (FA), bilirrubina y ALT normales. Se estudia la evolución de los parámetros de colestasis los días O, 1, 3, 8 y 1 O. Se observa un aumento de la gammaGT en las de grupos, pero mucho más marcado en el grupo con LCT (p < 0,005) al décimo día que en el grupo MCT/LCT. La FA aumenta sólo en el grupo LCT, siendo estadísticamente significativo (p < 0,001) al décimo día respecto al grupo MCT/LC

Estudio comparativo de la colestasis hepática entre la infusión de triglicéridos de cadena larga y mezcla de triglicéridos de cadena media y larga

Se realiza un estudio prospectivo, randomizado, doble ciego en pacientes quirúrgicos que requieren nutrición parenteral durante un período de diez días y estén en ayuno completo. Los pacientes deben tener una función hepática normal medida por gamma-GT, fosfatasa alcalina (FA), bilirrubina y ALT normales. Se estudia la evolución de los parámetros de colestasis los días O, 1, 3, 8 y 1 O. Se observa un aumento de la gammaGT en las de grupos, pero mucho más marcado en el grupo con LCT (p < 0,005) al décimo día que en el grupo MCT/LCT. La FA aumenta sólo en el grupo LCT, siendo estadísticamente significativo (p < 0,001) al décimo día respecto al grupo MCT/LC

Estudio comparativo de la colestasis hepática entre la infusión de triglicéridos de cadena larga y mezcla de triglicéridos de cadena media y larga

Se realiza un estudio prospectivo, randomizado, doble ciego en pacientes quirúrgicos que requieren nutrición parenteral durante un período de diez días y estén en ayuno completo. Los pacientes deben tener una función hepática normal medida por gamma-GT, fosfatasa alcalina (FA), bilirrubina y ALT normales. Se estudia la evolución de los parámetros de colestasis los días O, 1, 3, 8 y 1 O. Se observa un aumento de la gammaGT en las de grupos, pero mucho más marcado en el grupo con LCT (p < 0,005) al décimo día que en el grupo MCT/LCT. La FA aumenta sólo en el grupo LCT, siendo estadísticamente significativo (p < 0,001) al décimo día respecto al grupo MCT/LC

Changes in peripheral blood levels of platelet-activating factor after orthotopic liver transplantation

Platelet-Activating factor (PAF) is a phospholipid mediator structurally characterized as 1-alkyl-2-acetyl-sn-glycero-3-phosphocholine with a broad range of biological activities. PAF has been implicated as a mediator of the acute allergic and inflammatory response as well as in the pathogenesis of hyperacute rejection in organ transplantation, which is mediated..

Changes in peripheral blood levels of platelet-activating factor after orthotopic liver transplantation

Platelet-Activating factor (PAF) is a phospholipid mediator structurally characterized as 1-alkyl-2-acetyl-sn-glycero-3-phosphocholine with a broad range of biological activities. PAF has been implicated as a mediator of the acute allergic and inflammatory response as well as in the pathogenesis of hyperacute rejection in organ transplantation, which is mediated..

Ictericia obstructiva neoplásica. Tratamiento paliativo con prótesis metálica autoexpandible

Objetivo: estudio de la incidencia de complicaciones y la efectividad del tratamiento paliativo con prótesis biliar frente a cirugía paliativa en pacientes con ictericia obstructiva neoplásica. Diseño experimental: revisión retrospectiva. Pacientes: 35 pacientes con ictericia neoplásica considerados irresecables en los que se colocó prótesis biliar percutánea (neoplasia de cabeza de páncreas. n= 11: colangiocarcinoma. n= 11; neoplasia de vesícula biliar. n=4; y recidiva o metástasis de neoplasia no bilio-pancreática. n=8). Grupo control: 23 pacientes con intervención qu1rurgica paliativa de ictericia neoplásica. Resultados: las complicaciones más frecuentes fueron la colangitis y la obstrucción de la prótesis. La estancia media tras. la colocación fue de 6.8 días. siendo mayor en los pacientes que presentaron complicaciones {p=0,035). Un 22. 9% presentó recurrencia de la ictericia y el reingreso se produjo en 4 2, 9% de los pacientes. La superviviencia media fue de 163,33 días (rango 19-522). El descenso de bilirrubina tras la colocación fue significativo (215 vs. 82 mmol/I, p< 0.001). Conclusiones: comparando con nuestra experiencia previa en c1rug1a pahattva. no hay diferencias significativas en morbimortalidad. recurrencia ni reingresos. Los pacientes afectos de colangiocarcinoma hiliar y cáncer de cabeza de páncreas se benefician de una menor estancia post-tratamiento

Ictericia obstructiva secundaria a colangitis linfoplasmocitaria. Diagnóstico diferencial con el tumor de Klatskin

Sr. Director: los tumores de Klatskin son aquellos adenocarcinomas originados en la bifurcación del conducto hepático principal. Sólo la cirugía permite aportar la prueba histológica para diferenciar los distintos tipos de cánceres y descubrir lesiones benignas